Site hosted by Angelfire.com: Build your free website today!

Chapter 6 Pre-Natal Assessment

How often to go to the doctor?

Once a month for 7 months.

Once every 2 weeks during month 8.

Every week thereafter.

More often if high risk.

High risk: when something is identified in the history that would indicate complications.

First visit:

· Family history = chronic diseases, immunizations of family members.

· Past medical history = allergies, immunizations (particularly rubella), medications, injury to pelvic area ( or surgery to that area ).

· Reproductive history = menstrual cycle, prior pregnancy and how they went, ages of children, is it planned.

· Current S&S of pregnancy.

· Support system.

· Occupation.

· Social habits = drinking, smoking, drugs.

· Pelvic exam (empty bladder first).

· Pelvic measurements.

Two very important conjugate measurements:

1. Diagonal conjugate of the inlet: distance between the sacral promontory and lower edge of the symphysis pubis. It measures a/p. It’s the narrowest diameter of the pelvic inlet. Should be >11.5 cm.

2. True conjugate of the inlet: should be at least 10 cm. Measurement of a/p is the true conjugate. Subtract 1.5-2 from diagonal to get true.

The distance between the ischial spines is the narrowest part baby has to come thru in the outlet. This is called the transverse diameter.

· Pap smear.

· Blood tests: type and Rh, CBC, Hbg, Hct.

· VDRL for syphilis.

· Sickle cell history.

· Electrolyte studies.

· Antibody test for rubella and Hep B.

· Weight and baseline vitals.

Subsequent visits:

· Vital signs: watch for a rise in systolic of 30mmHg from baseline or a rise in diastolic of 15mmHg from baseline. We are most concerned with the diastolic because it is the resting of the ventricle (whereas systolic is the contracting).

· Weight.

· Fundal height at umbilicus at week 20 from symphysis pubis to top of fundus = McDonald’s rule.

· S&S of PIH: blurred vision, epigastric pain (this is a bad one), changes in BP, swollen hands and facial edema, gaining a lot of weight quickly. Will do a dipstick test for glucose and protein. The 3 major signs of PIH are increased BP, protein in urine and edema. First intervention is to put them to bed. The biggest problem with PIH is seizures. If they have the 3 symptoms, the they are called pre-eclampsic. If they have seizures, they are called eclampsic.

After first visit, pelvic exam is not done until due date.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Functions of Insulin:

1. Shifts glucose from the blood stream into the body’s cells.

2. Stimulates storage of excess glucose in the liver. Glycogen is stored glucose.

3. Enhances storage of dietary fat.