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38 terms

Nur 263 - OB Skills Lab - Antepartal

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Amniocentesis
A procedure in which a needle is inserted through the abdominal and uterine walls into the amniotic fluid; fluid is withdrawn; used for assessment of fetal health and maturity.
• Possible after 14 weeks
• Performed to obtain amniotic fluid (which contain fetal cells) for the purpose of a biochemical assessment/analysis of the amniotic fluid.
• Clinical significance: to evaluate for genetic disorders or congenital anomalies, assessment of pulmonary maturity, and diagnosis of fetal hemolytic disease
Amniocentesis
Procedure
• Properly drape and position.
• Have necessary supplies close by. Assist physician as well as woman.
• Assist with positioning for ultrasonography, locating fetus, placenta, and pockets of amniotic fluid for sampling.
• Once pocket is located and confirmed by physician, remove gel and prepare woman with antiseptic solution.
• On a tray have a 3 inch 20 gauge spinal needle and a 20 ml syringe ready for physician.
Amniocentesis
Procedure
• Under direct ultrasonography visualization, physician inserts needle trans abdominally into uterus. The physician removes and discards 1 to 2 ml of amniotic fluid then obtains 20ml for analysis.
• Amount withdrawn depends on gestational age and reason for testing. RN prepares sample and sends to lab
• After procedure, give woman injection of Rh immunoglobulin if ordered to prevent sensitization (observe closely).
• Reassess fetal heart rate while woman recovers for a couple of hours.
Amniocentesis
Complications
• To Mother: hemorrhage, fetomaternal hemorrhage with possible maternal Rh isoimmunization, infection, labor, placental abruption, inadvertent damage to intestinal bladder
• To Fetus: death, hemorrhage, infection, direct injury from needle, miscarriage or preterm labor, leakage of amniotic fluid.
• Because of the possibility of fetomaternal hemorrhage, administering RhoD immune globulin to the woman who is Rh negative is standard practice after an amniocentesis.
Abortion
Termination of pregnancy before the fetus is viable and capable of extra-uterine existence, usually less than 20 weeks of gestation. (or when the fetus weighs less than 500 grams)
Complete abortion
In which fetus and all related tissue have been expelled from uterus
Elective Abortion
Termination of pregnancy chosen by the woman that is not required for her physical safety
Habitual Abortion (recurrent)
Loss of 3 or more successive pregnancies for no known cause
Incomplete Abortion
Loss of pregnancy in which some but not all the products of conception have been expelled from the uterus
Induced Abortion
Purposeful interruption of a pregnancy before 20 weeks of gestation
Inevitable Abortion
Threatened loss of pregnancy that con not be prevented or stopped or is imminent
Missed Abortion
Loss of pregnancy in which the products of conception remain in the uterus after fetal death
Septic Abortion
Loss of pregnancy in which there is an infection in the products of conception and the uterine endometrial lining, usually resulting from attempted termination of early pregnancy
Spontaneous Abortion
A pregnancy that ends as a result of natural causes before 20 weeks of gestation; preferred term is miscarriage
Therapeutic Abortion
Pregnancy intentionally terminated related to medical reasons
Threatened Abortion
Possible loss of pregnancy, early symptoms present (i.e. cervix begins to dilate)
Amniocentesis
A procedure in which a needle is inserted through the abdominal and uterine walls into the amniotic fluid; fluid is withdrawn; used for assessment of fetal health and maturity. • Possible after 14 weeks
Nagele's rule
Method for calculating the estimated date of birth or "due date".
• After determining the first day of the last menstrual period subtract 3 calendar months and add 7 days;
• Or add 7days to the LMP and count forward 9 calendar months
NST- Non Stress Test
Evaluation of fetal response (fetal heart rate) to natural contractile uterine activity or to an increase in fetal activity.
EDC
Estimated date of confinement, ,
EDD
Estimated date of delivery
EDB
Estimated Date of Birth
Fundus
Dome shaped upper portion of the uterus between the points of insertion of the uterine tubes
Gestation
Period of intrauterine fetal development from conception through birth; the period of pregnancy
Gravida
A woman who is pregnant
GTPAL
System for summarizing the womans obstetric history.
• Acronym stands for Gavidity, Term, Preterm, Abortions, Living children.
- Gravidity = number of pregnancies,
- Term = number of deliveries after 37 completed weeks gestation',
- Preterm = number of deliveries after 20 weeks but before 37 weeks gestation,
- Abortion = number of pregnancies ending before 20 weeks,
- Living children = number of currently living children
Leopold's Maneuvers
Four maneuvers for diagnosing the fetal position by external palpation of the mothers abdomen while lying on her back.
• Prep: empty bladder, supine with one pillow under head and knees slightly flexed.
- Small rolled towel right or left hip to displace uterus off major blood vessels (prevents supine hypotensive syndrome
• Identifies:
- Number of fetus's
- Presenting part, fetal lie/attitude
- Degree of (presenting parts) descent into pelvis
- Expected location of the PMI of the FHR
Lightening
Sensation of decreased abdominal distention produced by uterine descent into the pelvic cavity as the fetal presenting part settles into the pelvis,
• It usually occurs 2 weeks before the onset of labor in nulliparas.
• After the woman breaths easier and feels less congested.
• Usually bladder pressure results from the shift.
• In multipara woman this may not occur until after contact ions start
LMP
Last menstrual period
Multigravida
A woman who has had 2 or more pregnancies
Nulligravida
A woman who has never been pregnant
born
Para (parity)
Number of pregnancies ending after 20 weeks counted as para whether baby is born living or dead
• Counts the pregnancy not the number of babies
Physiologic Anemia (Pseudoanemia)
A modest decrease in the hemoglobin concentration and hematocrit in pregnancy, caused by the relative excess of plasma
Primigravida
A woman who is pregnant for the first time
Quickening
Maternal perception of fetal movement (feeling of life) usually occurs between weeks 16 and 20 of gestation, but may be felt earlier by multiparous woman.
Stillbirth
The birth of a baby after 20 weeks of gestation and 1 day or weighing 350g (depending on the state code) that does not show any signs of life.
Supine Hypotension Syndrome (Shock)
Fall in blood pressure caused by impairedvenous return when gravida uterus presses on ascending vena cava,
• Occurs when woman is lying flat on her back
• Vena Cava Syndrome
Trimester
- one of three periods of about 3 months each into which pregnancy is divided