Pre-Conception & Antepartum NRS 317

preconception definition

The period before a pregnancy is conceived

antepartum definition

the period of pregnancy before birth

preconception definition: extra notes

Some patients are not trying to conceive (general GYN care), & some are looking to conceive in the near future

preconception overview: what is going on during this time?

•General reproductive & sexual health of patient (and partner as needed)

•Preparation to conceive OR contraception

antepartum overview: what is going on during this time?

•Confirmation of pregnancy

•Health of both patient and fetus (and family)

•Education/anticipatory guidance

•Screening for and treating alterations (complications)

•Preconception overview

•General reproductive & sexual health of patient (and partner as needed)

•Preparation to conceive OR contraception

Antepartum overview

•Confirmation of pregnancy

•Health of both patient and fetus (and family)

•Education/anticipatory guidance

•Screening for and treating alterations (complications)

How does the body change in Pregnancy: Endocrine

•HCG = pregnancy hormone

•Estrogen = lining building, hypercoagulability

•Progesterone = lining support

How does the body change in Pregnancy: Respiratory

•Increased O2 demand

•SOB r/t progesterone causing hyperventilation and/or uterine enlargement (later)

How does the body change in Pregnancy: Cardiovascular

•Increased volume, CO, HR

•Risk for elevated BP

•LE stasis = risk for DVT

How does the body change in Pregnancy: Musculoskeletal

•Balance of weight as baby grows = back pain

•Loosening of ligaments especially in pelvis

How does the body change in Pregnancy: Psychosocial

•Role changes

•Decision making

How does the body change in Pregnancy: Skin

•Hyperpigmentation

•Striae (stretch marks)

How does the body change in Pregnancy: GU

•Urinary frequency

•Uterine enlargement

•Breast changes

•Pause in menstrual cycle

How does the body change in Pregnancy: GI

•N/V

•Constipation

•Acid reflux (especially later on)

Preconception Assessments: Remember, these are the overall goals

•Support reproductive health of patient

•While considering chronic conditions

•Support reproductive health of partner as needed

•Prepare to conceive

•Establish contraception plan

Preconception Assessments
What Do We Actually Assess?

•General medical history --> including sexual, obstetric, family, vaccination history

•Social history --> including patient safety and culture/religion

•Mental health status --> including stress & coping

•Nutrition & exercise

•Substance use --> teratogens?

• •Alcohol

• •Caffeine

• •Marijuana, illicit drugs, etc.

•Current medication list

• •Including herbs & supplements

•Head to toe physical assessment (or focused assessment if appropriate)

Antepartum Assessments: what are the new goals?

•Confirm pregnancy

•Assess patient's plan & support system

•Monitor growth and development of fetus

•Monitor patient’s health status and adaptation to pregnancy

•Screen for and follow any alterations (complications) --> high risk pregnancy?

Antepartum Assessments: what do we actually assess?

• Signs of pregnancy – subjective, objective, diagnostic OR presumptive, probable, positive

• Dating of pregnancy – Nagele’s Rule

• Patient feedback regarding fetal movement (kick counts)

• Patient head to toe (or focused) physical assessments

• Patient experience and symptoms in pregnancy

• Fetal & patient diagnostic tests

• Education regarding pregnancy & newborns – don't forget to include family members!

Preconception & Antepartum Assessments

It’s important to double check documentation with your site. There are variations between communities.

Do not discuss OB history in front of a partner or support person. This is a sensitive topic and you do not want to share info that is not public knowledge.

Gravidity

# of times pregnant

Parity

# of births

alterations: nausea and vomiting

•Often occurs in first trimester likely due to increase in hCG

•What would you recommend to this patient?

•When would you raise the red flag?

alterations: ectopic pregnancy

•When the pregnancy implants OUTSIDE of the uterus (most commonly in the fallopian tube)

•Sx: one sided severe pain (even if it comes and goes)

•Tx: methotrexate if early on, surgery to remove embryo if it has developed more

•Can be life threatening (d/t internal bleeding) if not treated in time

alternations other examples  

gestational diabetes, deep vein thrombosis, vaginal bleeding —> à spontaneous abortion, Rh alloimmunization, Group B Strep infection, anemia, folic acid insufficiency