1. Antepartum Assessment and Care

2. 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)
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) / 22 /10

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

4. Uterine changes

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

6. Ovaries

7. Breast changes

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

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

10. Physiologic Anemia of Pregnancy

11. Gastrointestinal Changes

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

13. Skin and Hair Changes

14. Musculoskeletal Changes

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

16. 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.

17. 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.

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

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

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

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

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

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

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

27. 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

28. 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