PRENATAL CARE

HEALTH ASSESSMENT DURING 3. Family profile

PRENATAL VISITS • Identify important support persons
SCHEDULE OF PRENATAL VISITS • Marital status
• Up to 28th week of pregnancy • Size of apartment or house to talk
o Every 4 weeks about the availability of the baby’s
• 28th – 36th week of pregnancy room or space
o Every 2 weeks 4. History of past illnesses
• 36th week until Birth • Past medical history
o Every week o Kidney disease, varicosities
o Heart disease, hypertension
PURPOSE OF PRENATAL CARE
1. Establish a baseline of present health. o STD, UTI
2. Determine the gestational age of the fetus o Diabetes, Thyroid diseases
3. Monitor the fetal development and o Recurrent seizures, Gallbladder
maternal well-being disease
4. Identify women at risk for complications o Phenylketonuria, TB
5. Minimize the risk of possible complications o Asthma
by anticipating and preventing problems • Childhood diseases
before they occur. o Chickenpox (varicella)
6. Provide time for education about o Mumps
pregnancy, lactation, and NB care o Measles (rubeola)
o German measles (rubella)
PURPOSE INITIAL INTERVIEW o Poliomyelitis
1. Establishing rapport • Ask about HPV (human papillomavirus
2. Gaining information about a woman’s vaccine)
physical and psychosocial health o Has the potential to prevent
3. Obtaining a basis for anticipatory guidance cervical CA
for the pregnancy • Ask about allergies
COMPONENTS OF HEALTH HISTORY • Ask about past surgical procedures
1. Demographic Data 5. History of Family Illnesses
• Name, age, address, tel. no., e-mail • Can help identify potential problems in
address, religion, and health insurance a woman during pregnancy or in her
information infant at birth
2. Chief Concern 6. Day History/ Social Profile
• The reason a woman has come to the • Elicit information about:
health care setting (Chief Complaints) o Current nutrition (“24-hr. recall”)
• Inquire about the date of her LMP. o Elimination
• Elicit information about the signs of o Sleep
early pregnancy o Recreation
• Elicit information about: o Interpersonal interactions
o signs of early pregnancy • Ask about hobbies
o Discomforts of pregnancy o Smoking, drinking alcoholic
o Danger signs of pregnancy beverages
o Document if the pregnancy was • Medication history
planned
 PRENATAL CARE
7. Gynecologic History 9. Review of systems
• Ask about: • Head
o Age of menarche o headache, injury, seizures,
o Menstrual cycle, including interval, dizziness
duration, amount of menstrual • Eyes
flow, and associated discomforts o vision, infection, glaucoma
with her menstruation. • Ears
o Past surgery on the reproductive o earache, hearing loss
tract • Nose
o Reproductive planning has been o epistaxis ( nose bleeds ), allergy,
used sinus pain
o Sexual history • Mouth and pharynx
8. Obstetric History o dentures, bleeding of gums
• Ask about: • Neck
o Previous miscarriages or o stiffness, masses
therapeutic abortions • Breast
o If a woman’s blood type is Rh o lumps, secretions
negative if she received Rh immune • Respiratory system
globulin (RhIG [RhoGam]) after o cough, wheezing
miscarriages. • Cardiovascular system
o Used to prevent Rh- sensitization o history of a heart murmur, heart
of an Rh- woman. disease, hypertension, had a blood
o Blood transfusion to establish the transfusion
risk of hep B or HIV • GIT system
• Determine a woman’s status o prepregnancy weight, vomiting,
concerning the number of times she diarrhea, Constipation, change in
has been pregnant, including the bowel habits
present pregnancy, and the number of • Genitourinary system
children above the age of viability she o UTI, pelvic inflammatory Disease
has previously borne. (PID), hepatitis, HIV
• Comprehensive system of classifying • Extremities
pregnancy status (G.T.P.A.L.M) o varicose veins, fracture/dislocation,
o G (gravida) – total # of pregnancies pain
o P ( para) - number of deliveries that • Skin
reached viability o rashes, acne, psoriasis
o Para is broken down into :
o T = # of full-term infants born at 37
weeks or after
o P = # of preterm infants born
before 37 weeks
o A = # of spontaneous or induced
abortions
o L = # of living children
o M = # of multiple pregnancies
 PRENATAL CARE
PHYSICAL EXAMINATION
• Ask the woman to void for a clean catch
urine specimen before the exam.
• Physical exam includes inspection of major
body systems with an emphasis on changes
that occur with pregnancy
TYPES
A. Baseline height /weight and vital signs
measurement
• To establish a baseline for future
comparison
B. Measurement of fundal height and
Fetal Heart Sounds
C. Measurement of fundal height and
Fetal Heart Sounds
• 12-14 weeks uterus is palpable over
the symphysis pubis
• 20-22 weeks uterus is palpable at
the umbilicus
• 36 weeks xiphoid process
• 40 weeks uterus is 4 cm below
xiphoid process due to lightening
fetal heart sounds ( 120-160 beats
per minute ) can be heard at 10-12
weeks if Doppler is used, but not
until 18-20 weeks if a regular
stethoscope is used.
D. Pelvic examination
• Pelvis
o A bony ring formed by 4 united
bones:
A. Two innominate bones
(flaring hip)
1. Ilium
• Forms the upper and
lateral portion
2. Ischium
• Inferior portion
• At the lowest portion are the
ischial tuberosities
o These are important
markers to determine
lower pelvic width
• Ischial spines mark the
midpoint of the pelvis
o This marker is used to
assess the level to
which the fetus has
descended into the
birth canal during labor.
o Station 0 is when the
presenting part is at the
level of the ischial spine
.
3. Pubis
• Anterior portion of the
innominate bone
• Symphysis pubis is the junction
of the innominate
• bones at the front of the pelvis.
 PRENATAL CARE
B. Coccyx
• Just below the sacrum
C. Sacrum
• Forms the upper
posterior portion of the
pelvic ring.
• Used as a landmark to
identify pelvic
measurements.
• Pelvis
• Divided into:
o False pelvis (superior half)
o True pelvis (inferior half)
• Pelvic examination
• reveals information on the
health of both internal and
external reproductive organs
• Woman should void to reduce
her bladder size and then lie in
a lithotomy position
• Vaginal inspection
o Examination of pelvic organs
• early signs of pregnancy (
hegar’s sign ) can be
determined as well
ESTIMATING PELVIC SIZE
• This is to determine whether a woman’s
pelvic ring will be adequate for a fetus to
pass through its center
TYPES OF WOMEN’S PELVIS
A. Android
• Male pelvis
• Pubic arch in this type of pelvis is
extremely narrow
• Fetus may have difficulty exiting
B. Anthropoid
• “ape-like pelvis”
• Transverse diameter is narrow and
the anteroposterior diameter of
the inlet is larger than normal
• Structure does not accommodate
fetal head
C. Gynecoid
• normal " female pelvis
• inlet is rounded forward and
backward, and the pubic arch is wide
• pelvic type is ideal for childbirth
 PRENATAL CARE
D. Platypelloid
• “ flattened pelvis
• Inlet is an oval, smoothly curved,
and anteroposterior diameter is
shallow
• Fetal head may not be able to
rotate
1.
INTERNAL PELVIC MEASUREMENTS
1. Diagonal Conjugate
• Distance between the anterior
surface of the sacral prominence
and the anterior surface of the
inferior margin of the symphysis
pubis
• Adequate: 12.5 cm.
2. True conjugate or Conjugate Vera
• Measurement between the
anterior surface of the sacral
prominence and the posterior
surface of the inferior margin of
the symphysis pubis.
• Average diameter: 10.5 – 11 cm
3. Ischial Tuberosity
• Distance between the ischial
tuberosities, or the transverse
diameter of the outlet.
• Adequate: 11 cm
LABORATORY ASSESSMENT
Blood Studies
• CBC
• Genetic screen = ex. Beta thalassemia
• Serologic test for syphilis
• Blood typing including Rh factor
• MSAFP
o done at 16-18 wks AO
• Indirect Coombs’ test
o Determination if Rh antibodies are
present in an Rh- woman.
o If titers did not elevate Rh- the
woman will be given RhIG
(RhoGAM) at 28 weeks of
pregnancy
• Antibody titers for rubella and hepatitis
• HIV screening
o Screening is done by enzyme-linked
immunosorbent assay (ELISA), if
positive…
o Western blot
▪ Used to identify/detect
specific antibody
▪ Therapy with zidovudine (AZT) if
HIV antibody +
o Decrease the risk of an infant
acquiring the virus
 PRENATAL CARE
• OGTT (Oral Glucose Tolerance Test)
o Should not exceed 140 mg/dl at 1 hr
o If a woman has a history of
previously unexplained fetal
loss, has a family history of
diabetes, has had babies who
were large for gestational age
(9 lb or more at term), has a
BMI over 30, or has glycosuria
▪ she will need to be
scheduled for a 50-g oral 1-
hour glucose loading or
tolerance test (sometimes
called a glucose challenge
test) toward the end of the
first trimester (12 weeks) to
rule out gestational
diabetes.
o The addition of serum Glycosylated
hemoglobin(HbA1C) has the best
predictive value for identifying
diabetes because it measures
blood glucose levels for the past 2-
3 months.
2. Urinalysis
• For proteinuria, glycosuria, pyuria
3. Tuberculosis screening(MANTOUX TEST)
• a woman’s primary care provider may
prescribe a purified protein derivative
(PPD) tuberculin test for a woman as a
test for tuberculosis.
• For this test, a small amount (0.1 ml) of
tuberculin units are injected by a
needle and syringe intradermally (just
under the top layer of skin).
• In 48 to 72 hours, the area is inspected.
• If the woman has tuberculosis, has
been exposed to tuberculosis, or has
received the bacille Calmette–Guérin
(BCG) vaccine for tuberculosis
o a reddened, raised, hardened area
(called induration) will appear at
the injection site.
• If the induration area is at least 10 cm in
diameter
o the test is considered positive (a
person has been either exposed to
tuberculosis or has tuberculosis);
o in a person with a lowered immune
response, 5 cm can be considered a
positive result.
4. Ultrasonography
• If the date of the last menstrual period
is unknown, a woman will be scheduled
for a sonogram to confirm the
pregnancy length and document
healthy fetal growth at 7 to 11 weeks of
pregnancy.
• An ultrasound may also be done, ideally
between 11 and 13 weeks of pregnancy,
as a part of a first-trimester screening
to assess for increased risk of Down
syndrome.
• A sonogram can be scheduled between
16 and 20 weeks gestation to verify
healthy fetal structures and gender.
• Be certain women know that a
sonogram done under 8 weeks will
show only the presence of a gestation
sac, not a moving, kicking fetus, so
their expectations of what they will see
are not disappointing
COMPLICATIONS OF PREGNANCY
1. Vaginal bleeding
2. Persistent vomiting
3. Chills and fever
4. Sudden escape of clear fluid from the
vagina
5. Abdominal or chest pain
6. Increase or decrease in fetal movement
• Sandovsky method= Normal: 10-12x/hr.
7. PIH
• Rapid weight gain
o Over 2 lbs/week in 2nd tri, 1 lb/week
3rd tri
• Swelling of the face or fingers
 PRENATAL CARE
• Flashes of light or dots before the eyes DISCOMFORTS OF MIDDLE TO LATE
• Dimness or blurring of vision PREGNANCY
• Severe, continuous headache 1. Backache
• Decreased urine output • pelvic rock/tilt; squat instead of bend
2. Headache
HEALTH PROMOTION • due to expanding blood volume
1. Self-care needs 3. Dyspnea
• Bathing 4. Ankle edema
• Breast care • due to general fluid retention
• Dental care 5. Braxton Hicks contractions
• Perineal hygiene
• Clothing
2. Sexual activity
3. Exercise
• 220 – 20 (age of woman) = 200 x 70% =
140 bpm
4. Sleep
5. Employment
6. Travel

DISCOMFORTS OF EARLY
PREGNANCY (1ST TRIMESTER)
1. Breast tenderness
• wide strap bra
2. Palmar erythema
• calamine lotion
3. Constipation
4. Nausea, vomiting, and pyrosis (heartburn)
5. Fatigue
• increase the amount of rest & sleep
6. Muscle cramps
• dorsiflex foot; elevate LE freq., 
• Due to decreased serum calcium levels,
increased serum phophorus levels, and
possibly, interference with circulation.
7. Hypotension
8. Varicosities
• elevate leg 15-20 min 2x/day
9. Hemorrhoids
10. Heart palpitations
• due to increased blood volume
11. Frequent urination
12. Abdominal discomfort
13. Leukorrhea