Antepartum

1. Nursing care and obstetric support
1. General aspects of prenatal management
   1. Scheduled visits:
      1. Once monthly - until week 28.
      2. Every 2 week - week 28-36.
      3. Weekly - week 36 until labor.
   2. Assessment:
      1. General well-being, signs of deviations, concerns, questions.
      2. Weight gain pattern.
      3. Blood pressure (sitting).
      4. Abdominal palpation:
         1. Fundal height; tenderness, masses, hernia
         2. Fetal heart rate (FHR).
         3. Leopold’s maneuvers for presentation (after week 32).
      5. Laboratory tests:
         1. Urinalysis - for protein, sugar, signs of asymptomatic infection.
         2. Venous blood - for Hgb, Hct; done initially: VDRL, anti-body titer, sickle cell. HIV recommended for high-risk groups, and hepatitis for high-risk groups.
         3. Cultures (vaginal discharge; cervical scrapings, for Chlamydia trachomatis) prn.
         4. Tuberculosis (TB) screening in highrisk areas.
         5. Maternal alpha-fetoprotein screen, 16-18 week optimum time
         6. Serum-glucose screen, 24-28 week.
      6. Follow-up on medications (vitamins, iron) and nutrition.
      7. If TB positive during pregnancy, isoniazid (INH) and rifampin given daily. INH is associated with increase in fetal malformations, particularly neurotoxicity. Pyridoxine administered simultaneously to prevent their development.
2. Common minor discomforts during pregnancy
   1. Etiology: normal maternal physiologic/psychological alterations in pregnancy.
   2. Nursing care plan/implementation:
      1. Goal: anticipatory guidance Discuss the importance of adequate rest, exercise, diet, and hydration in minimizing symptoms.
      2. Goal: health teaching
   3. Evaluation/outcome criteria: woman avoids, minimizes, or copes effectively with minor usual discomforts of pregnancy.
3. Danger signs:
1. Etiology: Specific disease processes are discussed under Complications.
2. Nursing care plan/implementation:
Goal: health teaching - to safeguard status. Signs to report immediately:
1. Persistent vomiting beyond first trimester or severe vomiting at any time Possible cause: Hyperemesis gravidarum.
2. Fluid discharge from vagina - bleeding or amniotic fluid (anything other than leukorrhea). Possible causes: Placental problem, rupture of membranes (ROM).
3. Severe or unusual pain: abdominal. Possible cause: Abruptio placenta
4. Chills or fever. Possible cause: Infection.
5. Burning on urination. Possible cause: UTI.
6. Absence of fetal movements after quickening Possible cause: Intrauterine fetal death
7. Visual disturbances - blurring, double vision, “spots before eyes.” Possible cause: Preeclampsia
8. Swelling of fingers or face Possible cause: Preeclampsia
9. Severe, frequent, or continual headache Possible cause: Preeclampsia
10. Muscle irritability or convulsions. Possible cause: Preeclampsia
3. Evaluation/outcome criteria:
   1. Actively participates in own health rnaintenance/pregnancy management.
   2. Identifies early signs of potentially serious complications during the antepartal period
   3. Promptly reports and seeks medical attention.