Care of women during normal pregnancy

Prenatal care

Optimize health of women


any substances that pass from mother to unborn child and impair development-Exposure during the embryonic stage (weeks 3-8) is most likely to cause major structural abnormalitiesIngested, infectious, and environmental agents

Risk factors for adverse outcomes during pregnancy

Medications AccutaneAlcohol Anti-epileptic Diabetes Folic acid deficiency


the state of being pregnant


pregnant woman, number of pregnancies


number of deliveries at 20 weeks or greater


a woman who has never been pregnant


First pregnancy


woman who has been pregnant more than once

GTPAL system

G = gravidity (# of times pregnant)T = term (38-42 weeks)P = preterm birth (20-37 weeks)A = abortion (< 20 weeks)L = living children

Lab test for pregnancy

Serum pregnancy testCbc Blood type and antibodies HIV Hep B STIRubella titer Urine screen Pap Smear Glucose screening

estimated due date

calculation from LMP, can be done with obstetrical wheel, with a calculator or using Naegele's rule gestional wheel, ultrasound most accurate

Naegele's Rule

add 7 days to LMP, subtract 3 months, add 1 year

Prenatal visits

*Every 4 wks for first 28-32 weeks' gestation*Every 2 wks from 32 to 36 weeks' gestation*Every wk for 36 to 40 weeks

Screening during pregnancy

Maternal alphafetoprotein (MSAFP) 15-20wks Gestational diabetes 24-28wks Rh- women screened for antibodies (RhoGam) if indicated Group B streptococcus 35-37wks

Fetal kick counts

Record daily; count 2-3 times a day for 60 min each time Fetal movements of less than 3 in/hr or movements that cease entirely for 12 hr indicate a need for further eval (usual 10x in 2hrs)

Ultrasound during pregnancy

Assess gestational age, observe fetus, diagnosis complications, can be visualized at 6wks with transvaginal.

transabdominal ultrasound

Requires a full bladder, encourage fluids prior to exam and have client abstain from voiding prior to procedure. More common in 2nd and 3rd trimesters.

transvanginal ultrasound

Specialized prob, clearer image, used early in pregnancy

Alpha-fetoprotein (AFP)

a fetal protein that may be elevated in amniotic fluid and maternal serum in cases of certain fetal disorders

AFP screens for

Liver cancer, chromosomal abnormalities, defects in abdominal wall of fetus,Neural tube defect (high levels)Down syndrome (low levels)

triple marker test

- Performed at 15-18 weeks and is combined with maternal age to calculate risk factor- Combines information from AFP; estriol, and HcG levels- High AFP levels neural tube defects, anencephaly,mistaken dates-Low AFP and estriol and High HCG -trisomy 21 (downs), trisomy 18 (Edwards) or any other chromosome abnormalities.

Aminocentesis Procedure

a process where a long needle is put into the fluid around a developing baby to see if the baby will have any genetic disorders


Preformed at 15-20wks Risk of spontaneous abortion or injury to fetus, infection

chorionic villus sampling

sampling of placental tissue for microscopic and chemical examination to detect fetal abnormalities 8-12wks

Iithotomy position


Indications for CVS

Advanced maternal agePrevious children with chromosomal abnormalities History of recurrent pregnancy lossFetal anomaly noted on usAbnormal AFP triple-screen marker History of children with neural tube defects Both parents carriers of a recessive genetic trait

Non-stress test (NST)

noninvasive test to evaluate response of FHR to stress of fetal movement; response will be reflected on fetal monitor; mother will push button when she feels movement; after 28 wks; 2 or more FHR accelerations of 15 bpm lasting 15 seconds.

Danger signs of pregnancy

Fever or severe vomiting Headache unrelieved by Tylenol Blurred vision or spots before the eyes Pain in epigastric region Sudden weight gain or sudden onset of edema in hands or face Vaginal bleeding Painful urination Sudden gush of fluid of uncontrolled leaking from vaginaDecreased fetal movement

signs of preterm labor

- Painful menstrual-like cramps- Dull low backache- Pelvic pressure or heaviness- Diarrhea- Uterine contractions felt every 10 minutes for 1 hour- Leaking of water from vagina