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Lesson14 Prenatal Assessment

Lesson14 Prenatal Assessment

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Published by: Dennis Nabor Muñoz, RN,RM on May 24, 2010
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05/20/2012

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PRENATAL ASSESSMENT:GUIDELINES FOR ASSESSMENT AND CARE OF THE PREGNANT WOMAN
LESSON #14
John Dorsch, MDDirector of Rural Health ProgramsUniversity of Kansas School of Medicine – WichitaFamily and Community MedicineAnd Family Practice Preceptor for Via Christi Regional Medical Center Wesley Medical Center These lecture notes are based on the CR-ROM by Dr. Dorsch and selected references from the coursetextbook (Swartz, Textbook of Physical Diagnosis, chapter 20)
A Generally good Web Site for Women’s Health Issues:
SIGNIFICANCE OF MATERNAL MORTALITY IN THE UNITED STATES(FROM 1990-1995)
Embolism17%
Hypertension 12%
Ectopic pregnancy10%
Hemorrhage9%
Stroke8%
Anesthesia complications7%
Abortion related5%
Cardiomyopathy4%
Infection3.5%
GENERAL APPROACHES AND KEY ADJECTIVES FOR APPROACH TO THE PREGNANT PATIENT
Use a gentle, steady approach
Be thorough
Be efficient
Be systematic
INITIAL PRENATAL VISIT: Key Points
Provide time for a longer office visit, for example, 45 minutes
Have patient come in early & complete paper work 
Help patient feel comfortable
Begin interview with patient fully clothed
Sit down & make eye contact
First visit is preferred at 6 weeks gestation (6-8 weeks)
THOROUGH MEDICAL HISTORY: Key points
 
1
 
Importan
t, as with any initial health care visit
Attitudes
can indicate future parent-child relationship risk factors:
How does the patient feel about the pregnancy?
Was the pregnancy planned
Underlying medical problems
need to be identified, especially:
Diabetes
Hypertension
Renal disease
Hemoglobinopathy
Isoimmunization
STDs
Significant other infections
All components of 
PMH
are important, especially
Age
Last pelvic exam and pap smear 
Menstrual history
Previous pregnancies, abortions, miscarriages, deliveries
Birth control (methods used)
Fertility – infertility issues
Anesthesia issues or reactions
Pelvic injury
Medications:
prescription, OTC & complimentary therapies
Allergies reactions
Emphasize need to communicate allmedications considered during pregnancy
Social & home environment influences
Life-style issues: diet, exercise, sleep, drugs, alcohol, smoking…
ROS: pre-pregnancy weights & baselines
COMMON SYMPTOMS OF PREGNANCY TO CONSIDER: Key points
Amennorrhea:
Results from high levels of hormones:estrogen, progesterone & hCG (human chorionic gonadotropin)
Currently used pregnancy tests are based on amount of hCG in blood or urine, with hCG present as early as 8
 
days after fertilization
Depending on the specific test used, concentrated urine improves pregnancy detection rate of urine to equal that of serum testing
Test may be positive as early as 3-4 days after implantation
98% of test results are positive within 7 days after implantation
Nausea or “morning sickness of pregnancy”:
Most common between 8-14 weeks gestation
Hypersensitivity to odors may develop
Severe vomiting may result in dehydration or ketosis
Breast Changes:
Increased tenderness
Increased vascularity & sense of heaviness
 Nipples more erectile, with increased pigmentation
Raised Montgomery’s tubercles on areola
Colostrum secreted by 16
th
week 2
 
Heartburn:
Relaxation of gastroesophageal sphincter 
Upward displacement of stomach due to uterine enlargement
Digestions delays, due to decreases in gastric mobility & gastric acid
Backache
:
Increased hormone secretions (estrogen & progesterone)
Increased pelvic relaxation
Loss of abdominal muscle tone
Increased uterine weight
Abdominal Enlargement:
Uterus rises out of pelvis into abdomen by 12
th
week of gestation
Quickening:
Usually felt at 20 weeks in primigravida, but earlier in multipara
Skin Changes:
Hyperpigmentation
Linea alba darkens to linea nigra
Chloasma pigmentation of face
“Stretch Marks” or striae gravidarum
 Nail changes increased grooving, brittleness or softening
Increased sweating
Hirsutism
Urinary Changes:
Increased frequency due to uterine pressure in early & late pregnancy
Vaginal Discharge:
Increased asymptomatic, white, milky cervical mucous & vaginal discharge
Fatigue:
Common in early pregnancy
Headaches:
Common, especially around 16 – 20 weeks gestation
Other symptoms:
Varicose veins
Leg cramps
Edema of legs & hands
Constipation
Bleeding gums
Insomnia
Dizziness3

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