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Reproduction: Antepartum

Learning Outcomes

  • Describe abnormal physiologic changes and psychosocial responses of a pregnant client.
  • Interpret major screening tests and clinical findings during the antepartum period to plan collaborative care.
  • Provide culturally competent care to the pregnant client and family.
  • Assist pregnant clients and their families in making the best decisions regarding issues related to pregnancy, labor, and birth.
  • Identify classifications, mechanisms of action, therapeutic effectiveness, side effects, nursing implications, safe dose ranges, and generic/trade names for tocolytic medications, folic acid, and prenatal vitamins.

First Prenatal Visit

  • Occurs around weeks 8-12.
  • Follow-up visits every 4 weeks.
  • Screening tests include:
    • Urine analysis
    • CBC (complete blood count) with emphasis on hemoglobin (Hgb) and hematocrit (HCT)
    • Rubella titer
    • ABO & Rh blood typing
    • Hepatitis B screen (HBsAg)
    • STI screening (syphilis, gonorrhea, chlamydia, etc.)
    • Sickle cell screen (for individuals of African, Mediterranean, Latino, or Asian descent)
    • Cystic fibrosis screening (for all couples)
    • HIV screening
    • Transvaginal ultrasound

ABO & Rh Screen (Weeks 24-28)

  • Blood type and Rh factor, and antibody screen.
  • Determines blood type and screens for potential maternal-fetal blood incompatibility.
  • Incompatibility occurs when an Rh-negative person is exposed to Rh-positive blood, leading to the production of antibodies that attack Rh-positive blood cells (baby's blood cells).
  • Rho(D) immune globulin (RhoGAM or Rhophylac) is administered at 26-28 weeks for Rh-negative blood types (IM).
  • Rho(D) immune globulin is a sterile solution of human blood that contains a small amount of Rh-positive proteins to prevent the immune system from creating permanent antibodies to Rh-positive blood.
  • Infant blood type is tested at delivery using cord blood.
  • If the baby is Rh-positive, the mother receives a second injection of RhoGAM.
  • After 28 weeks' gestation, healthcare provider (HCP) visits occur every 2 weeks.

Calculating Estimated Date of Delivery (EDD)

  • Naegele's Rule:
    • Last menstrual period (LMP) began on [Date].
    • Subtract 3 months from the month of LMP.
    • Add 7 days to the date.
    • Example: If LMP began on May 15:
      • May 15 - 3 months = February 15
      • February 15 + 7 days = February 22
      • EDD would be February 22nd.
  • Pregnancy wheel:
    • Align the arrow with the LMP.
    • Locate 40 weeks on the wheel to determine the EDD.

Physiologic Responses to Pregnancy

  • Breasts:
    • Increase in size and become highly vascular.
    • Develop breast tenderness (especially in early pregnancy).
    • Colostrum is present beginning at 12-16 weeks.
  • Blood Components:
    • Total blood volume increases by as much as 45%.
    • Iron supplementation may be needed.
    • Leukocytes, fibrinogen, and other clotting factors increase.
  • Bladder:
    • Urinary frequency increases.
  • Skin:
    • Melasma/chloasma (mask of pregnancy): Increased pigmentation from elevated hormones, beginning as early as the 8th week.
    • Linea nigra: A line that marks the longitudinal division of the midline of the abdomen.
    • Striae gravidarum: