Week 2: Antenatal Care Flashcards
nausea/vomiting is a ______ sign of preg
presumptive
this is morgan’s second pregnancy (GA 13 wks). her 1st preg ended in a spontaneous abortion at 8 weeks. whats correct?
1) G2T0P1A0L0
2)G1T0P1A1L0
3)G2T0P1A0L0
4)G2T0P01L0
is she a primigravisa
is she a primipara
G2T0P0A1L1
so 2
she is not a primigravida
she is no a primipara
during preg do u get cardiac hypertrophy
yes, slightly
during preg what happens to HR
increases by 10-15bpm
what happens to the positioning of the heart during preg
enlarged uterus displaces diaphragm, elevating heart slightly and rotates to the left
what happens to blood volume during preg
increases by 1500 mL or 40-50% above pre-preg levels
what happens to RBC’s during preg
mass increase
what happens to hemoglobin and hematocrit during preg
decreases resulting in a state of hemodilution (physiological anemia)
what happens to WBC during 2nd and 3rd trimester
increase, peaking in 3rd
what happens to cardiac output during preg
increases by 30-50%
what happens to systolic BP during preg and for diastolic
systolic: has slight or no decreases from pre-preg levels
diastolic: has slight decrease mid preg (24-32 weeks) returning to norm by end of preg
what are some physical changes + risk in CVS during preg
- dependent edema
- varicose veins and hemorrhoids develop as part of compression of the iliac vein and inferior vena cava
- increased risk of blood clots due to increased clotting factors
describe supine hypotensive syndrome
during second half of preg, clients lying on back will cause compression of the vena cava
can decrease systolic bp
reflex bradycardia
cardiac output decreases
supine hypotensive syndrome s/s
pallor, dizziness, faintness, breathlessness, tachycardia, nausea, clammy, diaphoretic
interventions for supine hypotensive syndrome
position client on their left side until s/s go away and vitals stable
how does o2 consumption change in preg
by 20-40%
how does RR change in preg
unchanged or slight increase
what happens to chest expansion during preg
increased
what happens to tidal volume during preg
increased by 30-40%
what happens to congestion and vascularity of Upper resp tract
increased
(nasal stiffness, nosebleeds, sense of fullness in ears)
what happens to renal pelvis and ureters during preg
dilate
what happens w urinary stasis or stagnation
increased risk of UTIs
what happens w urinary frequency during preg
increased due to increased bladder sensitivity and compression on bladder
what happens to bladder tone during preg
may decrease
what happens to GFR and renal plasma flow
increase in early preg
- physiological or dependent edema results from decreased renal blood flow and GFR near end of preg
what happens to nipples, areola, axillae, vulva during preg
darkens
what is chloasma
called the mask of preg
causes blotchy, brownish hyperpigmentation in cheeks, nose, and forehead
what is linea nigra
pigmented line extending from symphysis pubis to top of fundus
what is striae gravidarum
stretch marks
appear in 50-90% of preg women
what happens to ur nail and hair growth during preg
increased
name 7 things that change to breasts during preg
- to estrogen and progesterone
- to blood vessels
- to nipples and areola
- to nipples
- to montgomery tubercles
6: what happens to the breastfeeding ducts - colostrum
- increase resulting in fullness and sensitivity
- become more visible
- become more pigmented
- become more erectile
- sebaceous glands that secrete lubrication and anti-infective substances to help protect nipples and areola during breastfeeding
- creamy, white to orange premilk fluid may be expressed from nipples
what happens to the uterus overall in preg
changes in size, shape, position due to estrogen and progesterone levels
what happens to the uterus btwn 12-14 weeks
palpable above symphysis pubis
what happens to the uterus at 20-22 wks
rises gradually to level of umbilicus
what is Hegar sign
softening and compressibility of lower uterine segment
after 4 months of preg _____________ can be felt thru abdomen
braxton hicks
irreg and intermittent contractions to facilitate uterine blood flow thru placenta and promote O2 delivery
not painful, do not increase in intensity or cause cervical dilation
goodell sign
softening of cervical tip
what happens to the friability of the vagina after a exam
increases and slight bleeding can occur
what does the cervix of the nullpara look like
is round
after birth, cervix becomes oval in horizontal plane and external os appears as a transverse slit
chadwick sign
increased vascularity resulting in a violet-bluish colour of the vaginal mucosa and cervix
leukorrhea
white or slightly grey mucoid discharge w faint musty odour in response to increased estrogen and progesterone
what happens to the pH of vaginal secretions
changes in thickness and pH of vaginal secretions acts as a barrier against some organisms (bacteria, yeast)
why is nausea/vomiting common in early preg
in response to hCG and altered carbohydrate metabolism
what happens to the gums in preg
increasingly swollen and vascular c/o excessive saliva
what are poor dental health/gingivitis risk factors
preterm birth, LBW, pre-eclampsia
why is it possible to get carpal tunnel syndrome in preg
caused by edema that compresses the median nerve
other changes in relation to neuro for preg
numbness of hands
tension headaches
faintness or syncope
acroesthesia
numbness of hands
9 things in routine antenatal assessment
- confirm gestation age
- current weight + BMI
- bp
- urinalysis
- symphysis fundal height in cm
- fetal pres
- fetal HR
- fetal movement
- health teaching discussion
what is fundal height, what is it an indicator of
distance from symphysis pubic bone to top of uterus measured in cm, shows fetal growth
from gestational weeks 18 fundal height should be…
equal to gestational age (+/- 2cm)
prior to assessment what should u ask pt to do
pee as a full bladder can cause variations
what can cause variation in fundal height measurement
- position of the fundus
- position of fetus
- variations in the amount of amniotic fluid
- presence of more than one fetus
- maternal obesity
- variation in examiner technique
when is leopold’s maneuver
- completed in 3rd trimester to assess for fetal lie, presentation, attitude, position, and engagement
what should fetal HR be
btwn 110-160/min
1.when do some women feel movement
2.by 24 wks what should you feel
3.why are baby kicks important/minimum amount/2hrs
1.as early as 13-16 wks
2. you should feel kicks in a predictable way
3. daily kick counts are recommended in high risk pregnancies, count baby’s movements in 2 hrs, minimum of 6 movements in 2 hours
what classifies a baby as having LBW
2500g or less
what is the recommended weight gain during pregnancy for someone w a BMI of 21
25-35 lbs
what does a test for hemoglobin look at
Hb screens for anemia
what does a ABO/Rh(D) test look for
refers to major blood types
Rh neg status is important to note as immune globulin is required
what does an antibody screen look at
any circulating antibody measured by indirect Coombs
+‘ve screen warrants additional testing in order to identify specific antibody as some will have implications for fetus
MCV test
any abnormality in red cell volume
low MCV may indicate iron deficiency or thalassemia
why do we check platelets
thrombocytopenia is common in preg and may represent benign or pathological conditions which require diagnosis and follow up
rubella, varicella, parvovirus B19 titre
determines immunity to rubella, chicken pox, and parvovirus
what does the HBsAg test look for
presence of Hep B surface antigen indicates prior Hep B infection and carrier status
Syphilis, gonnorhea, chlamydia, HPV
screen everyone. consider rescreening those at risk of acquiring during each trimester
HIV
offer screening to everyone
consider rescreening those at risk of acquiring HIV during preg in each trimester
urine c&s
screen everyone for asympt bacteriuria preferable in 1st trimester or at 1st presentation and treat if positive
what are immunizations that are recommended for pregnant clients
- tetanus, diphtheria, pertussis (Tdap) vaccine (21-32 weeks gestation)
- influenza (flu) vaccine
- COVID vaccine
- Respiratory syncytial virus (RSV) vaccine (32 and 36 weeks gestation)
what is included in fetal assessment (7 things)
prenatal screening
CVS/amniocentesis
ultrasounds
SFH monitoring growth
fetal health surveillance
fetal movement counting
biophysical profile
major uses of ultrasound
- confirm preg and viability
- determine gestational age
- prenatal screening
- assess level of amniotic fluid
- detect fetal growth/position
- detect placental previa or abruption
is prenatal screening mandatory
all optional
screening is not diagnostic
does not test for everything
all preg ppl have chance for trisomy 21, 18, and 13
3 prenatal screenings that are noninvasive
- enhanced 1st trimester (eFTS)
- second trimester serum
- integrated prenatal (IPS)
non-invasive prenatal testing (NIPT)
- screens method for prenatal genetic material using cell-free DNA
- performed anytime after 9-10 wks until the end of preg
- high detection rates Down Syndrome, trisomy 13, trisomy 18
- screens for sex chromosome disorders
- maternal venipuncture and results available in about 10 days
- provincial OHIP coverage for this test is currently limited to specific clinical circumstances
what is amniocentesis and when is it done, indications
GA>15 weeks
used for genetic information, fetal maturity, fetal hemolytic disease
when is chorionic villus sampling done
GA 10-13 wks
with risk of fetomaternal hemorrhage, Rh what should happen
pts should recieve Rh immune globulins (Winrho) to avoid isoimmunization
amniocentesis maternal risks
hemorrhage, fetomaternal hemorrhage, infection, labour, abruptio placentae, damage to intestines or bladder, amniotic fluid embolism
amniocentesis fetal risks
dealth, hemorrhage, infection, injury from needle, miscarriage or preterm labour, leakage of amniotic fluid
what are the 5 discrete biophysical variables
fetal movement, fetal tone, fetal breathing movements, amniotic fluid volume, FHR
normal/abnormal for NST/reactive FHR
norm (2 points): at least 2 accelerations in 20 min
abnorm (0 points): less than 2 accelerations to satisfy test in 20 min
normal/abnormal for US: fetal breathing movements
Norm: min one episode of >30 sec in 30 min
abnorm: none or less than 30 sec in 30 min
normal/abnormal for US: fetal activity/gross body movements
norm: at least 3 movements of torso or limbs
abnorm: less than 3 movements
normal/abnormal for US: fetal tone
norm: at least 1 episode of active bending and straightening of limb or trunk
abnorm: no movements or movements slow and incomplete
normal/abnormal for US: qualitative AFV/AFI
norm: at least 1 vertical pocket > 2cm or more in the vertical axis
abnorm: largest vertical pocket </=2cm
lily has a BPP at 38 wks gestation. FHR was 140 with 2 spontaneous accelerations. fetus has 2 episodes a practice breathing for 35 seconds. fetus was well flexed and moved actively throughout the assessment. amniotic fluid largest vertical fluid pocket was 0.75cm. whats the BPP score?
8
what blood test indicates further follow up related to potential development of erythroblastosis fetalis
RH neg
@ 26wks gestation how many cm should fundal ht be
26 cm +/- 2cm
@26 wks gestation, expected fetal HR is
110-160
