Demographic information, Menstural history, Gynecologic history, obstetric history
gravida, term, preterm, abortions, living
number of pregnancy's
Birth after 38 weeks
live births over 20 weeks (20-37 weeks)
both surgical and miscarriages
Female that has been pregnant 2 times before this one had a spontaneous abortion and a living child at home would be what?
why ask about genetic information?
risks for abnormalities
why ask about past medical and family history
medical dx, family history of congenital birth defects or exposure to teratogens
Why ask about lifestyle and social health practices?
Smoking, drinking, illicit drug use, environmental exposures
Why ask about Nutrition and exercise?
what mom eats, baby eats, lactation concern
Vegan diets with no consumption of animal products lack
females with a history of phenylketonuria should have what done?
plasma assay for phenylalanine to screen for elevated levels
how does elevated phenylalanine levels affect the fetus?
harmful to fetal brain development
Expected Date of delivery, number of weeks of gestation, signs and symptoms, and reaction to pregnancy
make sure these are stated
used to estimate DOB, first day of LMP + 7, number of month - 3(year of LMP +1 if Jan 1 is passed during pregnancy)
Avoid these to help prevent birth defects
cigarette smoke, lead (water and plants), carbon monoxide, mercury, pesticides, insect repellents, some oven cleaners, solvents such as alcohol and degreasers, pain, paint thinners, benzene, formaldehyde
administered if Rh- because if baby is Rh + the body may see it as foreign
Hemoglobin and Hematocrit
determine need for iron supplements
increase sign of infection
Sexually Transmitted diseases
risk to newborn, HIV (specific consent needed, dramatic decrease in transmission with medication), Hepatitis B, Gonorrhea, Chlamydia, Syphilis
Rubella titer (Common infections risks)
recommended maternal immunization after birth, avoid pregnancy for 3 months after immunized. Avoid 1st trimester exposure due to risk of congenital rubella syndrome
Respiratory - TB (Common infections risks)
teach respiratory precautions and smoking cessation
every visit, look for protein, glucose, ketones, RBC's & WBC's
Plasma lipid levels
increase as normal physiology, may be unrelated to nutrition, requiring no intervention. Special consideration should be given to screen for plasma and lead in females who report pica (eating not food items), because consumption of earth or clay can be a source of environmental contamination.
positive for bacteria is > 100,000 colony forming units. Report urgency, flank pain, frequency, &burning
refrain from intercourse or douching 2-3 days prior for accuracy
Multiple marker genetic screen
15-20 weeks, need for diagnostic testing if positive.
During the multiple marker genetic screening, blood tests check for what?
down syndrome and spina bifida
Other names for multiple marker genetic screen
quad screen test, triple screen, AFP plus
16-18 weeks, testing for neural tube defects, blood test including Alpha-fetoprotein, E3, and Inhibin A. factors in age (>35 higher risk), ethnic background, Weight, Gestational age
What are neural tube defects?
Abnormal fetal brain or spinal cord that is caused by folic acid deficiency during pregnancy.
Unconjugated estriol (E3)
form of estrogen only made during pregnancy
hormone released by placenta
11-20 weeks and/or3rd trimester for fetal lung maturity, a <1% risk of pregnancy loss, checks the AFP level in amniotic fluid
Chorionic villus sampling
10-12 weeks, genetic abnormalities, questionable results may require more testing
Using ultrasound, it can rule out what kind of birth defects?
down syndrome, trisomy 21 (markers on ultrasound), check baby's brain, spinal cord, kidneys, and heart
50g glucose challenge (GCT)
not fasting, done at 20-24, may be done at initial prenatal visit for clients with increased risk of GDM (gestational diabetes mellitus)
If initial 50g glucose challenge screening is negative, when should they be rescreened again?
Between 24 and 28 weeks
50g glucose challenge normal value
140 (some use 135)
If 50g glucose challenge normal value is greater than 140, they then do what?
the 3 hour
blood is drawn exactly how long after glucose is injected?
3hour GTT (glucose tolerance test)
Follow up test after the 50g glucose challenge test results were greater than 140. pt must FAST. no smoking, no cafeine prior to or during
How much glucose is given for the 3 hour GTT?
100g. 50g was given to the original test done before this one.
uses palpation of abdomen in sequence to answer series of questions to determine position of fetus in abdomen and pelvis after 28 weeks gestation
First Leopold's maneuver: what is in the fundus?
Client in supine position, stand facing her head, place ulnar surface of both hands on fundus, fingertips pointing to midline, palpate shape and firmness of contents of upper uterus
Second Leopold's maneuver: Where is the fetal back?
Move the hands down the sides of the abdomen along the uterine contour, a smooth, long, firm, continuous outline is found on the side with the fetal back. Irregular, lumpy, moving parts are found on the side with the fetal small parts, or feet and hands
Third Leopold's maneuver: What part of the fetus is presenting at the pelvis?
Slide hands down to area above symphysis pubis to determine the "presenting" part of the fetus, the part of the fetus entering the pelvic inlet. Palpate shape and firmness of presenting part. Use thumb and third finger of one hand to grasp the presenting part.
Fourth Leopold's maneuver: How deep in the pelvis is the presenting part?
Face client's feet. place ulnar surface of your two hands on each side of the client's abdomen. Follow uterine/fetal contour to pelvic brim. If fingers come together above superior edge of symphysis pubis, presenting part is floating above the pelvic inlet. If fingers snap over the brim of pelvis before coming together, the presenting part has descended into the pelvis.
(Developmental Considerations) woman older than 35
chronic diseases, medical complications (Diabetes and HTN)
Increased risk of perinatal deaths
Increased risk of neonatal deaths
death of a young, liveborn infant; classified as: early neonatal death, death of a liveborn infant occurring fewer than 7 completed days (168 hours) from the time of birth; late neonatal death, death of a liveborn infant occurring after 7 completed days of age but before 28 completed days.
can't get pregnant
giving birth to infant with Down Syndrome or other anomalies
genetic counseling, prenatal screenings
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