Eirene Grace Pilapil Bernalyn Montero CARE AND MANAGEMENT OF ANTEPARTAL WOMAN I.

Obstetric and Gynecologic History Antepartum Period refers to the nursing care given to the mother from fertilization to the beginning of true contractions. A. Personal Data 1. Name, Age, Address 2. Sex 3. Civil status 4. Religion 5. occupation 6. Education B. Diagnosis of pregnancy 1. Amenorrhea is usually the first sign of conception. Other symptoms include breast fullness and tenderness, skin changes, nausea, vomiting, urinary frequency, and fatigue. 2. Urine Pregnancy tests may be positive within days of the first missed menstruation. HCG is accurate up to a few days after implantation. a. HCG present at 40 100th day of pregnancy. b. HCG peaks at 60 70th day c. 6th week after LMP: best time to do the test. d. ELISA TEST done as early as 7-10 days e. RIA TEST can detect a beta sub_ unit of HCG as early as 8 days. 3. Fetal Heart Tones 120-160 beats per minute 4. Fetal Movement quickening are first felt by the mother at 18 20wks. 5. Ultrasound 6. Estimated Date of Delivery. C. Baseline Data 1. vital signs are crucial especially blood pressure. 2. Roll- over Test is performed to diagnose pre eclampsia using the blood pressure. D. Contraceptive History E. Gynecologic and Obstetric History 1. Gravidity is the total number of pregnancies. 2. Parity total number of viable pregnancies 3. Viability the ability of the fetus to live outside the uterus at the earliest possible gestational age: 20 24 weeks 4. GTPAL score 5. character and length of previous labors

6. type of delivery, complications, infant status, and birth weight are recorded. 7. assess prior cesarean sections and determine type of C section, and the reason it is performed. F. Medical and Surgical History - and also prior hospitalizations are documented. G. Medications and allergies H. Family history I. Social History J. Review of systems II. General Pre natal Care and Physical assessment A. Tetanus Immunizations - prevents tetanus neonatorum TT1 during pregnancies TT2 4 wks after TT1 TT3 6 months after TT2 TT4 1 year after TT3 TT5 1 year after TT4 B. Physical examinations C. Estimation of Gestational Age 1. Naegels Rule used to determine the EDD by determining the LMP of the mother. 2. Mc Donalds Rule used to determine the AOG Length of fundus in cm X 8/7 = AOG in weeks Length of fundus in cm X 2/7 = AOG in months 3. Bartholomews Rule to determine the AOG by fundic location. 3 months just above the symphysis pubis 4 months midway between symphysis pubis and umbilicus 5 months at the level of the umbilicus 9 months just below the xyphoid process 10 months level at 8 months due to lightening 4. Haases Rule to determine the length of the fetus in centimeter. (1 5 months) month squared (6 10 months) month x 5 D. Pelvic Examination Pap smear cytological exam to determine the presence of cancer cells. E. Leopolds Maneuver - done to determine the attitude, fetal presentation, lie, presenting part, degree of descent, estimate of fetal size, fetal back, FHT, number of fetuses in position (Leopolds 1,2,3,and 4) III. Antepartum Fetal Surveillance A. (DFMC) daily fetal movement counting -Also known as fetal kick count or Cardiff count to ten method a. fetus spends 10% of its time making gross movements

-Active fetal periods last 40 minutes -Inactive fetal periods last 20 minutes (< 75 minutes) b. fetal activity peaks with maternal Hypoglycemia -usually occurs between 9pm and 1 am Technique - mother self monitors kick counts daily at home - begin @ the same time each day - choose a time fetus is most reactive - consider performing after walking or exercising - lie on the left side in a comfortable position - count each fetal movement, noting how long it takes to count 10 fetal movements. Findings 10 12 movements in 1 hour or less than 1 hour. Warning signs: - more than 1 hour to reach fetal movement - less than 10 fetal movements in 12 hours - longer time to reach 10 fetal movements than on previous days. - movements are becoming weaker - < 3 fetal movements in 12 hours B. Non stress Test determines the response of the fetal heart rate to the stress of activity. Procedure: - done within 30 minutes wherein the mother is in semi fowlers position. - External monitors are applied to document fetal activity - Mother activates the mark button on the electronic monitor when she feels fetal movement. - Monitor until at least 2 fetal movements are detected in 20 minutes Interpretation: A. REACTIVE (normal) - FHT 120-160bpm - At least 2 acceleration of the fhrof at least 15 bpm - Normal irregularity of cardiac rhythm - Result indicates a healthy fetus with an intact nervous system. B. NON REACTIVE - stated criteria for a reactive result are not met. - no accelerations within 20 minutes. - adjuncts to assists fetal activity fail - requires further evaluation. Management: A.RNST reassuring for fetal well being for 3-4 days - follow daily fetal kick count. B.NRNST perform oxytocin challenge test or biophysical profile.

C. Oxytocin Challenge Test is done by intravenously infusing dilute oxytocin until 3 contractions occur within 3 minutes. Technique oxytocin incorporated in IV - goal is 3 contractions every 10 min. - nipple stimulation Interpretation a. Positive Test presence of late decelerations following 50 percent or more of the contractions. b. Negative test no late or significant variable decelerations. c. Equivocal suspicious pattern intermittent late or significant variable decelerations. d. Unsatisfactory test tracing is uninterpretable or contractions are fewer than 3 in 10 minutes. D. Biophysical Profile - refers to the sonographic assessment of four bio physical variables: 1. fetal body movement 2. fetal muscle tone 3. fetal breathing movement 4. amniotic fluid testing - a normal variable is assigned a score of 2 and abnormal variable a score of 0 - maximal score is 10/10 and minimal score is 0/10 Parameters Non stress test Amniotic Fluid Volume Fetal Breathing Movement Fetal body movements Fetal Muscle Tone Normal = 2 > 2 accelerations > 15 bpm above baseline during test lasting >15 sec in 20 min >5 or at least 1 pocket measuring 2x2cm Sustained FBM > 30 seconds > 3 episodes of either limb or trunk movement Extremities in flexion @ resr and >1 episode of extension of extremity, hand or spine with return to flexion. Abnormal = 0 < 2 accelerations AFV <5 or no pockets >2cm x 2cm Absence of FBM or short gasps only <30seconds total <3 episodes during test Extension at rest or no return to flexion after movement.