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Normal Antepartum

This document provides an overview of the care of the normal antepartum client. It discusses: 1) Maternal hormones produced during pregnancy, common discomforts and their interventions, and danger signs that require medical referral. 2) Components of prenatal visits including calculating due dates, describing gravidity and parity, and analyzing nutrition. 3) Physical, emotional and psychological changes that occur during each trimester. 4) Key terms related to pregnancy and the effects of pregnancy on body systems.

Education◦
Student will summarize the care of the Normal Antepartum client by :  identifying maternal hormones produced during pregnancy, their target organs and their major effects on pregnancy.  discussing common discomforts in pregnancy with nursing interventions.  describing danger signals in pregnancy.  identifying community resources for the childbearing family.
 describing the components of initial and subsequent prenatal visits.  calculating the estimated date of delivery.  describing gravidity and parity with the four-and- five-digit system.  analyzing the effects of different life situations on nutritional patterns and ways nutritional health can be improved
 Pregnancy- Period between conception through complete birth of the products of conception.  Pregnancy is divided into three trimesters The nurse must be aware of : Physical, emotional, and, psychological changes Discomforts that accompany each trimester Danger or warning signs that need medical referral.
 Gestation  Term  Preterm  Postterm  Antepartum  Intrapartum  Postpartum  Nulligravida  Primigravida  Multigravida  Abortion  Stillbirth
 Gravida refers to the number of times a woman has been pregnant  Para refers to the number of births 20 weeks gestation or greater  FPAL or TPAL
 The nurse is interviewing a client at the initial PNV. The client has had seven pregnancies prior to this one. She had two babies at 38 weeks each, one at 35 weeks, one at 41 weeks and 3 abortions at 6, 8 and 12 weeks gestation. She has four living children. What is her gravida/Para?
 Jane Doe is pregnant for the fourth time. At home she has a child who was born at 39 weeks. Her second pregnancy ended at 10 weeks gestation. She then gave birth to twins at 35 weeks but one of the twins died soon after birth. She has 2 living children. What is her gravidity and FPAL?
 A pregnant woman needs an additional 300 kcal/day  Protein  Carbohydrate  Dairy  Fruit & Vegetable
 Prenatal vitamins - High levels of Folic Acid, Calcium and Iron  Folic Acid – 400 mcg/day.  Calcium – 1000mg/day.
 RDA for iron is 27mg/dl  Iron supplements must be given to most women (ferrous sulfate or ferrous sequels)  Take with orange juice  Normal Value: HCT = 37-47% Hemoglobin = 12-16  What are some food sources of iron???
 PICA – eating substances that have no nutritional value
 Normal weight gain based on BMI is 25-35 lbs  If the woman is overweight before pregnancy: Gain 15 to 25 pounds during pregnancy.  If the woman are underweight before pregnancy: Gain 28 to 40 pounds during pregnancy
 The goal of prenatal care is to monitor the progress of a pregnancy and to identify potential problems  Weeks 4 to 28: 1 visit per month (every 4 weeks)  Weeks 28 to 36: 2 visits per month (every 2 to 3 weeks)  Weeks 36 to birth: 1 visit per week
 Progesterone  Estrogen  HCG - Human Chorionic Gonadotropin  HPL - Human Placental Lactogen  Relaxin  Prostaglandins
 CARDIOVASCULAR SYSTEM  RESPIRATORY SYSTEM  RENAL SYSTEM  GASTROINTESTINAL SYSTEM  INTEGUMENTARY SYSTEM  MUSCULOSKELETAL SYSTEM  ENDOCRINE SYSTEM  REPRODUCTIVE SYTEM
 Cardiovascular System  Physiologic anemia  Supine hypotension/venocaval syndrome/ aortocaval compression  Increase cardiac load and pulse  Blood pressure decreases in second trimester  Decreased blood flow causes edema and varicosities.
 Respiratory System Breathing changes from abdominal to thoracic Hyperventilation Shortness of breath Nasal stuffiness and epistaxis
 Renal System  Bladder- Urinary frequency  Ureter- Urinary stasis and pyelonephritis  Urethra- Poor emptying  Glomerular filtration rate increases
 Gastrointestinal system  Heartburn and acid reflux  Constipation and flatulence  Gum tissue soften and bleed  Nausea and vomiting/morning sickness  Hyperptyalism
 Integumentary System - Chloasma/melasma - Linea negra - Striae gravidarum
 Musculoskeletal Relaxation of pelvis joints = Waddling gait Changed center of gravity Lordosis Diastasis recti
 Endocrine  Thyroid - enlargement causes increased BMI  Parathyroid - allows for better use of calcium and vitamin D  Pancreas - in the first trimester decreased insulin production allows for more glucose availability for fetal growth
 Endocrine Continued  Pituitary - Produce hormones that support pregnancy such as prolactin, oxytocin, and vasopressin  Adrenals - Increased glandular activity
 Uterus  Increase in size  Lightening  Hegar’s sign  Braxton Hicks contractions  Are irregular contractions of the uterus  “False labor”
 Cervical Goodell’s sign Operculum/Mucus plug  Vaginal Chadwick’s sign Vaginal secretions are increased (leukorrhea)  Ovaries Ovum production ceases Corpus luteum persists and secretes hormones until weeks 6-8
 Breasts  fullness, tingling or tenderness  darkened areola  prominent blue veins maybe seen  secretion of colostrum by last trimester
 Acceptance of the Pregnancy often accompanied by feelings of ambivalence  Acceptance of Baby feelings such as introversion emotionally labile couvade syndrome  Preparation for baby- End of Pregnancy
 Subjective Changes (Presumptive)  Objective Changes (Probable)  Diagnostic Changes (Positive)
 Presumptive - Subjective  Amenorrhea  Nausea/ Vomiting  Excessive Fatigue  Breast changes  Quickening  Urinary frequency
 Probable- Objective Pelvic Organ Changes:- Goodell’s sign, Hegar’s sign, Chadwicks’s sign Enlarged abdomen Uterine souffle Changes in pigmentation Ballottement Pregnancy tests
 Positive - Diagnostic  Fetal heart tones  Fetal movement  Ultrasound
Nausea/ Vomiting (morning sickness) Fatigue Urinary frequency Breast tenderness Increased vaginal discharge Nasal Stuffiness/Nosebleed Salivation/Ptyalism
Backache Shortness of Breath Muscle cramps Carpel Tunnel Syndrome Constipation Varicosities & Hemorrhoids Heartburn Edema Braxton Hicks Contractions Insomnia Hypotension Palpitations Headaches
 Vaginal bleeding  Increased or decreased fetal movement  Headaches or blurred vision  Swelling of hands and/or feet  Burning on urination  Abdominal or chest pains  Chills or fever  Persistent vomiting  Increase in fluid from the vagina
 Alcohol     Smoking     Marijuana     Drugs & Herbs     Abuse     Hazardous Substances     Mercury
 Stress     Rodents    Live vaccinations  Heat (environmental, hot tubs, saunas)  X-rays  Kitty Litter or Cat feces
 Current Pregnancy Nagele’s Rule Fundal height measurement Presence of discomforts Attitude towards pregnancy  Past Obstetrical History Gravity/Parity - FPAL Pregnancy history Perinatal status
 Based on 280 day pregnancy 28 day cycle 40 weeks (38-42 is normal) Minus three months and plus 7 days to the first day of the last menstrual period  A client LNMP was June 10th . Figure her EDD.  6 month 10th day -3 +7 3rd month 17th day or March 17th of the following year
 LMP: February 16, 2007. Due date?  LMP: August 3, 2006. Due date?  LMP: March 26, 2006. Due date?
Fundal Height Measurement
 Gynecology History  Last pap  Prior infections  Previous surgery  Menarche  Contraception  Sexual history
 Current & Past Medical History  Personal History  Family Medical History  Partner’s Medical & Personal History
 Blood Studies  Blood type, CBC, VDRL, MSAFP  HIV, Hepatitis, Rubella, Sickle Cell, TORCH  Glucose testing  Urinalysis & Pap smear  Cultures – *GBS*  Tuberculosis - PPD  Ultrasound- AFI, Placenta
 Toxoplasmosis  Other Infections  Rubella  Cytomegalovirus (CMV)  Herpes Simplex
 Antigen – antibody reaction  Mother is Rh negative and baby is Rh positive  Sensitization-maternal body forms antibodies when baby blood is mixed.  Screening  Direct coombs test  Indirect coombs test  Prevention  Good pre-natal care  RhoGAM
 Nursing Management  Confidentiality  Develop a trusting relationship  Promote self esteem and physical health  Education- regular prenatal visits, STD’s, Substance abuse, signs of complications.
 Risk Factors  Preterm labor  Cephalopelvic disproportion (CPD)  Preeclampsia  Iron deficiency anemia  Low birth weight
 At the conclusion of the antepartum lecture you will have an understanding of the foundation necessary to understand Labor and Delivery , Postpartum and Newborn Nursery.