Antepartum care.docx

**Antepartum care:** - First prenatal visit at 6-8 weeks for low risk want to do risk assessment, health promotion, medical and psychosocial - Chronic medical issues, past pregnancies, gyn, genetic screening, social history - Estimated date of delivery: 40 weeks past LMP if regular...

**Antepartum care:** - First prenatal visit at 6-8 weeks for low risk want to do risk assessment, health promotion, medical and psychosocial - Chronic medical issues, past pregnancies, gyn, genetic screening, social history - Estimated date of delivery: 40 weeks past LMP if regular 28 day cycles - Each visit will do weight, blood pressure, fetal measurement - Diabetes screening, oral glucose test between 24-28 weeks, for obese women the diabetes screening will occur at initial visit. - Can hear HR at 12 weeks - Fetal survey ultrasound at 18-24 weeks - Nonstress test monitors fetal heart rate, patterns and accelerations for at least 20 minutes - Maternal kick counts; 5 movements in 1 hour or 10 movements in 2 hours - Fundal height measurement - Amniotic fluid volume - Respiratory system is the last system to develop in fetus - Folic acid: 0.4 mg daily; neurotube defect do 4 grams daily - Prepreg BMI \29 gain 11-20 lbs - Cannot drink cold lunch meat, unpasteurized milk and cheese - Can exercise and have sex, can travel up to 36 weeks but walk every 1-2 hours - Avoid ACE inhibitors, coumadin, retinols - Remember shared decision making with the patient, lots of education Care of the Pregnant Individual Antepartum Care: Initial Prenatal visit done around 10 weeks History: similar to the preconception history - Medications including herbs and supplements - Allergies - Medical/surgical/mental health - Reproductive - Health maintenance - Psychosocial - Family include genetic Physical Exam: - Full head to toe exam - Height and weight to calculate BMI - Vital signs - HEENT pay attention to dental and thyroid - Cardiovascular - Respiratory - Abdomen - M/S - Neuro - Gyn - Initial prenatal visit is around 10 weeks; similar history and physical like done in the preconception history Initial Prenatal Visit-Lab tests - Bloodwork: CBC w/diff, ABO blood group and Rh type, Antibody screen, RPR/VRDL, HIV, Hepatitis B surface AG, Rubella antibody (IgG), HCV Ab - Urine: UA, UC, Chlamydia and gonorrhea Additional tests based on history: - Diabetes screening (A1C, fasting or random blood glucose) for BMI over 25 plus one of these: prediabetes, hx of GDM, 1^st^ degree relative with DM, high-risk race/ethnicity, history of CVD, HTN, low HDL and/or elevated triglycerides (\>250), physical inactivity, PCOS - TSH: personal or family history or signs/symptoms of thyroid disorders; type 1 DM - Genetic screening: hemoglobin electrophoresis; cystic fibrosis carrier testing - Cervical cancer screening: Pap or hrHPV if due - Tuberculosis screening (high risk) - Varicella immunity (varicella IgG) without documentation of vaccine or known history of disease - Ultrasound: size/date discrepancy, unable to auscultate fetal heart rate, concern for ectopic Dating the Pregnancy: need to know the patient's LMP Uterine size: - Nonpregnant/5 weeks: small, unripe pear - 6 weeks: small orange - 8 weeks: large orange - 12 weeks: grapefruit Naegel's rule: add 7 days to the 1^st^ day of LMP, subtract 3 months, use the actual \# of days in a month when crossing over to another month i.e if LMP was 5/3/24 when is EDD? +7 = 5/10/24; 2/7/25? 5/14/24 **Ultrasound for Pregnancy Dating:** most accurate if done between 7-10 weeks accurate within 3 days 90% of the time **First Trimester Ultrasound:** gestational sac fetal cardiac activity fetal movement uterine abnormalities **Dating:** - Gestational sac dimensions - Crown-rump length - Biparietal diameter (head circumference at the widest part of the skull) - Femur length **Gravida and Para:** Gravidity: number of pregnancies (including the current one) Parity: number of births (both live born infants and stillbirths) of at least 20 weeks gestation, pregnancy loses (before 20 weeks), \*this is looking at the \# of deliveries not the \# of babies Term: 37 completed weeks Preterm: between 20-37 weeks Abortion: less than 20 weeks or 500 grams Living: number of living children - Education for Self-Care: Weight gain is based on BMI: - **\