Antepartum Care Overview

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Questions and Answers

What is the recommended weight gain target for an individual with a normal BMI during pregnancy?

  • 15-25 lbs
  • 28-40 lbs
  • 10-20 lbs
  • 25-35 lbs (correct)

What is the indicative blood pressure and symptom relationship for diagnosing preeclampsia?

  • High BP with normal urination
  • High BP with proteinuria after 20 weeks (correct)
  • Low BP with elevated liver enzymes
  • Normal BP with headaches and vision changes

Which of the following is NOT a danger sign of pregnancy as indicated by the mnemonic 'BURNT HOT'?

  • Red vaginal bleeding
  • Positive pregnancy test (correct)
  • Trauma
  • Oliguria

For optimal calcium intake during pregnancy, what is the daily requirement?

<p>1,000 mg (C)</p> Signup and view all the answers

Which nutrient's increase is essential for neural tube development during pregnancy?

<p>Folic Acid (A)</p> Signup and view all the answers

What should be the target blood glucose range for monitoring gestational diabetes?

<p>70-110 mg/dL (D)</p> Signup and view all the answers

Which symptom is commonly a result of increased progesterone during pregnancy?

<p>Constipation (D)</p> Signup and view all the answers

What is the best management action for a pregnant woman experiencing severe signs of preeclampsia?

<p>Deliver the baby if severe (B)</p> Signup and view all the answers

What is NOT a recommended limit for caffeine consumption during pregnancy?

<p>150 mg/day (D)</p> Signup and view all the answers

What is a significant cardiovascular change that occurs during pregnancy?

<p>Circulatory volume increases by 50% (C)</p> Signup and view all the answers

Which of the following best describes the characteristics of abruption?

<p>Painful dark red bleeding with a board-like abdomen (C)</p> Signup and view all the answers

What does the 'V' in VEAL CHOP represent?

<p>Variable decelerations (D)</p> Signup and view all the answers

Which stage of labor marks the transition from 0-6 cm dilation?

<p>Latent phase (A)</p> Signup and view all the answers

What is the primary intervention for a prolapsed cord?

<p>Knee-chest position and relieve pressure (A)</p> Signup and view all the answers

Which of the following is NOT one of the 4 T's of postpartum hemorrhage?

<p>Temperature (B)</p> Signup and view all the answers

Which lochia stage is characterized by a yellow/white discharge lasting from 11 days to 6 weeks postpartum?

<p>Alba (A)</p> Signup and view all the answers

What is a common sign of cold stress in newborns?

<p>Hypoglycemia (C)</p> Signup and view all the answers

Which newborn reflex is indicated when the baby's toes fan out when the sole is stroked?

<p>Babinski reflex (C)</p> Signup and view all the answers

What does the 'D' in the P-BAD mnemonic stand for in relation to abruption?

<p>Decelerations indicating fetal distress (B)</p> Signup and view all the answers

In postpartum assessment, what is the expected finding for the 'U' in BUBBLEHE?

<p>Firm, midline uterus (D)</p> Signup and view all the answers

Flashcards

Cardiac Changes in Pregnancy

Increased blood volume (by 50%) in pregnant women, leading to increased cardiac output. This is beneficial to the baby's development. However, it may also cause an increased risk of blood clots.

Preeclampsia

A condition where the pregnant woman's blood pressure goes up and protein is found in her urine after the 20th week of pregnancy.

HELLP syndrome

A condition related to preeclampsia, with a triad of hemolysis (destruction of red blood cells), elevated liver enzymes, and low platelet count. Leads to high blood pressure and protein in the urine.

Supine Hypotensive Syndrome

Blood pressure drops significantly when the pregnant woman lies flat on her back due to compression of the vena cava. This can reduce blood flow to the fetus.

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Gestational Diabetes Diagnosis

A one-hour glucose challenge test with a value greater than 140 mg/dL is a sign of possible gestational diabetes. This is then usually followed by a three-hour glucose tolerance test for confirmation.

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Placenta Previa

A condition where the placenta implants low in the uterus and partially or completely covers the cervix.

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Hormonal Effects on the Urinary System

The increased production of the hormones progesterone and relaxin leads to muscle relaxation throughout the body, including in the bladder. This can contribute to urinary tract infections.

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Fetal Heart Rate Decelerations

A condition in which the baby's heart rate drops or shows unusual patterns on the fetal heart rate monitor.

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Oliguria

A significant decrease in the amount of urine being produced, which could be a sign of dehydration, preeclampsia, or other complications.

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Shoulder Dystocia

A condition where the baby's head gets stuck in the mother's pelvis during delivery due to a large baby or small pelvic opening.

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Placental Abruption

A condition where the placenta detaches prematurely from the uterine wall, leading to painful bleeding that may resemble a board-like abdomen and fetal distress.

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Variable Decelerations

Variable decelerations in the fetal heart rate are often caused by cord compression, requiring immediate repositioning of the mother.

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Early Decelerations

Early decelerations in the fetal heart rate occur due to head compression during contractions. These are usually considered normal and require no intervention.

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Late Decelerations

Late decelerations in the fetal heart rate are a sign of placental insufficiency, requiring immediate intervention such as stopping pitocin, repositioning the mother, and administering oxygen.

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Prolapsed Cord

This condition occurs when the umbilical cord falls in front of the presenting part before the baby is born, causing potential obstruction of blood flow to the fetus, requiring immediate intervention.

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Uterine Rupture

A serious complication of labor characterized by a complete or partial tear in the uterine wall, often accompanied by sudden and severe abdominal pain, loss of fetal station, and absence of contractions, requiring immediate emergency C-section and supportive care.

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BUBBLEHE Assessment

A postpartum assessment consisting of evaluating: Breasts, Uterus, Bladder, Bowel, Lochia, Episiotomy, Homan's Sign, and Emotions.

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4 T's of Postpartum Hemorrhage

The four main causes of postpartum hemorrhage are: uterine atony, retained placental tissue, vaginal or cervical lacerations, and coagulation disorders.

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Study Notes

Antepartum Care

  • Breast Changes: Size increases, pigmentation changes
  • Cardiac Output: Increases by 50%. Watch for DVTs and PEs
  • Hematologic Changes: Hemodilution (increased plasma volume relative to RBCs), increased fibrinogen (hypercoagulable state), and slight decrease in hemoglobin and hematocrit.
  • Supine Hypotensive Syndrome: Avoid lying flat to prevent vena cava compression. Turn to the left side.
  • GI System: Slows, risk for constipation.
  • Endocrine: Increased progesterone and relaxin cause muscle relaxation (watch for UTIs).
  • Psychosocial: Normal ambivalence in early pregnancy

Key Mnemonics

  • "BURNT HOT": Danger signs of pregnancy
    • Blurry vision
    • Urinary pain/urgency
    • Red vaginal bleeding
    • Nausea/severe vomiting
    • Temperature > 101°F
    • Severe headaches
    • Low urine output
    • Trauma (falls, accidents)
  • Weight Gain Targets:
    • Normal BMI: 25-35 lbs
    • Overweight BMI: 15-25 lbs
    • Underweight BMI: 28-40 lbs

Nutritional Requirements

  • Protein: Increase by 10g/day.
  • Folic Acid: Essential for neural tube development (400-800 mcg/day)
  • Iron: Increase to 27 mg/day (best absorbed with Vitamin C)
  • Calcium: 1,000 mg/day (bone and tooth formation)
  • Hydration: 2-3 L/day; avoid excessive caffeine (limit to 200-300 mg/day)

Conditions

  • Preeclampsia: High BP with proteinuria after 20 weeks

Intrapartum Care

  • VEAL CHOP
    • Variable decelerations: Cord Compression → Reposition
    • Early decelerations: Head compression → OK
    • Accelerations: Oxygenated → OK
    • Late decelerations: Placental insufficiency → Stop Pitocin, reposition, give oxygen
  • Stages of Labor:
    • 1st Stage: Onset to 10 cm dilation (latent 0-6 cm, active 6-10 cm)
    • 2nd Stage: 10 cm to delivery
    • 3rd Stage: Delivery of placenta
    • 4th Stage: Recovery and stabilization

Postpartum Care

  • BUBBLEHE Assessment:
    • Breasts (engorgement, latch)
    • Uterus (firm, midline, fundal height)
    • Bladder (voiding issues, distension)
    • Bowel (constipation, hemorrhoids)
    • Lochia (rubra, serosa, alba)
    • Episiotomy (lacerations, healing)
    • Homan's Sign (DVT check)
    • Emotions (bonding, baby blues)
  • 4 T's of Postpartum Hemorrhage:
    • Tone: Uterine atony (boggy fundus)
    • Tissue: Retained placenta
    • Trauma: Lacerations, hematomas
    • Thrombin: Coagulopathy
  • 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
  • Signs of Cold Stress: Hypoglycemia, Increased oxygen demand, decreased surfactant production
  • Newborn Reflexes: Moro, Rooting, Babinski, Palmar Grasp
  • Breastfeeding Tips: Feed 8-12 times/day, proper latch, engorgement relief (warm/cold compress)

Key Medications

  • Magnesium Sulfate: Preeclampsia seizure prevention
    • Toxicity Signs (BURP): Blood pressure drop, Urine output <30 mL/hr, Respirations <12/min, Patellar reflexes absent
    • Antidote: Calcium gluconate
    • Monitoring: Continuous FHR monitoring, respiratory checks, DTR checks every 1-2 hours
  • Betamethasone: Promotes fetal lung maturity in preterm labor
    • Dose: 12 mg IM every 24 hours for 2 doses
  • Oxytocin (Pitocin): Labor induction, postpartum hemorrhage control

Emergencies

  • Prolapsed cord: Trendelenburg or knee-chest, relieve pressure, prepare for C-section
  • Shoulder dystocia: McRoberts maneuver, suprapubic pressure
  • Uterine rupture: Sudden, severe abdominal pain, loss of fetal station, no uterine contractions; Emergency C-section, supportive care

Practice Questions (Answers Provided)

  • Question 1: Painless, bright red vaginal bleeding at 34 weeks. Likely diagnosis? Answer: Placenta previa
  • Question 2: Postpartum client with boggy, displaced uterus. First action? Answer: Encourage the client to void.
  • Question 3: Prolapsed umbilical cord. Priority intervention? Answer: Reposition the client to relieve pressure on the cord.
  • Question 4: Late decelerations on fetal monitor. Priority action? Answer: Turn the client to the left side.
  • Question 5: Client receiving magnesium sulfate has a respiratory rate of 10 bpm. First action? Answer: Stop the infusion.

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