Chapter 23: Prenatal Period and Risk Conditions

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Think for a moment about the sheer adaptability of the human body, particularly the incredible transformation a woman's body undergoes to nurture and grow a new life over roughly nine months.

It's a period marked by just profound changes.

Today on the Deep Dive, we're embarking on a really comprehensive exploration of this prenatal period.

Yeah, and our guide for this is the prenatal period and risk conditions chapter.

It's from the Saunders Comprehensive Review for the NCLE -XPN Examination Seventh Edition, a really packed resource full of essential information.

Right, and our aim is to extract the most vital knowledge from this chapter, offering you, our listeners, a clear and structured understanding of this crucial time.

Exactly.

We know you're keen to grasp this quickly and thoroughly, so we'll be hitting the key nursing concepts, those foundational ideas, along with assessment guidelines, clinical procedures you might see, safety protocols, priority actions.

And maybe even touching some review questions to help it all sink in.

Definitely, and we'll be sure to define any medical terms as we go, make sure everyone's on the same page.

All right, let's jump right in then.

This chapter starts by laying the groundwork with gestation.

So what exactly are we talking about when we say gestation?

Okay, so gestation refers to the whole period of development inside the womb.

It starts from the moment of fertilization, you know, when the egg is fertilized, all the way until the estimated time of birth.

And that's typically how long?

Generally, it spans about 280 days, or you could say around 40 weeks.

And to get an idea of when that birth might happen, there's a pretty common method called Najalee's Rule.

Najalee's Rule, sort of like a calculation.

Yeah, it's a bit like a pregnancy calendar in reverse.

It gives you a way to estimate the expected date of birth, the EDB.

But it's most accurate for women who have regular 28 -day menstrual cycles.

That's important.

Okay, so how does the formula work, the one in box 23 to 1?

Right, you take the first day of the woman's last menstrual period, or LMP, and you subtract three calendar months.

After that, you add seven days.

And sometimes, depending on the dates, you might need to add one year to the result as well.

Can we maybe walk through an example, just to make it super clear?

Absolutely.

The example in box 23 to 1 is great.

Let's say a woman's last menstrual period began on September 12, 2019.

First subtract three months, that takes us back to June 12, 2019.

Then add seven days, so June 19, 2019.

And finally, since we crossed over the year, we add one year.

So the estimated date of birth, the EDB, is June 19, 2020.

Okay, that makes sense.

A straightforward calculation, but really depends on that regular cycle, doesn't it?

It really does.

That's the key caveat.

Of course, nowadays, early ultrasounds are also very commonly used for more precise dating, especially if cycles are irregular.

Right, right.

Good point.

So a bit of mathematical forecasting there.

Now, the chapter also brings in some specific terms related to pregnancy history,

gravidity, and parity.

These sound pretty fundamental.

Oh, they are.

Absolutely foundational in obstetric language.

Gravidity basically just tells us the number of times a woman has been pregnant.

Simple as that, regardless of the outcome.

And a pregnant woman is a gravita.

Correct.

A gravita.

And then we have terms to describe her history.

No gravita means she's never been pregnant.

Really gravita, that's her first pregnancy.

And multigravita means she's been pregnant at least two times.

Okay, that's gravita.

What about parity?

How is it different?

Parity focuses specifically on the number of births a woman has had that went past 20 weeks of gestation.

That 20 -week mark is key.

Ah, okay.

So it's about births, not just pregnancies.

Exactly.

And it doesn't matter if the baby was born alive or if it was twins or triplets.

It counts as one birth event past 20 weeks.

So the terms would be?

Millifera for a woman who hasn't had any births past 20 weeks.

Primipara for one birth past 20 weeks.

And multipara for two or more.

It gives healthcare providers a quick snapshot of her birth history.

That seems like quite a bit of information to track.

Is there a shorthand way to summarize all of this?

Yes, definitely.

The chapter introduces a really handy acronym, GDPAL.

It's detailed in box 23 .2.

It's a five -part system.

GDPAL.

Okay, break that down for us.

Sure.

G is for gravity total number of pregnancies.

T is for term births, births at 37 weeks or later.

P stands for preterm births, births between 20 weeks and just before 37 weeks.

Okay, GDP.

Then A is for abortions, pregnancies ending before 20 weeks.

That includes miscarriages and elective abortions.

And finally, L is for live births, the number of children currently living.

Wow, that's incredibly helpful.

A real snapshot, like you said.

Can you run through the example from the box?

You bet.

So the example is a woman pregnant for the fourth time.

Okay, fourth time, got it.

She had one elective abortion early on.

Then she had a daughter born at 40 weeks, that's term, and then a son born at 36 weeks, that's preterm.

Okay.

So let's see the GDPAL.

Gravidity G is followed by four pregnancies.

Term births, T is one, the daughter at 40 weeks.

Preterm births, P is one, the son, a son of six weeks.

Abortions A is one, the early elective abortion.

And live births is two, she has two living children.

So four, one, one, one, two.

Exactly, four, one, one, two.

Gives you a really concise, comprehensive picture.

That really clarifies how those terms work together.

Okay, shifting gears a bit.

The chapter moves into the signs and symptoms of pregnancy.

It breaks them down into presumptive, probable, and positive.

What's the main difference there?

Yeah, these categories basically help us understand how likely the pregnancy is.

Presumptive signs are things the woman herself might experience or notice.

They suggest pregnancy.

Okay, suggests.

Probable signs are more objective things a health care provider can find during an exam.

Stronger indicators.

Oh, or likely.

Right, and positive signs.

Those are the absolute undeniable proof that a pregnancy exists.

No doubt about it.

Okay, suspicion, increasing certainty, and then confirmation.

Let's start with presumptive.

What kinds of things might a woman notice?

Well, the classic one is amenorrhea, missing her period.

That's often the first clue for many women.

Right.

Then there's nausea and vomiting, you know, morning sickness, though it can happen any time.

Breast changes are common too, feeling bigger, fuller, maybe tender.

Nipples might get more pronounced.

Also needing to pee, more often urinary frequency.

And just feeling really tired, fatigue.

Some women notice a sort of bluish discoloration of the vaginal lining.

And later on, maybe weeks 16 to 20, she might feel quickening.

Quickening.

That's the first time she feels the baby move like little flutters initially.

All presumptive signs.

Okay, so those are the woman's own experiences.

What about probable signs?

What would a doctor or nurse pick up on?

Probable signs are things we can actually observe or measure.

Like uterine enlargement, the uterus getting bigger.

Makes sense.

There are also specific changes to the cervix and uterus.

Goodell sign that's a softening of the cervix, usually around the second month.

Chadwick sign, a bluish or violet color of the cervix.

Vagina, vulva, around week six due to more blood flow.

Okay.

And Higar's sign softening of the lower part of the uterus, also around week six.

Another one is Balamante, during a pelvic exam.

The examiner might feel the fetus kind of rebound in the amniotic fluid.

Braxton -Hicks contractions.

Those are regular, usually painless practice contractions.

They're also probable.

And of course, a big one is a positive pregnancy test.

Detecting HCG hormone in urine or blood.

So stronger indicators, but still not 100 % proof.

Exactly.

Things like uterine enlargement or even a positive test could, in rare cases, be caused by something else.

So they're probable, not positive.

Which brings us to the positive signs.

What are the definite confirmations?

Positive signs are the ones that leave no doubt.

Like actually visualizing the fetus, usually with ultrasound, seeing the outline of the structure.

Seeing the baby.

Pretty much.

Radiography used to be used, but ultrasound is the standard now.

Then there's detecting the fetal heart rate.

You can usually hear it with a Doppler device around 10 to 12 weeks.

Or in the heartbeat.

Or with a Fittiscope, a special stethoscope, around 20 weeks.

And finally, if the examiner can actually feel the baby moving, palpate, active fetal movements, that's a positive sign too.

That's a very clear distinction.

Presumptive, maybe.

Probable, likely.

And positive, definitely.

Great.

The chapter then talks about fundal height.

I remember this being measured at prenatal visits.

How is it used?

Right, fundal height.

It's the measurement, usually in centimeters, from the top of the pubic bone, the symphysis pubis, up to the top of the uterus, the fundus.

It's mainly used to check on the baby's growth and estimate the gestational age, especially in the second and third trimesters.

Between about 18 and 30 weeks, the measurement in centimeters often lines up pretty closely with the number of weeks of gestation.

So like 24 centimeters around 24 weeks?

Yeah, roughly.

Give or take about 2 centimeters.

Figure 23 to 1 in the chapter shows this correlation visually.

Are there key landmarks doctors look for?

Like where the fundus should be at certain weeks?

Yes, there are some general guides.

Around 16 weeks, the fundus is usually about halfway between the pubic bone and the belly button, the umbilicus.

Halfway.

Then by 20 to 22 weeks, it typically reaches the level of the umbilicus.

And then it keeps growing, reaching its highest point near the bottom of the sternum, the xiphoid process, around 36 weeks.

After that, it might drop a little as the baby engages in the pelvis, which is called lightning.

Right.

I've heard of that.

Is there anything important to remember when measuring fundal height?

Yes, definitely.

Box 23 to 3 points out something crucial.

Supine hypotension.

When the woman lies flat on her back for the measurement,

especially later in pregnancy, the heavy uterus can press on major blood vessels, like the vena cava.

Cutting off blood flow?

It can reduce blood return to the heart, causing her blood pressure to drop, making her feel dizzy or faint.

So the nurse needs to be really watchful for that.

Maybe tilt her slightly to one side.

Good safety point.

OK, the next big section is huge.

All the physiological changes the mother's body goes through.

It seems like almost every system gets involved.

Oh, absolutely.

It's a remarkable cascade of adaptations.

Pretty much every system adjusts to support the pregnancy.

And the text rightly notes that cultural beliefs can really influence health practices during this time.

So being culturally sensitive is vital for nurses.

Let's start with the cardiovascular system.

What are the major changes there?

One of the biggest is the increase in blood volume.

It goes up significantly, like 40 % to 50 % more than before pregnancy.

Wow, that much.

And interestingly, the plasma part increases more than the red blood cell part, which can lead to what we call physiological anemia.

It's a dilution effect.

The heart itself actually gets a bit bigger and shifts position slightly upward and to the left as the uterus pushes the diaphragm up.

Figure 23 to 2 shows that.

There's also a much higher demand for iron for both the mother's increased blood volume and the baby's needs.

Makes sense.

What about heart rate and blood pressure?

The resting pulse rate usually goes up a bit, maybe 10 to 15 beats per minute.

Blood pressure is interesting.

It often dips slightly in the second trimester, then comes back up towards pre -pregnancy levels in the third.

Ideally, it shouldn't go above the pre -pregnancy baseline.

And breathing.

Respiratory rate usually stays about the same or might increase just slightly.

But the body does tend to retain more sodium and water, contributing to weight gain.

Okay, quite a workout for the heart and vessels.

How does the respiratory system adapt?

Well, the mother needs more oxygen, about 15 % to 20 % more for herself and the baby.

And like we said,

that growing uterus pushes the diaphragm up.

Making it harder to take deep breaths.

Exactly.

It can lead to a feeling of shortness of breath, especially later on.

Less space for the lungs to expand fully.

That makes sense.

Now, the GI system, lots of changes listed there.

Morning sickness is probably the most famous one.

Absolutely.

Nausea and vomiting, very common in the first trimester.

It's thought to be linked to those rising HCG hormone levels.

Usually gets better by the second trimester for most women, thankfully.

But other things happen, too.

Oh, yeah.

Hormones, especially progesterone, relax smooth muscles everywhere, including the gut.

So gastric motility slows down.

Which causes...

Can lead to things like poor appetite, constipation, because things aren't moving through as fast.

Plus the uterus is pressing on the bowels.

Also, more flatulence and heartburn because of the slowed motility and relaxation of the sphincter at the top of the stomach.

Ugh, heartburn.

Yeah, common complaint.

Plus, increased pressure in the pelvic veins can cause or worsen hemorrhoids.

Gums might get swollen and bleed more easily due to estrogen.

And some women get tyalism, excessive saliva, hormones again, most likely.

And some notice changes in taste and smell.

It really sounds like those hormones wreak havoc on the digestive system.

What about the renal system, the kidneys and bladder?

Well, urinary frequency is a big one, especially early and late in pregnancy.

First trimester, it's more bladder sensitivity and hormones.

Third trimester, it's mainly the uterus pressing right on the bladder.

Interestingly, the bladder capacity actually increases because of progesterone.

But the muscle tone might decrease a bit.

And another thing, the kidneys become a bit less efficient at reabsorbing glucose, so the renal threshold is lower.

Meaning sugar might show up in the urine more easily?

Exactly.

A little bit of bicosuria can be normal, but persistent high levels need checking for gestational diabetes.

Okay.

Moving on to the endocrine system, the hormone control center.

What are the key hormonal shifts?

The whole endocrine system ramps up.

Basal metabolic rate increases more energy needed.

The pituitary gland enlarges.

The front part pumps out more prolactin for milk production prep.

And the back part releases oxytocin for contractions later.

Cyproate too.

Yep.

The thyroid might enlarge slightly and become more active.

Parathyroid glands enlarge too, helping manage calcium.

Aldosterone levels go up, helping retain sodium and water.

All contributing to weight gain and that increased water retention.

It's all interconnected.

Now the reproductive system itself, obviously huge changes there.

Tell us about the uterus cervix ovaries.

The uterus undergoes just incredible growth.

From about 60 grams, maybe the size of a pair to around a thousand grams by the end.

That's due to both hyperplasia, more cells, thanks to estrogen and hypertrophy, existing cells getting bigger.

Wow.

Blood vessels and lymphatics in the uterus increase dramatically too.

And those Braxton -Hicks contractions start appearing,

usually after 16 weeks, the practice contractions.

From the cervix.

The cervix gets softer, more elastic, and the opening might widen slightly.

It also forms that thick mucus plug we mentioned, sealing off the uterus as a barrier.

That increased blood flow causes the softening, good L sign, and the bluish color, Chadwick sign.

Around week six.

What about the ovaries?

They're crucial early on, secreting progesterone for the first six, seven weeks, until the placenta takes over that job.

After that, they basically stop maturing new eggs, and ovulation ceases for the duration of the pregnancy.

And the vagina and breasts.

The vagina wall thicken, and there's more discharge, typically thick,

white, and acidic.

The breasts, well, they change a lot due to estrogen and progesterone.

Increased size, tenderness, darker aerialism, more visible veins.

Those little bumps on the areola, Montgomery's follicles get bigger.

And colostrum, the early milk, might start leaking.

The whole system is gearing up.

The chapter also mentions skin changes.

Lots of women notice those.

Yes, skin changes are very common, mostly thanks to increased melanocytes stimulating hormone triggered by estrogen and progesterone.

Increased pigmentation.

That dark line down the abdomen, the linea nigra, and colasma, the mask of pregnancy.

Brownish patches on the face.

Stretch marks, or striae gravidarum, are also very common as the skin stretches on the abdomen, breasts, thighs.

You might also see vascular spider,

little spider -like blood vessels.

And some women find their hair grows faster.

And finally, the muscular skeletal system.

Pregnancy definitely changes posture and movement.

Oh, for sure.

As the uterus grows, usually starting in the second trimester, the center of gravity shifts forward.

Hormones like relaxin and progesterone loosen ligaments and joints.

Making women more prone to backache.

That forward shift increases the curve in the lower back lordosis leading to aching.

It could also cause numbness or weakness in arms and legs.

The gait often widens.

That characteristic waddle, which combined with the balance shift, increases the risk of falls.

Pelvic joints relax too, preparing for birth.

Abdominal muscles stretch too, right?

They do, losing some tone, but usually bounce back postpartum.

Even the belly button can flatten or pop out.

The chapter really stresses, using good posture and being careful to prevent back pain and falls.

It's truly amazing how interconnected all these physical changes are.

Now, let's shift from the physical to the psychological side.

The chapter covers maternal psychological changes too.

It's not just the body changing, is it?

Not at all.

That's a critical point.

The emotional journey is just as significant.

One common feeling, especially early on, is ambivalence, even in planned pregnancies.

Feeling unsure or having mixed feelings.

Exactly, conflicting emotions about being pregnant, about how life will change, maybe feeling torn between needing support and wanting independence, and partners often feel ambivalent too, thinking about new roles and responsibilities.

Seems very normal for such a huge life event.

What happens as the pregnancy progresses psychologically?

Acceptance becomes a key developmental task.

This often ties into how ready the woman feels for pregnancy and how much she starts to identify with being a mother.

Are there specific tasks involved in that?

Yes, the chapter outlines several,

like fully accepting the reality of the pregnancy, identifying with the mothering role, working on the relationship with her partners they prepared together, establishing a bond with the unborn baby, and realistically preparing for birth and parenting.

What about those mood swings we often hear about, emotional ability?

Ah, yes, very common.

Frequent, sometimes intense shifts in emotion.

It's largely driven by those major hormonal fluctuations.

While it's typical, the woman herself might feel like something's wrong, so reassurance and understanding are really important.

And body image, with all the physical changes.

That's a big one too.

How a woman feels about her changing body is very personal.

It evolves throughout the pregnancy.

It can be positive, negative, or a mix, influenced by the physical changes, symptoms, societal views.

It definitely impacts overall wellbeing.

And how does the relationship with the baby develop psychologically?

It's a gradual process.

It might start with daydreaming about the baby, thinking about what they'll be like, then comes accepting the biological fact there's a baby growing inside.

Feeling those first movements, quickening,

really helps solidify the idea of the baby as a separate individual.

And the final stage involves preparing realistically for birth and for actually caring for this new person.

It's such an intricate journey, physically and mentally.

Okay, the chapter then gets very practical, listing common discomforts of pregnancy.

There's a long list.

Let's tackle some major ones, and the advice given.

Nausea and vomiting, we know the hormonal cause.

What helps?

Some simple things can make a difference, like eating dry crackers or toast before getting out of bed.

Okay.

Avoiding brushing teeth right away, as that can be a trigger.

Eating small, frequent, low -fat meals instead of big ones.

Drinking fluids between meals, not with them.

Avoid certain foods.

Yeah, definitely avoid fried, spicy, greasy stuff usually.

Some find relief with acupressure bands on the wrist.

And always, always check with a provider before trying any herbal remedies.

Good advice.

Syncope or fainting.

What causes that and how to prevent it?

In the first trimester, it's often hormonal changes, causing blood vessels to relax.

Later on, that supine hypotension we talked about lying flat on the back is a major culprit.

So, avoid lying flat.

Definitely, especially after the first trimester.

Also, sitting with feet elevated helps.

Changing position slowly is key.

Don't jump up too fast.

Urinary urgency and frequency common early and late.

What helps manage that?

Well, you can't completely stop it, but managing helps.

Drink plenty of fluids during the day, aiming for around two liters, but maybe limit them in the evening.

To avoid nighttime trips.

Exactly.

Go when you feel the urge, don't hold it.

Sleeping on your side can help take pressure off the bladder.

Peroneal pads might be needed sometimes, and Kegel exercises are great for strengthening pelvic floor muscles.

Breast tenderness, often an early sign.

Relief.

A good, supportive bra is key.

Even sleeping in one can help some women.

Avoid soap directly on the nipples as it can be drying and irritating.

Loose cotton clothes might feel better, too.

Increased vaginal discharge is also common.

Best practices.

Good hygiene.

Just gentle washing.

Cotton underwear is best more breathable.

Definitely avoid douching.

It disrupts the natural balance, and it's crucial to know the signs of infection, like changes in color, odor, itching, and report those to the provider.

Nasal stuffiness or nosebleeds.

Seems random, but it happens.

It does.

Estrogen again.

It causes swelling and increased blood flow in the nasal passages.

A humidifier can help keep things moist.

Best to avoid over -the -counter nasal sprays or antihistamines, unless the doctor specifically says okay.

And gentle nose blowing.

Fatigue.

Especially first and third trimesters.

How to cope.

Rest is number one.

Frequent breaks.

Using good posture helps conserve energy.

Surprisingly, gentle, regular exercise can actually boost energy levels over time.

Relaxation techniques help, too.

And try to avoid stimulants like too much caffeine.

Heartburn later in pregnancy?

What works?

Small, frequent meals again.

Avoid the triggers, fatty, spicy foods, sometimes citrus or chocolate.

Stay upright for at least 30 minutes after eating.

Milk between meals sometimes helps soothe.

Elevating the head of the bed at night.

And talk to the provider before taking antacids.

Ankle swelling or edema.

Common later on.

How to reduce it.

Elevate those legs whenever possible.

Several times a day when resting.

Sleeping on the left side helps circulation.

Supported stockings can make a big difference.

And avoid standing or sitting still for long stretches.

What about varicose veins?

Similar advice.

Pretty similar, yes.

Elevate legs.

Wear support hose.

Avoid standing or sitting.

Don't cross legs.

Wear loose clothing.

Moving around helps.

Tromboflebitis is rare, but important to know the signs and encourage movement.

Especially avoiding long travel if possible.

Headaches.

Usually okay in the first trimester, but need checking later.

Benign headaches early on might be helped by changing positions slowly.

Cool cloth, staying hydrated, small snacks.

Acetaminophen only if prescribed by the provider.

But persistent or severe headaches later on need immediate evaluation, could be linked to blood pressure issues.

Hemorrhoids.

Painful.

Relief strategies.

Warm sit spas can be very soothing.

Sitting on a soft pillow reduces pressure.

High fiber diet and plenty of fluids are crucial to prevent constipation, which makes them worse.

Gentle exercise helps too.

Providers might prescribe ointments or compresses.

And constipation itself, often due to hormones and pressure.

Yep, same advice.

High fiber, lots of fluids at 2 ,000 milliliter daily.

Regular exercise.

If that doesn't work, talk to the provider about stool softeners or other options.

Avoid taking laxatives without checking first.

Backache, almost inevitable later on.

How to ease it.

Rest, good posture, proper body mechanics for lifting.

Low heeled, supportive shoes are a must.

Pelvic tilts, tailor sitting, relaxation exercises can help strengthen muscles.

And always be mindful of that fall risk due to the changed center of gravity.

Leg cramps, especially at night.

Ouch.

Yeah, they can be nasty.

Thought to be related to calcium phosphorous imbalance or nerve pressure.

When one hits, dorsiflex the foot, pull toes up towards the shin.

Regular exercise and ensuring enough calcium might help prevent them.

And finally, shortness of breath from the diaphragm being pushed up.

Again, frequent rest, avoid overdoing it.

Sleeping propped up with pillows or on the side can make breathing easier.

That's an incredibly helpful rundown of managing those common discomforts.

Okay, the chapter then shifts to maternal risk factors.

Starting with age, why are very young mothers, 20, and older mothers, 35, considered higher risk?

Both ends of the age spectrum present unique challenges.

For adolescents, especially under 16, they're often still developing physically and emotionally themselves.

They might face poor nutrition, lack of support, socioeconomic issues.

Leading to risks like.

Higher rates of stillbirth, low birth weight,

preeclampsia, anemia for the mother.

For women over 35, especially over 40, there's a higher chance of having preexisting conditions like hypertension or diabetes.

They also have increased risks for things like gestational diabetes, chromosomal abnormalities in the baby, and labor complications.

The chapter specifically calls out adolescent pregnancy.

What are the nurse's key roles there?

It's really about support and early intervention.

Encouraging early and consistent prenatal care is vital.

Providing education that's appropriate for their age and understanding.

Offering emotional support.

And importantly, connecting them with resources, nutritional help, parenting classes, social services, to address those unique challenges like lack of support or poverty.

They face higher risks for complications, so close monitoring is key.

Nutrition is obviously key for everyone, but folic acid gets special mention.

Why is that so critical?

Folic acid is absolutely crucial, ideally starting before conception, for preventing neural tube defects.

Like spina bifida.

Exactly.

Spina bifida and encephaly serious birth defects of the brain and spinal cord.

Adequate folic acid significantly reduces that risk.

It might also help prevent other things like cleft lip or palate.

Genetic considerations are listed as a risk factor too.

How do genetics play a role?

Well, parents can carry genes for inherited conditions.

A family history of genetic disorders, birth defects, or even multiple miscarriages can signal an increased risk for the current pregnancy.

So taking a thorough family history is part of the nurse's role, possibly leading to referrals for genetic counseling or testing.

Lack of prenatal and dental care is also highlighted.

Why is consistent care so vital?

Early and regular prenatal care catches problems early.

It allows monitoring of both mother and baby, identifying risks, providing education.

It's directly linked to better outcomes.

Skipping care increases risk for preterm birth, low birth weight, even dental health is linked.

Poor dental hygiene in pregnancy has been associated with preterm birth too.

That's interesting about dental care.

Sadly, abuse and violence are also listed.

What are the impacts during pregnancy?

Devastating impacts.

Abuse increases the risk of serious physical complications like abrupt yield placenta, the placenta separating prematurely preterm birth infections.

And the psychological toll is immense.

Increasing risk for depression, anxiety, substance use.

It's a critical safety concern.

Pre -existing medical conditions definitely increase risk, like what?

Things like diabetes, chronic hypertension, heart disease, autoimmune disorders.

These conditions can worsen during pregnancy due to the body's changes, and they can also negatively affect the pregnancy itself.

Increasing risk for complications like preeclampsia, growth restriction, preterm birth, close management by a whole team is crucial.

And German measles, rubella, still a concern.

Absolutely, especially in the first trimester.

It's highly teratogenic, meaning it can cause severe birth defects.

The virus crosses the placenta and can damage the baby's eyes, heart, ears, brain, causing congenital rubella syndrome.

That's why checking immunity, the rubella titer, is standard prenatal care.

Okay.

The chapter also groups STIs and substance abuse as major risks.

Can you briefly recap the dangers?

Sure.

Various STIs pose serious threats.

Syphilis can cross the placenta, causing miscarriage, stillbirth, or congenital syphilis with long -term issues.

HPV can cause growths in the baby's throat.

Gonorrhea and chlamydia can cause eye infections or pneumonia in newborns, plus increased preterm labor risk.

Herpes can be life -threatening for a newborn exposed during birth.

HIV can transmit during pregnancy, birth, or breastfeeding.

And substance abuse, alcohol, smoking, drugs.

All incredibly harmful.

They cross the placenta.

Alcohol can cause fetal alcohol syndrome, intellectual disability, physical defects.

Smoking is linked to low birth weight, preterm birth, stillbirth.

Illicit drugs cause a huge range of problems.

Growth restriction, placental abruption, withdrawal in the newborn.

The chapter lists signs of drug abuse.

And a key message.

No medications, even over -the -counter ones, without provider approval.

It's a stark reminder of those risks.

Okay, let's move into antipartum diagnostic testing.

What's the typical visit schedule like?

For a low -risk pregnancy, it's generally once a month for the first 28 to 32 weeks or so.

Then it ramps up to every two weeks until 36 weeks.

And then weekly until delivery.

But that can change based on individual risks.

First tests usually involve blood type and RH factor.

Why is that so critical?

It's all about preventing RH incompatibility.

If the mother is RH -negative and the baby is RH -positive, inherited from an RH -positive father, the mother's body can create antibodies against the baby's blood cells.

Which causes problems.

Not usually in the first pregnancy, but it sensitizes her.

In future RH -positive pregnancies, those antibodies can attack the baby's red blood cells, causing serious anemia, jaundice, even death.

That's why RH -negative moms with a negative antibody screen get Rho -D, immune globulin, Rho -Jam, around 28 weeks in after delivery if the baby is RH -positive.

It prevents her from making those antibodies.

Makes sense.

And the rubella titer, we mentioned immunity.

Right, this blood test checks if she's immune to German measles.

If the titer is low, like 1 .8, she's susceptible.

She can't get the vaccine during pregnancy because it's a live virus.

So she gets it after.

Exactly, postpartum, before discharge.

And she needs to avoid getting pregnant again for about one to three months after the shot.

We also check for egg allergies before giving it.

Okay, hemoglobin and hematocrit are checked routinely as well, too, looking for anemia.

Yes, we expect levels to drop a bit due to that physiological dilution we talked about.

But if hemoglobin falls below 10 GDL or hematocrit below 30%, especially later in pregnancy, it indicates true anemia that likely needs treatment, usually with iron supplements.

A pap smear is often done at the first visit.

Usually, yes, it's standard screening for cervical cancer or precancerous changes, just checking cervical health.

And screening for STIs and possibly sickle cell?

Yes, STI screening is routine.

Table 23 -1 lists common tests.

Sickle cell screening is done for women considered at higher risk based on ethnicity, African -Mediterranean, Middle Eastern descent, for example.

A positive screen needs follow -up testing to see if she has the trait or the disease.

What about the TB skin test?

The tuberculin skin test, or TST.

Providers might prefer doing it after birth, but it can't be done during pregnancy.

A positive test means exposure to TB at some point.

If it's positive, a chest x -ray is needed to rule out active disease, usually done after 20 weeks with shielding for the baby.

If someone convoes to positive during pregnancy, they might need treatment postpartum.

Hepatitis B testing is recommended for everyone.

Yes, screening for Hepatitis B surface antigen, HBSG, is universal.

This is crucial because Hep B can be passed to the baby during birth, leading to chronic infection.

Identifying positive mothers allows us to give the baby Hepatitis B immune globulin, HBIG, and the vaccine right after birth to prevent transmission.

The vaccine itself is safe during pregnancy if needed for high -risk women.

Your analysis is done at pretty much every visit, right?

What are you looking for?

Yep, routine urine dipstick.

We look for glucose.

Persistent high levels might signal gestational diabetes.

Protein could indicate a UTI or later on preeclampsia.

White blood cells suggest infection.

Ketones might mean she's not eating enough or is dehydrated from vomiting.

A two plus to four plus protein reading definitely needs more investigation.

Ultrasound is such a common tool now.

What can it tell us?

So much.

Early on, it's great for accurate dating.

Confirming the EDB, it lets us see the baby's anatomy, check for normal development, screen for abnormalities.

We can see the placenta, check the amount of amniotic fluid.

Can it be done in different ways?

Yes.

Abdominally, usually after the first trimester, sometimes needing a full bladder,

or transvaginally, especially early on, using a probe in the vagina gives really clear images and can measure cervical length to check for preterm birth risk.

It's considered very safe.

What about the biophysical profile, or BPP?

The BPP is a non -invasive check of fetal wellbeing.

It combines an ultrasound assessment with a non -stress test, NST.

The ultrasound looks at fetal breathing movements, gross body movements, fetal tone, like flexion, and the amount of amniotic fluid, AFI.

And the score tells you.

Each component gets points, usually two if present normal, zero if absent tab normal.

A score of eight to 10 is generally reassuring, suggests the baby's central nervous system is working well and they're not likely suffering from lack of oxygen.

Doppler blood flow analysis, what does that measure?

That uses ultrasound to look specifically at blood flow through vessels like the umbilical artery, fetal brain arteries, uterine arteries.

It helps assess placental function.

Reduced or abnormal flow can be a sign of placental insufficiency or fetal compromise, especially in high -risk situations like growth restriction or hypertension.

Percutaneous umbilical blood sampling, PEBS, sounds more invasive, when is that used?

It is more invasive, it's also called corticentesis.

A needle goes through the mother's abdomen into an umbilical cord vessel to get a fetal blood sample, all guided by ultrasound.

Why would you need fetal blood?

Usually for specific diagnostic reasons, maybe checking for severe fetal anemia, genetic disorders, infection, or sometimes to give the fetus a blood transfusion directly.

It has risks, so it's not done routinely.

Fetal heart rate is monitored closely afterward.

Alpha -fetal protein AFP screening, that's a blood test?

Yes, a maternal blood test, usually done between 16 and 18 weeks.

It measures a protein made by the fetal liver.

Abnormal levels, either high or low, can indicate an increased risk for certain conditions.

Like what?

High levels are associated with open neural tube defects like spina bifida or abdominal wall defects.

Low levels can be associated with chromosomal abnormalities like Down syndrome, trisomy 21.

But it's just a screening test, not diagnostic.

Abnormal results need follow -up, often with ultrasound or amyocentesis.

False positives are fairly common too.

DNA genetic testing, this is the newer cell -free DNA testing.

Exactly.

Non -invasive prenatal testing, or NIPT.

It analyzes tiny fragments of fetal DNA circulating in the mother's blood.

It's very good at screening for common chromosomal issues like trisomy 21, 18, and 13, plus sex chromosome abnormalities.

How early can that be done?

As early as seven weeks sometimes.

Just with a maternal blood draw.

It's highly sensitive, but still a screening test.

Positive results usually need confirmation with CVS or amyosin pieces.

Okay, so chorionic villus sampling, CVS, is one of those confirmatory tests.

Yes, CVS is an invasive diagnostic test.

It takes a tiny sample of the chorionic villi placental tissue that has the same genetic makeup as the fetus.

It's done earlier than amnio, typically between 10 and 13 weeks.

How is it done?

Either through the cervix or through the abdomen, guided by ultrasound.

There's a small risk of complications, including miscarriage.

Informed consent is crucial.

And arch -negative women need ROGAM after CVS because of the risk of sensitization.

And amniocentesis, probably the best known invasive test.

Right, amnio involves taking a sample of the amniotic fluid surrounding the baby using a needle inserted through the abdomen, again under ultrasound guidance.

It's usually done between 15 and 20 weeks for genetic testing.

What else can it test for?

Can check for neural tube defects by measuring AFP in the fluid.

Later in pregnancy, it can assess fetal lung maturity before a planned early delivery.

It does carry risks like infection, bleeding, rupture of membranes, preterm labor, though they are relatively small when done by experienced practitioners.

What are the key nursing points for CVS and amnio?

Informed consent is vital.

Ultrasound guidance is standard.

Baseline vital signs and fetal heart rate are checked before and monitored after.

For amnio, bladder might need to be full early on, empty later.

Afterward, the woman rests, often on her left side, and crucial instruction.

Report any fever, chills, bleeding, fluid leakage, decreased fetal movement, or contractions afterward.

Kit counts, that's something the mother does herself, right?

Yes, fetal movement counting.

A simple way to monitor fetal well -being at home.

She lies down quietly, usually on her side, and counts how many times she feels the baby move in a set time, maybe one or two hours.

What's considered normal?

The specific instructions vary, but a common guideline is feeling at least 10 movements in two hours.

If she notices significantly fewer movements than usual, or fewer than the set number, she needs to contact her provider right away.

It could be a sign of distress.

Okay, the Fern test and Nitrazine test these, check for ruptured membranes.

Exactly,

they check if her water is broken.

The Fern test takes a sample of vaginal fluid, puts it on a slide.

If it's amniotic fluid, it dries in a Fern -like pattern when viewed under a microscope because of the salts.

And Nitrazine?

It uses pH paper.

Vaginal fluid is normally acidic, pH 4 .5, 5 .5.

Amniotic fluid is alkaline, pH 7 .0, 7 .5.

So if the Nitrazine paper turns blue or blue -green when touched to the fluid, it suggests amniotic fluid is present.

What about the Fibernectin test?

Fetal Fibernectin, FFN, is a protein, sort of like a biological glue, found between the fetal sac and the uterine lining.

It's normally present in vaginal secretions early in pregnancy and then, again, near term.

So finding it in between means?

Finding it between about 20 and 37 weeks can indicate an increased risk of preterm labor starting within the next week or two.

A negative test during that time is actually more predictive.

It strongly suggests she's unlikely to go into labor soon.

It's used for women with preterm labor symptoms or risk factors.

Okay, finally in this section, the Non -Stress Test, NST, and Contraction Stress Test, CST.

What's the difference?

Both assess fetal well -being, but in different ways.

The NST, described in box 23 -4, is non -invasive.

It just monitors the fetal heart rate and looks for accelerations, temporary increases in the heart rate when the baby moves.

What does a good NST look like?

A reactive NST is good.

It means the baby had at least two accelerations of a certain size, 15 beats above baseline for 15 seconds, within a 20 -minute window.

It suggests good oxygenation.

A non -reactive test lacking sufficient accelerations needs further investigation.

And the CST, that involves contractions.

Yes, the CST, in box 23 -5, sees how the fetal heart rate responds to the stress of uterine contractions, which temporarily reduce oxygen flow.

Contractions are induced either with low -dose oxytocin or nipple stimulation.

What are you looking for then?

We're looking for decelerations,

specifically late decelerations, which are drops in the fetal heart rate that start after the peak of the contraction and return slowly to baseline.

A negative CST, normal, means no late decelerations occurred.

A positive CST, abnormal, means late decelerations happen with most contractions, suggesting the baby might not tolerate labor well.

That's a lot of tests.

Okay, let's switch back to nutrition, general guidelines.

The chapter mentions choose my plate as a resource.

For women starting at a normal weight, the goal is usually a 25, 35 -pound gain overall.

That means about 300 extra calories per day during pregnancy, maybe closer to 500 extra if breastfeeding.

And fluids, folic acid.

Folic acid is crucial.

400, 800 milligrams daily, ideally starting before pregnancy.

Fluids are as important too, eight to 10 glasses a day, mostly water.

Sodium isn't usually restricted unless there's a specific medical reason.

What about vegans or vegetarians?

Any special advice?

They need careful planning to get enough calories, protein, and certain nutrients often found in animal products like B12, iron, zinc, calcium, vitamin D, omega -3s.

Eating a wide variety of plant foods, focusing on complementary proteins like beans and rice together, and maybe taking supplements is important.

Combining plant -based iron sources with vitamin C helps absorption.

Chapter 11 has more details.

Lactose intolerance, how to get enough calcium.

Need non -dairy sources, fortified plant milks, tofu made with calcium, leafy greens.

Some people tolerate yogurt or hard cheeses better than milk.

Lactase enzyme pills or lactose -free milk are options too.

Pica eating non -food items like clay or ice.

Yeah, it happens sometimes.

The cause isn't totally clear.

It could be nutritional deficiencies like iron deficiency anemia or cultural factors.

It needs addressing because it can interfere with nutrient absorption and potentially be harmful.

And cultural considerations in diet.

Absolutely vital.

Fruit choices are deeply tied to culture.

Providers need to be sensitive, understand traditional diets and beliefs, and work with the woman to create a plan that's both healthy and culturally acceptable.

Chapter five discusses this more.

Okay, now we move into complications.

Starting with abortion or pregnancy loss before 20 weeks.

Box 23 to six lists different types.

Right, spontaneous abortion is a miscarriage.

Induced is elective or therapeutic.

Then there are types of spontaneous loss.

Threadened, bleeding cramping but cervix closed.

Inevitable, bleeding cramping cervix open.

Incomplete, some tissue passed, some retained.

Complete, all tissue passed.

Missed, fetus died but wasn't expelled.

And habitual, three or more consecutive losses.

What are the key signs and interventions?

Main signs are vaginal bleeding, maybe with clots tissue and cramping.

Interventions include monitoring bleeding, pad counts, vital signs, pain.

Saving any past tissue is important.

Dead rest might be advised.

Four fluids if needed.

If it's an incomplete or missed abortion, a DNC procedure might be necessary to empty the uterus.

And always, road jam for Rh negative women.

Anemia during pregnancy, mostly iron deficiency.

Yes, usually.

Makes women tired, pale, maybe headachey tachycardic.

Hemoglobin 10, hematocrit 30 are typical cutoffs.

You're eating it.

Monitor levels regularly.

Iron and folic acid supplements are key.

Educate on taking them correctly with vitamin C, not milk tea between meals.

Encourage iron rich foods.

Monitor for infection as anemia increases risk.

Severe cases might need IV iron or transfusion.

Postpartum, watch for bleeding.

Cardiac disease complicates pregnancies significantly.

What are warning signs of the heart struggling?

Signs of cardiac decompensation are critical to watch for.

Persistent cough, shortness of breath, extreme fatigue, palpitations, chest pain, swelling, edema.

Respiratory infections are also a concern.

How is care managed?

Close monitoring of mom and baby.

Limiting activity, ensuring rest.

Watching carefully for those decompensation signs or heart failure.

Good nutrition to prevent anemia.

Often a low sodium diet to reduce fluid retention.

Avoiding excessive weight gain during labor.

Continuous monitoring, sideline, position, oxygen.

Good pain control early on.

Control pushing.

Obesity adds even more stress.

Choreoimmunitis infection inside the amniotic sac.

Yes, a bacterial infection.

Can happen to after membranes rupture or related to other infections or procedures.

Can lead to maternal infection like endometritis postpartum or neonatal sepsis.

What are the signs?

Uterine tenderness, maternal fever, fast heart rate, mother and baby.

Foul smelling amniotic fluid.

High white blood cell count.

Intervention.

Monitor mom and baby closely.

Monitor uterine tenderness.

Blood cultures might be done.

Prepare for possible amniocentesis to test the fluid.

Give IV antibiotics after cultures.

May need meds to stimulate labor.

Newborn will need evaluation and likely cultures too.

Diabetes in pregnancy, preexisting or gestational, GDM.

How does pregnancy affect sugar control?

It's complex.

Maternal glucose crosses the placenta but insulin doesn't.

Baby makes its own insulin.

Early pregnancy, insulin needs might decrease.

But later, placental hormones cause insulin resistance so mom needs more insulin.

After delivery, needs drops sharply.

That's diabetes that starts during pregnancy, usually second or third trimester.

Pancreas can't keep up with the increased demand.

Usually screened for around 24, 28 weeks.

Often managed with diet but some need insulin.

Usually resolves after birth but increases lifetime risk for type two diabetes.

What are the risks for the baby?

Hypoglycemia right after birth because they're making extra insulin for mom's high sugar.

Jaundice, respiratory distress, low calcium, sometimes congenital anomalies, often large size.

Macrosomia.

What are the signs a mother might have diabetes or GDM?

Excessive thirst, hunger, weight loss, frequent urination, blurred vision, recurrent UTIs or yeast infections.

Like osuria, ketonuria.

Signs of gestational hypertension.

Polyhydramnios, too much amniotic fluid.

Large baby on ultrasound.

Interventions focus.

Diet, exercise, blood glucose monitoring.

Goal usually six, five, 130 ml of GDL.

Insulin if needed.

Watching for high low blood sugar, ketones.

Monitoring weight, fetal wellbeing.

Reporting infections during labor.

Careful insulin glucose regulation.

Continuous fetal monitoring, postpartum.

Watch mom closely for hypoglycemia as needs plummet.

Reregulate insulin.

Monitor for infection hemorrhage.

Disseminated intravascular coagulation.

DIC sounds scary.

Widespread clotting and bleeding.

It is very serious.

The clotting system goes into overdrive, forming tiny clots everywhere, which uses up all the clotting factors and platelets.

So paradoxically, you get both clotting and uncontrolled bleeding.

Figure 23 .3 shows this.

What triggers it in pregnancy?

Box 23 to seven mentions some causes.

Things like abruptio placenta, amniotic fluid embolism, severe pre -eclampsia -eclampsia, fetal death, sepsis, liver disease.

Signs?

Uncontrolled bleeding from IV sites, gums, nose, vagina, bruising, patechy, blood and stool urine, vomit.

Signs of shock.

Lab tests show low fibrinogen, low platelets, belong clotting times, PTPTT, high fibrin degradation products.

How is it managed?

Treat the underlying cause.

Monitor vitals, bleeding, shock signs constantly.

Give oxygen, fluids, blood products, platelets, plasma red cells, sometimes ebbing, controversially.

Monitor urine output, closely kidney failure is a risk.

Ectopic pregnancy implantation outside the uterus, usually the tube.

Exactly.

Classic signs are missed period, the one -sided abdominal pain, maybe dark red -brown spotting.

What if it ruptures?

That's an emergency.

Sudden, severe, sharp pain, often shoulder pain from blood irritating the diaphragm.

Signs of shock, dizziness, pallor, rapid weak pulse, low BP.

Interventions.

Monitor vitals and bleeding closely.

Prevent shock.

Sometimes methotrexate can be used if it's early and unruptured, otherwise surgery, laparoscopy or laparotomy to remove the pregnancy, maybe repair, remove the tube, antibiotics,

and ROJAM for RH negative women.

Fetal death in utero, IUFD, after 20 weeks.

Such a difficult situation.

What are the signs?

Mother reports no fetal movement, no heartbeat heard, uterus stops growing or gets smaller, ultrasound confirms no cardiac activity, also risk of DIC if the fetus is retained for weeks.

Nursing care must be incredibly sensitive.

Absolutely.

Prepare for birth.

Support the parents' decisions.

Facilitate grieving.

Respecting cultural religious practices.

Acknowledge their pain and anger.

Offer referrals to support groups.

It's about compassionate, non -judgmental care.

Hepatitis B, how to prevent transmission to the baby.

Limit vaginal exams during labor.

Clean the baby thoroughly right after birth, removing maternal blood.

Suction the baby well.

Beta before invasive procedures.

Clean eyes before prophylaxis.

Key intervention.

Give the baby HBIG, immune globulin, and the first dose of Hep B vaccine within 12 hours of birth.

Educate mom about the vaccine series.

Breastfeeding is usually okay after the baby gets HBIG vaccine.

Age of eights in pregnancy.

Zetavudine AZT is key.

Yes, AZT treatment for the mother, starting after 14 weeks orally, IV during labor, and for the baby, orally, for six weeks, dramatically reduces transmission risk.

How is it transmitted?

Sexually, through blood needles, or perinatally during pregnancy, birth, or breastfeeding.

Breastfeeding is usually discouraged in developed countries if safe alternatives exist.

Diagnosis and stages.

ELISA screening test, confirmed by Western Blatifa.

Box 23 to eight details the stages from initial infection to advanced AIDS.

Key interventions during pregnancy and birth.

Prevent opportunistic infections in mom.

Avoid procedures that increase transmission risk.

Amnio, scalp electrodes if possible.

During birth, minimize baby's exposure to blood fluids.

Prompt cleaning, suctioning.

Give IV AZT during labor.

Avoid episiotomy forceps if possible, postpartum.

Monitor mom for infection.

Protective isolation if severely immunocompromised.

Hide it to deform all the grape -like cluster?

Yes, gestational trophoblastic disease.

Abnormal placental development can be benign or develop into cancer.

Core carcinoma.

Signs.

No fetal heartbeat detected.

Vaginal bleeding, often dark brown, prune juice -like, or bright red.

Signs of preeclampsia before 20 weeks.

Uterus larger than expected for dates.

Very high HCG levels.

Ultrasound shows a snowstorm pattern.

No fetus, usually.

What's the treatment?

Uterine evacuation, usually suctioned DNC.

Tissues sent for analysis.

Crucial follow -up.

Monitoring HCG levels weekly by weekly until normal, then monthly for a year.

Strict contraception needed for that year pregnancy would confuse HCG monitoring for malignancy.

Monitor for hemorrhage infection post -procedure.

Hyperamesis gravidarm way beyond morning sickness.

Oh yeah.

Intractable nausea vomiting past the first trimester, causing dehydration, electrolyte imbalance, significant weight loss, like 5%.

How is it managed?

Try antibiotics first.

If that fails, possibleization for IV fluids, electrolytes, sometimes IV nutrition, parenteral nutrition.

Monitor vitals, INO, weight, labs, ketones, electrolytes.

Small frequent bland meals if tolerated.

Liquids between meals.

Sit up right after eating.

Monitor feel well -being.

Gestational hypertension, GH, preeclampsia, eclampsia.

Big topic.

Can you summarize the progression and key differences?

GH is high blood pressure, 14a90.

Starting after 20 weeks, no proteinuria.

Preeclampsia and proteinuria are signs of end -organ damage.

Low platelets, high liver enzymes, kidney problems, visual changes, bad headache.

It can be mild or severe.

Table 23 -3 compares.

Eclampsia is the onset of seizures in a woman with preeclampsia.

Who's at risk?

First time moms, age 19 or 40.

Chronic kidney disease, hypertension, diabetes, multiple gestation, history of it.

Toplectations.

Abruptial placenta, DIC, HELLP syndrome,

hemolysis, elevated liver enzymes, low platelets, fetal growth restrictions, stillbirth.

Interventions for mild to GH preeclampsia.

Monitor BP, fetal well -being, rest, sideline, maybe antihypertensives.

Monitor kidney function, INO, weight.

For mild preeclampsia, also monitor neurological status.

Reflexes, box 23 -9 explains reflexes clonus.

High protein carb diet.

And severe preeclampsia.

Bedrest, magnesium sulfate CD is key to prevent seizures.

Monitor closely for magnesium toxicity, loss of reflexes, respiratory depression, need calcium gluconate antidote ready.

Antihypertensives, but care for likely delivery.

The clampsia seizures happen, priority actions.

Box 23 -10 describes seizures.

Stay with patient, call for help.

Ensure airway, turn on side.

Give oxygen, monitor baby.

Give magnesium sulfate or other anticovulsants as ordered.

After seizure, suction, maybe oral airway.

Prepare for delivery, once stable.

Document everything.

It's preventable with good preeclampsia management.

Incompetent cervix opens too early.

Yes, painless dilation, usually second trimester leading to preterm birth.

Might see bleeding, feel pressure.

Membranes might bulge through cervix.

Treatment.

Cervical circleage, stitching the cervix closed, usually done 10, 14 weeks.

Bedrest, hydration, maybe tocolytics, stop contractions.

After circleage, pelvic rest, no intercourse.

Avoid heavy lifting per long standing.

Tits removed around 37 weeks, we're left for C -section.

Report contractions, bleeding, fluid leak post procedure.

TORCH infections, can you quickly recap what each letter means and the risk?

Sure.

T, toxoplasmosis from raw meat cat feces, risk of miscarriage, birth defects.

O, other, HIV, syphilis, pergovirus, hep B.

R, rubella, German measles, highly teratogenic first trimester causes defects in eyes, heart, ears, brain.

C, cytomegalovirus, CMV, common virus, often asymptomatic in mom, can cause IUGR, jaundice, hearing vision loss, developmental issues in baby.

HPOs, herpes simplex virus.

HSV, risk of severe neonatal infection, infected lesions at birth, often need C -section.

And group B strep, GBS, often gets mentioned here too.

Yes, sometimes included under O.

Leading cause of newborn sepsis meningitis.

Mom colonized, no symptoms, baby infected during vaginal birth.

Screened late pregnancy, 3537 WKs.

IV antibiotics for mom during labor, if positive.

Multiple gestation twins, triplets, more risks.

Definitely, higher risk of almost everything.

Miscarriage, anemia, birth defects, a hyperemesis, IUGR, preeclampsia, polyhydraminoids, PROM, preterm labor, postpartum hemorrhage.

What are the signs and interventions?

Uterus larger than expected, excessive fetal activity, hearing one heartbeat, excessive weight gain, interventions, close monitoring of mom and each baby, ultrasounds.

Monitor for preterm labor, anemia, preeclampsia.

Prepare for possible C -section due to presentation issues.

Prepare for postpartum hemorrhage risk, oxytocics ready.

Pylonephritis, kidney infection ascending from UTI.

Right, pregnancy increases UTI risk, stasis, hormones.

Untreated UTI, pylonephritis, increases risk for anemia, low birth weight, preterm labor, PROM, GH.

Chapters 34 and 51 have more detail.

We've touched on STIs a lot, table 23 to one.

Any final key points?

Just reiterate that screening is crucial as many are asymptomatic in women, but harmful to baby, gonorrhea, blindness,

syphilis, congenital issues, HPV warts, maybe throat issues for baby, cancer link for mom,

chlamydia, preterm birth, newborn pneumonia, conjunctivitis,

trichomoniasis, BVE, preterm birth risk.

Treat mom and partner.

Tuberculosis, TB in pregnancy.

Transmission risk.

Airborne, transplacental rare, but baby can inhale infected fluid at birth or get it from close contact postpartum.

Active TB and mom link to GH disorders.

Diagnosis, treat.

Chest x -ray after 20 weeks, shielded.

Skin test safe.

Treatment is usually nine months of multiple drugs.

Isoniazid, rifampin, pyrazinamide, plus B6 pyridoxine with isoniazid for fetal neuroprotection.

Breastfeeding usually okay if mom's not infectious.

Newborn, get skin test, maybe prophylactic isoniazid.

Urinary tract infections, UTIs.

Why more common in pregnancy?

Urinary stasis from uterine pressure, hormonal relaxation of urinary tract, can lead to pylonephritis if untreated.

Chapter 51 is details on symptoms treatment.

Lastly, obesity in pregnancy, a growing issue.

Huge issue, increases maternal risks.

Blood clots, C -section, GH, GDM increases baby risks.

Stillbirth, anomalies, future obesity, heart disease for the child.

Nursing care challenges.

Hard to fore -access epidurals, intubation.

Mobility issues, need larger equipment.

Higher risk of post -op wound infection.

Clots, needs vigilant care.

Maybe prophylactic heparin, early ambulation.

Well, that brings us to the end of this incredibly thorough deep dive into the prenatal period and risk conditions chapter.

We've really covered a lot of ground.

We certainly have.

From the very basics like gestation, gravity,

parity,

all the way through the signs of pregnancy.

The amazing physiological and psychological shifts.

The common discomforts, the many potential risks and complications, and the diagnostic tests used along the way.

Exactly.

It highlights just how dynamic and complex pregnancy is.

Understanding all these concepts is just fundamental for providing good care.

We hope this detailed exploration, drawing directly from the Saunders Review chapter, has given you, our listener, a really solid, structured understanding of this vital period.

We encourage you to think about all the information we've discussed.

Pregnancy is an incredible journey, and knowledge really is key to promoting those positive outcomes for both mother and baby.

We've aimed to cover all the key nursing concepts, assessment guidelines, clinical procedures, safety protocols, priority actions, and even the implicit review questions from this comprehensive chapter, defining the medical terms as we went.