Pregnancy Care and Assessment

Prophylactic Anti-D

• Women who are Rh-negative should receive Anti-D immunoglobulin at 28 and 34 weeks gestation and within 72 hours after birth if the baby is Rh-positive to prevent sensitization.

Urine Assessment

• Urine screening tests include checking for protein, glucose, ketones, and signs of infection.
• Urinalysis helps detect conditions like gestational diabetes, preeclampsia, and urinary tract infections.
• Urine tests screen for proteinuria (preeclampsia), glucosuria (gestational diabetes), and bacteriuria (UTIs).

Abdominal Assessment

• Aims of abdominal assessment: to assess fetal growth and well-being, and to determine the position and presentation of the fetus.
• Indications for palpation: routine antenatal check-ups, assessing fetal position, and estimating fetal size.
• Contraindications for palpation: preterm labor, placental abruption, or conditions where abdominal manipulation may cause harm.
• Inspecting the abdomen: look for size, shape, fetal movements, and any abnormalities such as scars or skin changes.
• Palpating the abdomen: feel for fetal position, presentation, and engagement, as well as uterine tone and tenderness.
• Auscultating the fetal heart: the best place is usually over the fetal back, often in the lower quadrant of the maternal abdomen.
• Normal fetal heart rate range: 110-160 beats per minute.
• Documenting abdominal assessment: record fetal position, presentation, engagement, estimated fetal size, fetal heart rate, and any abnormalities.

Terms Explained

• Lie: the relation of the long axis of the fetus to the long axis of the mother (e.g., longitudinal, transverse).

Placenta Examination

• Steps involved: inspect for completeness, check the umbilical cord, and examine maternal and fetal surfaces.
• Cord insertion types: central, eccentric, battledore, and velamentous.
• Normal mean diameter: approximately 22 cm.
• Fetal surface covering: covered by the amnion.
• Umbilical cord blood vessels: two arteries and one vein.
• Amniotic sac membranes: two membranes: the amnion and the chorion.
• Cotyledons: 15-20 cotyledons on the maternal surface.

Incomplete Placenta Implications

• Implications: postpartum hemorrhage, infection, and retained placenta necessitating surgical intervention.

Normal Blood Loss Post-Birth

• Normal range: up to 500 mL for vaginal delivery and 1000 mL for cesarean section.
• Timing for calculation: blood loss is calculated immediately after delivery and documented in the maternal records.

Benefits of Skin-to-Skin Contact

• Benefits: regulates baby's temperature, promotes bonding and breastfeeding, and stabilizes baby's heart rate and breathing.

APGAR Scoring

• APGAR acronym: appearance, pulse, grimace, activity, and respiratory effort.
• APGAR scoring: heart rate, respiratory effort, muscle tone, grimace, and color.

Water Birth APGAR Assessment

• Fetal contribution: the maturing fetal adrenal glands produce hormones that stimulate placental production of estrogens and prostaglandins, contributing to labor onset.

Assessment of Contractions

• Contraction aspects: duration, intensity, and frequency.
• Definitions of contraction strength: mild, moderate, and strong.

Vaginal Examination

• Indications: assess labor progress, determine cervical dilation and effacement, and evaluate fetal position and station.
• Contraindications: placenta previa, active vaginal bleeding with an unknown source, and premature rupture of membranes without labor.
• Information obtained: cervical dilation, effacement, fetal position, station, and membrane status.

Intermittent Auscultation and Fetal Heart Rate

• Intermittent auscultation: periodic listening to the fetal heart rate during labor to assess fetal well-being.
• Auscultation duration and normal range: listen for at least one full minute, ideally during and after a contraction, with a normal range of 110-160 beats per minute.

Questions for Assessing Hospital Admission

• Questions to ask: are you experiencing regular contractions? How far apart are they? Have your waters broken? Are you experiencing any vaginal bleeding? How is your baby's movement pattern?

Normal Maternal Observations

• Normal range for maternal observations: blood pressure (90/60 to 120/80 mmHg), pulse (60-100 beats per minute).