Healthy Pregnancy & Prenatal / Antental Testing (Week 2 OB)

Signs of Pregnancy

● Presumptive (what client reports to you)
● Probable (objective data)
● Positive (could be false positive)

ultrasounds identifies pregnancy

Fundal Measurement (size of fetus)

-Measure in centimeters from pubic bone to the top of the uterus

-can start measuring 16 weeks until 36 weeks

-should equal gestational age in (cm=weeks)

Naegele’s rule

subtract 3 months, add 7 days, MAYBE add year

GTPAL

Gravida = # of pregnancies (including current)

Term = # deliveries after 37 weeks

Preterm = # deliveries between 20 weeks and 36 weeks, 6 days

Abortions = # of pregnancies ending before 20 weeks

Living = # of children currently living

Reproductive changes

• cervix (softens + blueish)

• uterus (bigger/stretches)

• breasts (tender)

Cardiovascular changes

• blood volume (+40%-50%) (more iron)

• Heart rate (increases 15bpm over pregnancy)

• Blood pressure (drops, then goes back to baseline) (normal is 140/90, emergency is 160/110)

• Coagulation (increase clotting capacity) *warn for DVT

• Respirations (same)

Respiratory changes

-increased oxygen consumption (thoracic breathing)

-respiratory alkalosis (basic, pulls more CO2)

-Diaphragm adjustment (goes higher, heart shifts to left)

Musculoskeletal changes

• Lordosis

• Postural/gait changes (falls risk, lower back pain)

• Relaxin effects

• vena cava syndrome / supine hypotension (dizzy when laying down, lay down on side for solution))

Gastrointestinal changes

• constipation b/c of increase progesterone and decrease in motility (fiber, water)

• gag reflex

• more fluid in feet

Integumentary changes

• circulation increases

• hyperpigmentation (skin become darker in color)

• Cutaneous vascular changes

• Striae gravidarum (stretch marks)

• Linea nigra (vertical line that appears on the abdomen during pregnancy)

• Melasma (brown or hyperpigmented patches on the face)

Renal changes

• + blood flow to kidneys (work overtime)

• lots of glucose + protein in urine is dangerous (UTI, kidney stones)

• Pee a lot

Endocrine changes

• oxytocin (stimulates contractions)

• prolactin

• insulin (teaches body to be resistant to insulin so baby can get glucose)

COMMON DISCOMFORTS OF PREGNANCY

Nausea and vomiting
Heartburn
Constipation
Fatigue
Dizziness
Vena Cava Syndrome (Supine hypotension)
Breast Tenderness
Shortness of breath
Urinary Frequency
Edema
Round Ligament pain
Braxton Hick contractions

Rubella non-immune

vaccination after birth

Hepatitis B positive

baby vaccine

Syphilis positive

antibiotics

HIV positive

steroids

MSAFP and Cell free DNA

• from blood sample

• chromosome abnormalities

Group B Strept

treat with penicillin

PRENATAL CARE

• every 4 weeks until week 28

• every 2 weeks until week 36

• then weekly

• educate by giving symptoms, common discomforts and changes

Nutrition

• first trimester, mom does not need more cal

• second trimester, mom needs +300 cal

• third trimester, mom needs +400 cal

• folic acid reduces neural tube defects

• avoid lunchmeat (unless warmed), soft cheeses, tuna

less than 18 bmi

28 to 40 lb (weight gain)

18.5 to 24.9 bmi

25 to 35 lb (weight gain)

25 to 29.9 bmi

15 to 25 lb (weight gain)

more than 30 bmi

11 to 20 lb (weight gain)

Maternal Emotional Responses

• Ambivalence (mixed or contradictory feelings)

• Introversion (to myself)

• Acceptance

• Mood swings

• Changes in body image

What to report during first trimester

• Spotting/bleeding

• Pain with urination (UTI possible)

• Severe persistent vomiting

• Fever

• Abdominal pain

What to report during second trimester

• Regular contractions

• Calf pain

• Gush or leakage of fluid from
  vagina (breakage of amnotic sac)

• No fetal movement for more than 12 hours

What to report during third trimester

• Sudden weight gain

• Facial edema (should be in lower half of body)

• Severe upper abdominal pain

• Headache with visual changes

• Decrease in fetal movement than usual

Ultrasound

• Transvaginal (during first trimester)

  Education: empty bladder before, on back

• External - abdominal (after first trimester)

  Education: full bladder

Carrier Screening

to see if the baby has the disease the mother has a history of

Quad Maker screening

see if they have an increased risk for certain conditions like Down syndrome

Non stress test (NST)

a prenatal test that monitors the baby's heart rate and movements to assess its well-being

Contraction Stress test

• To assess the fetus's ability to tolerate labor contractions

• To identify potential problems with the placenta or umbilical cord 

Biophyscial Profile (graded 0-10)

• higher means baby is ok

• lower means baby is not happy and needs to be delivered soon, asap or c section.

• Fetal breathing movements, Fetal tone, Fetal movement, Amniotic fluid volume, Non-stress test