Antepartum Assessment
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| Timing for prenatal care: 1st visit by ___ months, then how often? | First visit by 3 months,Then every 4 weeks until 28 weeks, then every 2 weeks until 36 weeks, then every week until delivery (avg 12-13 visits)
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| The first prenatal visit - the initial maternal assessment includes... | 1. General Health History. 2. Obstetrical history (current & past pregnancies & due date). 3. Physical Exam. 4. Laboratory tests
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| Terms used for determination of due date include EDC, EDD and EDB what do they stand for? | Estimated Date of Confinement, Estimated Date of Delivery, Estimated Date of Birth
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| Date of Last Normal Menstrual Period (LNMP) is important because | It is used to assess due date, as long as it is a normal period and need to assess for presence of spotting or bleeding
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| How is Nagele's Rule used in determination of due date? | Start with First Day of Last Normal Menstral Period (LNMP) and subtract 3 months then add 7 days.
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| ____ is the number of pregnancies regardless of the outcome | Gravida
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| ____ is the number of births after 20 weeks of gestation | Para - includes stillbirths and live births
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| ____ is any births before 20 weeks of gestation | Abortion - elected or spontaneous. Not viable before this stage
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| Abbreviation for Living Children | LC
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| Another name for spontaneous abortion (SAB) | miscarriage
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| Elective Abortions - EAB, TAB, VIP what do they mean | elective AB (EAB), therapeutic AB (TAB), voluntary interruption in pregnancy (VIP)
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| When doing an OB history and counting the number of Gravida (Gr) don't forget to count | the current pregnancy - one Gr for twins, triplets, ect.
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| How many Para (Pa) for twins? | One - Para means birth, one birth for a set of twins, triplets, ect.
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| When obtaining an OB history, what does TPAL stand for? | T-term deliveries (Pa), P-preterm deliveries(B4 37 wks), A-abortions(AB), L-living children (LC)
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| During the Physical Exam of the initial prenatal visit a pelvic exam is done for what reasons, if indicated. | Determine uterine size (assess in relation to gestational date), Pap smear, and cultures for STD's and vaginal infections
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| Hgb less than ____ = anemia | 12
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| If pregnant woman is Rh-, check for ____ | Rh antibodies. If partner is Rh+, discuss need for antibody titers and possibility for Rh immune globulin
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| urinalysis checks for abnormal color and pH what are they looking for? | porphyria, hemoglobinuria, bilirubinemia, alkaline urine, metabolic alkalemia, proteus infection
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| Rubella titer lab testes for hemagglutination-inhibition (HAI test) what ratio indicates woman is immune | HIA titer less than 1:10. If greater than, a immunization will be given postpartum and instruct woman to avoid children who have rubella
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| A pregnant woman who tests positive for HepB surface antigen (HbsAg), the infant who test positive are given ____ soon after birth followed by first dose of hepB vaccine | Hepatitis B immune globulin
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| T/F only women who are at risk for HIV are encouraged to be screened for HIV | True - those who are at risk are ENCOURAGED and those who are not at risk are OFFERED
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| A client of African descent should be screened for ____ | sickle-cell screen, a positive test result would include a description of cells
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| Weight depends on body build, generally a prepregnant woman under ____ lbs should be evaluated. | 100 lbs - needs nutritional counseling
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| Weight depends on body build, generally a prepregnant weight over ____ lbs should be evaluated | over 200 lbs., also evaluate for rapid, sudden weight gain could be signs of preeclampsia at any prepregnancy weight
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| ____ is diagnosed when a pregnant woman over 20 wks develops high blood pressure (two separate readings taken at least 6 hours apart of 140/90 or more)- AND - 300 mg of protein in a 24-hour urine sample (proteinuria), and pitting edema can be significant | pre-eclampsia
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| Normal BP for pregnant women | 135/85. BP greater than 140/90 requires immediate consideration
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| Problems with high BP in pregnancy (over 140/90) include | essential hypertension, renal disease, pre-gestational hypertension, apprehension or anxiety assoc with pregnancy, exam, or other crisis. If over 20 wks - considered pre-eclampsia
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| Glucose in the urine is checked to determine | gestational diabetes mellitus (GDM), low renal threshold for glucose, if over 140, check for ketones.
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| The ultrasonic Doppler devise can detect fetal heartbeat on average at ___ - ____ wks gestation | 8-12 weeks from book (notes say 10-12 wks)
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| ____ is fetal movements felt by the mother and may indicate that the fetus is nearing 20 wks gestation. (may be experienced between 16-22 weeks and it is not completely accurate) | Quickening
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| T/F, kick counts is a fetal activity monitoring | True
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| In general, weight gain is between ____ - ____ lbs | 25-35 lbs
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| How is weight distributed by trimester | sb gradual - first=0-4lbs, second=12lbs, third=12lbs(l lb per wk)
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| Sudden, excessive weight gain is a sign of ____, may be brought on by pregnancy induced hypertension (PIH) | edema
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| Most critical vital sign assessment | blood pressure
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| due to physiological changes, BP ____ slightly in the second trimester | decreases
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| Either a BP greater than 140/90 or an increase of ____mm systolic and ____mm diastolic may indicate pregnancy induced hypertension | increase of 30mm systolic and 15mm diastolic
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| T/F episodic glycosuria is uncommon | False - it is common. but may also be a sign of gestational diabetes and need to be retested
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| T/F proteinuria (albuminuria) is a sign of pregnancy induced hypertension | True
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| How soon can fetal heart activity be seen by a sonogram | as early as 5 weeks
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| How soon is quickening felt with multigravida (subsequent pregnancy) | 14-16 wks
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| How soon is quickening felt in a primigravida (first pregnancy) | 18-20 weeks
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| measuring ____ heigth is a validation of estimated due date | fundal heigth
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| ____ method is when the fundal heigth correlates with weeks of gestation between 22 to 24 weeks to 34 weeks | McDonald's
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| possible reasons for fundal heigth less than expected | intrauterine growth retardation (IUGR) or Fetal demise
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| Possible reasons for fundal heigth greater than expected | Multiple pregnancy, hydraminos (>amniotic fluid) and molar pregnancy (an anomalous growth containing a nonviable embryo which implants and proliferates within the uterus)
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| normal hematocrit ____ - ____% | 38-47%, lower can be marked anemia or blood dyscrasias
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| The triple screen is performed between weeks ____ and include what | between weeks 15-20. maternal serum alpha-fetoprotein, unconjugated estriol, and hCG
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| what does maternal serum alpha-fetoprotein measure for | higher levels = neural tube defect, underestimated gestational age, and multiple gestation. lower levels = Down syndrome and trisomy 18
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| What does higher than normal hCG measure | down syndrome
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| What does lower than normal unconjugated estriol UE measure | down syndrome
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| What does the 50g, 1hr. glucose screen (between 24-28 wks) measure | gestational diabetes melitus (GDM) if plasma glucose level is over 140mg/dL
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| What is the possible cause of sudden gush of fluid from vagina | premature rupture of membranes
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| what is the possible cause of vaginal bleeding | abruptio placentae, placenta previa, lesions of cervix or vagina, or bloody show
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| What is the possible cause of abdominal pain | premature labor, abruptio placentae
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| possible cause for temp above 101 | infection
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| possible cause for dizziness, blurring of vision, double vision, spots before eyes | hypertension, preeclampsia
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| possible cause for persistent vomiting | hyperemesis gravidarum (severe form of morning sickness)
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| possible cause for severe headache | hypertension, preeclampsia
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| possible cause for edema of hands, face, legs and feet | preeclampsia
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| possible cause for muscular irritability, convulsion | preeclampsia, eclampsia
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| possible causes for epigastric pain | preeclampsia, eschemia in major abdominal vessle
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| possible cause for oliguria | renal impairment, decreased fluid intake
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| possible cause for dysuria | urinary tract infection
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| possible cause for absence of fetal movement | maternal medication, obesity, fetal death
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| administration of ____ prevents Rh sensitization | RhoGam (Rh immune globulin)
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| RhoGam works by preventing ____ immunity by providing passive immunity | active immunity
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| When is Rho Gam given | 28 weeks prenatally or within 72 hrs of delivery if baby is Rh+ or after SAB, TAB, ectopic pregnancy or amniocentesis
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| When to contact the care provider using the kick counts or cardiff count to ten method | fewer than 10 in 3hrs after meals, movements slowing and takes longer each day to note ten, no movements in the morning, fewer than 3 in 8 hrs without meals
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| T/F the ultrasound/sonogram is used as a routine test to determin gender | False
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| A reactive nonstress test will have at least two accelerations of ____ bmp above the baseline lastine how long | 15 bpm lasting 15 seconds in a 20 min time period, if nonreactive indicates fetus is at risk or asleep - so stimulate fetus with sound or vibration and feed mother
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| The biophysical profile (BPP) includes the nonstress test as well as what 4 other things | fetal breathing movement, fetal movement of body or limbs, fetal tone by extension and flexion, and amniotic fluid volume
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| How is the biophysical profile scored? What score indicates a healthy fetus? | Each of the 5 measurements has a max score of two, a score of 8-10 indicates a healthy fetus
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| ____ test is a means of evaluating the respiratory function (oxygen and carbon dioxide exchange) of the placenta | contraction stress test
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| The contraction stress test helps ID the fetus at risk for intrauterine ____ by observing the response of the FHR to the stress of contraction | asphyxia
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| A healthy fetus tolorates the reduction in blood flow in the placenta and maintains a steady ____ during the contraction stress test | heart rate
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| ____ or breast stimulation is used to stimulate a contraction for the contraction stress test | IV pitocin
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| Amniocentesis provides info about | genetic disorders (triple test), fetal health and fetal lung maturity (L/S ratio and PG level)
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| by ____ weeks gestation, the lecithin/spingomeylin ratio is 2:1 | 35 weeks, indicates that the risk of respiratory distress syndrome is very low
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| Presence of ____ (PG) is associated with fetal lung maturity | phosphatidylglycerol (PG) found in amniotic fluid at about 35 wks
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| ____ conjugate Distance from the lower posterior border of the symphysis pubis to the sacral promontory; may be obtained by manual measurement. | diagonal conjugate
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| ____ is the period of intrauterine development fromm conception through birth; pregnancy | gestation
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| ____ a woman who has never been pregnant | nulligravida
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| ____ conjugate is the distance from the middle of the sacral promontory to an area approx 1cm below the pubic crest | obstetric conjugate
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| ____ inflammation of the parametrial layer of the uterus | parametritis
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| ____ is labor that occures after 42 wks gestation | postterm labor
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| ____ is a woman who is pregnant for the first time | primigravida
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| ____ is a woman who has given birth to her first child (past the point of viability), whether or not the child is living or was alive at birth | primipara
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| ____ the normal duration of pregnancy | term
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| ____ factors is any findings that suggest the pregnancy may have a negarive outcome, either for the woman or her unborn child | risk factors
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| ____ removal of amniotic fluid by insertion of a needle into the amniotic sac; amniotic fluid is used to assess fetal health or maturity | amniocentesis
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| ____ villus sampling is a procedure in which a specimen of the chorionic villi is obtained from the edge of the developing placents at about 8 wks gestation, the sample can be used for chromosomal, enzyme, and DNA tests | Chorionic villus sampling
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| ____ a technique for directly observing the fetus and obtaining a sample of fetal blood or skin | fetoscopy
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| ____ umbilical blood sampling (PUBS's) is a technique used to obtain pure fetal blood from the umbilical cord while the fetus is in utero. Also called cordocentesis | percutaneous umbilical blood sampling (PUB's)
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| ____ a surface-active mixture of lipoproteins secreted in the alveoli and air passages that reduces surface tension of pulmonary fluids and contributes to the elasticity of pulmonary tissue | surfactant
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| ____ is high-frequency sound waves directed through a transducer. The ultrasonic sound waves reflect underlying structures of varying densities and allow various fetal tissues, bone and fluids to be identified | ultrasound
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