First Antenatal Assessment Lab one 1 Antepartum Assessment

First Antenatal Assessment Lab one 1

Antepartum Assessment and Care: Objective Antepartum care is to ensure that pregnancy ends in the birth of a healthy infant without impairing the health of the mother. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc. 2

Antepartum Assessment and Care benefits Ideally before conception Identify problems Provide education to help achieve a healthy pregnancy History, vital signs, and physical examination Screening Medications and nutrition Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc. 3

Antepartum Assessment and Care: Initial Prenatal Visit goals Establish trust and rapport with family. Verify or rule out pregnancy. Evaluate woman’s physical health. Assess the growth and health of the fetus. Establish baseline data. Evaluate the psychosocial needs. Assess the need for counseling or teaching. Negotiate a plan of care. Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier Inc. 4

First Antenatal Assessment • It is a Comprehensive health history. • Is taken during the initial visit, including: 1. 2. 3. 4. 5. 6. 7. 8. 5 Demographic data Menstrual history Pregnancy History Prior obstetric history Prior Gynecologic History Past medical and surgical/psychological history Family history Genetic screening

First Antenatal Assessment 9. Medications 10. History of exposure to infections (STDs) (Use the prenatal history form is the best way to document these data) 6

First Antenatal Assessment form 1 - Reason for seeking care -When she missed her menstrual period or had a positive pregnancy test at home, she will seek for a care. - Ask the women about her last menstrual period (LMP), any probable signs of pregnancy and B-h. CG (Human Chrionic Gonadotropin) is made to confirm pregnancy. 7

First Antenatal Assessment 2 - Past health history § Past medical and surgical history § urinary tract infections. § chronic diseases like Diabetes mellitus, heart diseases, hypertension, § History of allergies from medications, foods, or environmental substances. § Mental health problems like depressions and anxiety 8

3. Personal history • occupation • possible exposure to teratogens • exercise and activity level • recreational patterns (alcohol, tobacco, and drugs) • sleep patterns • nutritional habits, and general lifestyle. 9

First Antenatal Assessment 4. Reproductive History a- Menstrual history • describe the menstrual cycle including the her age at menarche • number of days in her cycle • typical flow characteristics • any associated discomforts • last time she used the contraception. • Ask the LMP to estimate the EDD (Expected Date of Deliver) Nagele's rule (Subtract 3 months and then add 7 days to the first day of LMP. Then add 1 to the year. The margin error is plus or minus 2 weeks. e. g. , 14 October 2014 LMP EDD is 21 July 2015. 10

First Antenatal Assessment • b- Obstetric hi past pregnancies • any problems encountered in during past pregnancies, labors, deliveries. • G and P is used, G means Gravida-number of pregnancy, P means Para means story • number of deliveries. c- Gynecologic history • reproductive tract surgeries • tubal pregnancy, polyps, • papilloma, endometriosis…etc. 11

Follow-up visits -Continuous prenatal care is important for a successful pregnancy outcome. -Recommended follow-up visit schedule for healthy pregnant women is: *Every 4 weeks up to 28 th weeks (7 months) *Every 2 weeks from 29 th till 36 th week *Every week from 37 th to birth. 12

Follow-up visits Physical exam • Vital signs • Weight and blood pressure • Urine test for protein, sugar, ketones, and nitrites • Fundal height measurement to assess fetal growth-A distance measured by a tape from pubic bone till top of uterus(fundus) while she is in supine position -Mc. Donald's method. • Assessment the quickening/fetal movements to determine fetal wellbeing. Usually perceived between 16 th and 20 th week of gestation. • Assessment of fetal heart rate (Normal is 110 -160 bpm) • 13

Copyright © 2014, 2010, 2006, 2002, 1998, 1994, by Saunders, an imprint of Elsevier

Fundal height 15

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Lab Activity • History Taking practice 18

Reference “Foundations of Maternal-Newborn and Women's Health Nursing” by Sharon Murray, Emily Mc. Kinney, 6 th Edition; Saunders 19