Antepartum Flashcards
(109 cards)
1
Q
Leboyer meyhod
A
Premise: birth as a traumatic experience to the baby
▪ To decrease trauma [of baby] at birth
* Dim lights
* Avoidance of noise in the environment
* Warm bath after birth
2
Q
Tens
A
▪ Use of low-intensity, high-frequency electrical stimulation of the nerves on the lower back
3
Q
Hydrotheraphy
A
to relieve symptoms like pain and stiffness
4
Q
Biofeedback
A
May lower pain by reducing tension of abdominal muscles
5
Q
Acupressure
A
Raises endorphin levels to reduce pain
6
Q
CUTANEOUS STIMULATION TECHNIQUES
A
o Effleurage
o Temple and shoulder or palm and sole massage
o Sacral pressure
o Thermal stimulation
o Positioning
7
Q
Thermal stimulation
A
▪ Alternating heat and cold application at the lower back
▪ Cool clothes for wiping the face
▪ Ice chips for eating
▪ Warm bath
8
Q
Positioning
A
▪ Frequent change in position (every 3-60 min)
▪ Ambulating or upright position lessens pain
9
Q
RELAXATION TECHNIQUE
A
o Progressive relaxation
o Neuromuscular dissociation (differential relaxation)
o Touch relaxation
10
Q
Progressive relaxation
A
▪ Involves relaxing portions of body parts to prevent tension and unnecessary strain
11
Q
Neuromuscular dissociation (differential relaxation)
A
▪ Relaxation of the body even when one group of muscles is strongly contracted
12
Q
Touch relaxation
A
▪ Purpose: help woman learns to loosen taut muscles when they are touched by her partner
13
Q
Slow full respirations at 6-12 bpm
A
level 1
14
Q
higher than level 1 with light expansion of the rib cage: 40 bpm
A
level 2
15
Q
shallow, “sternum” breathing with stronger exhalation than inhalation: 50-70 bpm
A
level 3
16
Q
“pant-blow” breathing (3-4 quick breaths and 1 forceful expiration)
A
level 4
17
Q
very shallow chest panting at 60 bpm
A
level 5
18
Q
strong contractions and 8-10 cm cervical dilation
A
level 5
19
Q
transition contractions
A
level 3 qnd 4
20
Q
4-6 cm cervical dilation
A
level 2
21
Q
early contractions (latent)
A
level 1
22
Q
BREATHING TECHNIQUE
A
o Cleansing breath
o Consciously controlled breathing
23
Q
Strengthens abdominal muscle during pregnancy and prevents constipation in the postpartal period
A
Abdominal contractions
24
Q
Best exercise during pregnancy
A
Walking
25
promotes perineal healing; relieves congestion and discomfort in pelvic region; tones up pelvis muscle
pelvic floor contractions (kegel's)
26
Maintains good posture; relieves abdominal pressure and low backache; strengthens
abdominal muscles following delivery
pelvic rock
27
stretches the pelvic floor muscle; should be done 15 minutes daily
squatting
28
stretches and strengthen perineal muscles; increase circulation in the perineum; make
pelvic joints more pliable
tailor sitting
29
Methods of birth/ pain management
￭ Bradley method
￭ Psychosexual method
￭ Dick-Read method
￭ Lamaze method
￭ LeBoyer method
30
-developed byShiela Kitzinger in Englandduring the 1950s
-The method stresses pregnancy, labor, and birth,and the early newborn periodare some of the mostimportant points in thewoman’s life
psychosexual method
31
also known as "Husband-Coached Childbirth," is a holistic approach developed by American obstetrician Dr. Robert A. It emphasizes comprehensive education, self-awareness, and active participation by the pregnant woman and her coach during labor and delivery. The goal is to achieve a natural birthing experience without unnecessary medical interventions
Bradley method
32
A woman should break thechain of events occurring(between fear and tension or tension and pain) to reduce the pain during contractions. Relaxation, comfort, and minimal pain are achieved only if the woman focuses on abdominal breathing during contractions
Dick-Read Method
33
Lamaze introduced a methodthat included teaching femaleanatomy, physiology ofpregnancy, labor and birth,breathing techniques, andother exercises.Laboring women areencouraged to move around, ifthey like, and follow theirbody's urges to push.
Lamaze method
34
Leboyer method is a childbirth method that aims to minimize trauma for the newborn. The method uses a quiet, dimly lit room and avoids pulling the infant's head. Immediate bonding between mother and child is encouraged. The method is designed to reduce trauma for the newborn by avoiding the use of forceps and bright lights in the delivery room.
LeBoyer method
35
▪ Resting in side-lying position
▪ Sitting half an hour in the afternoon and in the evening
▪ Avoid constricting clothing such as girdles, or knee-high stockings
Ankle edema
36
▪ Sleep upright or use extra pillows
▪ Limit activities to prevent exertional dyspnea
Dyspnea
37
▪ Rest with cold towels on forehead
▪ Acetaminophen as ordered
Headache
38
MIDDLE TO LATE PREGNANCY
o Backache
o Maintain correct posture with head up and shoulders back
o Headache
▪ Rest with cold towels on forehead
▪ Acetaminophen as ordere
o Dyspnea
o Ankle edema
39
o Breast tenderness
o Palmar erythema
o Constipation
o Nausea, vomiting
o Heart burn (pyrosis)
o Muscle cramps
o Hypotension
o Varicosities
o Hemorrhoids
o Heart palpitations
o Frequent urination
o Abdominal discomfort
o Leukorrhea
FIRST TRIMESTER
40
❖ Amniocentesis
❖ Ferning’s test—determines if amniotic fluid has ruptured or not
❖ Nitrazine paper test
Amniotic fluid tests
41
- Differentiates urine and amniotic fluid
- Paper turns yellow: urine. Paper turns blue green/gray: amniotic fluid [(+) rupture]
Nitrazine paper test
42
—determines if amniotic fluid has ruptured or not
Ferning's test
43
❖ BUN, creatinine, electrolyte
❖ Evaluates level of possible renal compromise among women with a history of diabetes, hypertension
or diabetes
RENAL FUNCTION TEST
44
❖ Proteinuria
❖ Glycosuria
❖ Pyuria/bacteria
❖ Ketonuria
❖ Urine Culture
URINALYSIS
45
—indicates contamination by vaginal secretions, kidney disease, or PIH
Proteinuria
46
-small amounts: physiologic “spilling” during normal pregnancy; large amounts (140 mg/dL or
higher)
-requires further glucose screening tests
Glycosuria
47
⚬ Test for glucose in urine
⚬ Positive: red, green or yellow color
Benedict’s test
48
—associated with UTI
Pyuria/bacteria
49
ketones may be found after a heavy exercise or as a result of inadequate intake of food or
fluid
Ketonuria
50
❖ 1-hour glucose tolerance test
❖ 3-hour glucose tolerance test
GLUCOSE TOLERANCE TEST
51
* Screens for diabetes in women with ↑ glucose level after 1-hour test
* Must have two elevated readings for diagnosis
❖ 3-hour glucose tolerance test
52
* Screens for gestational diabetes
* Done at initial visit for women with risk factor; done at 28 weeks for all pregnant women
❖ 1-hour glucose tolerance test
53
a. HBsAg
b. Rubella titer
c. PPD
d. HIV antibody test (with patient’s permission
e. Toxoplasmosis test
f. RPR/VDRL/FTA-ABS
ANTIBODY TITER/SCREENING TESTS
54
—done to determine the presence of hepatitis B virus in the blood in either an active or a carrier
state
HBsAg
55
o <1:8—susceptible
o 1:10-1:32—past rubella exposure
o 1:32-1:64—immune
o >1:64—definite immunity
Rubella titer
56
_____ TYPING AND __ FACTOR ___________
blood, RH, Determination
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* Decreased (thrombocytopenia)
* Elevated (thrombocytosis)
❖ Platelet count (150,000-400,000 μL)
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Decreased (thrombocytopenia):
ITP, leukemia (lymphocytic, myelocytic, monocytic), anemia (aplastic,
iron deficiency, pernicious, folic acid deficiency, sickle cell), DIC, eclampsia
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Elevated (thrombocytosis)
acute blood loss
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* Decreased: anemia (aplastic, pernicious), viral infection
* Elevated: infection, tissue necrosis, leukemia, anemia (hemolytic & sickle cell)
❖ WBC count (450-10,000 μL (mm3))
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infection, tissue necrosis, leukemia, anemia (hemolytic & sickle cell)
Elevated WBC
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anemia (aplastic, pernicious), viral infection
Decreased WBC
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* Decreased: anemia (IDA, aplastic, hemocytic), leukemia, severe hemorrhage, thalassemia major
* Elevated: dehydration/hemoconcentration, polycythemia
❖ Hemoglobin (12-15 g/dL)
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anemia (IDA, aplastic, hemocytic), leukemia, severe hemorrhage, thalassemia major
Decreased HEMOGLOBIN
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dehydration/hemoconcentration, polycythemia
Elevated HEMOGLOBIN
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* Decreased: anemia (30% or less with no known bleeding) and blood loss
* Elevated: Dehydration and hypovolemia (hemoconcentration)
❖ Hematocrit (36-46%)
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anemia (30% or less with no known bleeding) and blood loss
Decreased hematocrit
68
Dehydration and hypovolemia (hemoconcentration)
Elevated hematocrit
69
* A contraceptive pill is taken by the woman three times a day for 3 days. Pregnancy test pill (Gestex) is
taken once.
* If menstruation occurs within 10-15 days after, the woman is not pregnant. If pregnant, there will be no
menstruation because the corpus luteum produces enough hormones to neutralize the effect of
withdrawn synthetic progesterone
PROGESTERONE WITHDRAWAL TEST
70
o Latex agglutination test
▪ Positive: clear, milky solution on a slide or test tube
▪ Results available in 2 minutes
▪ Accurate 4-10 days after a missed period
o Hemagglutination test
▪ Positive: ring (blood cells) at the bottom of the test tube
▪ Results available in 1-2 hours
▪ Accurate 4 days after a missed period
AGGLUTINATION INHIBITION TESTS
71
▪ Positive: clear, milky solution on a slide or test tube
▪ Results available in 2 minutes
▪ Accurate 4-10 days after a missed period
Latex agglutination test
72
▪ Positive: ring (blood cells) at the bottom of the test tube
▪ Results available in 1-2 hours
▪ Accurate 4 days after a missed period
Hemagglutination test
73
* Basis of most OTC PT kits
* Most popular pregnancy test
* Can detect as low as 25 IU/mL
* Result at about 5 minutes
* Home pregnancy testing guidelines
ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA)
74
❖ ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA)
❖ AGGLUTINATION INHIBITION TESTS
URINE PREGNANCY TESTS
75
❖ RADIORECEPTORASSAY TEST
* 1-hour serum test
* Accurate at the time of missed period (14 days after conception)
❖ RADIOIMMUNOASSAY
* 1- to 5-hour test
* Uses radioactively labeled markers
* Most sensitive pregnancy test
* Confirms pregnancy 1 week after
conception
SERUM PREGNANCY TEST
76
o Swelling of the fingers or puffiness of the face or around the eyes
o Continuous pounding headache
o Visual disturbances (blurring of vision, dimness, flashes or spots before the eyes)
o Decreased urine output
o Rapid weight gain (over 2 lbs per week in the second trimester, 1 lb per week in the third trimester)
Signs of pregnancy-induced hypertension
77
* 1- to 5-hour test
* Uses radioactively labeled markers
* Most sensitive pregnancy test
* Confirms pregnancy 1 week after
conception
❖ RADIOIMMUNOASSAY
78
* 1-hour serum test
* Accurate at the time of missed period (14 days after conception)
❖ RADIORECEPTORASSAY TEST
79
o Vaginal bleeding with or w/o discomfort
o Rupture of membranes
o Persistent or severe abdominal/chest pain
DANGER SIGNS / WARNING SIGNS
80
SUBSEQUENT PRENATAL ASSESSMENT
* Prenatal visits
* Weight Gain
SEXUAL ACTIVITY
DIET
EXERCISE
o Squatting and Tailor Sitting
▪ Strengthen perineal muscles
▪ increase circulation in the perineum
▪ Make pelvic joints more pliable
o Pelvic Rocking
▪ Strengthens abdominal muscle following delivery
▪ Maintains good posture
▪ Relieves abdominal pressure and low backache pain
VACCINATION
▪ TETANUS TOXOID
Health Teachings and Interventions
81
* Prenatal visits
▪ Every 4 weeks for the first 28 weeks’ gestation
▪ Every 2 weeks until 36 weeks’ gestation
▪ After week 36, every week until childbirth
* Weight Gain: Recommended 25 to 35 lb
▪ Overweight, recommended gain is 15 to 25lb.
▪ Underweight: Gain weight needed to reach ideal weight plus 25 to 35 lb
SUBSEQUENT PRENATAL ASSESSMENT
82
▪ Moderation
▪ No sexual activity when there is spotting, ruptured BOW, Incompetent cervix
SEXUAL ACTIVITY
83
▪ Instruct client to choose from 3 basic food groups
▪ An increase of about 300 calories per day is needed during pregnancy
▪ A diet of consisting of 2500 calories per day depending on age, should meet the nutritional demands of
pregnancy
▪ Calories needed are greater in the last two trimester than in the first
▪ An increase of about 500 calories per day is needed during lactation
DIET
84
o Squatting and Tailor Sitting
▪ Strengthen perineal muscles
▪ increase circulation in the perineum
▪ Make pelvic joints more pliable
o Pelvic Rocking
▪ Strengthens abdominal muscle following delivery
▪ Maintains good posture
▪ Relieves abdominal pressure and low backache pain
EXERCISE
85
Tetanus toxoid
Vaccine
86
Perform to check if your baby has a genetic or chromosomal condition such as Down’s Syndrome, Edward’s
Syndrome or Patau’s Syndrome
* Amount: 15-20 mL
* AOG: 15 and 20 weeks of gestation (second trimester)
* Size of needle: 22-gauge or 20-gauge
* Normal color and appearance: Slight yellow tinge (clear and healthy)
o Strong yellow: presence of bilirubin, which can be a sign of hemolytic disease in the fetus
o Green: sign of meconium, the baby's first stool
1. AMNIOCENTESIS
87
* Involves retrieval and analysis of chorionic villi for
chromosome or DNA analysis
* Can be done as early as 5 weeks AOG; commonly
at 8-10 weeks AOG
CHORIONIC VILLI SAMPLING (CVS)
88
* Abdominal, transvaginal, 2D, 3D, Doppler UTZ
* PURPOSES:
o Diagnose a pregnancy of 6 weeks’ gestation
o Confirm the presence, size, and location of
the placenta
o Establish that the fetus is growing
o Detect any gross anomalies
o Establish the fetal sex
o Determine the presentation and position of
the fetus.
o Predict fetal maturity by the measurement
of the biparietal diameter of the fetal head.
o Measurement of amniotic fluid
o Placental grading
ULTRASONOGRAPHY
89
* Combines NST AND UTZ to check five
parameters into one assessment:
o Body movements
o Muscle tone
o Breathing movements
o Amniotic fluid
o Heartbeat
BIOPHYSICAL PROFILE
90
Assessment of fetal well-being
1. Fteal movement
2. Fetal heart rate
91
1. AMNIOCENTESIS
2. CHORIONIC VILLI SAMPLING (CVS)
3. PERCUTANEOUS UMBILICAL BLOOD SAMPLING (PUBS)
4. FETAL IMAGING
5. FETOSCOPY
DIAGNOSTIC PROCEDURES FOR DISORDERS
92
This method focuses on counting fetal movements over the course of a day.
Cardiff Method
93
1. Sandovsky method
2. Cardiff method
FETAL MOVEMENT
94
The mother counts fetal movements during a specific period of time, usually after a meal when the baby tends to be more active.
Sadovsky Method
95
Procedure: This method focuses on counting fetal movements over the course of a day
Cardiff Method
96
* Normal: 120-160 bpm
* Doppler: 10-12 wks; stethoscope: 18-20 wk
Fetal Heart Rate
97
1. RHYTHM STRIP TESTING
2. NONSTRESS TEST
3. CONTRACTION STRESS TEST
4. VIBROACOUSTIC STIMULATION
FHR METHODS
98
✓ Position: semi-Fowler’s
✓ Duration: 20 minutes
✓ Short-term variability—small changes in rate from second to second; reflects PSNS
✓ Long-term variability—changes in rate over a 20-minute period of time; reflects SNS
RHYTHM STRIP TESTING
99
✓ Measures response of fetal heart rate to fetal movement
✓ Duration: 10-20 minutes
✓ Movement: ↑ in FHR by 15 bpm and remain elevated for 15 seconds
o Reactive: 2 FHR accelerations (15 beats or more) lasting for 15 seconds occur after fetal movement
o Non-reactive: No FHR acceleration with fetal movement or no fetal movement
NONSTRESS TEST
100
* Means of evaluating the respiratory function of the placenta
* Identifies the fetus at risk for intrauterine asphyxia by observing the response of the FHR to the stress of
uterine contractions (spontaneous or induced)
o Negative: absence of abnormal decelerations with all contractions
o Positive: abnormal FHR decelerations with contractions
CONTRACTION STRESS TEST
101
* Simple, non‐invasive technique where a device is placed on the maternal abdomen over the region of the
fetal head and sound is emitted at a predetermined level for several seconds.
* It is hypothesized that the resultant startle reflex in the fetus and subsequent fetal heart rate (FHR)
acceleration or transient tachycardia following VAS provide reassurance of fetal well‐being.
VIBROACOUSTIC STIMULATION
102
1. MC DONALD’S RULE
2. NAEGELE’S RULE
3. BARTHOLOMEW'S
4. HAASES’S RULE
5. JOHNSON’S RULE
6. BIMANUAL EXAM
7. ULTRASOUND
ASSESSMENT OF EDD /EDB
103
* The measurement of the fundal height from the symphysis pubis.
* The distance between in centimeters depicts the week of gestation between the 20th to the 31st weeks
of pregnancy.
* F ht(cm) /4 = AOG
⚬ Used when woman is at 20 – 31 wks AOG
* Lunar months= Fundal Height (cms) x 2/7
* Weeks of pregnancy= Fundal height (cms) x 8/7
MC DONALD’S RULE
104
* LMP Date (January-March 24)
o Add 7 Days to LMP
o Then add 9 months
* LMP Date (March 25-Dec)
o Subtract 3 months from the LMP
o Add 7 Days to the LMP
o Add 1 Year
NAEGELE’S RULE
105
* Calculates the estimated age of gestation (aog) of a fetus depending on the height of the fundus.
* Does not use a numerical height value to compute gestational age, but landmarks
* Calculating gestational age is an approximation
* At 12 weeks, the uterine fundus should be at the level of the symphysis pubis.
* At 20 weeks, the uterine fundus should be at the level of the umbilicus.
* At 36 weeks, the uterine fundus should be at the level of the xiphoid process.
BARTHOLOMEW'S
106
* Length of fetus in cm
o 1st half: square the no. of month (4mos. X 4 = 16cms)
o 2nd half: month x 5 (7mos. X 5 = 35 cms. )
HAASES’S RULE
107
* Estimates weight of the fetus
* Formula: fundic ht. in cm. – (n x K) = Weight (grams)
▪ n = constant (155)
▪ k = JOHNSON’S RULE12 if fetus is engaged
= 11 if fetus is not engaged
* Example: 32 cm – (155 x 11) = 1,673 gms
▪ (1,673 x 2.2 = 3.7 lbs)
JOHNSON’S RULE
108
* Done to check the pelvic organs (such as the uterus and ovaries).
* The doctor places two gloved, lubricated fingers into the vagina while pressing on the abdomen with the
other hand (bimanual means with two hands).
* This allows the doctor to check the size and shape of the pelvic organs
BIMANUAL EXAM
109
