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Before Pregnancy: IDEALLY , a woman planning to have a child should have a medical evaluation before she becomes pregnant. * Place the patient on PNV-Folic acid (Vit B) 400mcg or .4 mg to prevent neural tube defects ( which are birth defects of the baby's brain (anencephaly) or spine (spina bifida). *
Steps you should take to prepare for the examination:
*Ask woman to empty bladder (collect urine for testing). *Prepare to follow a logical order. *Prepare to chart logically immediately after exam (make notes). *Remember to explain everything you are doing.
PH- Measures acidity/alkalinity of the urine, Levels below normal indicate high fluid intake, levels above the norm indicate inadequate fluids & dehydration.
Glucose: Normal = <+ 1. High levels of glucose may be one indicator of high blood sugar, gestational diabetes or diabetes mellitus. Always ask what woman has recently eaten if her BS is high.
Protein: Normal = Negative, Small amounts may be in urine from vaginal secretions & dehydration, Amounts of 2+ to 4+ may indicate be one indicator of possible UTI, Kidney Infection or PIH.
Leukoesterase: UTI vs trich.
Ketones: Normal = Negative. Ketones are products of the breakdown of fatty acids caused by fasting. The body breaks down fats because there are not enough carbohydrates and proteins available. Ketones may be deleterious to fetus.
26-28wks: hematocrit (if low, mother will receive iron supplementation)
26-28wks: glucose loading test (GLT) - screens for gestational diabetes; if > 140 mg/dL, a glucose tolerance test (GTT) is administered; if fasting glucose > 105 mg/dL, gestational diabetes is suggestive.
>36wks- vaginal/rectal culture for Group B strep.,Gonn, Chlamydia
Encourage Good Nutrition Should include: Whole and organic foods; Proteins, fats; micronutrients such as, calcium, iron, magnesium, zinc and vitamins; moderate salt restriction, all in a balanced diet .
The score for a nonstress test with a healthy (reactive) result is 2.
During the ultrasound exam four things are checked and given a score of 0 or 2:
the amount of amniotic fluid
movements of the baby's body
the baby's muscle tone
breathing movements made by the baby
Management based on BPP score Score Interpretation MGT 10 Normal Repeat testing 8 Normal Repeat testing 6 Suspect chronic asphyxia If>36wk, deliver or rpt in 4-6hr 4 Suspect chronic asphyxia If >32wk, deliver Or rpt 4-6 0-2 Strongly suspect chronic asphyxia Extend testing 120min, if score<4 deliver @ any gest. age
BPP-designed to identify a compromised fetus during the antepartum period
score of 8 or 10 is considered normal.
A score of 6 is borderline.
A score of 4 or less suggests there may be problems. Your health care provider may recommend an early delivery of the baby.