Recognition and Wellness of Antepartum Patients

Presumptive Signs of Pregnancy

Subjective patient experiences that could suggest pregnancy OR another physiological factor

Presumptive S/S of Pregnancy

Amenorrhea, fatigue, enlarged breasts, sore breasts, urinary frequency, perceived fetal movement, nausea/emesis

Probable Signs of Pregnancy

Objective findings that would make an advanced practitioner consider possible pregnancy

Probable S/S of Pregnancy

+ pregnancy test, return of fetus when tapped, palpable fetus outline, braxton hicks contractions, enlarged uterus

Positive Signs of Pregnancy

Signs that can only be explained by pregnancy

Positive S/S of Pregnancy

Fetal heart sounds, visualization of fetus via ultrasound, fetal movement felt by provider

What is Dating and Viability Testing?

Method used to determine the gestational age of the fetus and it’s likelihood of survival outside the womb via an ultrasound showing a fetus in the uterus w/ heart tones

Ectopic Pregnancy

Pregnancy that occurs outside of the uterus (commonly fallopian tubes)

Pregnancy of Unknown Location

A positive pregnancy test with no visible pregnancy on an ultrasound

2 Methods of Verifying Pregnancy

Human Chorionic Gonadotropic (hCG) via pregnancy test OR Serum Blood Test

What is hCG?

A hormone produced by a fertilized ovum and chronic villi which is detected via urine on an at home pregnancy test (qualitative)

What is a Serum Blood Test for Pregnancy?

A qualitative AND quantitative test that is typically ordered by a provider prior to initial prenatal visit

When are Initial Prenatal Intake’s Scheduled?

8-10 weeks; ideally before end of 1st trimester

What is Reviewed during Initial Prenatal Intake’s?

Current medications, medical history, lab tests, EDD (expceted due date)

What Medications do Pregnant women need to discontinue while Pregnant?

Psych meds, anti-seizure meds, ibuprofen, fish oil

What Medical History is obtained during an Initial Prenatal Intake?

Menarche, prior STI’s and treatment, # of pregnancies, pregnancy complications

When is Naegele’s Rule not accurate for EDD?

Patients with irregular periods or amenorrhea

Pregnancy puts you at a _____________ state which increases your risk for blood clots

Hypercoagulable

Initial Prenatal Labs and Cultures

CBC, type & screen, rubella titer, pap smear, cervical cultures, HbSAg, HIV antibody, RPR (syphilis), urinalysis, glucose challenge test, GBS culture

CBC Considerations

Hgb, hematocrit, and WBC levels checked to monitor for anemia; rechecked at 28 weeks

Anemia Treatment and Instructions

Iron supplements; iron causes constipation so also take a stool softener AND take with OJ for better absorption

Rubella Titer Considerations

Determines if mom needs a booster during post-partum whether breastfeeding or not

Pap Smear and Cervical Culture Considerations

Test for Gonorrhea (GC) and Chlamydia (CT); anticipate Azithromycin NOT Doxycycline if test is positive

HbSAg Considerations

Screens for Hepatitis B so we know if baby needs to be bathed before receiving immunizations

HIV Antibody Considerations

Test for HIV antibodies that is REQUIRED due to detrimental effects it can have on mother and fetus

RPR Considerations

Screening for Syphilis that is important to avoid transmission to the fetus

Urinalysis Considerations

Screening for UTI’s due to higher susceptibility during pregnancy; educate mothers about proper hydration and urinary frequency

Glucose Challenge Test Considerations

Screening for gestational diabetes that is done between 24-28 weeks gestation or earlier if mom has multiple risk factors

GBS Culture Considerations

Screening for Group B Streptococcus via vaginal/rectal culture at 35-37 weeks gestation; if positive mother will receive antibiotics during labor for suppression

T or F: GBS is mostly asymptomatic in mothers and symptomatic in fetus’s

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Prenatal Injections

RhoGAM, TdAP, Flu, RSV

RhoGAM Isoimmunization Considerations

Administered to Rh negative moms at 28 weeks to prevent the moms blood from attacking the Rh positive baby; second does is given after delivery if baby is Rh+; additional doses given if mom experiences bleeding or trauma

Maternal Complications of Rh Incompatibility

Recurrent fetal loss

Fetal Complications of Rh Incompatibility

Anemia, hydrops fetalis (fetal edema), fetal CHF, erythroblastosis fetalis (severe hemolytic syndrome)

TdAP Injection Considerations

Primarily worried about Pertussis (Whooping Cough) due to it’s detrimental effects on a fetus

RSV Injection Considerations

Offered to pregnant mothers to prevent the spread of RSV to their child; often offered to everyone in the household due to detrimental effects RSV can have on a child

1st Trimester Range

1-13 weeks

2nd Trimester Range

14-26 weeks

3rd Trimester Range

27-40 weeks

Preterm vs. Term Pregnancies

Preterm: Delivery before 37 weeks

Term: Delivery after 37 weeks

Very Preterm vs. Moderately Preterm vs. Late Preterm

Very Preterm: < 32 weeks

Moderately Preterm: 32-34 weeks

Late Preterm: 34-36.6 weeks

Early Term vs. Full Term vs. Late Term vs. Post Term

Early Term: 37-38.6 weeks

Full Term: 39-40.6 weeks

Late Term: 41-41.6 weeks

Post Term: 42+ weeks

Categories of “Birth Planning”

Overall expectations, pain management, feeding options, people in delivery room, location of delivery

Recommended Weight Gain for BMI < 18 (Underweight)

28-40 lb

Recommended Weight Gain for BMI 18.5-24.9 (Normal)

25-35 lb

Recommended Weight Gain for BMI 25-29.9 (Overweight)

15-25 lb

Recommended Weight Gain for BMI > 30 (Obese)

11-20 lb

Is Exercise acceptable during Pregnancy?

Yes; moderate and familiar exercise is good during pregnancy (don’t try anything new)

1st Trimester Caloric Intake

Same as non-pregnant state

2nd Trimester Caloric Intake

Additional 340 calories/day

3rd Trimester Caloric Intake

Additional 452 calories/day

How much Fluids should a Pregnant patient ingest per day?

8-13 glasses (3 L) of hydrating liquids (water, fruit juice, milk) per day

Nutritional Factors to be Monitored during Pregnancy

Folate (Folic Acid), iron, calcium, potassium, caffeine, alcohol, artificial sweeteners, PICA/food cravings, special diets, food safety

What does Folic Acid do?

Prevents Neural Tube Defects (NTD)

Calcium Considerations

Baby’s can “steal” calcium from mothers which can cause cavities

Potassium Considerations

Pregnancy can cause low K levels which can cause charlie horses or eye twitching

Caffeine Considerations

1 small cup of coffee per day is acceptable; NO ENERGY DRINK

T or F: Pregnant patients should use natural sweeteners over artificial sweeteners

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What is PICA?

Abnormal food cravings like laundry detergent, mattresses, dirt, or ice

Foods to Avoid during Pregnancy

High mercury fishes (shark, swordfish, king mackerel, tilefish), high listeria foods (hot dogs, deli meats, soft cheeses, unpasteurized milk)

T or F: In order for pregnant women to eat hot dogs or deli meat they MUST be reheated to STEAMING hot

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