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G Number of pregnancies
T Number of term deliveries
P Number of preterm deliveries
A Number of abortions
L Number of living children
Para Number of pregnancies that have ended at 20 weeks, regardless if infant was born alive or still born
Antepartum Visit • Complete history including OB
- Physical examination
- Potential risks
- Baseline data/Labs
- Plan of care
Nagele's rule 1st day of last period + 7 days - 3 months
PreSumptive (Subjective) Signs of Pregnancy • Amenorrhea
- Nausea & vomiting
- Fatigue
- Urinary frequency
- Breast & skin changes
- Fetal movement
PrObable (Objective) Signs of Pregnancy • Abdominal enlargement
- Cervical softening
- Uterine changes
- Pregnancy tests
Probable Signs of Pregnancy • Hegar's sign: Softening of the cervix and uterine isthumus (6-8 weeks)
- Goodell's sign: softening of the cervix ,uterus, and vagina during pregnancy. (4- weeks)
- Ballottement: dropping and rebounding of the fetus in its surrounding amniotic fluid in response to a sudden tap on the uterus
- Positive pregnancy test
- Braxton Hicks contractions (false labor) more frequently felt after 28 weeks. They usually disappear with walking or exercise.
Positive Signs of Pregnancy (Diagnostic) 1. Auscultation of Heart tones
- Fetal movement felt by examiner 3 .Visualization of fetus
Early Pregnancy Lab Testing • Blood typing
- Rh factor
- CBC
- H&H
- VDRL (Venereal Disease Laboratory) or RPR (Rapid plasma reagin)
- Rubella titer
- TB test
- HIV
- Hepatitis B
- Genetic testing (if at risk)
- Urinalysis
- Pap smear
- Multiple Marker Screen (Quad)
- GBS culture
- Glucose Challenge (GDM)
Ultrasound • Used during pregnancy to determine a variety of fetal and placental conditions
- Presence & location of pregnancy
- Multifetal gestation
- Gestational age
- Viability confirmation
- Aids in the performance of other tests, such as amniocentesis
- Doppler ultrasound blood flow assessment
Nuchal Fold Translucency
Cell-free Fetal DNA (cffDNA) • Targeted sequencing of chromosomes 18 and 21
- Highly accurate
- Expected to identify 98% of cases of T21 with a false-positive rate of <0.5%
Pregnancy WBC 6,000-16,
Pregnancy Platelets 10% down during pregnancy
Pregnancy Alkalince Phosphatase Up to 400
Pregnancy Creatinine <0.84 mg/dL
Pregnancy AST/ALT < 30
Vena Cava Syndrome (Supine Hypotensive Syndrome) • Never allow a pregnant patient to be supine
Danger Signs During Pregnancy • Vaginal bleeding, with or without discomfort
- Rupture of membranes prematurely
- Swelling of fingers, puffiness of face or around eyes
- Continuous, pounding headache
- Visual disturbances (blurred vision, dimness, spots)
- Persistent or severe abdominal pain
- Chills or fever
- Painful urination. Frequency?
- Persistent vomiting
- Changes in frequency or strength of fetal movements
- Signs of preterm labor: uterine contractions, cramps, constant or irregular low backache, pelvic pressure
Gestational Diabetes • All pregnant women are screened for gestational diabetes (GDM)
- Usually at 28 weeks. |50-g oral glucose challenge test.
- Positive screen is a level >130-140mg/dL. Client will then undergo a 3 hour diagnostic oral glucose tolerance test.
- Gestational diabetes is responsible for two major complications in the fetus: Macrosomia & Hypoglycemia
Maternal Effects of Gestational Diabetes • Urinary tract infection
- Hydramnios
- Premature rupture of membranes
- Preeclampsia
Risk Factors for Gestational Diabetes • Overweight or obesity (BMI >25)
- Maternal age older than 25 years
- Previous birth outcome associated with gestational diabetes
- Gestational diabetes in previous pregnancy
- History of abnormal glucose tolerance level
- History of diabetes in close relative
- Member of high-risk ethnic group
Group B Strep Group B strep is a bacterial infection found in the lower GI tract and urogenital tract of 10-40% of women
Indications fo Intrapartum Antibiotic Prophylaxis (IAP) • Previous infant with invasive GBS (Group B Strep) disease
- GBS bacteriuria during any trimester of the current pregnancy
- Positive GBS screening test in late gestation during current pregnancy (unless a planned cesarean delivery, in the absence of labor or amniotic membrane rupture)
- Unknown GBS status AND any of the following:
- Delivery at <37 weeks' gestation
- Amniotic membrane rupture >18 hours
- Intrapartum temperature >100.4°F (>38.0 °C)
Antepartum Fetal Surveillance • NonStress test (NST)
- NST evaluates fetal heart rate (FHR) accelerations, with or without fetal movement.
- FHR reactivity with accelerations is a reassuring sign (good).
- Reactivity is associated with adequate fetal oxygenation and intact neural pathways.
- FHR reactivity may not develop until 32 weeks in the fetus.
- Contractions Stress Test (CST): Used to determine how the fetal heart responds to uterine contractions that temporarily decrease placental blood flow. Cannot be done if stimulated uterine contractions are contraindicated
Biophysical Profile BPP provides information on five parameters:
- NST
- Fetal breathing movements
- Gross fetal movements
- Fetal tone
- Amniotic fluid volume
- The amniotic fluid index (AFI) is a method to quantify the amount of amniotic fluid visualized by ultrasound.
Biophysical Profile Score Normal: 8- Equivocal: 6 Abnormal: <
Hyperemesis Gravidarum • Persistent, uncontrollable vomiting that begins in the first weeks of pregnancy and may continue throughout
Management:
- Prevent dehydration and electrolyte imbalance
- Prevent malnutrition
- Reduce nausea & vomiting
- Emotional support
Gestational Trophoblastic Disease A spectrum of diseases that includes:
- Benign hydatidiform mole
- Gestational trophoblastic tumors
- Management
- Evacuation of molar pregnancy
- Regular follow-up for 1 year to detect malignant changes
