Care Lecture 15: Antepartum Period

-1st trimester: 0-13 weeks

-2nd trimester: 14-26 weeks

-3rd trimester: 27-40 weeks

how many weeks makes up each trimester?

-1st = major fetal organ formation

-2nd = growth & development

-3rd = mostly weight gain

what is the main goal of the 1st trimester? 2nd? 3rd?

↓ risks of neural tube defect

what is the main benefit of folic acid?

0.4 mg of folic acid daily (400 mcg)

all adolescents and women who can become pregnant should take how much folic acid?

-no raw meats/fish

-wear gloves when gardening

-don't change cat litter

what are some nutritional and safety needs associated with pregnancy?

-antepartum = lower risk

-postpartum = increased risk

when is the risk of depression highest and lowest in relation to pregnancy?

egg drops from uterus

↓

fertilized by sperm

↓

implants in uterus

↓

placenta is developed by day 14

outline the steps of fertilization

-embryonic = weeks 3 to 8

-fetal = weeks 9 to 38

what weeks of pregnancy make up the embryonic and fetal period?

human chorionic somatomammotropin

hormone secreted by placenta that alters maternal metabolism to ensure adequate supply of energy to the fetus

human chorionic gonadotropin (hCG)

hormone produced by the placenta to sustain pregnancy by stimulating the ovaries to produce estrogen and progesterone

stays low until end of pregnancy --> raises at the end when we start to dilate

what is true of relaxin levels in regard to pregnancy status?

maintain endometrium lining

when estrogen and progesterone levels are high, what effect does this have on the endometrial lining?

↑ right before 40 weeks = causes cervix to thin and dilate

when do prostaglandin levels usually rise during pregnancy and what does this cause?

begins to form at implantation on the side of the uterus

when does the placenta begin to form? where does it form?

on day 17 (when embryonic heart starts beating)

when is maternal-placental-embryonic circulation in place?

-respiration

-nutrition

-excretion = takes toxins out of body

-storage = stores nutrients

what are the metabolic functions of the placenta?

-oxygen = from maternal blood to the placenta

-carbon dioxide = from placenta to maternal blood

what direction do oxygen and carbon dioxide diffuse regarding the placenta?

-2 arteries

-1 vein

how many arteries and veins make up the umbilical cord?

takes wastes away from the baby

what is the role of the arteries in the umbilical cord?

perfuses oxygen and nutrients to the baby

what is the role of the vein in the umbilical cord?

functions as an endocrine gland regulating hormones

what is the role of the placenta regarding hormones?

1. presumptive signs

2. probable signs

3. positive signs

what are the 3 types of signs of pregnancy?

-amenorrhea

-nausea and vomiting

-fatigue

-urinary frequency

-breast changes

-quickening

what are some examples of presumptive signs of pregnancy?

-stress

-BMI

-excessive exercise

-poor nutrition

what are some possible causes of amenorrhea, excluding pregnancy?

high progesterone levels

what is the underlying cause of breast changes?

-when you feel the baby "move" in your stomach

-could be peristalsis/gas

what is 'quickening'? what are some possible causes of this?

presumptive signs

subjective signs that may or may not be associated with pregnancy

probable signs

objective signs that may or may not be associated with pregnancy

-positive pregnancy test

-enlarged uterus

-Goodell's Sign

-Chadwick's Sign

-Hegar's Sign

-McDonald's sign

what are some examples of probable signs of pregnancy?

-tumors

-endometriosis

the uterus enlarging could be attributed to what, in addition to pregnancy?

Goodell's sign

significant softening of the vaginal portion of the cervix; probable sign of pregnancy

Chadwick's sign

bluish discoloration of the cervix, vagina, and vulva; probable sign of pregnancy

Hegar's sign

softening of the lower segment of the uterus; probable sign of pregnancy

positive signs

diagnostic signs of pregnancy; confirms pregnancy

-fetal heartbeat

-fetal movement (felt by an examiner)

-visualization of fetus (ultrasound)

what are some examples of positive signs of pregnancy?

12 weeks with a fetal doppler

**anything prior you have to do an ultrasound

how early can you listen to a fetal heartbeat with a fetal doppler?

~ 23 weeks-24 weeks

what is considered the gestational week of viability?

between 37 and 0 days and 41 weeks and 6 days

what is considered a 'term' pregnancy?

after 20 weeks' gestation but before 37 weeks

what is considered a 'preterm' pregnancy?

42 weeks and 0 days and beyond

what is considered a 'post term' pregnancy?

-shoulder dystocia

-macrosomia

-↓ oxygenation to the baby d/t placenta starting to calcify at 40 weeks

what are some potential complications associated with post term pregnancies?

gravida

term used to describe a woman who is pregnant

parity

term used to describe the number of pregnancies in which fetuses have reached 20 weeks' gestation

nullipara

term used to describe a woman who has not completed a pregnancy with a fetus or fetuses beyond 20 weeks

primigravida

term used to describe a woman who is pregnant for the first time

primipara

term used to describe a woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks' gestation for the first time

multigravida

term used to describe a woman who has had two or. more pregnancies

multipara

term used to describe a woman who has completed two or more pregnancies to 20 weeks' gestation or more

abortion

pregnancy ending prior to 20 weeks' gestation; can be referred to as spontaneous, miscarriage, or elective

stillbirth/IUFD (intrauterine fetal demise)

term used to describe a infant delivered after 20 weeks' gestation through 42 weeks that has died

-antepartum = time of conception to the time of labor

-intrapartum = laboring process to childbirth

-postpartum = time from delivery until 6 weeks post-delivery

describe antepartum, intrapartum, and postpartum timelines

G = gravidity/gravida

T = term birth

P = preterm births

A = abortions

L = living children

what does GTPAL stand for?

1. find 1st day of LNMP (last menstrual period)

2. subtract 3 months

3. add 7 days

**used to find estimated date of conception (EDC)

what is Nagele's rule?

-determine EDC

-look at 3 signs of pregnancy

-planned pregnancy?

-discomforts/pain?

-any bleeding, vaginal discharge/itch?

-cramping?

-burning/frequency of urination?

-sleep/rest/nutrition/exercise patterns

-current medications

when completing the initial health history of a pregnant woman, what should be included/done?

-ACE inhibitors

-carbamazepine (antipsychotics)

-coumadin (anticoagulants)

-cytomegalovirus

-ethanol

-iodides

-ionizing radiation

-lead

-lithium

-rubella

-syphilis

-varicella

what are some things that are considered toxic exposures to humans?

PICA

practice of consuming nonfood substances (i.e., clay, soil, laundry starch) or substances with a low nutritional value (i.e., cornstarch, ice); craving items that you usually don't eat

a sign that a pregnant woman is missing some type of nutrient, vitamin, or mineral in their body

what does PICA usually indicate?

absorption of nutrients, especially minerals

PICA can interfere with what process?

-no alcohol

-no smoking (both partners)

-avoid caffeine

-avoid x-rays

-warning signs to report to physician

-no OTC drugs (unless approved first)

-take prenatal vitamins

what are some safety education points to include in the antepartum period?

-headache

-blurred vision

-↓ fetal movement

-leaking of fluids

what are some warning signs to report to the physician during the antepartum period?

after 28 weeks, prematurely close the ductus arteriosus = cardiac pulmonary problems

what effect can NSAIDs have on the ductus arteriosus?

-normal to see it drop a little bit at first

-↑ progesterone relaxes vascular system

what is true of blood pressure during the antepartum period? why?

-pulse ↑ 10-15 beats/min

-blood volume ↑ 40-50% (1200-1500ml)

what is true of HR and blood volume during the antepartum period?

can occur due to ↑ blood volume

what is true of murmurs and palpitations during the antepartum period?

↑ slightly d/t ↑ in BMR and the effects of progesterone

what is true of body temperature during the antepartum period?

-↑ RR

-more thoracic breathing

-deeper breath volume

-SOB may be experienced d/t compression on diaphragm

what is true of respiratory rate and pattern during the antepartum period?

-protein

-ketones

-WBC's

-glucose

when doing a UA during the antepartum period, nurses should look for abnormalities in what values?

-RBCs ↑ 20-30%

-WBCs ↑ (immune process to protect mom and fetus)

what is true of RBCs and WBCs during the antepartum period?

↓ = moms are hemodiluted

what is true of the H&H levels during the antepartum period?

24-28 weeks

when should a glucose tolerance test be done during the antepartum period?

-H&H

-WBCs

-blood type/Rh factor

-rubella titer

-tuberculin

-UA/culture

-HIV

-BUN and creatinine

-cervical, vaginal, anal cultures

what are some laboratory tests typically done throughout the pregnancy during the antepartum period?

swab between vaginal and anal area close to time of delivery

where and when is a group beta strep test conducted?

-look for positive pregnancy test

-pap smear

-breast exam

-prenatal screening tests

-laboratory tests

-ultrasound (maybe)

what are some diagnostics and screenings done in the 1st trimester (0-13.6 weeks)?

maternal:

-PROM

-preterm labor

-postpartum endometritis

fetal:

-low birth weight

regarding chlamydia, what are the maternal and fetal effects of this infection?

maternal:

-miscarriage

-preterm labor

-PROM

-postpartum endometritis

-chorioamnionitis

fetal:

-preterm birth

-IUGR

regarding gonorrhea, what are the maternal and fetal effects of this infection?

maternal:

-intrauterine infection

fetal:

-congenital infection

regarding herpes simplex virus, what are the maternal and fetal effects of this infection?

maternal:

-UTI

-chorioamnionitis

-sepsis

-postpartum endometritis

-meningitis (rare)

fetal:

-preterm birth

regarding group beta streptococci, what are the maternal and fetal effects of this infection?

maternal:

-dystocia from large lesions

-excessive bleeding

-birth trauma

fetal:

-none known

regarding HPV, what are the maternal and fetal effects of this infection?

maternal:

-miscarriage

-preterm labor

fetal:

-preterm birth

-stillbirth

-IUGR

-congenital infection

regarding syphillis, what are the maternal and fetal effects of this infection?

-every 4 weeks: until they are 28 weeks

-every 2 weeks: 29-36 weeks

-every week: 37 weeks till delivery

what is the recommended appointment schedule to promote a healthy pregnancy?

-nausea/vomiting

-urinary frequency

-fatigue

-breast tenderness

-↑ vaginal discharge

-epistaxis/nasal congestion

-ptyalism (metallic taste)

what are some common 1st trimester discomforts that a woman might experience?

> 5% of initial weight in weight loss

what amount of weight loss constitutes a diagnosis of hyperemesis gravidarum?

umbilical vein

what provides fetal oxygenation?

fetal has a ↑ affinity for O2 and carries 20-30% more O2 than maternal

what is true of fetal hemoglobin affinity in contrast to maternal hemoglobin affinity?

hemoglobin concentration of fetus is ~50% greater than maternal

what is true of fetal hemoglobin concentration in contrast to maternal hemoglobin concentration?

-15-18 weeks: quadruple screen

-15-20 weeks: amniocentesis

-24-28 weeks: glucose tolerance test

-20-22 weeks: ultrasound

what are some screening tests done during the 2nd trimester (14-26.6 weeks) and what weeks are they typically done?

-fundal height assessment

-leopold's maneuvers

-FHTs (fetal heart tones)

what are some additional physical assessments performed during the 2nd trimester?

how many cm = how many weeks pregnant they are

how do we measure the fundus?

fundal height ↓ as baby drops down into pelvis to prepare for birth

what is true of fundal height during the last 4 weeks of pregnancy?

leopold's maneuvers

used to try to feel how the baby is positioned

look for the backside of the baby so you know where to put the fetal monitor

what do you want to look for when performing leopold's maneuvers?

-heartburn (pyrosis)

-varicose veins

-flatulence

-hemorrhoids

-constipation

-backache

-leg cramps

-round ligament pain

-faintness

-SOB

-carpal tunnel

what are some common 2nd trimester discomforts that a woman might experience?

educate mom to eat small, frequent meals

what is a care management strategy for a pregnant woman with heartburn?

cholasma

pigmented area of the face (mask of pregnancy); caused by hormones; normal variance

linea nigra

a dark line appearing on the abdomen and extending from the pubis toward the umbilicus; due to hormone changes

-feeling baby move - regularly!

-maternity clothes

-some relief of urinary frequency

what are some 2nd trimester comforts?

-detailed history and assessment each visit

-same physical assessments at 2nd trimester

-cervical check for effacement and dilation near term

-NO NSAIDs

what are some assessments done during the 3rd trimester (27 weeks to delivery)?

-24-28 weeks: glucose tolerance test

-28 weeks: Rhogam if Rh-

-35-37 weeks: Group B strep screen

what are some specific tests done during the 3rd trimester (27 weeks to delivery) and what weeks are they typically done?

Rhogam

causes suppression of the immune response in non-sensitized women with Rh- blood who receive Rh+ blood cells due to fetomaternal hemorrhage, transfusion, or accident

-following miscarriage

-ectopic pregnancy

-amniocentesis

-within 72 hours of the delivery of an Rh+ newborn

when should Rhogam be given?