Antaenatal Screening
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| What is the name of the equation used to calculate EDD? | Naegele's Rule
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| How does Naegele's Rule work? | 28 Day Cycle - Subtract three months from the first day of the LMP and add seven days to that date
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| How does Naegele's Rule work on a 24 Day Cycle? | LMP date - 3 months + 7 days LESS 4 days from EDD date given
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| How does Naegele's Rule work on a 30 Day Cycle? | LMP date - 3 months + 7 Days PLUS 2 days
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| Jane telephones you as she suspects she is pregnant. Discuss your response... | Why??
- Amenorrhoea
- When was her LMP?
- Any pregnancy symptoms?
- Length of cycle
- Conception/Contraception
- Has she done a pregnancy test?
- Ask if this is her first pregnancy
- ?? Primip/Multip
= Organise an appt + DOCUMENT
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| What is Amenorrhoea? | The absence of a menstrual period in a woman of reproductive age
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| What are some reasons for Amenorrhoea? | - Pregnancy
- Contraception
- BF
- Stress
- Medication
- Hormone imbalance
- Low weight
- Thyroid malfunction
- Ovarian insufficency
- Uterine scaring
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| Ways for a MW to confirm pregnancy | - Blood Test
- Urine Test
- USS
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| Symptoms of early pregnancy | - Nausea
- Sore breasts
- increased micturition (urine)
- tiredness
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| Routine antenatal bloods | - Blood Group + rhesus factor
- Rhesus antibodies
- FBC
- Syphilis
- Hep B
- Rubella antibodies
- HIV (with consent)
- Hb (haemoglobin)
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| What does a urine test screen for? | PROTEINURIA - marker for pre-eclampsia + UTI,
GLYCOSURIA - marker for gestational diabetes
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| Why use a MSU? | All hypertensive pregnant women with positive proteinuria should do a MSU confirm pre-eclampsia and to exclude a UTI
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| What does an MSU test for? | - Blood
- Protein
- Nitrites
- Leukocytes
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| Sue is 15/40 and would like to book you as her LMC. What is your PHYSICAL ASSESSMENT? | - Weight + Height = BMI
- Basic Obs = BP + Pulse
- Urinalysis = MSU (asymptomatic bacteria)
- Bloods = FBC, Blood Group, + Antibodies, Rubella, Heb B, Haemoglobin, Syphylis, HIV (w consent)
- Palpate = Observe scars, Fundal height, FHR
- DOCUMENT
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| Routine antenatal bloods | - Blood Group + rhesus factor
- Rhesus antibodies
- FBC
- Syphilis
- Hep B
- Rubella antibodies
- HIV (with consent)
- Hb (haemoglobin)
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| What does a urine test screen for? | PROTEINURIA - marker for pre-eclampsia + UTI,
GLYCOSURIA - marker for gestational diabetes
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| Why use a MSU? | All hypertensive pregnant women with positive proteinuria should do a MSU confirm pre-eclampsia and to exclude a UTI
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| What does an MSU test for? | - Blood
- Protein
- Nitrites
- Leukocytes
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| Sue is 15/40 and would like to book you as her LMC. What is your PHYSICAL ASSESSMENT? | - Weight + Height = BMI
- Basic Obs = BP + Pulse
- Urinalysis = MSU (asymptomatic bacteria)
- Bloods = FBC, Blood Group, + Antibodies, Rubella, Heb B, Haemoglobin, Syphylis, HIV (w consent)
- Palpate = Observe scars, Fundal height, FHR
- DOCUMENT
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| Sue is 36/40 this visit. What assessments will you make? | Discuss physiological changes
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| What are some CIRCULATORY physiological changes of pregnancy? | CIRCULATORY - Oedema, Carpal Tunnel, Fainting + Dizziness, Palpatations, Varicose Veins (leg, vulval, anal), bleeding gums or nose.
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| What are some MUSCLE + LIGAMENT physiological changes of pregnancy? | MUSCLE + LIGAMENT - Leg Cramps, Abdominal Pain, Back Pain, Sciatica, Symphysis Pubis Dysfunction, Incontinence, Uterine Cramps (braxton hicks)
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| What are some DIGESTIVE physiological changes of pregnancy? | DIGESTIVE - Nausea + Vomiting. Constipation, Heartburn + Indigestion, Ptyalism, Bloating + excessive wind, Diarrhoea
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| Breast changes during pregnancy | - tenderness
- growth
- colour+size of areola
- leaking
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| Vagina changes during pregnancy | - increased discharge
- pH (thrush susceptibility)
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| Urinary changes during pregnancy | - Frequency
- UT Dilation + Shortening (increased UTI susceptibility)
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| Sleep changes during pregnancy | - pattern
- insomnia
- nature
- dreams
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| Nose changed during pregnancy | - congestion
- bleeds
- hay fever
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| Hair changes during pregnancy | - growth on skin (abdomen + face)
- loss from head
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| Skin changes during pregnancy | - itching
- pregnancy rash (PUPP)
- acne
- chloasma,
- linea nigra
- stretch marks
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| Dietary changes during pregnancy | Hypersensitivity to smell, taste, pica, appetite and metabolism changes
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| Sexuality changes during pregnancy | Libido changes
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| Emotional changes during pregnancy | Volatility and mood swings
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| Tiredness and fatigue increase | 1st and 3rd trimesters
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| Ways to reduce morning sickness | - increase rest periods
- eat carbs 20min b4 getting out of bed
- eat protein before bed or during night
- low energy/impact exercise after eating
- avoid refined/fried/spicy foods
- eat food rich in B group vit
- increase fluids
- reduce coffee/te
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| MW skills for antenatal care | - establish EDD
- Abdominal Palp
- BP
- Routine blood + urine screening
- nature + significance of fetal movements
- physiological changes associated with pregnancy + issues + management
- antenatal education
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| What history do you take at a clinical booking? | - Medical
- Surgical
- Obstetric
- Social
- Gravida/Parity
- LMP + EDD
- Previous labour outcomes
- Breastfeeding
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| Examples of MEDICAL Hx | - Cardiac
- Hypertension
- Epilepsy
- Bleeding disorders
- Asthma
- Current meds
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| Examples of SURGICAL Hx | - Previous gynaecological surgery
- Prev GA
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| Examples of SOCIAL Hx | - Mental health
- Family Violence
- Smoking/drugs
- Relationship/whanau
- Diet/nutrition
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| 38+/40 risk markers | - fresh blood loss
- Reduced FM
- Signs of pre-eclampsia
- Rupture of membranes without contractions
- Meconium stained liquor
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| Fundal Assessment - 5 Stages | - Initial visual (observe)
- Fundal assessment
- Lateral assessment
- Pelvic assessment
- Listening or auscultation
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| In a Visual Assessment, we look for | - initial impression of progress
- physiological changes (linea nigra, stretch marks
- size, shape, contours in relation to gestation/presentation/position
- surgical scars
- bruising or other signs of FV
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| In a Fundal Assessment, we look for | - upper most part of fundus
- Lie (position of babes spine relative to mum)
- Presentation
- Landmark of fundal height re gestation
- Measurement of fundal height
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| Reasons for discrepancies with fundal height and gestation are | - large/small baby
- multiple preg
- molar preg
- poly/oligohydramnios
- errors in gestational age estimation
- oblique or transverse lie
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| In a Lateral Assessment, we look for | - confirms lie+presentation with orientation of baby
- identifies position (anterior, posterior, lateral)
- identifies denominator in relation to points of the pelvis
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| In a Pelvic Palpation, we look for | - presenting part
- descent into womens pelvis
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| Cephalo Pelvic Disproportion (CPD) should be considered | if the babies head is not engaged at 40 weeks gestation
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| The purpose of Auscultation is to | Listen to baby's FHR, to confirm baby is alive
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| The FHR is audible with a dopplar at | 12 weeks
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| The FHR can be heard with a pinard at | 24-28/40
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| Fetal movement can be felt from around | 18/40
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| Most women will feel fetal movements by | 22-24/40
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