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OB ATI
CHAPTERS
1-7
ANTEPARTUM
2.
TRIMESTERS
3.
TERMS
4.
LABS!!
5.
CONT'D
6.
ABG
PH: 7.35-7.45
PCO3 35-45
PCO2: 80-100
HCO3: 22-28 (BICARB)
*IF BICARB IS OFF, ITS METABOLIC
*IF PCO2 IS OFF, ITS RESPIRATORY
7.
CONT'D
8.
CH 1
ANTEPARTUM
RN CARE
CH 1
ANTEPARTUM RN CARE
9.
OVULATION
10.
SPERM AND
OVUM
11.
CALENDAR
METHOD
12.
VARIOUS
BC
13.
CONTD
14.
CONT'D
19.
PROBABLY
15.
CH 2
INFERTILITY
CH 2
INFERTILITY
20.
POSITIVE
16.
STUFF
21.
PREG TEST
-hCG
-Px can start on day of conception
-Detected 7-10 days in serum after conc
-hCG peaks 60-70 days gest, declines until day
80, then INC til term
-Higher hCG=Multiples, extopic, hydatilform
mole, or genetic abnorm like DS
-Lower hCG=Miscarriage
-False Pos or False Neg: Anticonvulsants,
diuretics, tranquolziers
22.
GTPAL
23.
GTPAL
G=Gravida
T=Full term (completion of END of 37th week to
END Of 42 weeks)
P=Pre term (After 20th week but before start of
38th week)
A=Abortions or miscarriages before 20 weeks
L=Living children
24.
TERMS
-GRAVIDA=# of Pregnancies
-PARA=# of VIABLE Pregnanices
-VIABLE=20 weeks or greater
-NULLIGRAVIDA=Never pregnant
-PRIMIGRAVIDA=1st time preg "primit"
-MULTIGRAVIDA=2 or more pregnanices
-PRIMIPARA=1st viable pregnanices
-MULTIPARA=2 or more viable preg (babies
delivered after 20 weeks either dead or alive)
-NULLIPARA=Woman has not px'ed any viable
offspring
25.
CHANGES
17.
18.
CH 3
NORMAL
CHANGES
DURING
PREG
CH 3
NORMAL CHANGES DURING PREG
PRESUMPTIVE
SIGNS
-Amennorhea
-Fatigue
-N/V
-Urinary freq
-Breast changes
-Quickening (slight flutter of fetus around 1620 wk)
-Uterine enlargement
-Montgomerys Glands
26.
EXPECTED
VS
27.
NUTRITOIN
CH 4
PRENATAL
CARE
CH 4
PRENATAL CARE
29.
VISTIS
-Monthly until 7 mo
-Q 2 weeks 8th mo
-Q week 9th mo
30.
ONGOING
VISITS
28.
31.
COOMBS
TEST
-Rh
-For pt who are Rh neg and not sensitized, its
repeated bw 24-28 wk
32.
ROUTINE
LABS
-Rh
-CBC w diffential (for inf)
-Hgb Hct (for anemia)
-Hgb electrophoresis (for sickle cell and thallasmia)
-Rubella titer
-Hep B screen
-Group B Strptococc at 35-37 wk
-Urinalysis (DM, gest HTN, renal dis)
-PAP for cerv cancer
-PPD after 20 wk chest xray
-VDRL-Syphyllis screen
-HIV-rec for all unless refuse
-TORCH: Toxoplasmosis, other, Rubella,
Cytomegaolvirus, and Herpes-all cross placenta
and adversely affecet fetus
-Maternal serum alpha-fetoprotein MSAFP-Screen
bw 15-22 wk to rule out DS
33.
MSAFP
34.
GLUCOSE
TESTS
1 HR GLUCOSE TOLERNACE:
-Done at 1st visit for high risk
-Done at 24-28 for ALL
-Over 140 requires follow up
-Fasting NOT necessary
3 HOUR GLUCOSE TOLERANCE
-Fasting necessary
-Take 1 2 and 3 hr
-For high 1 hr levels
-Need 2 highs for gest diab
35.
RHOGAM
36.
HEALTH
PROMO
37.
CONT'D
38.
FEELINGS
AMBIVALENCE-1ST
ACCEPTING-2ND
PREPARING-3RD
39.
DANGER
SIGNS:
42.
ETC
43.
CONT'D
44.
PKU
45.
CH 6
ASSESSMENT
OF FETAL
WELL BEING
CH 6
ASSESSMENT OF FETAL WELL BEING
46.
TESTS
1. US
2. BPP
3. NST
4. CST
5. AMNIOCENTESIS
47.
HIGH RISK
PREG TESTS
CH 5
NUTRITION
CH 5
NUTRITOIN
41.
WEIGHT
GAIN
-25-35
-1ST TRIM: Gain 1-2 kg (2.2-4.4) lb
-2ND AND 3RD TRIM: .4 lg (1 lb!!) / week
-If underweight: Gain 28-40 lbs
-If overweight-gain 15-25
48.
TESTS
BY
TRIM
1ST:
-CHORIONIC VILLUS
2ND:
-US
-AFP
-QUAD
-AMNIOCENTESIS
3RD:
-NST
-BBP
-US
49.
1. US
50.
2.
BBP
51.
CONT'D
52.
3. NST
53.
CONT'D
54.
4. CST
56.
5. AMNIOCENTESIS
55.
CONT'D
57.
CONT'D
58.
HIGH RISK
59.
1. PERCUTANEOUS
UMBILICAL BLOOD
SAMPLING
60.
61.
2.
CHORIONIC
VILLUS
SAMPLING
3. QUAD OR
AFP
69.
BLEEDS
BY TRIM
1ST TRIM:
1. SAB
2. ECTOPIC PREG
2ND TRIM:
3. GEST TROPHOBLASTIC DIS
3RD TRIM:
4. PLACENTA PREVIA
5. PLACENTA ABRUPTO
70.
1. 1ST
TRIM:
SAB
71.
RISK
FACTORS
FOR SAB
72.
DO
62.
CONT'D
FINDINGS
-LOW AFP=Risk for DS
-HIGH AFP=Risk for NTD
-HIGHER hCG and INHIBIN=Risk for DS
-LOWER ESTRIOL=Risk for DS
63.
AFP
64.
L/S
65.
AFP
66.
KLEINHAUERBETKE TEST
67.
COOMBS
68.
CH 7
BLEEDING
DURING
PREG
CH 7
BLEEDING DURING PREG
73.
74.
2. 1ST TRIM:
ECTOPIC
2. 2ND TRIM:
GESTATIONAL
TROPHOBLASTIC DIS
-HYDATIDIFORM
MOLE (=RARE MASS
OR GROWTH IN
UTERUS)
CHORIOCARCINOMA
-MOLAR
PREGNANCY
75.
3. 3RD
TRIM:
PLACENTA
PREVIA
-Placenta over OS
-Results in bleed during 3rd trim
-Marginal or low lying previa-placenta attached in
lower uterine but does not reach cervical os
RISKS=Uterine scarring, age 35-40, multiples,
closely spaced pregs, smoking
S/S=Painless bright red bleed, soft uterus
nontender, fundal heigh greater than expected,
breech oblique or transverse fetus, reassuring
FHR, VS within normal limits, dec UO
DO
-Leopalds
-Lung steroid (betamethasone) if delivery
anticiaptd (C/S)
-IV fluids, blood, meds
76.
4. 3RD
TRIM:
PLACENTA
ABRUPTO