preconception/care of pregnant women pt 1

It begins at every annual gyn visit, identify potential risk factors, developing health lifestyles, routing screening to identify risk factors

preconception care

is a well-known model of group prenatal care that involves three components: health care assessment, education, and peer support - Learn about breastfeeding, parenting etc., Less privacy, Not preferred by all patients, first visit within first trimester (12 wks), q4 wks from 16-28 wks, biweekly from 29-40 wks

centering pregnancy

first visit within first trimester (12 wks), monthly between 16-28 wks, biweekly 29-36 wks, weekly from 36 wks-birth

traditional prenatal model

the most likely deterrent of prenatal care is

modesty

less likely to receive prenatal care, More likely to smoke, Less likely to gain adequate weight, elevated rates of LBW, (VLBW, <1,500 g), and infant mortality, more likely to have complications, DO NOT have increased likelihood of C-sections

adolescents

may be referred to as advanced maternal age (AMA), typical scenarios are: multiparous, primigravidus, higher chance of having pre-existing health conditions, Increased risk for miscarriage, stillbirth, diabetes, hypertension, placenta previa, placental abruption, cesarean birth, and pregnancy-related mortality, are more likely to have infants with chromosomal abnormalities, LBW infants, preterm birth, and multiple gestation

over 35

has given birth to more than one child either across pregnancies or have twins, etc in a single pregnancy, can bring feelings of joy as women consider continuing the maternal role and expanding the family, For some older people, pregnancy can evoke feelings of isolation as an individual of advanced maternal age

multiparous

women who have deliberately delayed childbearing until their late 30s or early 40s and those who previously were unable to conceive due to fertility problems and became pregnant through assisted reproductive technology (ARTs) - just the term that includes them being pregnant not the fact they are past 20 wks

primigravidas

A woman who has given birth once past the point of viability (usually 20 to 24 weeks), whether the baby was born alive or stillborn

primiparous

There is evidence of increased risk for ——— and ——- for women older than 40 years of age who conceive through ART

preterm labor, preeclampsia

When older individuals in a same-sex relationship or with a history of fertility problems become pregnant through ART, they can have —- feelings about the pregnancy

ambivalent

is more likely with multifetal gestation; the risk rises as the number of fetuses increases. IUGR or discordant growth, LBW, VLBW, congenital abnormalities, neonatal death, and cerebral palsy are more common in multifetal gestation

preterm birth

Higher hcG (which can be the case with a multifetal pregnancy) = more likely to have ——

hyperemesis gravidarum

Benefits associated with ——prenatal care include improved birth outcomes such as lower rates of preterm birth, increased knowledge, improved satisfaction, and higher rates of breastfeeding initiation

group

classes for early pregnancy:

fetal development, physiologic changes, nutrition

classes for mid pregnancy:

self care, planning for labor, feeding options

class for late pregnancy:

coping for labor/birth

recommends that clinicians screen for intimate partner violence (IPV) in women of reproductive age and provide or refer women who screen positive to ongoing support services.

US preventative services task force

has been linked to many other health problems such as headaches, abdominal pain, back pain, GI disorders, limited mobility, unexplained or multiple injuries in various stages of healing, chronic pain, arthritis, STIs, reproductive health problems, substance abuse, depression, PTSD, and suicide, women with any of these symptoms should be carefully assessed

IPV

Abusive behaviors usually starts with—— and increases in severity

nonphysical methods

Humiliation, Afraid, Rape, Kick (HARK); Hurt, Insult, Threaten, Scream (HITS); Extended–Hurt, Insult, Threaten, Scream (E-HITS); Partner Violence Screen (PVS); and Woman Abuse Screening Tool (WAST)

screening for IPV

No assumptions in —- documentation - patient stated, provider notified, can use quotations

IPV

The primary responsibility of the nurse who suspects or confirms intimate partner violence against a patient is to ——

document in EHR

The American College of Obstetricians and Gynecologists (ACOG) advises that all women be screened for IPV at periodic intervals, including during obstetric care (at the —— visit, at least once per —-, and at the —- checkup)

first prenatal, trimester, PP

Union of a single egg and a single sperm, Not an isolated event but part of a sequential process of cell division

conception

the process of egg (ovum) formation

Oogenesis

the process of sperm formation

spermatogenesis

removal of sperm’s protective coating

capacitation

a cap on the sperm’s head to be able to break through egg barrier

acrosome

Two protective layers, Considered fertile for about 24 hours after ovulation

ovum

6-10 days after conception

implantation

fertilization takes place in the —— of the fallopian tube

outer third

is the earliest biochemical marker for pregnancy, Production begins as early as day of implantation

HcG

Many pregnancy tests available:

serum, quantitative serum, urine

subjective signs of pregnancy; changes experienced by the woman (e.g., amenorrhea, fatigue, breast changes)

presumptive

objective signs of pregnancy; changes observed/perceived by an examiner (e.g., Hegar sign, ballottement, pregnancytests) & strongly suggest pregnancy

probable

objective; changes observed/perceived by an examiner (e.g., fetal heart tones, ultrasound) - indicateproof of pregnancy

positive

presumptive sign of pregnancy that can happen at 3-4 wks

breast changes

presumptive sign of pregnancy that can happen at 4 wks

amenorrhea

presumptive sign of pregnancy that can happen at 4-14 wks

N/V

presumptive sign of pregnancy that can happen at 6-12 wks

urinary frequency

presumptive sign of pregnancy that can happen at 12 wks

fatigue

presumptive sign of pregnancy that can happen at 16-20 wks

quickening

the very first time the pregnant person feels fetal movement

quickening

probable sign of pregnancy that can happen at 5 wks - aka a significant softening of the cervix

Goodell sign

probable sign of pregnancy that can happen at 6-8 wks - bluish/purple tint to vagina/vulva and or cervix

Chadwick sign

probable sign of pregnancy that can happen at 4-12 wks

positive serum pregnancy test

probable sign of pregnancy that can happen at 6-12 wks

positive urine pregnancy test

probable sign of pregnancy at 16 wks

Braxton hicks

probable sign of pregnancy that can happen at 16-28 wks - aka doctor pushes on uterine wall, baby floats in amniotic fluid and falls back down tapping the doctor’s finger

internal ballottement

positive sign of pregnancy that could happen at 5-6 wks

fetus on ultrasound

positive sign of pregnancy that could happen at 6 wks

FHTs on ultrasound

positive sign of pregnancy that could happen at 16 wks

fetus seen on radiographic study

positive sign of pregnancy that can happen at 8-17 wks

FHTs on doppler

positive sign of pregnancy that could happen at 17-19 wks

FHTs on fetoscope

positive sign of pregnancy that could happen at 19-22 wks

fetal movements palpated

positive sign of pregnancy that could happen in late pregnancy

fetal movements visible

woman who is pregnant, in G/P system also means how many times you’ve been pregnant

gravida

pregnancy

gravidity

woman who has had two or more pregnancies

multigravida

woman who has completed two or more pregnancies to stage of fetal viability

multipara

woman who has never been pregnant

nulligravida

Number of pregnancies in which fetus or fetuses have reached viability, not the number of fetuses born

parity

Woman who has not completed pregnancy with a fetus or fetuses who have reached the stage of fetal viability

nullipara

A woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation

primipara

A woman who has completed two or more pregnancies to 20 weeks of gestation or more

multipara

what does GTPAL stand for

gravidity, term, preterm, abortion, living children

a pregnancy that has reached term is at

37-42 wks

a pregnancy that is preterm is at

20-36 wks

abortion in the GTPAL system includes elective or involuntary at less than —-

20 wks

G/P system stands for

gravida, para

para in the G/P system means —— (living or deceased)

birth after 20 wks

Moves from pelvic to abdominal organ at 12 weeks, Changes in size, shape, and position, Changes in contractility – increases after 4th month (Braxton Hicks contractions), blood flow – increases 20 fold

uterus

Fundus at level of umbilicus at —- grows 1 cm each wk (20 cm) - start measuring at pubic bone

20 wks

displacement of the fundus to the left or right could mean

distended bladder

(6 wks) – softening of the uterine isthmus

hegar sign

(38-40 wks) – fundal height decreases as fetus descends into pelvis

lightening

increased whitish vaginal discharge

leukorrhea

of cervix - tissue is easily damaged

friability

HR increases —— bpm

15-20

Slight hypertrophy of heart, Increased blood volume (1500 cc) or 40-50%, Plasma increases faster than RBCs causing physiologic anemia, Increased C.O. 30-50%, Systolic murmur common during pregnancy, B/P same in 1st  and 3rd trimester, slight decrease in 2nd by 5-10 mm Hg

CV system

Compression of iliac veins & inferior vena cava à reduced blood flow to legs =

dependent edema, varicose veins, hemorrhoids