Antepartum Assessment and Care

How do we calculate the EDD? Nagele’s Rule: LMP minus 3 months add 7 days and adjust the year accordingly. Ex: 9 – 29 – 09 (LMP) -3 +7 6 36 10 Which is really 7/6/10! What if the month is January, February or March? Then add 9 months, add 7 days and adjust the year accordingly. Ex. 1 – 15 – 10 (LMP) +9 +7 10 / 22 /10

What nursing interventions are utilized in pregnancy? Client education Monitoring for potential complications

Uterus changes

Cervix and Vagina Chadwick’s sign Goodell’s sign Hypertrophy of epithelium Increased mucus discharge Mucus plug

Ovaries

Breast changes

Respiratory Changes Hyperventilation Increased tidal volume Decreased airway resistance Breathing changes from abdominal to thoracic

Cardiovascular changes Blood volume increased by 45% Decreased systemic and pulmonary vascular resistance Vital sign changes Venal caval syndrome

Physiologic Anemia of Pregnancy

Gastrointestinal Changes

Urinary Changes Increased bladder pressure Increased glomerular filtration rate Increased renal plasma flow.

Skin and Hair Changes

Musculoskeletal Changes

Changes of Pregnancy Presumptive (Subjective) Probable (Objective) Positive (Diagnostic)

Psychologic tasks of Pregnancy Ensuring safe passage through pregnancy and labor & delivery. Seeking acceptance of this child by others. Seeking of commitment and acceptance of self as a mother to the infant (binding-in). Learning to give of oneself on behalf of one’s child.

Initial Nursing Examination: Initial interview Client history LMP Problems or complications Any discharge Concerns/questions Past pregnancy Gynecologic history Religious/cultural/ occupational hx Partner’s history.

Initial Prenatal Physical Exam Vital signs Height and weight Urinalysis Blood testing

Fetal Assessment at Visits Fetal heart rate Fundal Height Gestational Age Health Status

Ultrasound Examination Transabdominal or transvaginal Nursing implications: Provide opportunity to ask questions Client advocate

Doppler Flow Studies Blood Flow analysis via ultrasound- measure velocity of flow umbilical vessels and other fetal blood vessels

Biochemical Assessment Maternal Alpha-fetoprotein (AFP)-16-18 weeks screen for NTD, trisomies *Triple marker test 16-18 weeks (AFP, unconjugated estriol, hCG *Four Markers 14-22 weeks + inhibin A

Fetal Biochemical Assessment Amniocentesis- genetic disorders, Fetal maturity L/S ratio Phosphatidylglycerol Amniotic creatinine Meconium

Chorionic Villus Sampling (CVS) Genetic studies done earlier results –more risk Percutaneous umbilical blood sampling

Electronic Fetal Monitoring Nonstress test- HR^ when fetus moves reactive 2 or more accelerations of 15bpm for 15sec in 20 min period with normal baseline and average variability (stimulate if needed) Contraction stress test Negative No decels with contractions

Biophysical Profile real time ultrasound measures 5 parameters score 2 for each fetal breathing movements gross body movements fetal tone reactive fetal heart rate qualitative amniotic fluid volume(AFV) Normal 8-10 Equivocal 6 Abnormal <4