maternity week 2 Flashcards by Amanda S.

morning sickness, heartburn, etc. cause

unknown, likely hormones

How well did you know this?

Not at all

Perfectly

how many ppl plan to get pregnant?

about 50%

How well did you know this?

Not at all

Perfectly

main issues w/ pregnancy (the usual)

HTN and diabetes

How well did you know this?

Not at all

Perfectly

what is purpose of prenatal care?

Purpose of PNC: To reduce risks to pregnant person and fetus.
Routine assessments and screenings that increase in frequency.
Individualized counseling related to diagnoses and prenatal testing.
Patient education.
Individual vs. Group setting

How well did you know this?

Not at all

Perfectly

CENTERING PREGNANCY® PRENATAL CARE

Evidence-based model
Group visits w/ pregnant people w/ similar EDD
Improves health outcomes/reduces disparities
Greatest impact for Black childbearing people
Often CNM led (best for Black community)

How well did you know this?

Not at all

Perfectly

prenatal scheduled visits (one, a month to 28 days, 2 weeks to 36, then weekly)

First visit within the first trimester (12 weeks)
Monthly visits weeks 16 through 28
Every 2 weeks from weeks 29 to 36
Weekly or bi-weekly visits week 36 to birth

How well did you know this?

Not at all

Perfectly

baby is viable at

24 weeks

How well did you know this?

Not at all

Perfectly

if bleeding in the middle of the night before 24 weeks, go to

labor and delivery

How well did you know this?

Not at all

Perfectly

midwife vs doctor

can have medication with both

How well did you know this?

Not at all

Perfectly

first prenatal visit

Confirm pregnancy: Blood or urine pregnancy test
Determine Estimated Due Date (EDD - estimated due date), EDC, EDB - same thing)
Screening exams: blood tests, weight/BMI, urine dip, STI tests, full physical assessment/pelvic exam
Health Baseline: Baseline VS, reproductive history, medications, substance use, nutritional status, comorbidities (including age) (Ricci p. 370, Fig12.2, Health History Summary)
Comprehensive history taking: Family structure, psychosocial risk factors (Ricci p. 366, Fig. 12.1: Preconception screening tool)

How well did you know this?

Not at all

Perfectly

urine

checking protein, glucose, specific gravity,

How well did you know this?

Not at all

Perfectly

nagele’s rule

Last Menstrual Period (LMP)
Plus 7 days
Minus 3 Months
= Estimated Due date

How well did you know this?

Not at all

Perfectly

stress test at when? (Stressed not quite at 28 weeks later)

24 weeks and above

How well did you know this?

Not at all

Perfectly

at least 15 bmp

above the baseline for 15 min (stress test, look this up in the book)

How well did you know this?

Not at all

Perfectly

BPP

NST, breathing movement, fetal tone, fetal movements

How well did you know this?

Not at all

Perfectly

follow up visits

Weight tracking
Assessment physical and emotional well being
VS/BP
Urine checked for protein, glucose
Additional blood tests PRN
Education
Additional tests 2nd/3rd tri: GBS, Gestational Diabetes Screening
Rhogam (immunoglobulin) PRN
Planning for birth/preferences - usually 3rd trimester - pain management at birth, etc.
Genetic Testing

How well did you know this?

Not at all

Perfectly

RH test**

COOMBs test - anytime the blood is mixed with RH - mom, will get a coombs test.

How well did you know this?

Not at all

Perfectly

follow up visits - fetus

Fetal growth: fundal height
Fetal wellbeing subjective: FHR via U/S or doptones
Fetal wellbeing subjective: fetal movement (a “VS”) - (quickening) - fist baby 20 weeks, 2nd - 12 weeks
Genetic Screening exams/results

How well did you know this?

Not at all

Perfectly

fundal height at what time

12-14 weeks (check this)

How well did you know this?

Not at all

Perfectly

potential complications

Infection: All trimesters
Spontaneous Abortion (SAB)/Miscarriage: 1st
Hyperemesis: All trimesters
Pyelonephritis: All trimesters
IUFD: 2nd/3rd tri
Kidney Stones: All trimesters
Gestational Diabetes: 3rd tri (but could be
earlier)
PPROM: 2nd/3rd
Hypertensive disorders: All trimesters

How well did you know this?

Not at all

Perfectly

pylonephritis main symptom

pain

hypertension++ what is the number? (The normal number)

140/90

Hypertensive Disorders of pregnancy - death++

Hypertensive Disorders of pregnancy 2nd leading cause of morbidity.

3rd Trimester Testing:
Group B Strep++

Vaginal/Rectal Swab at 35-37 weeks
Considered GBS+ if urine contains GBS in first tri
Affects 50% of pregnant people
GBS normal vaginal flora
GBS+: ABX prophylaxis in labor

rhogam - dose (rhogam costs $300)

300 mcg IM, deltoid

interventions for morning sickness

Eat dry carbs in AM before getting up Avoid empty stomach/eat small frequent meals Avoid: strong smelling foods/fatty, fried foods Ginger Vit B6, & doxylamine (unisom), or Zofran may be prescribed PNV to maintain adequate nutrition

physical changes - Round ligament pain (my stomach is round)

abdominal pain. 2nd and 3rd trimester a lot of abdominal pain. (exercise and belt for patients)

sexual changes***

no problem having sex during pregnancy.

only time sex can be harmful is...

if pt has history of preterm labor.

MMR and varicella -can you give during pregnancy?

given during pregnancy bc they are live vaccines.

genetic screening

Screening test vs. Diagnostic Tests Screening for neural tube defects, trisomy 21 and other chromosomal abnormalities. Screening tests may be followed by diagnostic tests. Individual counseling based on risk factors/beliefs/preferences to guide decision-making. screening tests lower risk, diagnostic higher risk

earliest test - Cell-free fetal DNA: 8-10 weeks

Blood draw from pregnant person Detects fetal cells in maternal circ High sensitivity to Tri 21 (99.9%)

diagnostic - Amniocentesis

Amniocentesis: 15-20 wks gestation (may be done 11-14 w/ higher SAB risk. Risk of SAB similar to CVS Amniotic fluid anayzed for chromosomal abnormalities, infection, Rh sensitization 3rd tri: used to test for lung maturity

diagnostic - Chorionic Villus Sampling (cronion is early, it's genetics)

Chorionic Villus Sampling: 10-13 wks of gestation Placenta specimen obtained trans-abd. or trans-vag. Genetic material analyzed for common chromosomal abnormalities. Does not detect neural tube defects. Risks: damage to structures, 0.5-1.0% risk of miscarriage (SAB).

Excessive intake - how big will the baby be? (The baby weighs 4000 tons)

baby over >4000 grams

more at risk for malnutrition during pregnancy

* Adolescence or less than 2 years post menarche * Frequent pregnancies: three within 2 years * Poor fetal outcome in a previous pregnancy * Poverty/food insecurity * Poor diet habits with resistance to change * Use of tobacco, alcohol, or substances * Weight at conception under or over normal weight * Problems with weight gain * Weight loss during pregnancy

nutrtional risk during pregnancy - what weight gain is dangerous?

Weight gain of more than 3 kg (6.6 lb)/month after the first trimester Weight gain of less than 1 kg (2.2 lb)/month after the first trimester Multi-fetal pregnancy Low hemoglobin and/or hematocrit values (biochemical measure Diabetes Chronic illness, including an eating disorder, that affects intake, absorption, or metabolism of nutrients

nutritional assessment

Anthropometric: obtain baseline and serial weight/BMI Obtain diet record Review supplement intake Formulate individualized plan of care based on objective/subjective data Education on food choice/calorie intake: additional 300 kCal (2nd/3rd tri.) Physical assessment: head to toe/signs of malnutrition?

calcium - what nut has it?

Sources: dairy, almonds, canned fish, dried beans/lentils

folic acids (black eyed peas on acid)

Leafy greens, black-eyed peas and other legumes, citrus, peanuts, liver Deficiency: risk for NTD

iron

Animal meats, leafy greens, eggs, tofu, tempeh, fortified foods (but whole foods are better) Vit C aids absorption Low iron=anemia

folic acid*****

Necessary for RBC formation  risk of NTD (neural tube defect) People who may become pregnant should take supplement

alcohol*****

No safe amount in pregnancy

Artificial Sweeteners

Unknown effects: may be linked to higher birthweight/childhood obesity No nutritional value

mercury

May lead to pregnancy complications & childhood developmental delays Limit fish to 2x/week & avoid fish higher in mercury

Listeriosis

Unpasteurized & raw foods, deli meats, refrigerated smoked fish, deli salads, “old” food, poorly refrigerated May pass through placenta Risk of miscarriage, stillbirth, neonatal demise

Psychological Adaptation to Pregnancy: Stages

(1st - 3rd trimester) Ambivalence Introversion Acceptance

Psychological Adaptation to Pregnancy: 2nd trimester

Establishing a relationship with the fetus Fetal movement/fetus as separate being Pregnancy/fetus main focus Attention to own mother and others who are pregnant (more outward focus)

Psychological Adaptation to Pregnancy: 1st Trimester

Introversion: Focus on self. The baby isn’t real Ambivalence: Examines what needs to be given up Emotional lability Change in body image.

Psychological Adaptation to Pregnancy: 3rd Trimester

Tired of being pregnant Prepares realistically for the birth and parenting May be unconfident about parenting Identifying with the mother/parent role Reordering of relationships