Prenatal Care Chapter 7

1. Prenatal Care Chapter 7

2. Goal of Early Prenatal Care • Optimize the health of the woman and fetus • Increase the odds the fetus will be born healthy to a healthy mother • Allow for initiation of strategies to promote health and early intervention in event of complications • Healthy People 2010 goal

3. First Prenatal Visit • Longest visit • Obtain the baseline data • Major objectives of this visit • Confirm or rule out a diagnosis of pregnancy • Ascertain risk factors • Determine the due date • Provide education on maintaining a healthy pregnancy

4. First Prenatal Visit (cont.) • Objectives met through • History taking • Most important element • Written questionnaire • Face-to-face interview

5. First Prenatal Visit (cont.) • History taking (cont.) • Several parts to the history • Chief complaint • Reproductive history • Medical-surgical history • Family history • Social history

6. Reproductive History (Terminology) • Gravida • The number of pregnancies the woman has had • Nulligravida • A woman who has never been pregnant • Multigravida • A woman who has had more than one pregnancy • Parity • Communicates the outcome of previous pregnancies

7. Recording the Obstetric History (GTPAL) • G:Gravida - the total number of pregnancies • T: Term - the number of pregnancies that ended at term (at or beyond 38 weeks’ gestation) • P: Preterm - the number of pregnancies that ended after 20 weeks and before the end of 37 weeks’ gestation • A: Abortions - the number of pregnancies that ended before 20 weeks’ gestation • L: Living - the number of children delivered who are alive when the history is taken

8. First Prenatal Visit (cont.) • Objectives met through (cont.) • Physical examination • Head-to-toe physical • Vaginal speculum examination • Bimanual examination of the uterus • Laboratory work • Complete blood count • Blood type and antibody screen • Tests for presence of infection • Pap smear

9. First Prenatal Visit (cont.) • Objectives met through (cont.) • Teaching • Avoiding substance abuse • Diet, nutrition, and exercise • Infection control and medications

10. Methods of Determining the Due Date • Nagel’s rule • Add 7 days to the date of the first day of the LMP, then subtract 3 months • Pelvic examination • The practitioner feels the size of the uterus to determine the term of the pregnancy • Obstetric sonogram • High frequency sound waves reflect off fetal and maternal pelvic structures, allowing visualization

11. Question Tell whether the following question is true or false. When doing a GTPAL you know that the T stands for how many pregnancies a woman has had that ended at term (or beyond 38 weeks’ gestation).

12. Answer True Rationale: “T” stands for term, the number of pregnancies that ended at term (at or beyond 38 weeks’ gestation).

13. Risk Assessment • Takes into account all of the information gathered from • The history • Physical examination • Laboratory tests • Factors that are risks during pregnancy • Negative attitude toward the pregnancy • Unwanted pregnancy • Seeking prenatal care late in the pregnancy

14. Risk Assessment (cont.) • Factors that are risks during pregnancy (cont.) • Maternal substance abuse • History of complications with previous pregnancies • Presence of maternal disease • Inadequate living conditions • Domestic violence or physical abuse • Age • Unplanned pregnancy

15. Subsequent Prenatal Visits • Client usually seen once monthly from weeks 1-32 • Weeks 32-36, prenatal visits are biweekly • Week 36 until delivery, client seen weekly • Visits include specific assessments • Weight • Blood pressure • Urine protein and glucose • Fetal heart rate

16. Subsequent Prenatal Visits (cont.) • Ask regarding the danger signals of pregnancy • Fetal movement • Contractions • Bleeding • Membrane rupture • Practitioner measures the fundal height in centimeters • Between weeks 18 and 32, the fundal height in centimeters should match the number of weeks the pregnancy has progressed

17. Subsequent Prenatal Visits (cont.) • Screening done throughout pregnancy • Between 15 and 20 weeks’ gestation maternal serum alpha-fetoprotein (MSAFP) • At 28 weeks, a woman who is Rho(D)-negative • Screened for antibodies • Given anti-D immune globulin (RhoGam) • Group B streptococcus (GBS) after 35 weeks and before the end of 37 weeks.

18. Assessment of Fetal Well-Being During Pregnancy • Fetal kick counts (screening) • Ultrasonography (Diagnostic Gold Standard) • Transabdominal ultrasound • Endovaginal ultrasound • Doppler flow study or Doppler velocimetry • Maternal serum alpha-fetoprotein screening (screening) • Triple-marker (or multiple-marker) screening

19. Assessment of Fetal Well-Being During Pregnancy (cont.) • Amniocentesis (diagnostic) • Chorionic villus sampling (diagnostic) • Percutaneous umbilical blood sampling (PUBS) (diagnostic) • Nonstress test (NST) (diagnostic) • Vibroacoustic stimulation • Contraction stress test (CST) (diagnostic) • Biophysical profile (BPP)

20. Question If the results of a maternal serum alpha-fetoprotien (MSAFP) is lower than expected it may indicate that the baby will be born with what? a. Neural tube defect b. Oomphalocele c. Down’s syndrome d. Trisomy 17

21. Answer c. Down’s syndrome Rationale: Low MSAFP levels may also indicate a problem, in particular Down’s syndrome.

22. Nurse’s Role in Prenatal Care • Nursing process for prenatal care • Assessment • Selected nursing diagnosis • Outcome identification and planning • Implementation

23. Common Complaints of Pregnancy • Anxiety • Nasal stuffiness and epistaxis • Nausea • Feeling faint • Frequent urination • Increased vaginal discharge

24. Common Complaints of Pregnancy (cont.) • Shortness of breath • Heartburn • Backaches • Round ligament pain • Trouble sleeping • Leg cramps • Constipation and hemorrhoids

25. Teaching Topics for Self-Care During Pregnancy • Maintaining a balanced nutritional intake • Dental hygiene • Exercise • Hygiene and clothing • Breast care • Sexual activities • Employment and travel • Medication use • Substance abuse

26. Maintaining Safety of the Woman and Fetus • Monitor for warning signs at every visit • Elevated blood pressure is reported immediately if accompanied by • Headache • Epigastric pain • Blurred vision.

27. Preparing the Woman for Labor, Birth, and Parenthood • Packing for the hospital or birthing center • Communicating expectations about labor and birth • Choosing the support person • Childbirth education classes • Pregnancy and postpartum exercise classes • Breast feeding classes • Baby care and siblings classes

28. Question During pregnancy some women experience pain that is usually on the right side and can be severe enough to awaken them at night. What is this pain called? a. Exercise pain b. Round ligament pain c. Leg pain d. Abdominal pain

29. Answer b. Round ligament pain Rationale: Because ligaments are pain sensitive structures, some women experience round ligament pain. The pain most frequently occurs on the right side and can be severe. The pain can occur at night and awaken the woman from sleep, or exercise can bring it on.