1. MODULE 2: 1 ST, 2 ND, AND 3 RD TRIMESTER NURSING CARE By Professor A. Portzline 8/2010

2. I N THIS MODULE WE WILL : Discuss things that occur during prenatal appointments, up until labor begins Introduce you to electronic fetal monitoring Please note- this Module only covers the normal course of pregnancy. We will discuss abnormal aspects in Module 4.

3. A woman calls her OB’s office and says she took a pregnancy test, and it was positive. She’s very excited!

4. S O WHAT HAPPENS NOW ? Usually the first prenatal appointment occurs between 8-10 weeks gestation. The earliest a woman can discover she’s pregnant is 5 days before her menses is due. This is different for each woman, but typical menstrual cycles are considered 28 days.

5. T HE 1 ST TRIMESTER = WEEKS 1 TO 13  During the first OB appointment, the woman is interviewed by the nurse, who completes a health history called the Hollister form (named after the man who created the form).  Prenatal labs are drawn at this time.

6.  A med check is done to ensure the woman is taking a prenatal vitamin and that none of her meds are contraindicated in pregnancy.  A transvaginal ultrasound may be done to measure length and auscultate the fetal heartbeat.

7. Notice the gestational age= 13weeks 5 days

8. T HE 2 ND TRIMESTER = WEEKS 14-27

9. Many things occur during the 2 nd trimester: 1. If her blood is Rh negative, she receives Rhogam between 24- 28 weeks. 2. Optional amniocentesis and/or genetic testing to determine the risk of syndromes. 3. 1 hour glucola test ~28 weeks. 4. Fetal monitoring occurs at OB appointments, starting ~24 weeks.

10. AMNIOCENTESIS Under the guidance of ultrasound, a needle enters the amniotic sack through the woman’s abdomen and draws a sample of amniotic fluid. This is tested for various genetic syndromes, like Downs (aka Trisomy 21).

11. THE GLUCOLA TEST Checks for gestational diabetes mellitus. A fasting blood glucose level is drawn, then the patient drinks a glucose solution. A 1 hour blood glucose level is drawn to check her metabolism of the glucose solution. Any value > 130mg/dL is considered abnormal. This will be discussed at length in Module 4. Explore this website for details if you’re curious: Gestational Diabetes

12. I NTRODUCTION TO FETAL MONITORING View this patient educational video first: http://www.youtube.com/watch?v=DvcDXvlCXAE http://www.youtube.com/watch?v=DvcDXvlCXAE

13. Fetal monitoring can be: external, using a tocodynamometer or toco and an electronic fetal monitor disc or EFM. internal, using an intrauterine pressure catheter or IUPC and a fetal scalp electrode or FSE. These can only be used once the amniotic sack is ruptured. or a combination of the above. Please read this fetal monitoring article

15. Internal fetal monitors

17. Main types of fetal heart rate decelerations Variable Early Late

18. Intro to fetal heart rate monitoring Please read an overview about fetal heart rate monitoring here: http://www.brooksidepress.org/Products/Military_O BGYN/Textbook/LaborandDelivery/electronic_fetal_ heart_monitoring.htm#Variable%20decelerations http://www.brooksidepress.org/Products/Military_O BGYN/Textbook/LaborandDelivery/electronic_fetal_ heart_monitoring.htm#Variable%20decelerations  You are responsible to know: tachycardia, bradycardia, baseline heart rate, accelerations, variability (long-term only), contraction pattern, early, late and variable decels.

19. Please contact me with any questions. I’m here to help you! Don’t be overwhelmed by all this new info. You will come to understand it. Module 3 will continue with info about electronic fetal monitoring. Thank you for viewing this presentation.

20. R EFERENCES Edwards Hospital. (2010). Fetal monitoring. Retrieved from http://www.youtube.com/watch?v=DvcDXvlCXAE http://www.youtube.com/watch?v=DvcDXvlCXAE Medline Plus. (2010). Fetal heart monitoring. Retrieved from http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_h eart_monitoring.htm#Variable%20decelerations http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_h eart_monitoring.htm#Variable%20decelerations Norman, J. (2010). Diagnosing diabetes. Retrieved from http://www.endocrineweb.com/diabetes/diagnosis.html The Brookside Associates Medical Education Division. (2009). Electronic fetal heart monitoring. Retrieved from http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_h eart_monitoring.htm#Variable%20decelerations http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_h eart_monitoring.htm#Variable%20decelerations