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Antepartum

Reproduction: Antepartum

QuestionAnswer
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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