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.