Antepartum Care Overview

Antepartum Care

• Breast Changes: Size increases; pigmentation changes.
• Cardiac Output: Increases by 50%. Monitor for DVT and PE.
• Hematologic Changes: Hemodilution (increased plasma volume), increased fibrinogen (hypercoagulable state), slight decrease in hemoglobin and hematocrit.
• Supine Hypotensive Syndrome: Avoid lying flat to prevent vena cava compression. Turn to the left side.
• Gastrointestinal (GI) System: Slows down, increased risk of constipation.
• Endocrine System: Increased progesterone and relaxin cause muscle relaxation (watch for UTIs).
• Psychosocial: Normal ambivalence in early pregnancy.
• Danger Signs of Pregnancy ("BURNT HOT"):
  • Blurry vision (B)
  • Urinary pain or urgency (U)
  • Red vaginal bleeding (R)
  • Severe nausea/vomiting (N)
  • Temperature > 101°F (T)
  • Severe headaches (H)
  • Low urine output (O)
  • Trauma (T)
• Weight Gain Targets:
  • Normal BMI: 25-35 lbs
  • Overweight BMI: 15-25 lbs
  • Underweight BMI: 28-40 lbs
• Nutritional Requirements:
  • Increase protein by 10g/day
  • Folic acid: 400-800 mcg/day for neural tube development
  • Iron: 27 mg/day, best absorbed with Vitamin C
  • Calcium: 1000 mg/day for bone and tooth formation
  • Hydration: 2-3 L/day; avoid excessive caffeine (limit to 200-300 mg/day).
• Preeclampsia: High blood pressure with proteinuria after 20 weeks.

Intrapartum Care

• VEAL CHOP:

  • V: Variable decelerations - Cord compression - Reposition
  • E: Early decelerations - Head compression - OK
  • A: Accelerations - Oxygenated - OK
  • L: Late decelerations - Placental insufficiency - Stop pitocin, reposition, give oxygen

• Stages of Labor:

  • 1st Stage: Onset to 10 cm dilation (latent phase 0-6 cm, active phase 6-10 cm)
  • 2nd Stage: 10 cm to delivery
  • 3rd Stage: Delivery of placenta
  • 4th Stage: Recovery and stabilization

• Severe Signs- include vision changes, headaches, epigastric pain, hyperreflexia. Magnesium sulfate for seizure prevention if these are severe.

• HELLP Mnemonic: H: Hemolysis, EL: Elevated Liver Enzymes, LP: Low Platelets

• Gestational Diabetes:

  • Diagnosis: 1-hour glucose challenge test (>140 mg/dL); confirm with 3-hour test
  • Complications: Macrosomia, shoulder dystocia, neonatal hypoglycemia
  • Management: Diet, exercise, insulin if needed.
  • Monitoring: Blood glucose target 70-110 mg/dL

• Placenta Previa (P-CLUB) vs. Abruption (P-BAD):

  • Placenta Previa (P-CLUB): Painless bright red bleeding, c-section possible, low lying placenta.
  • Abruption (P-BAD): Painful dark red bleeding, board-like abdomen, sudden onset, decelerations (fetal distress).

Postpartum Care

• BUBBLEHE Assessment:
  • Breasts (engorgement, latch)
  • Uterus (firm, midline, fundal height)
  • Bladder (voiding issues, distension)
  • Bowel (constipation, hemorrhoids)
  • Lochia (rubra, serosa, alba)
  • Episiotomy (healing)
  • Homan's Sign (DVT check)
  • Emotions (bonding, baby blues)
• 4 T's of Postpartum Hemorrhage: Tone, Tissue, Trauma, Thrombin
• Lochia Stages:
  • Rubra: Days 1-3 (dark red)
  • Serosa: Days 4-10 (pink/brown)
  • Alba: Days 11-6 weeks (yellow/white)

Newborn Care

• Thermoregulation: Keep baby warm and dry to prevent cold stress.
• Signs of Cold Stress: Hypoglycemia, increased oxygen demand, decreased surfactant production.
• Interventions: Skin-to-skin contact, warm blankets/room.
• Newborn Reflexes: Moro, rooting, Babinski, palmar grasp

Breastfeeding Tips

• Feed often (8-12 times/day).
• Ensure proper latch.
• Relief for engorgement: warm or cold compresses.
• Signs of healthy feeding: 6-8 wet diapers/day, yellow stools.

Key Medications

• Magnesium Sulfate: Preeclampsia seizure prevention. Toxicity signs: blood pressure drop, urine output < 30 mL/hr, respirations < 12/min, absent patellar reflexes.
• Betamethasone: Promotes fetal lung maturity in preterm labor. Dosage: 12mg IM every 24 hrs for 2 doses.
• Oxytocin (Pitocin): Labor induction, postpartum hemorrhage control.

Practice Questions

• Client with painless, bloody discharge (34 weeks): Likely diagnosis is Placenta Previa
• Postpartum boggy, displaced uterus: Encourage the client to urinate
• Prolapsed umbilical cord: Reposition the client to relieve pressure.
• Fetal monitor showing late decelerations: Turn the client to the left side.
• Magnesium sulfate-low respiratory rate: Stop the infusion and administer oxygen.