The document provides information on anatomy and physiology changes during pregnancy and assessment of high-risk conditions. It discusses the uterus, cervix, vagina and other organs. It also covers fetal development stages and complications that can arise. Common high-risk conditions addressed include preterm labor, incompetent cervix, premature rupture of membranes, diabetes, and abruptio placenta. Nursing interventions are outlined for monitoring and managing clients with various complications.

1. THE ANTEPARTAL PERIODBY:Zosi Farah w. Fernandez, RN

2. Anatomy and PhysiologyUterusServes as an organ of implantation for the fertilized ovum that becomes the fetus

3. Responsible for expulsion of the fetus during childbirth from the strong muscle contractions as well as menstruation

4. Fundal height a. At the level of the sypmphysis at 12-14 weeks b. Rises at 1 cm/week until 36 weeks of gestation c. At the level of umbilicus at 20 weeks

5. b. CervixGoodell’s Sign

6. Chadwick’s signc. VaginaSlight acidic pH (4-5) to decrease risk of infections

7. Functions include out passage for menstrual flow from the endometrium of the uterus, the female organ for intercourse, and a passageway for vaginal childbirth

8. During pregnancy the mucosa of the vagina may have a bluish violet color, has increased vascularity, and increase vaginal mucus discharged. External structureExternal genitals organs, or vulva, include all the structure found externally between the pubis and the perineum

9. Structures include the mons pubis, labia majora, labia minora, prepuce, frenulum, fourchette, clitoris and vestibulee. OvariesPhotograph of the vulva. 1. Pubic hair (shaved), 2.Clitoral hood, 3. Clitoris, 4. Labia majora, 5. Labia minora (enclosing the Vaginal Opening), 6. Perineum.

10. e. PlacentaChorionic villi form and invade the lining of the uterus where endometrial arteries fill with blood.

11. Earliest function is as an endocrine gland to excrete: a. hCG b. hPLMetabolic function of placenta: a. Respiration b. Nutrition c. ExcretionFetal blood cells can leak into maternal circulation from occasional breaks in the placenta membrane and the mother may develop antibodies to the fetal blood cells.

12. Interference with the circulation to the placenta, such as maternal vasoconstriction from hypertension or cocaine or decreased maternal blood pressure or decreased maternal cardiac output, impedes the blood supply to the fetus.g. Membraneh. Umbilical cordTwo arteries

13. One vein

14. Wharton’s jelly

15. Usually located centrally as the placenta develops from the chorionic villiAmniotic fluidFunctions include fetal lung development, protection of the cord, and allows for normal limb development and development of GI and renal Systemj. Cardiovascular SystemVena caval syndrome

16. Blood volume increases 30-50% during pregnancyk. Gastrointestinal system- Constipation and gastroesophageal reflux

17. l. Urinary SystemSimilar relaxation of the urinary tract places the pregnant client at risk for UTI or pyelonephritis from bacteria ascending from perineumm. Endocrine systemPancreasThyroidPituitaryn. Respiratory systemIncreased BMR requires more oxygen for the pregnant body

18. Tidal volume and minute ventilation increase until the third trimester when the large uterus may impede lung expansion

19. CO2 output increases, resulting in slight respiratory alkalosiso. Hematologic systemRBC increased by one-third

20. Plasma volume increase is greater, resulting in physiologic anemia of pregnancy

21. Clotting factors increase in pregnancy, which increase the client’s risk for blood clotsp. Breastq. SkinIncreased pigmentation

22. Chloasma

23. Linea nigra

24. StriaegravidarumChloasmaLinea nigra

25. Striaegravidarum

26. r. Fetal developmentFertilizationImplantationPlacental developmentDevelopmental landmarks a. Fetal heart tones b. Quickening5. Infants at genetic risk of abnormalitiesa. African American: sickle cell diseaseb. Jewish ethnicity of Northern European descent: Tay-sachs diseasec. Mediterranean: Thalassemiad. Family history of hereditary condition such as cystiic fibrosis or cleft lip palatee. Born to a woman of advanced maternal agef. Parents are closely related blood relatives

27. 6. Chromosomal abnormalitiesa. Types of transmission to the fetus:1. Autosomal dominant2. Autosomal recessive3. Sex-linked transmissionb. Down syndromeRisk increases in women over 35 years old and continues to increases with each year of age

28. Characteristics: Low-set ears, large fat pads at the nape of a short neck, protruding tongue, small mouth and high palate, epicanthal folds and slanted eyes, small rounded head with flattened occiput, hypotonic muscle with hypermonility of joints, simian crease across the palm of hand and mental retardation

29. c. Turner’s syndromeCharacteristics:Usually infertile

30. Small stature

31. Cognitive functions unimpairedd. Klinefelter’s syndromeCharacteristics: * usually infetrille * cognitive functions vary from unimpaired to mild mental retardation

32. e. Inborn errors of metabolismPhenylketonuria (PKU)Tay-sachs diseaseCystic fibrosisCongenital adrenal hyperplasiaCongenital hypothyroidism

33. AssessmentPrenatal careAssessment of positive pregnancy

34. 2. Naegele’s ruleTo determine the estimated date of confinement or estimated date of delivery, count back 3 months from the first day of the last menstrual cycle and then add1 year and 7 days3. Obstetrical classificationGrvidaPara or parityG-T-P-A-L4. Frequency and elements of maternal and fetal assessmentInitial visita.1 Intake assessmenta.2 Lab evaluationa.3 Client educationb. Period specific evaluation in pregnancyb.1 Every 4 weeks until 28 weeks AOGb.2 5-20 weeks of gestation:Maternal alpha-feto protein, begin preterm birth prevention education and review warning signsb.3 20-24 weeks of gestation:Preterm prevention education

35. b.4 24-28 weeks of gestation:1 hour glucose tolerance test, cervical exam, begin education and treatment if diabetic, and review preterm birth prevention and warning signsb.5 every 2 weeks from 28 to 36 weeks of gestationb.6 28-36 weeks of gestation:CBC, blood group antibody screen if Rh negative, give Rh immune globulin; cervical examination, follow up with a dietician if diabetic, breast assessment and education preparation for breastfeeding, review of warning sign, and begin parenting classb.7 35-37 weeks of gestation:Vaginal and rectal group B beta strep cultureb.8 weekly visits from 36 weeks of gestation until deliveryb.9 36-40 weeks of gestation:CBC, repeat gonorrhea, chlamydia, RPR,HIV, hepatitis B screen if indicated, educate about sign of labor and begin childbirth preparation

36. Assessment of psychosocial aspect of pregnancyEconomic statusMarital statusAgePerceived supportSelf-esteemCultureReligion and importance of faith beliefsStability of living conditionAssess mood i.1 ambivalence i.2 Increased sensitivity and irritability i.3 sense of vulnerability i.4 fear

37. j. Assess developmental task of pregnancy 1. Pregnancy validation 2. Fetal embodiment 3. Fetal distinction 4. role transition

38. B. Assessment of High-Risk PregnancyHealth historySocial historyProblems with pregnancyPhysical examInspectionAuscultationPalpitationVital signs

39. Diagnostic Studiesa. Sterile Speculum ExamIndicated for suspected ruptured membranes

40. Amniotic fluid will turn Nitrazine paper blue because of the alkaline pH

41. Free flow of fluid may be seen coming through the cervix when the clients is asked to cough or perform a valsalva maneuverPreprocedure:Client is assisted into the lithotomy positionGather supplies

42. b. Urinalysis with reagent stripsUrine is tested with a reagent strip to test for the presence of components in the urine such as WBC, blood, protein, bilirubin, leukocytes, ketones, glucose, specific gravity, pH, urobilinogen and nitrite.PreprocedureInstruct the client not to discard urinePostprocedureCompare the result with the legend on the side of the bottle to determine normal or abnormal findingsDiscard the urine and record the resultc. 24 hour UrineThe clients total urine output for 24 hours is collected and analyzed for amount, specific gravity, pH, presence and amount of protein and creatinine clearance.PreprocedureInstruct the client not to discard any urine for 24 hoursObtain specimen on ice for the duration of the testHave the client empty the bladder and record the start timePost sign in the bathroom to remind the client, family, and all staff that the test is in progress

43. Postprocedure:Send the entire specimen to the labRecord the end timed. Urinalysis and cultureThey are useful in determining the presence of a UTI, which during pregnancy can result in preterm laborPreprocedureObtain the specimen as orderedLable the specimen and send it to the labe. Laboratory Serum EvaluationCBCMetabolic panelLiver proofileD-dimer and fibrinogenKleinhauer-BetkeC-reactive protein (CRP)Beta hCGMaternal serum alpha-fetoprotein (AFP or MS-AFP)OB panelTORCH

44. f. Fetal FibronectinA protein found in amniotic fluid, the placental tissue itself and following injury to membranes-either mechanical or inflammatory

45. Used to gauge the risk of preterm birth for client hospitalized with PTLPreprocedure:1. Assist the client in assuming the lithotomy position 2. Gather the equipmentsg. Oral glucose tolerance test (OGTT or GTT)Blood glucose greater than or equal to 140 indicates an abnormal screen, and the 3 hour GTT is indicated

46. 3-hour GTT: 100 grams of glucose is given to the client to drink in a liquid form in 5 minutes; fasting is now required for 12 hours before the test as well as for 3 hours after, serum glucose levels are evaluated at 1,2, and 3 hours after drinking the glucose solutionPreprocedure:Obtain the glucose solution and arrange for the blood draw on schedule

47. h. Daily Fetal Movement countAdvised to do daily or twice daily in high-risk client

48. Counting 10 movements in 1hour is reassuring kick counti. Electronic fetal monitoring (EFM)j. UltrasoundUltrasound scanning can be either transvaginally or transabdominally

49. Indication for antepartum care include estimation of fetal age, fetal weight and fetal presentation, placenta position and integrity, or a follow-up of fetal anomalies or well beingk. Biophysical Profile (BPP)

50. l. Umbilical artery dopplerVelocimertyNoninvasive test is done via ultrasound, examining the umbilical artery

51. Test is done when placenta/fetal perfusion compromise is suspectedm. AmniocentesisAmniotic fluid is then removed for the following indicators: *genetic screening * diagnostic for isoimmunization *follow-up after an abnormal ultrasound * to evaluate fetal lung maturity * to evaluate for subclinical infection * or to aspirate amniotic fluid to reduce volumePreprocedureWritten consent discussion must take place between the client and the physicianEducate the client about the procedurePostprocedureEFM for minimum of 30 minutesGive Rh immune globulin for women who are Rh negative

52. n. Group B Beta Streptococcus (GSBBS) Culture Universal screening at 35-37 weeks of gestation