Nursing Management During Pregnancy (Chapter 12)

Flashcards covering key vocabulary terms related to nursing management during pregnancy, based on lecture notes from Chapter 12.

Preconception Care

Promotion of health and wellbeing prior to a pregnancy; a tool for improving perinatal outcomes.

Interconception Care

The time between pregnancies when a person can improve their health status, especially if the prior pregnancy had a poor outcome; a tool for improving perinatal outcomes.

Naegele's Rule

A method to calculate the estimated due date (EDC/EDD), typically based on a 28-day cycle with adjustments for longer/shorter cycles.

Ultrasound (CRL) Dating

Used to calculate due date, especially with irregular periods, unknown LMP, or a significant difference between LMP and CRL in the 1st trimester.

Gravid

The state of being pregnant.

Gravida/Gravidity

The total number of times a person has been pregnant, regardless of outcome or number of infants.

Nulligravida

A person who has never experienced pregnancy.

Primigravida

A person pregnant for the first time.

Multigravida

A person pregnant for at least the third time.

Para/Parity

The number of times a person has given birth to a fetus of at least 20 gestational weeks (viable or not), counting multiple births as one birth event.

Nullipara (para 0)

A person who has not produced a viable offspring.

Primipara

A person who has given birth once after a pregnancy of at least 20 weeks.

Multipara

A person who has had two or more pregnancies of at least 20 weeks' gestation resulting in viable offspring.

G-TPAL

An obstetric history notation: Gravida (total pregnancies), Term births, Preterm births, Abortions (spontaneous or induced), Living children (example: G4P2012 means 4 pregnancies, 2 term, 0 preterm, 1 abortion, 2 living children, and current pregnancy).

Low-Risk Pregnancy

An uncomplicated pregnancy with no co-morbidities or chronic health issues, where fetal well-being progresses typically.

High-Risk Pregnancy

A pregnancy complicated by conditions jeopardizing the health of the pregnant person and putting the fetus at risk (e.g., diabetes, hypertension, multiple gestation, drug use).

Routine Prenatal Follow-Up Schedule

Every 4 weeks until 28 weeks, every 2 weeks until 36 weeks, and weekly until birth.

Components of Each Prenatal Visit

Includes blood pressure, weight, fundal height, FHT, assessment of fetal movement, screening for complications, and education.

Fundal Height

Distance from symphysis to fundus, measured in centimeters, reflecting fetal growth. Should correspond within 1-2cm of weeks gestation.

Fundal Height at 12 Weeks and 20 Weeks

At 12 weeks, the fundus is at the symphysis; at 20 weeks, it is at the umbilicus.

Quickening

The first perception of fetal movement.

Normal Fetal Heart Rate (FHR)

110-160 beats per minute.

Pregnancy Danger Signs

Spotting or bleeding, unilateral pain/dizziness/shoulder pain (1st trimester), painful uterine contractions before term, leaking fluid vaginally before term, decreased fetal movement, dysuria, persistent nausea/vomiting, fever, DVT/PE symptoms, or preeclampsia symptoms.

Symptoms of Preeclampsia

Sudden large weight gain, sudden worsening edema, RUQ pain, headache, and visual changes.

Non-Invasive Prenatal Screening Tests

Include cell-free fetal DNA (NIPT), AFP, Ultrascreen, or Quad Screen.

Invasive Prenatal Diagnostic Tests

Used for confirmation of genetic screening, including Amniocentesis and Chorionic Villus Sampling (CVS).

Amniocentesis

Transabdominal collection of amniotic fluid, typically done at 11+ weeks for genetic diagnosis.

Chorionic Villus Sampling (CVS)

A sample taken from the placenta, typically done at 10-13 weeks for genetic diagnosis.

Gestational Diabetes (GDM) Testing

Routine testing performed around 28 weeks gestation.

Group B Strep Testing

Routine testing performed around 36 weeks gestation.

Nonstress Test (NST)

The most common non-invasive method for indirect assessment of uteroplacental function and fetal well-being.

Biophysical Profile (BPP)

Combines ultrasound findings (fluid, tone, gross body movement, breathing movements) with a Nonstress Test, scoring out of 10.

Environmental Contaminants in Early Pregnancy

Factors like heavy metals and air pollution that can cause irreversible alteration in epigenetic markers, leading to negative outcomes such as pregnancy loss, stillbirth, preterm birth, and other disorders.

Teratogens

Agents that can cause birth defects, such as STIs, antiepileptic medications, and isotretinoin. Rubella and varicella sero-negativity are also risk factors.

Recommended Vaccines in Pregnancy

Influenza, Tdap, COVID boosters, RSV; live vaccines should be avoided.

RSV Vaccine in Pregnancy

A single dose is recommended for pregnant individuals 32 0/7 - 36 6/7 weeks (eligible Sept-Jan) who do not have a planned delivery within 2 weeks and whose infant is not receiving nirsevimab.

Prohibited Practices/Substances in Pregnancy

Hot tubs and saunas (risk for fetal tachycardia), douching, scented perineal products, live vaccines, certain foods (sushi, rare meat, unpasteurized cheese, deli meat, excessive coffee).

Acetaminophen in Pregnancy

Remains one of the only safe pain and fever relievers in pregnancy.

Periodontal Disease in Pregnancy

Can be linked to an increased risk of preterm or low birth weight infants, emphasizing the importance of regular dental care.

Perinatal Education

Childbirth education preparing pregnant people, their support person(s), and families for realistic birth experiences, coping, newborn care, and transition to parenthood.

Unmedicated Birth

The preferred term for what is inaccurately called 'natural childbirth'.

Common Pregnancy Discomfort: Fatigue

Most common in 1st trimester due to increased progesterone and metabolic demands.

Common Pregnancy Discomfort: Breast Tenderness

Most significant in 1st trimester due to increased estrogen and progesterone causing breast changes in preparation for lactation.

Common Pregnancy Discomfort: Urinary Frequency/Incontinence

Caused by increased blood volume and pressure on the bladder from the gravid uterus.

Common Pregnancy Discomfort: Nausea & Vomiting of Pregnancy (NVP)

Caused by elevated estrogen, progesterone, hCG, and sometimes vitamin B6 deficiency; affects 70-90% of pregnancies, generally peaks 8-12 weeks.

Pyridoxine (Vitamin B6) for NVP

A common anti-emetic for NVP, often prescribed at 50mg BID.

Doxylamine-Pyridoxine (Diclegis) for NVP

An antihistamine (H1 antagonist) combined with B6, a common medication for NVP.

Ondansetron (Zofran) for NVP

A serotonin antagonist used for NVP, typically 4-8mg PO q8h.

Metoclopramide (Reglan) for NVP

A dopamine antagonist used for NVP, typically 5-10mg PO q6-8h PRN; watch for tardive dyskinesia.

Promethazine (Phenergan) for NVP

A dopamine antagonist used for NVP, typically 12.5-25mg PO or PR q4h PRN.

Lifestyle Management for NVP

Includes smaller, more frequent meals/snacks with protein, separating liquids from foods, carbonated drinks, and avoiding constipation.

Common Pregnancy Discomfort: Backache

Caused by shifting of the center of gravity due to an enlarged uterus and joint laxity. Round ligament pain is also common.

Common Pregnancy Discomfort: Leg Cramps

Primary in 2nd and 3rd trimester, affecting 50% of pregnancies; caused by pressure on pelvic nerves and calcium/magnesium deficiencies.

Common Pregnancy Discomfort: Leukorrhea

Increased vaginal secretions due to increased estrogen, leading to hypertrophy of cervical glands and vaginal cells.

Common Pregnancy Discomfort: Heartburn/GERD

Occurs in 80% of pregnancies; progesterone relaxes the lower esophageal sphincter, and the stomach is displaced upward.

H2RA (Histamine 2 Receptor Antagonists) for Heartburn

Medications like Famotidine (Pepcid) used for mild and intermittent heartburn in pregnancy.

PPI (Proton Pump Inhibitors) for Heartburn

Medications like Omeprazole (Prilosec) or Pantoprazole (Protonix) used for severe and/or frequent heartburn in pregnancy.

Common Pregnancy Discomfort: Varicosities

Abnormally enlarged superficial veins (legs, vulva) due to vasodilation from progesterone.

Common Pregnancy Discomfort: Hemorrhoids

Varicosities of the rectum, caused by progesterone-induced vasodilation and pressure from the uterus on the lower intestine and rectum.

Common Pregnancy Discomfort: Constipation

Caused by decreased GI contractility and slower movement through the colon, leading to increased water absorption.

Common Pregnancy Discomfort: Dependent Edema

Swelling in dependent areas due to increased total body fluids (6-8L) and increased capillary permeability caused by elevated hormones and blood volume. Rapid weight gain and generalized edema may indicate preeclampsia.

Braxton-Hicks Contractions

Irregular, commonly painless contractions that occur without cervical dilation, increasing uterine muscle tone before labor.

Common Pregnancy Discomfort: Bleeding Gums, Nasal Congestion, Epistaxis

Caused by increased estrogen levels, leading to edema of the mucous membranes of the nasal and oral cavities. Decongestants should be avoided.

Pregnancy Cravings

Cause unknown, likely hormonal; not linked to physiologic need. Screen for Pica (craving non-nutritive substances).

Common Pregnancy Discomfort: Shortness of Breath (SOB)/Dyspnea

Affects 60-75% of pregnant people; caused by the growth of the uterus preventing complete lung expansion and diaphragm expansion. Dyspnea with ADLs not resolving with rest can indicate heart/lung disease.