NRSG 328 Antenatal

what is mothering about?

being with others in a context in which mutual flourishing is a shared goal

caring and being cared for

what is family centered care?

focus on dignity and respect for pt and family

explicit attention to pt/family values and preferences

shared decision-making: involve pt and family in care decisions

maximize participation of families in care, in accordance w patient preferences

what is included in trauma-informed care?

minimize potentially traumatic/distressing aspects of medical care

address distress: pain, fear, anxiety

provide emotional support to pts/support effective coping

promote effective emotional support of pt by family members

address family members distress

what do pt/fam centred care and trauma-informed care have in common?

share info w pt and family

encourage fam presence

provide pt/family w choices and sense of control

consider fam needs

respect fam strengths

cultural competence

what are colonialism contexts in maternity?

Imposition of Western medicine, practice, and ideals How do we define a "good mother" vs. "good father" Disruption of cultural practices and ceremonies Residential schools

Sixties Scoop

what are slavery contexts in maternity?

•During the period of slavery in the US, black women were forced to breastfed white babies

•Development of "modern" obstetrical procedures

•The myth that Black women feel less pain

•Forced and coerced sterilization and removal of infants from mothers

what are unique issues in maternity care?

•Prenatal testing: autonomy, consent, choice, resource allocation

•Intrapartum consent

•Treatment of prematurity or severe illness

•Choice to breastfeed

•Circumcision

•Caesarian birth upon request

•Birth plans and consent

what are the ethical principles?

beneficence, non-maleficence, autonomy, justice, care and compassion, relational autonomy

what are individual level of health promotion goals in maternity care?

promoting physical, mental and psychosocial wellness

promoting breastfeeding

healthy wt gain

what are system/community level of health promotion goals in maternity care?

access to affordable, healthy foods

access to housing

support for breastfeeding

maternity/parental leave

contraception access

availability of maternity care

what is gravida?

Any pregnancy, including the one in progress

what is nulligravida?

a person who has never been pregnant

what is primigravida?

pregnant for the first time

what is multigravida?

a woman who has had two or more pregnancies

what is para?

The number of pregnancies >20 weeks

what is primipara?

A person who has given birth to their first child after 20 weeks

what is Multipara

A person who has given birth to 2 or more children after 20 weeks

what is Nullipara

A person who has not completed a pregnancy past 20 weeks

what is Abortion

spontaneous or elective

what is abortion?

spontaneous or elective

what is gestational age?

The prenatal age of the developing fetus calculated from the 1st day of the pregnant person's LMP

what is age of viability?

Usually 22 to 24 weeks gestations

what is presumptive?

amenorrhea

nausea

breast tenderness

fatigue

urinary frequency

quickening

what is probable?

Goodell sign

Chadwick sign

hegar sign

mcdonald sign

abdominal enlargement

braxton hicks

ballottement- baby rebounds from pressing on uterine wall

positive pregancy test: serum or urine

what are positive signs of pregnancy?

audible fetal heartbeat

fetal mvmt felt by examiner

US visualization of fetus

what is the Goodell Sign?

softening of the cervix

what is the Chadwick sign?

Bluish discoloration of the vagina

-indication of early pregnancy

what is the Hegar sign?

softening of the lower uterine segment

what is the Mcdonald sign?

an ease in flexing the body of the uterus against the cervix

what are 1st trimester pregnancy discomforts? (7)

fatigue, nausea, HA, freq urination, mood swings, breast changes, constipation

what are 2nd trimester pregnancy discomforts? (6)

nasal congestion, nosebleeds, infamed/bleeding gums, constipation, changes in pigmentation (face, abdomen), stretch marks

what are 3rd trimester pregnancy discomforts? (11)

lower backache, fatigue, leg cramps, frequent urination, SOB, heartburn, constipation, swelling of feet, varicose veins, hemorrhoids, insomnia

what weeks are the 1st trimester?

0-13 weeks

what weeks are the 2nd trimester?

14-27 weeks

what weeks are the 3rd trimester?

28-40+ weeks

what are breast physiological changes in pregnancy?

inc breast size

heaviness

tingling

fullness

darkening of nipple

thin watery secretion

what are resp physiological changes in pregnancy?

inc tidal volume

inc O2 consumption

elevated diaphragm

nasal stuffiness

what does the hormone human chorionic gonadotropin do?

produced in pregnancy by fertilized ovum and chorioinic villi--stimulates progesterone and estrogen by corpus luteum

hormone that is tested for in preg tests, present=preg

what does the hormone progesterone do?

inhibits oxytocin & uterine contraction; prepares breasts for lactation; reduces smooth muscle tone - GI (constipation; heartburn) & varicosities)

what produces progesterone?

produced first by the corpus luteum (until day 14) and then by the placenta (maintains endometrium;

what produces human chorionic somatomammotropin?

produced by the placenta

what does the hormone human chorionic somatomammotropin do?

allows inc glucose to stimulate the pancreas and inc insulin levels, breast development

increases insulin resistance

what produces estrogen?

Produced first by the corpus luteum (until day 14) and then by the placenta

what does estrogen do?

•enlarges uterus, breasts & genitals; promotes fat deposit changes; triggers skin changes; vascular changes, relaxes pelvic ligaments, decreases ability of pancreas to produce insulin)

•Uterus expands gradually and houses the fetus, the amniotic fluid, and the placenta

what produces relaxin?

Produced first by the corpus luteum & placenta

what does relaxin do?

causes connective tissue of symphysis pubis to be more moveable and cervix to soften; inhibits uterine activity

what are the vagina and cervix physiological changes?

changes in color: purple/blue aka Chadwick sign

cervix becoming softer: Goodell sign

vaginal pH inc (protect against inf)

vaginal secretions inc in glycogen

risk of yeast inf

what are breast physiological changes?

estrogen and progesterone prepare for breastfeeding

pigment inc

colostrum can be expressed at the end of pregnancy

what is colostrum?

A milk-like substance secreted right after delivery

what % does CO increase by in preg?

30-50%

pulse rate may inc

does BP inc in preg?

no

because resistance to blood flow through vessels decreases

what is dilutional anemia?

fluid part of the blood increases more than erythrocyte component and physiologic anemia

what may hematocrit fall to?

from 0.37-0.47 to 0.33

when may WBC inc?

in the 2nd and 3rd trimester

when may blood volume increase by 40-50%

24-32 weeks gestation

when may coagulation factors increase?

during 2nd and 3rd trimester

what are 3 resp changes in preg?

thoracic breathing

compensatory measures lead to inc tidal volume

dyspnea may occur

what happens when mom lays flat on their back?

uterus compresses inferior vena. cava

reduces blood returned to her heart

can lead to fetal hypoxia

what are some SS when mom lays on their back?

faintness

lightheadedness

dizziness

agitation

what position can relieve pressure on the inferior vena cava?

turning on the left side

what are urinary physiological changes?

filtration rate of kidneys increase, water is retained for inc blood volume and glycosuria and proteinuria

what can progesterone cause the urinary system to do?

relaxes the uterus and bladder and can cause stasis of nutrient rich urine and may lead to an UTI

what are GI physio changes in preg?

uterus displaces the stomach and intestines

mouth tissue may become more tender and bleed

relaxed pyloric scphincter

is the digestive system faster or slower in preg?

slower

what can a relaxed pyloric sphincter cause?

heartburn

what are MSK changes in preg?

posture changes as fetus grows: low back pain, rounding of shoulders

pelvic joint relax: waddling gait as symphysis pubis slightly separates

what is GTPAL

Gravida, Term, Preterm, Abortions or Miscarriage, Living

what is Gravida?

number of pregnancies

what are term births?

infant born at term >37 weeks

twin and triplets count as one

what are preterm births?

infant born after 20 wks and before 37 weeks

what are abortion and miscarriage?

pregnancies aborted before 20 weeks

what are living children?

current living children, do not include the current pregnancy

what is the GTPAL of this scenario?: Rose is a 32-year-old woman who is attending your prenatal class and is in her 37th week of gestation.

She had an induced abortion (9 weeks) when she was 19 years old. She had a spontaneous abortion (8 weeks) at 30 years old. She has twins who are 3 years old, who were born at 35 weeks 3 days, and a 2 year old child who was born at 39 weeks.

G-5

T-1

P-1

A-2

L-3

what is Nagele's rule?

identify the first day of the last menstrual period, count back 3 months and then add 7 days and one year

what is Nagele's rule used to calculate?

EDB

estimated date of birth

what is the EDB in this case study? Anna's last menstrual period began on September 9, 2021 and ended on September 13, 2021. What is her estimated due date?

June 16, 2022

who performs the prenatal visit assessments?

Family physician

midwife

obstetrician

others: MOA

US technician

Doula

when is the prenatal visit?

ideally, prenatal care should begin prior to the pregnancy to assist the pregnant person in being in optimal health prior to conception

what 12 components are included in the prenatal care?

history; medical, family, social, env, genetic

initial testing: bloodwork, sonography, screening

physical assessment

initial discussion of expectations

prenatal education

discussion of preg intention

access to care

use of folic acid

smoking cessation

STIs

recreational and prescription med use

mental health history

what trimester is the intake prenatal visit?

first trimester

what is the frequency of prenatal visits from contraception to 28 weeks?

every 4 weeks

what is the frequency of prenatal visits from 29-36 weeks?

every 2-3 weeks

what is the frequency of prenatal visits 37 weeks to birth?

weekly

what are 9 antenatal fetal health things to surveillance?

BP

assess fetal mvmts

fetal heart tones

fetal HR monitoring

Nonstress test/NST: discussed in furture class

symphysis-fundal height

STI screening

urinary dipstick proteinuria

weight measurement

how often should you monitor fetal movements?

all preg individuals should be advised to regularly monitor fetal mvmts from 26 weeks gestation and should present immediately for further assessment if reduced fetal mvmts are suspected

what is the purpose of listening to fetal heart tones?

assess viability

what is the symphysis-fundal height?

a measurement taken during pregnancy to estimate fetal growth and size

what is the purpose of the urinary dipstick?

to assess for proteinuria as it is a classic symptom of pre-eclampsia and needs to be followed up with

what are the 3 prenatal screening tests?

US for nuchal translucency

blood work at 11-14 weeks

non-invasive prenatal testing

when should you assess using the US for fetal anatomy?

18-22 weeks

what is isoimmunization?

when the baby's Rh-positive blood leaks into the Rh-negative mother's circulation, resulting in her body producing antibodies that would destroy Rh-positive erythrocytes.

what happens in subsequent pregnancies after isoimmunization?

the women's antibodies against Rh-pos blood cross the placenta and destroy the fetal Rh-pos erythrocyte before the infant is born

when is RhoGAM given?

28 weeks and within 72 hours of delivery

when else is RhoGAM given? (4)

amniocentesis

miscarriage

abortion

after abdominal trauma

what assessment are done for moms needing RhoGAM?

fetal assessments

what may be done for the fetus if they are anemic?

intrauterine transfusion

what are the 5 complications during pregnancy?

hypertensive disorders of pregnancy: pre-eclampsia, eclampsia

gestational diabetes

placenta previa

placenta abruption

infections

what is the BP reading to diagnose HTN in preg?

greater or equal to 140/90 mmHg for 2 separate readings based on the avg of at least 2 measurements taken at least 15 min apart using the same arm

what is classified as pre-existing/chronic HTN?

before 20 weeks gestation

what is classified as gestational HTN?

after 20 weeks gestation