Antepartum and Pregnancy Guidelines

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Questions and Answers

What are the key signs that may indicate hyperbilirubinemia in a newborn?

Normal weight gain, bright skin color

Increased body temperature, normal feeding

Excessive crying, bulging fontanelles

Jaundice, lethargy, poor feeding (correct)

Which condition is characterized by a soft ill-defined enlargement area over the fetal head that crosses suture lines?

Molding

Hydrocephalus

Cephalohematoma

Caput succedaneum (correct)

What physiological mechanism is activated in response to cold stress in newborns?

Thermogenesis (correct)

Reduced metabolism

Vasodilation

Apnea

Which symptom is NOT commonly associated with macrosomic infants?

Low birth weight Signup and view all the answers

Which method of family planning involves a permanent surgical procedure for women?

Tubal ligation Signup and view all the answers

What is the ideal weight gain for a pregnant woman with a normal BMI?

24-30 pounds Signup and view all the answers

Which danger sign of pregnancy may indicate a serious condition that requires immediate evaluation?

Temperature > 101 degrees Signup and view all the answers

What is a likely outcome if a biophysical profile score is below 4?

Emergency intervention is necessary Signup and view all the answers

What is the primary consideration for managing diabetes in pregnancy?

Prioritizing patient safety and glucose management Signup and view all the answers

What characterizes the bleeding associated with placenta previa?

Painless, bright red bleeding Signup and view all the answers

Which condition is associated with sudden, painful dark blood bleeding during pregnancy?

Placental abruption Signup and view all the answers

What is the role of Rhogam in pregnancy?

To stop the production of maternal antibodies Signup and view all the answers

What is a common symptom of hyperemesis gravidarum?

Excessive nausea and vomiting beyond the first trimester Signup and view all the answers

What is a primary nursing intervention for a patient experiencing magnesium toxicity?

Administer calcium gluconate Signup and view all the answers

Which nursing action should be prioritized during late decelerations identified on the fetal monitor?

Position the mother on her left side Signup and view all the answers

What is the most significant risk factor for developing shoulder dystocia during labor?

Fetal macrosomia Signup and view all the answers

What is the expected characteristic of the fundus immediately postpartum?

Firm, round, and midline Signup and view all the answers

In the postpartum assessment, what does the abbreviation 'BUBBLEHE' stand for?

Breasts, Uterus, Bladder, Bowels, Lochia, Emotional support Signup and view all the answers

During which situation should the nurse prepare for rapid delivery?

When there is a prolapsed umbilical cord Signup and view all the answers

Which of the following is NOT a complication associated with postpartum hemorrhage?

Sepsis Signup and view all the answers

What is the main intervention to prevent hypothermia in a newborn?

Wrap the infant in warm blankets Signup and view all the answers

Study Notes

Antepartum

Ideal weight gain during pregnancy is 24-30 pounds.
Overweight women should gain 16-20 pounds.
Pregnant women need 300 extra calories per day.
Weight gain recommendations vary based on pre-pregnancy BMI.
Underweight (BMI <18.5): 28-40 lbs (12.5-18 kg) recommended weight gain.
Healthy weight (BMI 18.5 to 24.9): 25-35 lbs (11.5- 16 kg) recommended weight gain.
Overweight (BMI 25.0 to 29.9): 15-25 lbs (7-11.5 kg) recommended weight gain.
Obese (BMI ≥30): 11-20 lbs (5-9 kg) recommended weight gain.

Danger Signs of Pregnancy

Vaginal bleeding at any trimester
Abdominal pain during pregnancy
Fever (temperature above 101°F) at any trimester.
Dizziness and blurred vision
Facial and hand swelling
Lack of fetal movement after quickening
Avoid lying flat on back(supine hypotension)

Fetal Assessment - Non-Stress Test

Look for two accelerations in 15 minutes.
Non-reactive tests: insufficient acceleration.
Biophysical profile testing is another option

Hemodilution of Pregnancy/Normal CBC

Decreased hematocrit and hemoglobin
Increased white blood cells
Increased fibrinogen

High Risk Antepartum

PIH (Preeclampsia): Patient safety is priority. Insulin requirements may increase as pregnancy progresses. Diabetes complications include stillbirth, macrosomia, shoulder dystocia, and hypoglycemia. A good blood glucose level range is 45-60.
Diabetes: Patient safety is priority. Insulin needs may decrease initially and increase as pregnancy proceeds. How well the mother manages blood glucose directly impacts the baby.
Hyperemesis: Excessive vomiting that continues past the first trimester. Serious situations necessitate immediate care. Adequate fluids and frequent, small meals are crucial.
PTL and Betamethasone: Preterm labor that occurs between 20 and 37 weeks gestation. It is a concern. Betamethasone promotes lung maturity in a premature fetus and is administered through an injection to the mother.

Placenta Previa

Painless bleeding, bright red blood.
Soft abdomen.

V/S changes, Hypotension

Predisposing factors- surgical procedures of uterus, multiparity, older age
Diagnosed via ultrasound
Cautions: NO vaginal exams or pitocin
Intervention: C-Section

Placental abruption

Sudden, painful dark red bleeding, board-like abdomen.
Vital signs (V/S) changes, hypotension
Predisposing factors include trauma, hypertension, substance abuse (cocaine),
External or internal hemorrhage
Uterine irritability
Management: bed rest, monitor fetal heart rate (FHR), assess blood loss, prepare for cesarean section (C-section).

Rh/ABO incompatibility

RH antibodies are created in response to an Rh+ fetus.
Rhogam stops maternal antibody production and reduces complications. It is usually administered at 28 weeks for RH- women and within 72 hours after birth.
It can also be given for trauma, spontaneous abortion, and amniocentesis.

Infections, GBS/TORCH

Group B Streptococcus (GBS) is treated with antibiotics during labor when concerns arise.
GBS can cause imbalances or low body temperatures if infection is present

Magnesium Toxicity

Lethargy
Decreased blood pressure
Absent deep tendon reflexes (DTR)
Slowed respiration
Antidote is calcium gluconate

Intrapartum

VEAL CHOP: A mnemonic device for recognizing fetal heart rate patterns associated with cord compression, head compression, accelerations and placental insufficiency.
Nursing actions for various conditions in labor.

High risk intrapartum

Prolapsed cord - baby is high and not engaged, small baby, breech presentation, transverse lie Intervention - Put trendelenburg, push presenting part upwards relieving pressure off cord, Prepare for rapid delivery

Shoulder dystocia - shoulders are stuck, macrosomic babies are at risk. Do neonatal assessment of arms and clavicle.

Postpartum

Fundal assessment/priority nursing actions:
Fundus should be firm, round, and midline
Boggy = bleeding
Involution: reduction of fundus to pre-pregnancy fundus
Lochia rubra, serosa, alba
After-pains = uterine contractility. Pitocin and breastfeeding can assist with this issue. Administer NSAIDS as appropriate.
Pitocin use: Promotes uterine contraction, control postpartum bleeding.
Postpartum assessment: Evaluate postpartum recovery.

Breastfeeding Issues

500ml of vaginal blood loss following a vaginal delivery or >1000ml following a C-section is considered a hemorrhage.
Postpartum complications include uterine atony, tissue trauma, infection, and blood clots.
4 T's: Tone, Tissue, Trauma, Thrombin
Postpartum infections include endometritis and mastitis

Newborn

Maternal role adaptation
Thermoregulation, maintenance of baby's body temperature, keep baby dry and warm.
Thermogenesis: physiological mechanism for heat production ie. using brown fat
Preventing cold stress: ensure adequate heat.

Macrosomic Infant

Large size baby
Tremors
Hypoglycemia
Jittery respiratory distress
Excessive levels of bilirubin
Jaundice, lethargy, poor feeding, vomiting, bulging fontanelles

Discharge instructions:

Concerns (inconsolable crying, lethargy, poor feeding)
Note normal vital signs (temperature, heart rate)

Cephalohematoma/Caput

Caput: Soft enlargement of edema on fetal head, caused by pressure against cervix; usually resolves after days or weeks.
Cephalohematoma: Bleeding between skull periosteum and skull (does not cross suture lines) may last weeks.

Family Planning

Tubal ligation (permanent method).

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Description

This quiz covers essential guidelines for weight gain during pregnancy, identifying danger signs, and understanding fetal assessments like the Non-Stress Test. It helps participants learn the recommended weight gain based on pre-pregnancy BMI and recognizes red flags in pregnancy health.