Chapter 12 - Nursing Management During Pregnancy

preconception care

promotion of health and wellbeing prior to a pregnancy

• assessments of reproductive goals and planning/risk assessment

• contraceptive counseling

• health maintenance and encouraging healthier behaviors

interconception care

time between pregnancies when a person can improve their health status, especially if the prior pregnancy had a poor outcome

risk factors for adverse pregnancy outcomes

diabetes, teratogens (infectious disease, AEDs, isotretinoin), rubella and varicella seronegativity

prenatal care

reduces risk of adverse health effects for pregnant person/fetus/newborn by addressing modifiable risk factors and providing education about having a healthy pregnancy

first prenatal visit includes

• comprehensive health history

• calculate estimated due date

• laboratory tests

• physical exam/head to toe

G in GTPAL

the current pregnancy to be included in the count

T in GTPAL

the number of term gestations delivering between 38-42 weeks (term births)

P in GTPAL

the number of preterm pregnancies ending viably >20 weeks but before 37 weeks (preterm births)

A in GTPAL

the number of pregnancies ending before 20 weeks or viability (miscarriage/abortion)

L in GTPAL

the number of children currently living (living children)

frequency of follow up visits

every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, and then weekly until birth

follow up visits include

• blood pressure, weight

• fundal height

• assessment of fetal movement and heart tones

• common discomforts and management

• screening for complications

• education

fundal height development

should correspond 1-2 cm for each week of gestation; 12 weeks at symphysis, 20 weeks at the umbilicus

fetal movement measures

first perception is usually in the 2nd trimester, fetal kick counts measured by provider (looking for 10 movements in 2 hours typically)

fetal heart rate should be

110-160

danger signs during pregnancy

• spotting/bleeding

• dysuria

• persistent n/v

• fever

• regular/painful uterine contractions

• leaking fluid

• decreased fetal movement

• symptoms of DVT

symptoms of preeclampsia

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

non-invasive prenatal screening tests

alpha-fetoprotein → neural tube defects

cffDNA → chromosomal screening

nuchal translucency

marker screening → hormonal markers (not super accurate)

ultrasound

confirm IUP, pregnancy dating based on crown-rump length, 18-20 week anatomy assessment, fetal growth and activity, amniotic fluid

doppler flow studies

examines flow of blood in umbilical vessels in high-risk pregnancies

nonstress test (NST)

most common method; indirect assessment of uteroplacental function

biophysical profile

ultrasound + NST, scored out of 10

regular dental care during pregnancy

enhanced inflammatory response increases pregnant person’s risk for gingivitis and periodontal disease

vaccination rules during pregnancy

no live vaccines when pregnant (influenza and Tdap are most common), other vaccines are fine

perinatal education includes

• info about types of birth (medicated vs unmedicated)

• preparation for labor, birth, newborn care, feeding, etc

• partner health promotion

• Lamaze, Bradley, Dick-Read, hypnobirthing

benefits of breastfeeding for the baby

lower risk of SIDS, obesity, diabetes, asthma, otitis media, upper respiratory infections, food allergies

the ideal balance of nutrition for newborns, breastmilk will change and adapt to the baby’s needs as it grows

benefits of breastfeeding for the nursing parent

lower rates of breast and ovarian cancer, Type 2 diabetes

recommended breastfeeding time

exclusively until 6 months if possible, no recommended stop point