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APGO educational topic number ten
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antepartum care antepartum care refers
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to care before labor and delivery and
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begins with the first prenatal visit
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women who receive antepartum care during
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the first trimester have better
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pregnancy outcomes meet our patient
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newly preggers in this video we will
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follow newly’s journey through
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antepartum care the objectives of this
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video are to diagnose pregnancy to
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assess risk factors for pregnancy
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complications including screening for
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intimate partner violence to describe
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appropriate diagnostic studies and their
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timing for normal pregnancy to list the
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nutritional needs of pregnant women and
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to identify adverse effects of drugs and
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the environment on pregnancy to perform
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a physical examination on an obstetric
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patient to discuss answers to commonly
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asked questions concerning pregnancy
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labor and delivery to describe
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approaches to assess in the following
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fetal wellbeing fetal growth amniotic
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fluid volume fetal lung maturity and to
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describe the impact of pregnancy on
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medical problems and the impact of
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medical problems on pregnancy newly has
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regular 28-day cycles and she has just
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missed a period most women will take a
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home pregnancy test how sensitive is a
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home pregnancy test it becomes positive
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with a beta HCG as low as 25 newly may
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notice symptoms such as fatigue nausea
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vomiting and breast tenderness early in
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pregnancy for low-risk women the first
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prenatal visit will be an intake visit
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at six to eight weeks followed by her
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first prenatal visit before twelve weeks
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what are the goals of prenatal care
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early and continuing risk assessment
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health promotion medical and
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psychosocial intervention and follow-up
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at the time of newly’s first prenatal
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visit a comprehensive history will be
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performed special attention will be paid
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to chronic medical issues past
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pregnancies and their outcomes
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gynecologic issues genetic screening
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issues and social history smoking during
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pregnancy has well-known risks including
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miscarriage placental abruption fetal
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growth restriction preterm delivery
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birth defects and sudden infant death
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syndrome alcohol is a known teratogen
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alcohol consumption during pregnancy is
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a leading preventable cause of mental
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retardation developmental delay and
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birth defects in the fetus other
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important issues
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discuss our drugs environmental and
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health hazards domestic violence which
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occurs with high prevalence during
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pregnancy and seatbelt use one of the
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most important aspects of the first
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prenatal visit is establishment of the
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estimated date of delivery remember that
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we use gestational age that starts on
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the first day of her last menstrual
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period the estimated date of delivery or
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EDD is calculated as 40 weeks past the
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LMP if she has regular 28-day cycles
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vaginal ultrasound can be used to
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determine the EDD if the patient cycles
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are irregular or to confirm the EDD if
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the patient cycles are regular since
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newly is a normal low-risk pregnancy she
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will be seen at four week intervals
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until 28 weeks than every two weeks
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until 36 weeks than every week until
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delivery during each of these visits she
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will have a weight blood pressure and
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fetal assessment for diabetes screening
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there will be a one-hour glucose
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tolerance test between 24 and 28 weeks
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to screen for gestational diabetes for
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obese women the diabetes screening
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should occur at the initial prenatal
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visit how do we monitor the fetus during
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newly’s pregnancy fetal heart rate can
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be verified with a Doppler device
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starting in about 12 weeks chromosomal
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screening provides the probability of
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chromosomal abnormalities the first
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trimester screen provides the
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probability of trisomy 21 and tries to
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be 18 it is performed between 10 and 13
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weeks it is an ultrasound assessment of
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the nuchal translucency and a maternal
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serum test of PAP a and free beta HCG
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alternatively maternal serum screening
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also provides probabilities of
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chromosomal abnormalities
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this is performed between 15 and 20
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weeks the triple test consists of
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alpha-fetoprotein s3l HCG and the quad
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test consists of alpha-fetoprotein stl
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HCG and inhibin the fetal survey
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ultrasound is performed between
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approximately 18 to 20 weeks if we are
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especially concerned about the fetus for
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conditions such as maternal diabetes
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hypertension or fetal growth restriction
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then we will monitor the fetus more
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closely with non-stress test the
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non-stress test measures fetal heart
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rate patterns and accelerations by an
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external transducer for at least 20
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minutes it is considered reactive if
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there are at least two accelerations
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over the twin
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minute period maternal kick counts are
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away for newly to reassure herself of
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fetal well-being starting at around
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thirty two weeks if she is concerned
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about decreased fetal movement then she
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should lay on her side and she should
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feel five movements in one hour or ten
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movements in two hours let’s now move to
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fetal growth the most commonly used
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assessment of growth is fundal height
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measurement this measures the distance
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from the pubic symphysis to the top of
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the fundus the fundal height measurement
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is approximately the number of weeks
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gestation amniotic fluid volume is
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assessed with an amniotic fluid index
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this is a four quadrant assessment of
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amniotic fluid pockets decreased
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amniotic fluid is secondary to the fetus
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shunting blood away from the kidneys to
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the brain which leads to decreased urine
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output let’s now talk about fetal lung
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maturity the respiratory system is the
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last fetal system to mature functionally
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and if newly has to be delivered preterm
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then it can be sometimes helpful to
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assess fetal lung maturity this is done
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by sampling her amniotic fluid through
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an amniocentesis procedure and checking
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for markers of lung maturity what our
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new Lee’s unique nutritional needs
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during pregnancy for folic acid she
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should take at least 0.4 milligrams of
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folic acid daily starting around the
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time of conception and this
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significantly reduces the risk of neural
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tube defects if she’s had a pregnancy
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affected by a neural tube defect and she
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should take four grams of folic acid
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daily excessive weight gain during
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pregnancy leads to an increased risk of
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pregnancy complications such as fetal
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macrosomia it significantly also
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increases the risk of postpartum obesity
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weight gain recommendations are based on
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pre pregnancy BMI for a pre pregnancy
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BMI less than 19 point eight the weight
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gain recommendation is 28 to 40 pounds
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for nineteen point eight to twenty six
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recommended is 25 to 35 pounds for 26 to
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29 it is 15 to 25 pounds and if the pre
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pregnancy BMI is greater than 29 pounds
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the recommended weight gain is 11 to 20
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pounds alternatively inadequate weight
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gain in pregnancy is associated with
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preterm delivery intrauterine growth
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restriction and low birth weight
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there are also foods with specific risks
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during pregnancy unpasteurized milk and
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dairy products and cold lunch meats
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could potentially carry listeriosis
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which causes an increased risk of
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and fetal demise fish is a great source
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of omega-3 oils however large fish such
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as tuna shark and king mackerel have a
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higher mercury content because they eat
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the smaller fish and should be avoided
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during pregnancy herbal remedies are not
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regulated and therefore pregnant women
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should be counseled to consider avoiding
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them
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moving on to frequently asked questions
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can newly exercised during pregnancy yes
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she should avoid exercises that carry
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risks of falling or abdominal trauma and
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she probably shouldn’t start any new
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strenuous exercises during pregnancy
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that she did not partake in pre
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pregnancy can newly have sex yes unless
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she is conditions such as placenta
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previa or premature rupture of membranes
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she and her partner will likely need to
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work together to find positions that are
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more comfortable during pregnancy can
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newly travel yes most airlines allow
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travel up to 36 weeks have her avoid
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long periods of prolonged sitting and
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have her walk every one to two hours to
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promote circulation remind newly of the
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importance of seat belts worn low on her
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hip bones should newly expose yourself
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to teratogen during pregnancy no there
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are very few medications that are proven
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human traditions common ones to avoid
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our East inhibitors coumadin and
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isotretinoin for ionizing radiation it
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is recommended to limit exposure the
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fetus to less than five rads a CT scan
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of the abdomen and pelvis has
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approximately 3.5 rads a CT scan of the
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head is approximately less than 1 rad an
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abdominal x-ray is 100 to 200 milli rads
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and a chest x-ray is 0.02 to 0.075 it
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during newly’s journey 3 antepartum care
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we have discussed pregnancy specific
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needs and considerations and ways of
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assessing fetal well-being and address
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frequently asked questions