Antepartum 1

Pregnancy is not a disease.

Fertilization

• In fallopian tube → uterus 3 days later

• Timing necessary

  • Sperm survive <1-2days

  • Ovum can be fertilized no <24 hr after ovulation

• Day 3-5, egg in uterus

  • want implant in top half of fundus

Know Key Terms

Embryonic period

• week 3 to 8

• by end, major organ systems in place, still developing

• Teratogens cause major damage

Fetus

• penis begins to appear

• fetus is moving, mother’s can’t feel

• 9 weeks till birth

• dramatic growth and refinement of organ systems

• CNS is vulnerable to damaging agents

• 12 weeks

  • sucking reflex

  • sex determined

  • lanugo begins (fetus hair)

  • urination into amniotic fluid

  • HR heard at 10-12 weeks with doppler

• 16 weeks

  • mothers can feel fetus move

• 20 weeks

  • mothers start to show bump

  • fetus reacts to loud noises

  • brain developing rapidly

  • vernix (protective coating; “cream cheese”)

  • lanugo covers entire body

  • HR with fetoscope

• 24 weeks

  • surfactant needed for breathing begins

  • eyelashes and brows, fingernails

  • hiccup

• 28 weeks

  • eyes open

  • subcutaneous ft deposited

• 32 weeks

  • rapid growth

  • rapid brain growth

• 38-40 weeks

  • fully developed and can survive outside mother’s body

Terms

• Late preterm: 34 -36 6/7

• Early term: 37-38 6/7

• Full term: 39-40 6/7

• Late Term: 41-41 6/7

• Postterm: 42 weeks and beyond

Auxillary Structures

Placenta

• metabolic and gas exchange

• Hormone production:

  • Progesterone (facilitates implantation)

  • estrogen

  • hCG (in urine tests)

  • hPL (promotes fetal growth via glucose regulation)

• Fully functional btw 8-10 weeks

• Maternal side is rough (dirty duncan)

• Fetal side is smooth (Shiny shultz)

Amniotic Sac (Bag of Waters)

• amnion (inner) membrane develops from embryoblast

• chorion (outer) membrane from trophoblast

• Timeline:

  • 1st: amniotic fluid produced by amniotic membrane

  • 2nd 3rd: fluid is produced by fetal kidneys

  • Peaks at 500-1000mL; varies during last trimester

• Fluid:

  • Helps baby move and cushions fetus

    • constant thermal insulation

  • Polyhydramnios: above 2000mL

    • may have chromosomal disorders

  • Oligohydramnios: less than 500 mL

    • congenital renal problems

Umbilical Cord

• 2 arteries and 1 vein

Pregnancy

• 280 days

• 40 weeks

• 3 trimesters

  • 1st: 1-13 weeks

  • 2nd: 14-26 weeks

  • 3rd: 27-40 weeks

Partum

• Antepartum: 1st LMP (last menstrual period) - onset of labor

• Intrapartum: onset of labor - expulsion of placenta

• Postpartum: expulsion of the placenta - 6 weeks

How do we determine the due date? aka EDD, EDC, EDB

• Pregnancy Calculators

• Nagele’s Rule

  • Most common method

  • First day of LMP - 3 months + 7 days = EDB

  • Note the months that have 30/31 days, so some will be off

• Pregnancy Wheel

Diagnosis of Pregnancy

• 3 Ps

  • Presumptive

    • Subjective Changes

    • Can be caused by other conditions

    • Ex: amenorrhea, N/V, fatigue, urinary frequency, breast and skin changes, vaginal color changes

  • Probable

    • Objective Changes

    • May be caused by other conditions

    • Ex: Positive pregnancy test, return of fetus when cervix is tapped, outline of fetus to palpate, braxton hick, hegar sign

      • Pregnancy are probable, based on hCG in urine

  • Positive signs

    • Diagnostic; completely objective and caused by pregnancy

    • Fetal movement, electronic device detects FHR, delivery of baby, ultrasound, see visible movement of fetus by provider

Physiological Changes

• CV Change

  • CO increases 30-50%

    • Can pose risk in those with heart issues

  • Systolic murmurs common

  • Diastolic BP decreases in first two trimesters

  • Supine hypotension because of baby on stomach

    • encouraged to lie on side

  • Blood Volume increases 30-40%

    • starts 6 weeks and peaks 34 weeks

  • Dietary iron required to avoid anemia

• Respiratory Changes

  • Diaphragm becomes higher bc organs moving

  • Respirations become deeper, but not more frequent

• Metabolic Changes

  • weight gain of 25-35 lbs is recommended

  • Pancrease produces more insulin

    • if it continues after birth → gestational diabetes

  • eat more protein

• GI Changes

  • Nausea and vomiting

  • Heartburn and reflux common in 3rd trimester

  • Constipation