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Antepartum
Reproduction: Antepartum
| Question | Answer |
|---|---|
| Antepartum | The period from conception to the onset of labor |
| Risk Factors for Adverse Pregnancy Outcomes | -Isotretinoin/Accutane (acne med) -Alcohol misuse -Antiepileptic drugs -Diabetes -Folic acid deficiency -HIV/AIDS -Hypothyroidism -Maternal phenylketonurea -Rubella seronegativity -Obesity -Oral anticoagulant -STI -Smoking |
| Risk Factors for Adverse Pregnancy Outcomes | -Abuse and neglect -Poverty -Age: <15 and >35 -Raw meat and shellfish -Multigravida (5+) -Genetic issues -Mental illness -Cardiac conditions -Underweight |
| Folic Acid Deficiency | -Common slowly progressive form of anemia -is a B vitamin needed for RBC formation and DNA synthesis -Common with alcohol abuse -Contributing risk factor in neuro tube defects, abortions and abruptio placentae |
| Folic Acid Deficiency Signs and Symptoms | -Cheilosis (cracks in the corner of the mouth) -Glossitis (inflammation of the tongue) -Severe progressive fatigue -Shortness of breath -Palpations -N/V/D -Anorexia -Headaches -Weakness -Generalized pallor and jaundice -Macrocytic RBCs |
| Folic Acid Deficiency Causes | -Seizure meds (Dilantin) interferes with folate absorption -Hormonal contraceptives -Alcohol abuse -Pregnancy with multiples -Underlying hemolytic illness |
| First Trimester Tests | -Pregnancy test -CBC with diff -Blood type & Rh factor -Rubella titer -Hep B titer -RPR or VDRL -Urinalysis & culture -Pap -G & C cultures -Nuchal translucency screening (10-12 wks) -Amniocentesis as needed -Emotional well-being |
| Second Trimester Tests | -Repeat CBC with diff (24-26 wks) -1 hour glucose tolerance test -MSAFP screen (genetic problem screening) -Amniocentesis as needed -Emotional well-being |
| Third Trimester Tests | -Group B strep (approx. 36+ weeks) -Screening and diagnostic ultrasound -Kick counts (10 kicks in 2 hrs minimum) -Emotional well-being |
| Signs and Symptoms of Pregnancy | -Presumptive (subjective of what mom feels) -Probable (objective findings of the HCP) -Positive signs: Proof of pregnancy (ultrasound, fetal movement, auscultation of fetal heart tones) |
| First Trimester Complications | -Maternal-fetal infections -Toxoplasmosis -Ectopic pregnancy -Trauma -Spontaneous abortion |
| Second and Third Trimester Complications | -Fetal congenital and chromosomal anomalies -Maternal conditions (GDM, HTN, preeclampsia) -Preterm labor -PROM -Placenta previa -Abruptio placentae -Trauma -Fetal distress -Intrauterine fetal death (IUFD) |
| Generalized Discomforts of Pregnancy | -Syncope -Fatigue -Headache -Backache -Nausea -Nasal congestion -Weight gain -Generalized edema -Round ligament pain -Diastasis recti -Itching -Gait changes |
| Genitourinary Discomforts of Pregnancy | -Urinary urgency -Urinary frequency -Vaginal discharge -Breast tenderness increases -Increase in yeast infections |
| Cardiovascular Discomforts of Pregnancy | -Varicose veins -Feet and ankle edema -Carpal tunnel -Leg cramps -Shortness of breath |
| Gastrointestinal Discomforts of Pregnancy | -Nausea -Vomiting -Constipation -Hemorrhoids -Heartburn |
| Follow-up Visit Frequency | -Every 4 weeks up to 28 weeks -Every 2 weeks from 29-36 weeks -Every week from 37 weeks to birth |
| Follow-up Visit Assessments | -Weight -BP -Urine testing for protein, glucose, ketones and nitrites -Fundal height -Quickening/fetal movement -Fetal heart rate |
| Calculation of Estimated or Expected Date of Birth (EDB) | Nagele's Rule -Use first day of last menstrual period (ex: 11/21/19) -Subtract 3 months (=08/21/19) -Add 7 days (=08/28/19) -Add 1 year (=08/25/20) |
| Obstetric History- GTPAL | G: gravida- total pregnancies (including current pregnancy) T: term births- # of pregnancies born after 37 wks P: preterm births- # of pregnancies born after 20 wks before 37 wks A: abortions- # of pregnancies ending before 20 wks L: living children |
| Uterus Adaptations | -Increases in size and overall capacity -Pear shape to ovoid shape; positive Hegar's sign -Enhanced uterine contractility -Ascent into abdomen after 3 mths -Fundal height by 20 wks until 36 wks should equal # of wks gestation |
| Cervix Adaptations | -Softening; Goodell's sign -Mucous plug formation -Increased vascularization (Chadwick's sign) -Ripening about 4 wks before birth |
| Vagina Adaptations | -Increased vascularity with thickening -Lengthening of vaginal vault -Secretions more acidic, white and thick; leukorrhea |
| Ovary Adaptations | -Enlargement until 12th-14th week of gestation -Cessation of ovulation |
| Breast Adaptations | -Increase in size and nodularity to prepare for lactation -Nipples become more pigmented -Production of colostrum; conversion to mature milk after delivery |
| Placenta Adaptations | -Endocrine organ -Produces estrogen, progesterone, hCG, hPL, relaxin and prostaglandins |
| Relaxin | Hormone secreted by the corpus luteum to inhibit uterine activity, softens the cervix, allows dilation at delivery and relaxes the lower spine to enlarge the birth canal |
| hCG | Human chorionic gonadotropin; secreted by the trophoblast cells of the placenta in early pregnancy and stimulates progesterone and estrogen until the placenta assumes this role |
| hPL | Human chorionic somatomammotropin; secreted by the placenta. Promotes the breakdown of fat (lipolysis), providing the patient with alternative source of energy so that glucose is available for fetal growth. Inhibits the action of insulin. |
| Prostaglandins | Hormone that affect smooth muscle contractility to trigger labor at the pregnancy's term |
| Corticosteroids | Increases to suppress the inflammatory response to reduce the body's ability to reject the foreign fetus and helps to regulate glucose metabolism |
| Aldosterone | Increases to promote sodium reabsorption and maintain the osmolarity of retained fluid. Helps with blood volume and providing adequate perfusion pressure across the placenta. |
| Pituitary Gland Adaptations | -High levels of estrogen and progesterone in the placenta stop the pituitary gland from producing follicle-stimulating hormone and luteinizing hormone. Increased production of growth hormone and melanocyte-stimulating hormone cause skin pigment changes |
| Thyroid Gland Adaptations | -Causes rise in total T4 which increases basal metabolic rate (BMR), cardiac output, pulse rate, vasodilation, and heat intolerance |
| Parathyroid Adaptations | -Increases hormone production of calcium and phosphorus |
| Pancreas/Insulin Adaptations | -Increases insulin production -Insulin is less effective bc of hormonal effects of the placenta -Estrogen, progesterone, and hPL act as antagonist |
| GI System Adaptations | -Gums: hyperemic, swollen and friable -Ptyalism -Gingivitis -Constipation -Hemorrhoids -Slowed gastric emptying -Heartburn -Prolonged gallbladder emptying -N/V |
| Cardiovascular System Adaptations | -Increase in blood volume (50%) -Increase in cardiac output; increased venous return; increased heart rate -Slight decline in BP until 2nd -Increase in RBCs; plasma volume > RBC leading to hemodilution -Increase in iron demands |
| Respiratory System Adaptations | -Breathing more diaphragmatic than abdominal d/t increase in diaphragmatic excursion, chest circumference and tidal volume -Increase in oxygen consumption -Congestion secondary to increased vascularity |
| Renal/Urinary System Adaptations | -Dilation of renal pelvis -Increase in length and weight of kidneys -Increase in GFR; increased urine flow and volume -Increase in kidney activity |
| Musculoskeletal System Adaptations | -Softening and stretching of ligaments holding sacroiliac joints and pubis symphysis -Increased swayback and upper spine extension -Forward shifting center of gravity -Waddle gait -Increase in lumbosacral curve |
| Integumentary System Adaptations | -Hyperpigmentation; mask of pregnancy -Linea nigra -Striae gravidarum -Varicosities -Vascular spiders -Palmar erythema -Hirsutism (excessive hair growth) |
| Endocrine Adaptations | -Slight enlargement of thyroid gland; increase in BMR -enlargement of pituitary gland; decrease in TSH, GH, gradual increase of oxytocin -Insulin resistance -Increase in cortisol and aldosterone -Prostaglandin secretion -Placenta: hCG, hPL, relaxin |
| Maternal Weight Gain | Healthy BMI (19.9-24.9): 25-35 lb gain BMI <19.8 (underweight): 28-40 lb gain BMI >25 (overweight): 15-25 lb gain |
| Gestational Hypertension | Two BPs more than 4 hours apart greater than 140/90 with no other symptoms or protein in the urine |
| Preeclampsia | BP greater than 140/90 after 20 weeks with protein in urine |
| Preeclampsia with Severe Symptoms | BP greater than 140/90 after 20 weeks with protein in urine, presenting with other symptoms that include: nausea, headache, dizziness, abdominal pain over liver area |
| HELLP Syndrome | -Hemolysis -Elevated Liver enzymes -Low Platelet count |
| Eclampsia | -Preeclampsia with seizures -Give magnesium sulfate (raises threshold for seizures -Risk still present up to 6 weeks postpartum (preeclampsia/eclampsia) |
| Fetal Heart Rate (FHR) | Normal range 110-160 |
| Contractions | Normal is 5 in 10 mins |
| Tachysystole | More than 5 contractions in a 10 min span |
| Fetal Heart Rate Variability | -Absent: undetectable -Minimal: >undetectable, <5 bpm -Moderate: 6-25 bpm (sweet spot for baby) -Marked: >25 bpm |
Created by:
NikkiLeigh83
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