Week 2 - Antenatal Care Flashcards
(105 cards)
1
Q
T or F: The majority of women in Canada receive their prenatal care from midwives.
A
FALSE
OBs (followed by Fam Docs, then midwives)
2
Q
T or F: Continuity of care in pregnancy and the post-partum period improves client satisfaction and safety.
A
TRUE
3
Q
Main practitioners involved in prenatal care (4)
A
1) Fam doc
2) OB
3) Midwife
4) Doula
4
Q
Family physician role in prenatal care
A
follow patient throughout antenatal period
may deliver baby
5
Q
OB role in prenatal care
A
skilled
able to support more HIGH-RISK pregnancies
perform C-sections
6
Q
Midwife role in prenatal care
A
LOW-RISK pregnancies
supporting normal physiological birth, promoting informed choice, and optimizing the patient’s childbirth experiences
7
Q
Doula role in prenatal care
A
labour/postpartum support
NO clinical tasks
8
Q
Birth setting choices (3)
A
1) Hospital
2) Birth center
3) Home birth
9
Q
Where do 98% of births take place?
A
hospital!
birth center (1.2%), home birth (<1%)
10
Q
T or F: Home births are never safe.
A
FALSE
SAFE as long as low-birth, specific criteria for this
midwives and patient need to discuss potential transfer to hospital
11
Q
T or F: Canada has standards for the minimum number of prenatal appointments and length of appointments.
A
FALSE
12
Q
Prenatal care characteristics
A
Multidisciplinary
Traditional prenatal care frequency:
-initial visit usually in the first trimester
-monthly visits until 28 weeks
-visits every two weeks until 36 weeks
-weekly visits until birth
Different approaches:
-individualized schedule of care
-group prenatal care
13
Q
Ontario Perinatal Record
A
HCPs use this form to document
standardized approach
collection of demographic info, understanding info regarding family, education, language, occupation, accommodations etc.
14
Q
Which hormones maintain pregnancy? (2)
A
1) estrogen
2) progesterone
15
Q
Role of hCG
A
produced by the placenta
preserves function of corpus luteum
corpus luteum produces estrogen and progesterone
basis of pregnancy tests
16
Q
Role of estrogen
A
stimulates growth in tissues and breast
responsible for preventing ovulation
continues to rise up until about 38 weeks
17
Q
Physiological changes to the cardiovascular system (many)
A
1) slight cardiac hypertrophy
2) displaced diaphragm from enlarged uterus
3) HR increase
4) blood volume increase
5) RBC mass increase
6) hemodilution
7) increase in WBC
8) CO increase
9) systolic BP decrease
10) diastolic BP decrease
11) compression of the iliac vein and inferior vena cava
18
Q
HR increases by ________
A
10 - 15 bpm
does not typically exceed 100 bpm
120 bpm is abnormal
19
Q
Blood volume increases by _______
A
1500 ml
OR
40-50% above pre-pregnancy levels
20
Q
What is the majority of the blood volume increase made of?
A
plasma!
21
Q
Hemodilution effect
A
blood is watered down by increased plasma
hemoglobin and hematocrit levels drop
(see this in blood work)
state of physiological anemia
22
Q
WBC increase in the __ trimester and peak in the ___ trimester
A
2nd, 3rd
inflammatory response
NOT indicative of infection
23
Q
CO increases by:
A
30-50%
preload and stroke volume also increase
24
Q
Systolic BP
A
slight OR no decrease from pre-pregnancy levels
25
Diastolic BP
slight decrease mid-pregnancy (24-32 weeks)
gradually returns to pre-pregnancy levels by the end of the pregnancy
26
Which hormone influences BP changes?
a) progesterone
b) estrogen
a) progesterone
causes vasodilation
might feel lightheaded dizzy if lying down and get up quickly
27
Compression of the iliac vein and inferior vena cava causes.... (3)
1) dependent edema (by gravity - legs, feet, arms)
-creating pooling
-minimal in morning, more swelling by the end of the day
2) varicose veins
-at surface of skin
-strong family component
-normally in lower extremities, sometimes vulva
3) hemmys
-common
-constipation due to progesterone
28
How can clients prevent varicose veins?
avoid standing for prolonged periods
wearing compression stockings
elevating legs
maintaining exercise
29
Supine Hypotension Syndrome
2nd half of pregnancy
lying on back compresses vena cava
may result in decrease SYSTOLIC BP
initial reflex bradycardia response (slowing of HR in response to decreased BP)
CO output decrease
30
Signs and symptoms of supine hypotension syndrome (many)
pallor
dizziness
faintness
breathlessness
tachycardia (compensatory)
nausea
clammy
diaphoretic
31
Intervention
LEFT lateral recovery position
until signs and symptoms subside, vitals improve
32
Changes to the respiratory system (5)
1) oxygen consumption increase
2) respiratory rate slight increase
3) increased chest expansion
4) tidal volume increase
5) increased congestion and vascularity
33
Oxygen consumption increases by...
20-40%
34
Respiratory rate
unchanged OR slight increase
not outside normal parameters
slight tachypnea in 3rd trimester
35
Which hormone facilitates chest expansion?
estrogen
ligaments loosen for increase lung expansion
36
Tidal volumes increases by ____
30 - 40%
37
Symptoms of increased congestion and vascularity
nasal stiffness
nosebleeds
sense of fullness in ears
38
Changes in the renal system (6)
1) renal pelvis and ureters dilate
2) urinary stasis/stagnation
3) increased urinary frequency
4) decreased bladder tone
5) GFR and renal plasma flow increase
6) physiological or dependent edema
39
Urinary stasis can increase the risk of _______
UTIs
screen for this, even if asymptomatic
untreated UTIS can lead to inflammatory response that weakens membranes, leading to preterm birth
40
Which hormone is involved in increased urinary frequency, GFR, and urine output, and stasis?
progesterone
vasodilation
stasis - decreased motility in the bladder
41
Physiological or dependent edema can result from ___________ and ____________
decreased renal blood flow and GFR
near the end of pregnancy
42
Changes to the integumentary system
1) darkening of the nipples, areola, axillae, and vulva
2) chloasma
3) linea nigra
4) striae gravidarum
5) gum hypertrophy
6) increased nail and hair growth
43
Chloasma
mask of pregnancy
blotchy, brownish hyperpigmentation in the cheeks, nose, and forehead
can resolve after pregnancy, but some residual
44
linea nigra
pigmented line extending from the symphysis pubis to the top of the fundus
normal
typical starts at around 20 weeks
usually goes away
45
striae gravidarum
stretch marks
appear in 50-90% of pregnant women
initially have hyperpigmentation, becomes more white and translucent over time
due to rapid growth
hereditary component
46
gum hypertrophy
increased saliva
risk for gingivitis
47
T or F: Breasts are not fully mature until someone has been pregnant at least once.
TRUE
wow!
48
Changes to the breasts (7)
1) increased fullness and sensitivity
2) blood vessels become more visible
3) pigmentation of nipples and areola
4) nipples more erect
5) secretion of lubrication and anti-infective substances
6) increased proliferation of ducts for breastfeeding
7) colostrum
49
Which hormones increase fullness and sensitivity in the breasts?
estrogen
progesterone
50
Montgomery tubercles
sebaceous glands
secrete lubrication and anti-infective substances to help protect the nipples and areola during breastfeeding
scent for babies
51
Colostrum
creamy, premilk fluid expressed from nipples
white to orange/golden yellow
normal towards end of pregnancy
not harmful
first component of breastmilk
high immunological properties, rich in protein
52
Changes to the uterus
1) changes in size, shape and position
2) palpable above the symphysis pubis (12 -14 weeks)
3) umbilical level at 20-22 weeks
4) Hegar sign
5) Braxton Hicks contractions
6) Goodell sign
7) friability increases
8) Chadwick sign
9) Leukorrhea
53
Hormones that change uterus shape
estrogen and progesterone
54
Shape of uterus at BEGINNING of pregnancy
upside down pear
55
Shape of uterus LATER in pregnancy
sphere, globular shape
56
Hegar sign
softening and compressibility of the lower uterine segment
internal and external exam
57
Shape of internal os in NULLIPARA patient
round
58
Shape of internal os in MULTIPARA patient
transverse slit
59
Braxton Hicks contractions
“Practice contractions”
after 4 months - can be felt through the abdomen
irregular, intermittent contractions
facilitate uterine blood flow through the placenta and promote O2 delivery
NOT painful
NO changes to cervix
don't increase in intensity
60
What can help ease Braxton Hicks contractions?
walking
does not true contractions
61
Goodell sign
softening of the cervical tip
62
Friability
bleeds easily
increases
can result in slight bleeding after a vaginal exam or coitus
63
Chadwick sign
increased vascularity resulting in a violet-bluish colour of the vaginal mucosa and cervix
64
Leukorrhea
white or slightly grey mucoid discharge with a faint musty odour in response to an increase in estrogen and progesterone
protective, barrier to bacteria and yeast
65
Changes to the GI System
1) appetite and intake may fluctuate
2) N/V
3) increased gum swelling and vascularity due to increased saliva
4) heartburn
5) Constipation
6) Hemmys
66
N/V
common in EARLY pregnancy
most individuals - resolves between 12-14/16 weeks
in response to increase in hCG and altered carb metabolism
hyperemesis gravidarum = severe N/V
67
Oral health related risk factors for preterm birth, LBW, and pre-clampsia
gingivitis
poor dental health
68
Interventions for N/V
Avoiding large meals
Avoiding wet and dry foods together
Non-pharmacological - acupuncture, ginger
Pharmacological
-Diclectin, can be increased in dosing, antihistamine and vitamin
-Odansetron after 1st trimester
69
Changes to the neurological system (4)
1) carpal tunnel syndrome
-caused by edema compressing median nerve
2) acroesthesia
-numbness of hands
3) tension headaches
4) faintness or syncope
-can be related to supine hypotension
70
Differentiating tension headache vs pre-eclampsia headache
important!
preeclampsia - hypertension, protein in urine, frontal headache
71
Routine Antenatal Assessment
1) confirm gestation age
2) current weight
-calculate BMI at initial visit
3) BP
4) urinalysis (if requested)
5) symphysis fundal height (SFH) in cm
6) fetal presentation
7) fetal HR (intermittent auscultation doppler)
8) fetal movement
9) health teaching
72
Fundal Height
distance from the symphysis pubic bone to the top of the uterus
measured in centimetres
73
What does fundal height indicate?
fetal growth
74
From gestational weeks 18-20, the fundal height should equal _________
the gestational age
+/- 2cm
75
Factors that influence symphysis fundal height (7)
1) position of the fundus
2) position of the fetus
3) amniotic fluid
4) multiples
5) maternal obesity
6) variation in examiner technique (helpful if same examiner)
7) full bladder - ask if they need to use washroom
76
In the case of multiples, what should be used instead of symphysis fundal height?
ultrasound
symphysis fundal height NOT reliable
77
Lightening
drop of fetus into uterus around 40 weeks
getting ready for birth
78
When are Leopold’s Maneuver's completed?
3rd trimester
79
What do Leopold’s Maneuver's assess for? (5)
1) fetal lie: orientation of the fetus in relation to the mother’s spine (longitudinal, transverse, or oblique)
2) presentation: part of the fetus that is entering the pelvis first (cephalic/head, breech, or shoulder)
3) attitude: flexed or deflexed
4) position: direction the fetal back is facing in relation to the maternal abdomen (e.g., left or right)
5) engagement: whether the fetal presenting part has descended into the maternal pelvis
80
Leopold’s Maneuver steps
1) fundus palpation
-head or butt at top of fundus
2) palpate the sides
-back or extremities
3) palpate the lower abdomen
-head or butt
4) palpate side of lower abdomen
-engaged=deep in the pelvis
81
How to measure fetal HR
Doppler stethoscope or fetoscope for intermittent auscultation
use Leopold’s maneuvers are used to determine the fetus’ back (best space to listen)
1 FULL MINUTE
quality and rhythm
82
Normal fetal HR
110 - 160 bpm
normally fairly irregular
83
How to know you're listening to the fetal pulse and not the mother's
assess maternal pulse to compare with the fetal sounds
palpate maternal pulse and distinguish between Doppler
84
What type of fetal HR monitoring to use for high risk
a) intermittent
b) continuous
b) continuous
intermittent sufficient for most!
85
What quality of fetal movements is important to note?
changes!
86
Fetal movements
feels like a flutter, not everyone will notice
early as 13-16 weeks
24 weeks - almost all women will feel their baby’s movements in a predictable way
glucose can increase excitability of fetus
placement of placenta can alter feeling of fetal movement
87
Tool to assess fetal movements
kick counts
88
How to do kick counts
minimum of 6 movements in 2 hours
do once a day
e.g. kicks, flutters, or rolling movements
89
T or F: Daily kick counts are recommended in high-risk pregnancies.
TRUE
90
Prenatal nutrition
300-500 calories per day increased
determinants of health impact dietary intake
good nutrition before and during
long-term effects on children’s health
inadequate nutrition - LBW or preterm
91
During which trimester(s) should most weight be gained?
2nd and 3rd trimesters
92
Common lab test in 1st trimester (9)
1) Hemoglobin
2) ABO/Rh(D)
3) Antibody screen
4) MCV
5) Platelets
6) Rubella, varicella and parvovirus B19 titre
7) HBsAg
8) Syphilis, Gonorrhea, Chlamydia, HPV, HIV
9) Urine C&S
93
1) Hemoglobin
screens for anemia which requires diagnosis and follow up
hemodilution - want to know baseline
94
2) ABO/Rh(D)
refers to major blood types
Rh negative status (client) is important to note as immune globulin required
95
Which Rh status is concerning and why?
client: Rh-
baby: Rh+
=erythroblastosis fetalis
maternal antibodies start to form, can start to attack the surface of the RBCs of fetus
immune globulin required
Winrho - reduces maternal antibodies
96
3) Antibody screen
any circulating antibody measured by indirect Coomb’s
positive screen warrants additional testing in order to identify the specific antibody as some will have implications for the fetus
97
4) MCV
refers to any abnormality in red cell volume
Low MCV may indicate iron deficiency or thalassemia
98
5) Platelets
Thrombocytopenia relatively common
may represent benign or pathological conditions which require diagnosis and follow up
99
7) HBsAg
Hepatitis B surface antigen indicates prior Hepatitis B infection and carrier status
identifies newborns that require Hep B immunoprophylaxis after birth
100
T or F: Every client should be screened for STIs and those at increased risk should be rescreened.
TRUE
101
9) Urine C&S
screen everyone for asymptomatic bacteriuria (ABU)
treat if positive
102
Common lab tests in 2nd and 3rd trimester (4 main)
1) Hemoglobin, platelets, antibodies
-repeat at 28 weeks
2) 1 hour glucose challenge test (GCT)
-gestational diabetes
-28 weeks, earlier if risk factors
3) 2 hour glucose tolerance test (GTT)
-follow up to GCT or if risk factors
4) GBS
-vaginal and rectal swab for group B streptococcus normally collected between 35-37 weeks
103
Recommended vaccines during pregnancy
1) Tdap
-21-32 weeks gestation
2) Influenza
3) COVID
4) RSV vaccine
-32 and 36 weeks gestation
104
Average blood loss with a vaginal delivery
500 mL
105
Average blood loss with a C-section
1 L
