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What is prenatal care?
this is a late 20th-century innovation aimed at reducing maternal and fetal/infant
morbidity and mortality
What are the 3 traditional components of prenatal care (4)?
1. the initial visit
2. subsequent visits at every 4-week intervals
3. visits every 2 weeks from 28-36 weeks
4. visits every week after 36 weeks
What takes place during the initial visit for prenatal care (6)?
1. patient medical history including prescriptions, OTC, and any other medications or
drug use
2. determination of due date
3. discussion of fetal screening and testing options
4. promotion of flu vaccine
5. initial pregnancy lab panel
6. education and anticipatory guidance
What takes place at the subsequent visits every 4 weeks before the 28 weeks of
pregnancy for prenatal care (7)?
1. maternal vital signs and weight
2. obtain interval history
3. maternal emotional state
4. assess fundal height and FHR
5. inquire as to fetal movement (16-20 weeks)
6. 24-28 week visit, GDM testing and also VDRL/RPR (syphilis)
7. promote Tdap vaccination
What takes place at every two-week visit from 28-36 and every weekly visit after
36 weeks for prenatal care (3)?
1. determine presenting part no later than week 36
2. GBS culture; Hgb at the 36-week visit
3. review danger signs; provide and reinforce labor instructions
When does the fetal stage of development begin?
this begins at the end of the 8th week of gestation
What mile stone is hit during the 8-12 weeks of gestation?
the fetal heart rate can be auscultated per fetal doppler
What milestones occur by the 20th week of gestation (2)?
1. the FHR can be heard per fetoscope
2. biological mother feels fetal movement
What is important about the 23rd week of gestation?
at this point the fetus is medically viable
What is characteristic of the 24th week of gestation?
, 1. very early preterm
2. fetal respiratory movements
3. vernix caseosa present
What is characteristic of the 28th week of gestation (2)?
1. early preterm
2. fetus can breathe
What is characteristic of 32-weeks gestation?
the fetus starts to accumulate subcutaneous fat
What is characteristic of weeks 34-36 weeks gestation (3)?
1. late preterm
2. most fetuses can breathe and maintain body temperature without undue difficulty
3. the fetus assumes the final birth presentation
What is term gestation?
38-40 weeks gestation
What are the major components of the initial antepartum risk assessment?
1. social and personal
2. obstetrical
3. preexisting medical conditions
4. current risks
-be sure to use the EPDS or the PHQ-9
What are the subjective signs of pregnancy during the first trimester (6)?
1. absence of menses
2. extreme fatigue
3. urinary frequency
4. breast tenderness
5. food aversions
6. N/V
What ais the subjective sign of pregnancy during the second trimester?
fetal movement
What is human chorionic gonadotropin (hCG)?
Hormone produced by women shortly after conception-present so the body can sustain
pregnancy. Home pregnancy tests detect this.
-this hormone stimulates estrogen and progesterone production and measurable levels
double every 48 hours in early pregnancy
What is human placental lactogen (hPL)?
this hormone decreases maternal glucose metabolism to favor fetal growth
What is the role of estrogen during pregnancy?
this hormone stimulates uterine development and assists in the development of the
breasts ductile system in anticipation of lactation
What is the role of progesterone during pregnancy?
this hormone plays a key role in maintaining pregnancy by maintaining endometrium
and inhibits uterine contractility preventing early spontaneous abortion (SAB); also helps
develop breast lobules for lactation
What is the role of relaxin during pregnancy?
this is secreted by the placenta and decidua and inhibits uterine contractility and assists
in the softening of the cervix