Antepartum and Pregnancy Guidelines

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).