1. Antepartal Nursing Care
Lunar month- 4 weeks, 28 days

2. OB Terminology Pregnancy – divided into 3 trimesters 13 weeks each
EDC - estimated date of confinement
EDB - estimated date of birth *same thing
Gestation - number of weeks since first day of last menstrual period
Abortion - birth that occurs before end of 20 weeks gestation
Preterm weeks
Term wks
Postterm after 42 weeks
Gravida -any pregnancy (any: when preg lasts 4, 5, 6wks or to term)
Para - birth after 20 weeks gestation multiples count as one
Stillborn - born dead after 20 weeks
Primigravida - first time pregnancy
Multigravida - second or any subsequent pregnancy

3. Essential Components of a Prenatal History
Basis of prenatal care- reevaluated and updated throughout the pregnancy.
Obstetric history – pertaining to pregnancy current and past
Gynecologic history- …how long pt has had menses.
Medical history - Current and past
Family medical history including Father’s health history
Religious, spiritual, and cultural history
Occupational history
Personal information about woman
Comprehensive psychosocial assessment

4. Comprehensive OB History Acronym
TPAL
T - term births, twins or more count as one
38 weeks
P - birth from weeks
A - spontaneous or therapeutic abortion
L - living children- multiples count here
Just knowing a woman’s gravida and para does not always provide you with the complete OB picture. The following acronym gives the entire OB story: Start with gravida then >

5. Practice
Cindy is currently 34 weeks gestation and in labor with her first baby.
Gravida 1 Para 0
After delivery - G 1 P 1
More detail:
Gravida 1
Term 0
Preterm 1
Abortions 0
Living 1

6. Practice
Mary is currently 26 weeks gestation and she has a 4 year old daughter that was born at 38 weeks gestation.
G P 1
More detail:
G 2
T 1
PT 0
AB 0
L 1

7. Practice
Ms Johnson is pregnant for the 4th time. She had one abortion at 8 wks gestation. She has a daughter who was born at 40 wks gestation and a son born at 34 weeks gestation.
G P 2
More detail:
G 4
T 1
PT 1
AB 1
L 2

8. More Practice
Ms T, at 27 weeks gestation, comes to the clinic for a routine prenatal visit. This is her 4th pregnancy. She has three children at home. One child was born at 34 wks gestation and the other two were 40 wks gestation.
G P 3
More Detail:
G 4
T 2
PT 1
AB 0
L 3

9. One More Practice
Sharon is 22 wks pregnant. She has a 2 year old and a 4 year old that were born at 39 wks. She lost 4 pregnancies at 12 wks and she has 10 year old twin boys that were born at 33 wks gestation.
G P 3
More detail:
G 8
T 2
PT 1
AB 4
L 4

10. Determination of Due Date
Nagele’s Rule- one method of determining the EDB. Fairly accurate method to use if woman’s cycle is every 28 days.
First day of LMP
Subtract 3 months
Add 7 days
EDB
Nagele’s Rule - one method of determining the EDB. Fairly accurate method to use if woman’s cycle is every 28 days. If woman unsure about when the first day of her last menses was, other methods will have to be utilized to determine EDB,

11. Nagele’s Rule Example LMP April 6 Subtract 3 months - 3 months Jan 6
Add 7 days _7 days
EDB Jan 13

12. Another Option of Nagele’s Rule
Just change the month to number
December 10 becomes
Subtract 3 months _3___
9 -10
Add 7 days __+_7
EDB Sept 17

14. Other Indicators of EDB
Fundal Height – correlates with weeks gestation (top of a pregnant woman's uterus (fundus) to her pubic bone)
Quickening - fetal movement felt be the mom (~16-22wks, not very accurate)
Fetal heartbeat - Doppler wks and wks with fetoscope.
Ultrasound - most accurate
Quickening - usually occurs around 20 wks but could range from wks. So, not very accurate method.
Ultrasound - ID fetal sac at 5-6 wks, heart activity at 6-7 wks, crown to lump measurements, femur and biparietal measurements can determine EDC

15. Initial Physical Assessment
Head to toe physical assessment
8-12 wks gestation
Starts with VS and ends with pelvic exam.
A complete head to toe physical assessment is done on the first visit with the provider to mainly establish baselines and identify any issues that may have a impact on the pregnancy.
Usually the first assessment is done at about 8-12 wks gestation
The exam starts with assessment of vital signs, proceeds through a head-to-toe assessment and ends with the pelvic exam.

16. Pregnancy Physical Assessment
Blood pressure - trimester specific changes (1st tri = BP drops and will rise towards the 3rd)
Weight - sudden wt gain
Skin - pigmentation
ENT - nosebleeds and swollen gums, dental infection preterm labor
Breast – enlarge, colostrum 12 wks
Abdomen - becomes larger, measured each visit (Fundal Height Measurement)
Blood pressure > trimester specific changes. Could exhibit pregnancy related hypertension after about 20 wks gestation
Weight > sudden wt gain in a short period of time could be related to PIH (pregnancy induced HTN)
Skin > pigmentation changes normal
ENT > nosebleeds and swollen gums may be expected, poor dental situation associated with preterm labor
Breast > enlarge, “feel heavy”, pigmentation changes, colostrum formation at about 12 wks
Abdomen > becomes larger, stretch marks,

17. Fundal Height Measurement
Measure in centimeters from the top of the symphysis pubis to the top of the uterine fundus.
weeks - fundal height correlate with weeks of gestation
Too small or too large - needs to be evaluated.

18. Figure 8–3 A cross-sectional view of fetal position when McDonald’s method is used to assess fundal height.

19. Fundal Height Assessment
10-12 wks - fundus slightly above symphysis pubis
16 wks - fundus halfway between symphysis and umbilicus
20-22 wks - fundus at umbilicus
28 weeks - fundus three finger breadths above umbilicus
36 wks - fundus just below ensiform cartilage

21. Abdominal Assessment Fetal movement felt by examiner -18 weeks
Ballotment - Fetus floating in amniotic fluid
Fetal heart tones BPM
Doppler 10-12wks
Fetoscope wks
Palpate fetal movement > felt by examiner at about 18 weeks
Ballotment > noted beginning the 4-5 month. Fetus floating around in amniotic fluid
Fetal heart tones > Bpm, may be heard by doppler 10-12wks gestation; heard with fetoscope at wks.

22. Physical Assessment cont
Extremities - edema of hands and feet in later pregnancy
Reflexes - hyperactivity or clonus associated with preeclampsia
Pelvic - Pelvic measurement assessed for shape and size; dilatation and effacement
Rectum - hemorrhoids (if already present, give advice about incr fiber and fluids)

23. Initial Laboratory Evaluation and Screening
CBC (Anemia  give more iron)
ABO and Rh typing, Antibody Screen, Blood type
Serolgy (RPR  tests for syphilis)
Rubella
Hepatitis
HIV
PAP smear
STD screen
Urinalysis – C&S; drug screen, can have a UTI that is asymptomatic
Thyroid panel- because of chance of cretinism

24. Subsequent Prenatal Visit Routines
Every 4 weeks until 28 wks
Every 2 wks until 36 wks
Every wk until delivery
Visits include teaching and assessment of maternal/fetal well-being.

25. Subsequent Prenatal Assessments
Vital signs
Weight - 1st trimester > 3.5 – 5lbs
2nd and 3rd trimester > lbs, then a lb per wk
Monitor for Edema
Uterine size and uterine activity
FHT’s and fetal movement
Urine screen for protein, glucose and ketones
Lab
CBC at 7 months
AFP at wks
Indirect coombs for Rh negative moms at 28 wks
Glucose screen 28 wks
GBS vag culture 36 wks, “Group B Strept”- Carriers must understand the dangers for the baby.
Define: AFP- Alpha Fetal Protein, measurements in amniotic fluid are used for early diagnosis of fetal neural tube defects
High = Neural Tube defect (ex: spina bifida)
Low = Down’s Syndrome

26. Danger Signs in Pregnancy
Vaginal bleeding (Any bright red bleeding  call phys)
Nausea and vomiting that last over 24hrs
Dehydration leads to preterm labor
Fever
Dizziness - sudden and extreme, associated with pelvic or uterine pain
True Labor- Lower back pain to the front
False labor- Abd pain only
Preterm labor symptoms
Leaking of fluid from vagina
Preeclampsia symptoms - edema, rapid wt gain, headaches, visual disturbances, vomiting, epigastric pain, irritability, scanty urine output (usually won’t see till after 20wks)
Decreased fetal movement
Symptoms of UTI - dysuria, severe backache, fever

27. 1st Trimester Discomforts and Measures to Alleviate
Nausea (due to HcG levels) and vomiting - avoid odors, eat small frequent meals, crackers, avoid spicy or greasy foods
HcG- a hormone produced by the placenta about 10 days after fertilization. Its detection is the basis for most pregnancy tests.
Urinary frequency - void when needed; increase fluids in day and slow down at night
Fatigue - plan rest periods, get help from support system
Breast tenderness - wear good supportive bra
Increased vaginal discharge - frequent bathing, cotton underwear
Nasal stuffiness & epistaxis - cool mist, avoid nasal decongestants and sprays
Ptyalism – “excessive saliva/bad taste in mouth” treat w/ mouthwash, chewing gum, candy
N&V - seen in about 85% of pregnancies; many times caused by increased hCG levels
Urinary frequency > due to pressure of enlarging uterus
Fatigue > may be aggravated by nocturia
Breast tenderness > from increased estrogen and progesterone
Increased vaginal discharge > from hyperplasia of vaginal mucosa
Nasal stuffiness and epistaxis > elevated estrogen produces edema of nasal passages
Ptyalism > cause unknown

28. 2nd and 3rd Trimester Discomforts and Measures to Alleviate
Pyrosis – “hrt burn” treat w/ small frequent meals, avoid spicy or greasy meals, sit or stand after meal
Ankle edema - rest frequently, elevate legs when resting, avoid garters
Varicose veins - elevate legs, wear support hose, avoid crossing legs, avoid constrictive bands
Flatulence - avoid constipation and gas producing foods
Hemorrhoids - avoid constipation
Constipation - increase fluids and fiber in diet, exercise, stool softeners as ordered by physician
Make sure softeners are okay’d by phys first.
Pyrosis > from displaced stomach due to enlarged uterus, progesterone relaxes cardiac sphincter of stomach and decreases GI motility
Ankle edema > decreased venous return
Varicose veins > from pressure of enlarged uterus that prevents good venous return
Flatulence > from increased progesterone that decreases GI motility, and pressure of uterus on the large intestine
Hemorrhoids > from underlying constipation, increased blood volume, and uterine pressure on veins
Constipation > increased progesterone, displaced intestines from enlarging uterus, possibly from iron intake

29. 2nd and 3rd Trimester Discomforts and Measures to Alleviate cont
Backache - proper body mechanics; avoid high heels, practice pelvic tilt exercise
Leg cramps - dorsiflexing foot
Faintness - rise slowly from sitting or lying, evaluate hematocrit and hemoglobin
Shortness of breath - eat small frequent meals
Difficulty sleeping - prop with pillows, use side-lying position
Lt Side is better for baby
Round ligament pain - position change, heating pad
Carpal tunnel syndrome - avoid repetitive movements of hands
Backache > lumbosacral curve as uterus enlarges and becomes heavier
Leg cramps > pressure from uterus on pelvic nerves or blood vessels
Faintness > from increased blood volume and postural hypotension from blood pooling in legs
Shortness of breath > from enlarging uterus pressing on diaphragm, which decreases vital capacity
Difficulty sleeping > difficult to find comfortable position
Round ligament pain > from stretching due to enlarging uterus
Carpal tunnel syndrome > from compression of the median nerve in the wrist

30. Promotion of Self Care During Pregnancy
Fetal activity monitoring - after 28 wks
Breast care and preparation for breastfeeding
Prenatal classes and exercises
Clothing
Bathing
Employment
Travel- wear safety belts, travel only if you have no problems, stop every 2 hrs, stay hydrated
Activity
Fetal activity monitoring - after 28 wks
Breast care and preparation for breastfeeding, well fitted bra
Prenatal classes and exercises
Clothing - loose nonconstricting, no high heels
Bathing - bathe daily, tub safety
Employment - may have to alter to decrease fatigue, careful with exposure, related to SGA
Travel > wear safety belts, travel only if you have no problems, stop every 2 hrs, stay hydrated
Activity and rest > rest important, may continue prepregnant activity

31. Promotion of Self Care During Pregnancy cont
Dental Care
Immunizations
Complementary and alternative therapy
Before anything over the counter they need to talk to their phys
Tertatogens
Medications
Categories A – X, pg. 247 – 249; Cat. A is safe during Preg. No to Accutane!!
Tobacco- IUGR  Growth retardation, Tobacco vasocontricts!
Alcohol
Caffeine- limit intake
Street drugs
Flu Vaccine is okay, just not live ones.
Dental care > important, poor dental hygiene associated with preterm labor
Immunizations - immunizations using killed viruses may be used during pregnancy
Complementary and alternative therapy > only under physicians direction
Medications
Tobacco - IUGR
Alcohol – Fetal Alcohol syndrome
Caffeine – limit intake
Street drugs – ch. 14
Dental care > important, poor dental hygiene associated with preterm labor

32. Concerns About Sexual Activity
Safety for fetus
Contraindications
PROM “Premature rupture of membranes” (water-break), preterm labor, vag bleeding Changes in sexual desire and response
pregnant woman
partner

33. Nursing Care of the Pregnant Woman’s Family
Father – involved, participation
Siblings – regression, rivalry
Grandparents – involvement, conflicts
> assess his knowledge level and intended degree of participation and then work with the couple to assure they meet their goals for this pregnancy