Antepartum Complications

• Biophysical

• Psychosocial

• Sociodemographic

• Environmental

• genetics

• nutrition

• medical/OB disorders

• caffeine

• mental health

• alcohol/drug use

• smoking

• age

• party

• marital status

• residence

• income

• ethnicity

• infections

• pollution

• stress

• chemicals/air quality

..

• identify those at risk for injury

• Help identify a disease or provide information to diagnose

• Usually in high risk pregnancies

• diagnostic testing

• the obstetrician/midwife selects the tests based on effectiveness and individual client

Education and Counseling

• Alpha-fetoprotein (AFP)

• Multiple Marker Screening

a glycoprotein produced in the fetal GI tract and liver

maternal serum

screening; need amniocentesis to diagnose

16-18

down syndrome or hydatidiform mole

neural tube defects

15-16 weeks

• AFP

• hCG

• estriol

• trisomy 21 and 18

• neural tube defects

• Amniocentesis

• Chorionic Villus Sampling

• Cordocentesis

removal of amniotic fluid

done after 14th week

ultrasonography (ultrasound)

• genetic disorders

• fetal lung maturity

  • lamellar bodies count

• intrauterine infection

• monitor for supine hypotension (lying on back)

• obtain NST after procedure

• know maternal blood type; if Rh -, administer RhoGAM

18

test for anemia in fetus

• Daily Fetal Movement Count – “kick count”

• Contraction Stress Test (CST)

• Ultrasound

• Biophysical Profile

• EVERY pregnant woman

• easiest and most non-invasive screening

28 weeks

• 10 movements in 2 hours

  • helpful to eat or drink something or lie on side

Non-stress test (NST)

• looks at fetal heart rate patterns in response to fetal movement, contractions, or stimulation

• Reactive vs. Nonreactive

Reactive - want an increase in HR of 15 bpm lasting 15 seconds (accelerations) in 20 min

NO accelerations in 40 min

*can try feeding mom

a Contraction Stress Test or Biophysical Profile

Evaluation of FHR in response to contractions

• Get mom hooked up to oxygen to help promote contractions

• Nipple stimulation can also cause contractions

*Need 3 contractions in a 10 min period

Negative (GOOD):

• no late decelerations

Postive (BAD):

• repetitive late decelerations

women with uteroplacental insufficiency

ex. diabetes and HTN

trimester

• multiples?

• anatomy scan?

• growing properly in utero?

18 weeks

too much or too little fluid volume

fetal disorders

too little fluid volume

• renal agenesis

  • a complete absence of one or both kidneys

• IUGR

  • intrauterine growth restriction

too much fluid volume

• neural tube defects

• obstruction of GI tract

• fetal hydrops

  • a condition in which large amounts of fluid build up in a baby's tissues and organs, causing extensive swelling (edema)

  • hydrops fetalis r/t Rh incompatibility

late 2nd trimester and 3rd trimester

assess fetal well being

• fetal breathing movements

• gross body movements

• fetal tone

• reactive FHR (NST)

• qualitative amniotic fluid volume

Acute and Chronic markers

current CNS status =

• fetal HR

• fetal movements

• fetal tone

• fetal breathing

amniotic fluid volume ---demonstrates adequacy of placental function over longer period of time

can take longer to complete

• 8-10: CNS is functional and fetus is not in hypoxia

• 6

• <4

N/V with…

• weight loss

• electrolyte imbalance

  • hyponatremia and hypokalemia

• nutritional deficiencies

• ketonuria

1st trimester

• high levels of estrogen and hCG (Human chorionic gonadotropin)

• psychological component

• IV therapy - fluid and electrolyte replacement

• Gut rest -- NPO

•Small frequent meals

•Bland food but what sounds good

•Ginger tea/ginger ale

•Compassionate, calm, and sympathetic care

Calling the provider

• Miscarriage

• Ectopic pregnancy

• Hydatidiform mole

ER -- could be lots of bleeding

outside of uterine cavity (mostly in fallopian tube)

PAIN

*want to catch them before rupture

the uterus grow abnormally fast

• Placenta previa

• Placenta abruption

C-section and will be delivered early b/c we don’t want hemorrhage

• always see bleeding

• blood is bright red

• could be a small amount to hemorrhage

painless

• Usually soft, relaxed, non-tender

• Contractions may or may not be present

we have bleeding

• Hgb

• Hct

• coag studies

• platelet count

preterm birth

the vagina -- will hit uterus first and could cause rupture

++

Multiple C-sections

placenta has come away from uterine wall

dark red vaginal; concealed

severe

Most common: maternal HTN

Others:

• cocaine use

• smoking

• blunt abdominal trauma (vehicle accident)

• preeclampsia

• no relaxation between contractions

• tetanic, persistant contractions

• abdomen is board-like (hard)

• late decelerations

• decreasing variability and rate

• potential stillbirth

Corticosteroids - Betamethasone most common

A, B, D

people who have DM before getting pregnant - type I and type II diabetics

3 months before getting pregnant

• first trimester is a sensitive time where things can go wrong

• if pregnant woman is not controlling her BS then she is at increased risk for miscarriages or congenital anomalies

people who become diabetics while in pregnancy

24-28 weeks - fail screening they become GDM

• Rising hormones in second trimester start acting as insulin antagonists (resistance) - most of population can handle this and don’t become diabetics because body can still meet insulin needs

Some peoples body’s cannot handle the increased insulin resistance and their body’s will not meet the insulin needs thus glucose begins getting higher and higher and then they become gestational diabetics

7%; 2

• 1st and 2nd: q1-2 weeks

• 3rd: 1-2x a week

• BS

• ketones

• diet

• exercise

• insulin

• spontaneous

• preeclampsia

• pre-term labor

• polyhydramnios

• macrosomia (shoulder dystocia)

• c-section or assisted brith

• infections

• ketoacidosis

• birth injuries d/t larger size (>4,000-4,500 grams)

  • shoulder dystocia

• mortality rate is 3x higher

  • Delayed lung maturity d/t delayed surfactant production r/t excess maternal blood glucose levels.

  • Still birth

  • RDS and TTN

  • Extreme prematurity

• 1st trimester hyperglycemia affects organs and organ systems

  • main cause of diabetes-related congenital birth defects (CNS and cardiovascular)

• hypoglycemia at birth d/t

  • abrupt loss of maternal glucose

  • newborn pancreas still producing higher insulin

• strict BG control

• diet

  • carbs should be 50% of caloric intake

• self monitoring of BG

  • Upon rising in a.m.

  • 1-2 hrs after breakfast

  • Before and after lunch; before dinner

  • Bedtime

• most will require insulin

• BG should be checked q2-4hrs

• 70-110

Spontaneous abortion -- mom has already made it past the 20 week mark since we don’t find out that she has diabetes until 24-28 weeks

They increase during the second and third trimesters