1. THE ANTEPARTAL PERIOD BY: Zosi Farah w. Fernandez, RN

3. Responsible for expulsion of the fetus during childbirth from the strong muscle contractions as well as menstruation

4. Fundal height a. At the level of the sypmphysis at 12-14 weeks b. Rises at 1 cm/week until 36 weeks of gestation c. At the level of umbilicus at 20 weeks

7. Functions include out passage for menstrual flow from the endometrium of the uterus, the female organ for intercourse, and a passageway for vaginal childbirth

9. Structures include the mons pubis, labia majora, labia minora, prepuce, frenulum, fourchette, clitoris and vestibulee. Ovaries Photograph of the vulva. 1. Pubic hair (shaved), 2.Clitoral hood, 3. Clitoris, 4. Labia majora, 5. Labia minora (enclosing the Vaginal Opening), 6. Perineum.

13. One vein

14. Wharton’s jelly

16. Blood volume increases 30-50% during pregnancyk. Gastrointestinal system - Constipation and gastroesophageal reflux

18. Tidal volume and minute ventilation increase until the third trimester when the large uterus may impede lung expansion

20. Plasma volume increase is greater, resulting in physiologic anemia of pregnancy

22. Chloasma

23. Linea nigra

25. Striaegravidarum

26. r. Fetal development Fertilization Implantation Placental development Developmental landmarks a. Fetal heart tones b. Quickening 5. Infants at genetic risk of abnormalities a. African American: sickle cell disease b. Jewish ethnicity of Northern European descent: Tay-sachs disease c. Mediterranean: Thalassemia d. Family history of hereditary condition such as cystiic fibrosis or cleft lip palate e. Born to a woman of advanced maternal age f. Parents are closely related blood relatives

28. Characteristics: Low-set ears, large fat pads at the nape of a short neck, protruding tongue, small mouth and high palate, epicanthal folds and slanted eyes, small rounded head with flattened occiput, hypotonic muscle with hypermonility of joints, simian crease across the palm of hand and mental retardation

30. Small stature

32. e. Inborn errors of metabolism Phenylketonuria (PKU) Tay-sachs disease Cystic fibrosis Congenital adrenal hyperplasia Congenital hypothyroidism

33. Assessment Prenatal care Assessment of positive pregnancy

35. b.4 24-28 weeks of gestation: 1 hour glucose tolerance test, cervical exam, begin education and treatment if diabetic, and review preterm birth prevention and warning signs b.5 every 2 weeks from 28 to 36 weeks of gestation b.6 28-36 weeks of gestation: CBC, blood group antibody screen if Rh negative, give Rh immune globulin; cervical examination, follow up with a dietician if diabetic, breast assessment and education preparation for breastfeeding, review of warning sign, and begin parenting class b.7 35-37 weeks of gestation: Vaginal and rectal group B beta strep culture b.8 weekly visits from 36 weeks of gestation until delivery b.9 36-40 weeks of gestation: CBC, repeat gonorrhea, chlamydia, RPR,HIV, hepatitis B screen if indicated, educate about sign of labor and begin childbirth preparation

36. Assessment of psychosocial aspect of pregnancy Economic status Marital status Age Perceived support Self-esteem Culture Religion and importance of faith beliefs Stability of living condition Assess mood i.1 ambivalence i.2 Increased sensitivity and irritability i.3 sense of vulnerability i.4 fear

37. j. Assess developmental task of pregnancy 1. Pregnancy validation 2. Fetal embodiment 3. Fetal distinction 4. role transition

38. B. Assessment of High-Risk Pregnancy Health history Social history Problems with pregnancy Physical exam Inspection Auscultation Palpitation Vital signs

40. Amniotic fluid will turn Nitrazine paper blue because of the alkaline pH

41. Free flow of fluid may be seen coming through the cervix when the clients is asked to cough or perform a valsalva maneuverPreprocedure: Client is assisted into the lithotomy position Gather supplies

46. 3-hour GTT: 100 grams of glucose is given to the client to drink in a liquid form in 5 minutes; fasting is now required for 12 hours before the test as well as for 3 hours after, serum glucose levels are evaluated at 1,2, and 3 hours after drinking the glucose solutionPreprocedure: Obtain the glucose solution and arrange for the blood draw on schedule

54. Normal pregnancy 40 lunar weeks gestation Term pregnancy is from the beginning of the 38th weeks until the completion of 42 weeks. Normal concerns of pregnancy Nausea and vomiting Breast tenderness Urinary frequency Constipation and hemorrhoids Light headedness or dizziness Leg cramps Fatigue Heartburn Backaches Emotional reactions Sexuality and intimacy

56. Risk factors for PTL:

57. African-American race

58. Young or advanced maternal age

59. Low socioeconomic status

60. History of previous PTB

61. Multiple pregnancy losses or abortion

62. Uterine or cervical anomalies

63. Infection

64. Incompetent cervix

65. Bleeding during pregnancy

66. Multiple pregnancy

67. PROM

72. Evaluate cervical changes through a digital rectal exam or vaginal sonogram

74. Medical-surgical management Prophhylactic antibiotic Antenatal glucocorticoids Induction of labor Emergency CS Close observation for complication Nursing intervention Medicate as prescribe Encourage bed rest Encourage hydration Monitor maternal vital sign Monitor intake and output Provide comfort measures and support Encourage side-lying position Assess for contraction Palpate the abdomen and uterus for tenderness Ask the client about pain Monitor FHR pattern

76. Maternal complication include increased risk for the mother developing DM later in life if GDM and fetal complications include risk to pregnancy such as macrosomia, stillbirth, organ malformation,pre-eclampsia, and increased chance of operative deliveryDiagnostic test OGTT Screen at first prenatal if client has any risk Nursing intervention Provide the client with an appropriate diet Instruct the nature of disease Encourage hydration Encourage side-lying Blood glucose reading Administer insulin Encourage the client to monitor fetal movement Ask about risk factors

78. Associated causes and risk include cocaine, trauma, sudden decompression of the uterine cavity as in PROM, maternal hypertension, cigarette smoking, advanced maternal age and multiparityAssessment Severe abdominal pain Painful hard abdomen Fetal distress Diagnostic test D-dimer and fibrinogen Ultrasound Nursing intervention Monitor vital sign Assess fetal status with EFM Assess the clients blood type and Rh factors, gestational age, amount of bleeding, painful or painless bleeding, and presence of other medical conditions

79. d. Obtain IV access e. Prepare for emergency CS f. Administer IV fluids bolus or blood transfusion as ordered g. Provide lab specimen h. Provide emotional support to the client and family Clarify question s to help differentiate between previa and abruption; labor contraction j. Avoid performing a vaginal exam k. Palpate the abdomen for hard, board like texture l. Estimate blood loss

83. May progress into HELLP syndrome with liver involvement and platelet destruction, which life is threatening, or seizure from cerebral edema

85. Visual changes

86. Right upper quadrant pain

87. Epigastric pain

90. Criteria for the disorder are met with 5% weight loss along with dehydration, electrolyte imbalance, ketosis, and acetanuria

91. Risk factors include young maternal age, obese, nonsmoker, multifetal pregnancy and molar pregnancy

92. Maternal complication include decreased maternal weight gain and electrolyte imbalance, and fetal complications include decreased fetal weight with an increased mortality rateNursing intervention Provide small, frequent meals, as tolerated, after an intial period of NPO Administer IV hydration Monitor intake and output Administer antiemetics as ordered Provide parenteral nutrition via central line Monitor daily weight

94. Most common complication is heart failure

95. The prognosis for the pregnancy and plan of care depend on the degree of cardiac compromiseAssessment Edema Poor oxygenation Tachycardia, murmurs, chest pain, and irregular pulse Nursing Intervention Monitor the client for sign of cardiac overload throughout pregnancy Evaluate fetal well-being Instruct the client as follow: avoid excessive weight gain and emotional stress, report any sign of infection promptly and avoid anemia with adequate nutrition and supplement Avoid anemia Administer prophylactic antibiotic Administer prescribe diuretic Treat dysrhythmias and use cardiac glycosides

98. Antiretroviral drugs that control replication of the virus are given to the clientAssessment Flu-like syndrome Night sweats Chronic diarrhea Recurrent headaches External fatigue Oral hairy leukoplakia Diagnostic test ELISA Western blot

99. Nursing intervention: Maintain a nonjudmental attitude Offer emotional support and counselling as needed Monitor the client for presence of infection Implement universal precaution Instruct the client about the need for antiretroviral medications Prepare the client for the need to formula feed the infant Monitor for fetal well-being Evaluate for other sexually transmitted diseases and hepatitis B Monitor the progress of vital status or disease state with lab test

101. Risk factors include tubal sugery leading to scarring and narrowing, infections in the tubes, pelvic inflammation disease (PID) and IUD contraceptive deviceAssessment Vaginal bleeding Abdominal pain Hypotension Diagnostic Test B-hCG Ultrasound Nursing Intervention Monitor for sign of hemodynamic instability and shock Start an 18 gauge IV, have oxygen available and prepare the client for surgery Allow the client and her family Administer RhoGAM for appropriate client

103. It can develop into choriocarcinoma or into malignant trophoblastic diseaseAssessment Will have positive pregnancy clinical manifestation but abnormal lab values Excessive nausea and vomiting Ultrasound has classic “snowstorm” pattern May have vaginal bleeding or pass parts of the mole Diagnostic test B-hCG and alpha-fetoprotein Ultrasound Nursing Intervention Assess client with very high B-hCG level Assist with the evacuation of the mole Assist the evacuation of the mole Allow the client and family to grieve Administer RhoGAM for appropriate client Instruct client on the importance of follow-up in the next year Instruct the client on contraception for the next year