Hehi Test 1 - Prenatal Care

Front 1

Increased risks w/ a lack of prenatal care?

Back 1

Inc. risk of low birth weight.
Inc risk of preterm delivery
Inc risk of maternal infant mortality

Front 2

Trimesters of pregnancy

Back 2

1st - Week 1 - 13
2nd - Week 14 - 27
3rd - Week 28 -40

Front 3

Nagele's Rule

Formula

Back 3

assumes 28 day cycle
used to determine EDD

EDD = [(LMP + 7 days) - 3 months] + 1 yr

Front 4

Initial Assessment - Physical Exam should include

Back 4

- VS
- Height and weight
- Examination of mouth, teeth, and gums
- Palpation of thyroid
- Auscultation of maternal heart sounds
- Inspection and palpation of breasts
- Inspection and palpation of abdomen
- Inspection of extremities
- Measurement of fundal height
-Auscultation of FHT
- Pelvic exam
-BP - will be a baseline measurement, 30/15 increase during pregnancy, should always be taken w/ patient in same position for each visit.

Front 5

Antibody titer screen - Rh
- A problem if ___mother + ___ fetus.
- How does it happen?
- Fetus at risk for:
-routing laboratory test done at

Back 5

Rh- mother + Rh+ fetus

Mother's body reacts to the blood of the fetus as a foreign protein produces IgG & IgM. IgG crosses placenta, antibodies bind to fetal RBCs -> cell lysis -> fetal anemia. Fetus at risk for erythroblastosis fetalis or hyperbilirubinemia.
- Routine IM injection at 28wks (or after exposure risk (bleeding during preg, truma, delivery, amnio, CVS) - Rogan

Front 6

Laboratory tests

Hemoglobin normal values:
Hematocrit normal values:

Back 6

Hgb > 10.5g/100ml

Hct > 32-34%

used to detect anemia or infection

Front 7

Other laboratory tests done

Back 7

PPD
Rubella screening
STI screening - syphillis, GC, chlamydia,
HIV
PAP Smear
HbsAg
Sickle cell- + result -> further testing for SC trait or disease
Urine analysis - C&S

Front 8

Laboratory tests

DMS
done at:

Back 8

24-28 wks

blood sample drawn 1hr after 50g glucose drink. levels are taken 2 and 3 hrs after. If all are high mother is considered to have GDM.

Front 9

Ultrasound
Routine at ___ wks.
Used to see:

Back 9

16-20 wks.
congenital malformation
fetal measurement vs. EGA
placental location
fetal #
amniotic fluid volume

Front 10

Gentetic testing

Amniocentesis
done at __ wks.
Rec for women:

Rate of miscarriage

Back 10

16-18wks
Women at risk for fetal abnormalities.
35yo and above
Family history
US abnormality

1 in 200-400 procedures

Front 11

Genetic testing

CVS - Chorionic Villi Sampling
done at:
Miscarriage risk

Back 11

10-13 wks
Misc. risk 1-2%

Becoming more common then amnio. Advantage is earlier detection - 1st tirmester

Front 12

Ongoing Assessments for prenatal visits

Back 12

- Weight - watching for TRENDS
- VS
- Urine - protein, glucose - looking for UTIs
- Abdominal palpation - tenderness (would indicate possible uterine infection), Leopold maneuvers

Front 13

Leopold Maneuvers

Back 13

reveals presenting part of the fetus, can also be used to estim. fetal weight

(dont have to memorize)
#1 What is in the fundus? Head or breech?
#2 Where is the back
#3 What is the presenting part?
#4 Where is the cephalic prominence?

Front 14

Fundal Height

McDonalds measurement

Back 14

measurement of the height of the uterus above the symphysis pubis. Provides a gross estimate of the duration of pregnancy

done after 20wks gestation, measured in cm, app the wks in pregnancy.

watch for trending, # of wks should = # of cm

Front 15

Fetal heart tones
Auscultation done with
___ at 10-12wks
___ at 18-20wks

Back 15

doppler 10-12
fetascope 18-20
Difficult in: obese women, back of fetus is facing the womens back, hydraminos (lg amt of amniotic fluid), fetal movement

Front 16

Anticipated schedule of prenatal visits

Back 16

Initial visit w/ in 1st 4-8wks.
q 4wks until 28wks
q 2wks until 36
q wk until delivery

Front 17

Initial Prenatal education

Back 17

- S&S to report to HCP - any concerns, bleeding
- Practices to promote health maintenance. - seat belt use, lap belt worn low across pelvic bones, shoulder harness above uterus, below neck.
-substance use
- childbirth education

Front 18

3rd Trimester Education classes

Back 18

3rd Trimester Education

Front 19

3rd Trimester Education
Birth Plan

Back 19

Birth plan

Front 20

Antepartum fetal surveillance

Back 20

Antepartum fetal surveillance

Front 21

When to phone health care provider?

Back 21

- Frequent, regular, painful uterine contractions x 1 hour
- ROM - gush or trickle of clear, watery fluid from vagina
- Bloody show
- Vaginal bleeding
- Decreased or absent fetal movement

Front 22

Non-stress Test (NST)

Back 22

Antepartum fetal surveillance
Observed fetal heart rate accelerations associated w/ fetal movement
-reactive = 2FH accelerations in 20min
-nonreactive

Front 23

Contraction stress test (CST)
2 methods
Adequate UC:
Interpretation of CST

Back 23

observed fetal heart response to uterine contractions.
1) nipple stimulated
2) oxytocin stimulated
If no late decels the test is negative, if positive further testing is done.

*Good contractions: UC lasting 40-60sec w/in 10min pd.

Front 24

Biophysical profile (BPP)

Back 24

non invasive assessment of the fetus and its environment using ultrasonography and fetal monitoring; includes fetal breathing movements, gross body movements,
fetal tone,
reactive fetal heart rate, and qualitative amniotic fluid volume.

Front 25

Amniotic fluid volume
increases until ___wks
volume decreases by ____% per week after ___wks

Back 25

inc until 33wks
volume dec 10-15% per wk until 40wks

extremes of inc or dec are related to poor perinatal outcomes.

Front 26

Fetal kick counts

Back 26

# of fetal movements not defined or minutes for testing. Recommended 60min or 1-3 times per day. Mother counts fetal movements.

Concern is if no movements in 12hr period. A count of fewer then 3 in 1hr warrents further evaluation.