6. Assessments & Discomforts

routine prenatal visit schedule

• every 4 weeks up to 28 weeks

• every 2 weeks from 29 to 36 weeks

• every week from 37 weeks to birth

assessments at follow-up prenatal visits

• compare weight and BP with baseline

• test urine

• measure fundal height

• assess fetal movement and fetal HR (w/ doppler)

• teach pregnancy danger signs

what can nitrites in prenatal urine indicate?

a bacterial UTI

• UTIs can increase preterm labor risk

what does fundal height help assess?

fetal growth compared with gestational age

• around midpregnancy, centimeters match gestational weeks

  • ex: at 20 weeks, about 20 cm

when is the fetal anatomy ultrasound performed?

around 16 weeks

• assesses fetal structures, growth, and possible malformations

what does maternal serum alpha-fetoprotein screening assess?

risk of open neural tube defects

• elevated levels can suggest a defect

• testing is ideally performed at 16–18 weeks

what do prenatal marker screening tests assess?

risk of chromosomal abnormalities and neural tube defects

• screening estimates risk, it doesn’t confirm a diagnosis

what is nuchal translucency screening?

ultrasound measurement of fluid behind the fetal neck at 11–14 weeks

• increased fluid = concern for chromosomal abnormalities

what is amniocentesis?

needle sampling of amniotic fluid for diagnostic testing

• usually performed at 15–20 weeks for genetic abnormalities

• later testing can assess fetal lung maturity

why might amniocentesis be done later in pregnancy?

to assess fetal lung maturity

• antenatal steroids promote fetal lung development when preterm birth is expected

what is chorionic villus sampling?

sampling of placental tissue for genetic testing at 10–13 weeks

• doesn’t detect open neural tube defects

• increases limb-defect risk

risks of invasive prenatal testing

• pregnancy loss

• infection

• bleeding

• membrane rupture or fluid leakage

• early chorionic villus sampling also increases limb-defect risk

what happens during a nonstress test?

external monitors record fetal HR and uterine activity

• mother presses a button when she feels fetal movement

• fetal HR should accelerate with movement

what are the for a reactive (good) nonstress test?

at least 2 accelerations within 20 minutes

• each rises at least 15 bpm above baseline and lasts at least 15 seconds

what happens if a nonstress test lacks sufficient accelerations?

monitoring may continue to allow for fetal sleep (mom should have something sweet or stimulate the fetus)

• persistent nonreactivity requires further assessment, such as a biophysical profile

what does a contraction stress test assess?

the fetal HR response to uterine contractions

• helps assess how the fetus tolerates reduced placental blood flow during contractions

• negative result = good

five components of a biophysical profile

1. fetal heart rate (nonstress test)

2. fetal movement

3. fetal tone

4. fetal breathing movements

5. amniotic fluid volume

how is a biophysical profile scored?

each component receives 0 or 2 points

• maximum total: 10 points

what does a biophysical profile score of 8–10 indicate?

reassuring fetal status if amniotic fluid is adequate

what does a biophysical profile score of 6 indicate?

an equivocal (suspicious) result requiring further evaluation

what does a biophysical profile score of 0–4 indicate?

concern for fetal compromise

• needs prompt evaluation

common first-trimester discomforts

• urinary frequency, fatigue, and breast tenderness

• nausea, vomiting, constipation, and cravings

• nasal stuffiness, bleeding gums, and epistaxis

• leukorrhea (normal)

what is leukorrhea during pregnancy?

increased white vaginal discharge that can be normal

• foul odor, itching, or irritation requires assessment

which medication may be used for pain during pregnancy?

acetaminophen

it might be ok to have this med in the first trimester, but _____ should be avoided during the rest of pregnancy

NSAIDs

what fetal cardiac risk is associated with NSAID use later in pregnancy?

premature closure of the ductus arteriosus

common second-trimester discomforts

• backache

• vulvar and leg varicosities

• hemorrhoids

• flatulence and bloating

common third-trimester discomforts

• return of first-trimester discomforts

• dyspnea (uterus elevates diaphragm)

• heartburn and indigestion

• dependent edema

• Braxton Hicks contractions

how does dependent edema differ from concerning pregnancy swelling?

• dependent edema = gradual ankle or leg swelling from gravity and venous pooling

• concerning swelling = sudden facial or hand swelling, especially with headache or visual changes

key differences between breast milk and formula

breast milk provides maternal antibodies, but formula does not

how should the nurse support infant feeding decisions?

provide accurate teaching and support the family’s informed choice

• prioritize adequate infant nutrition