N4441 Prenatal Care Visit Skills Video Part B

Betty made an appointment at her midwife's office and came in for a visit the next week She met with nurse Susan, who ran the official pregnancy test, which was positive

"So I understand that you've just found out that you're pregnant?" "Yes!" "Good, and I understand that you're very excited about that" "Yes!" "So is this your first pregnancy?" "First baby" Very good Okay Well, Congratulations!" "Thank you

" "When you come in for your prenatal visits, we're going to ask several things of you each time" "One of the things we're going to do is get a urine sample" "Another thing we'll do is check your blood pressure and check on the baby Once you are past 20 weeks we'll be listening to the baby every time actually, after you're about 12 weeks" But we need to check on the urine of pregnant women to determine if there is protein or glucose in the urine, because those can both indicate complications of pregnancy Okay, very good So now I'm going to test the urine with a chemstrip and again, we're testing this in order to determine if there is any glucose or protein in the urine

And that's important because as the pregnancy progresses we want to make sure that you are not developing diabetes or preeclampsia So we dip the urine and then we observe the results comparing it to the different type of chemistry that is available wherever you're having your prenatal care or in the hospital "So you said I think I know what diabetes is but what was the other thing you said? "Preeclampsia, which is a complication of pregnancy which involves high blood pressure and you can also spill protein in your urine

So that's a signal to us that you could be developing that complication of pregnancy We want to follow you more closely and do lab work and that kind of thing But the urine is negative today So that's very good At the initial prenatal visit, the healthcare provider will discuss with the patient the meaning of the terms gravida and para, as well as how to calculate the pregnancy due date and how to determine the baby's gestational age during pregnancy Is this your first pregnancy? Yeah Okay Part of the terminology that we use in pregnancy is "gravida" and "para

" "Gravida" means how many pregnancies you have had; "para" is the number of live births or the number of births after 20 weeks So if this is your first pregnancy, you would be a gravida 1, para zero Gravida refers to the number of pregnancies regardless of outcome a woman has had Multiple fetuses count as one pregnancy one gravida and one birth one para Para refers to the number of pregnancies that have reached 20 weeks gestation, regardless of outcome: live, deceased ,stillborn, etc

TPAL stands for: T is the number of term infants born after 37 completed weeks of gestation P is the number of preterm infants born between 20 weeks and 37 weeks of gestation A is the number of pregnancies ending in spontaneous Or therapeutic abortion, miscarriage, or elective abortion before 20 weeks gestation That is a pregnancy loss before 20 weeks L is the number of living children

For example Mrs B has a positive pregnancy test today She has a three year old boy born at term, and she lost a baby at 11 weeks in 1999 What is her GTPAL? She is a gravida 3 Term: one (para) Preterm zero A: one Living one Do you remember when your last menstrual period was? November 10 Okay, November 10th

So using a dating wheel, we can determine the due date if we know the last menstrual period So November 10th and then

Your due date will be August 17th based on this wheel We like to use the last normal menstrual period–the first day of the last normal menstrual period This could be confirmed later on with a sonogram if we need to, but since we're pretty certain about your dates

Then that's the due date that we will use August 17th

Okay Dating of pregnancy is 10 lunar months 9 calendar months 40 weeks or 280 days Terminology that we use includes: EDC – estimated date of confinement EDD– estimated date of delivery EDB– estimated date of birth

These are based on LMP which is last menstrual period or LNMP — last normal menstrual period The EDC is 40 weeks from the first day of the LNMP Naegele's rule is: The last normal menstrual period, minus three months, plus seven days Equaling the EDC or estimated due date For example, if the first day of the last normal menstrual period is May sixth, you subtract three months and add seven days

The EDB would then be 2/13/2011 A second way to calculate the due date is using a gestational wheel Her last menstrual period is December 15th The due date that corresponds with the black line is September 21st We can also calculate the gestational age of the baby at anytime during the pregnancy if we know either the last menstrual period or the EDC on the wheel

lined up at the correct arrow For example Mrs

Brown is here for her appointment She is due August 17th Her last menstrual period was November 10th Using the inside of the wheel we find the date today, which is May 24th, and we see that she's 29 weeks pregnant Leopold's maneuvers are manual palpations of the pregnant woman's abdomen performed to assess the number of fetuses, the presenting part, the fetal lie, and fetal attitude, the degree of the presenting parts' descent into the pelvis, and the expected location of the point of maximum impulse or the PMI of the fetal heart rate on the woman's abdomen

This is the pregnant woman's abdomen This is the top of the abdomen and this is the pelvis Standing next to the woman and with her supported on her back, the first maneuver identifies the fetal part that occupies the fundus (or top) of the uterus This maneuver is used to help identify the fetal lie Whether it's longitudinal or transverse, and the presenting part is (either) cephalic or breech

The second maneuver is done by placing the hands on the abdomen to locate the smooth convex part of the fetal back And the small irregularities of the hands and feet by palpating side-to-side This maneuver helps identify the fetal presentation and fetal lie as well as the number of fetuses present The third maneuver is used to determine which fetal part is presenting over the inlet to the pelvis? You gently grasp the lower pole of the uterus between the thumb and the fingers and press in slightly This manoeuvre helps determine the presenting part, fetal attitude, and descent

The fourth maneuver is done by changing position to face the woman's feet and by palpating the outline of the fetal head or the presenting part This is done to help verify presentation, as well as attitude and descent After 20 weeks gestation, at each prenatal visit, the healthcare provider will also measure the height of the fundus of the uterus To measure fundal height you begin by placing the tape measure at the top of the symphysis pubis, which is the top of the pelvic bone With a tape measure

in centimeters and measure to where the fundus of the uterus begins to descend into the abdomen This measurement roughly corresponds to the number of weeks of gestation of pregnancy Therefore it is a easy way to tell if the baby is growing appropriately For instance, if the gestational age is 38 weeks, you would expect to find a 38 centimeter fundal height After the initial visit Betty had prenatal visits every four weeks through the first and second trimester

She chose to have a quad screen done at 18 weeks to test for Down syndrome neural tube defects and trisomy conditions It was then that she and her husband caught a glimpse of the gender of their baby, a girl! At 28 weeks Betty began her third trimester Her midwife visits were every two weeks now Betty was taught to count her baby's movements at least once a day and was instructed to call the office if she did not feel her baby move or felt that the baby did not move enough So you have not been having any problems at home? Good, and how far along are you today? "I'm 29 weeks

" "Good, so you're making good progress and the baby's moving?" "Yes" "GoodAll right

Well, today we're going to listen to the baby's heartbeat So I'm going to get the Doppler to do that The fetal heart rate is loudest over the back We call that the point of maximum impulse, so I'm going to listen to the baby's heartbeat We do that by determining where the baby's back is at

Okay, so I think he's about right there Very good Strong And I'm gonna count for about a minute And his heart rate is about a hundred and fifty which is normal, okay? So everything looks good

The weeks that followed were filled with last-minute preparations for the arrival of the new baby Betty and her unborn child's health remained good without complications The family gave her two baby showers, which supplied Dan and Betty with all the necessities for the baby They received a car seat plenty of diapers and dresses that would outfit her until she was three years old Dan and Betty attended a childbirth preparation class which took place all day on a Saturday

They learned about pregnancy from conception to birth They learned about the various medications as well as unmedicated delivery using breathing techniques, effleurage, and relaxation Dan learned to coach Betty through pretend contractions and they giggled as they tried to remain serious throughout the exercise One morning just a few days after her due date, Betty was feeling energetic She got up and immediately started scrubbing the kitchen floor She then decided to make Dan's favorite cookies –chocolate chip

Just as she was ready to scoop the first batch onto the cookie sheet She felt a trickle down her left leg She walked into the bathroom to clean herself off, when suddenly a gush of clear odorless fluid came from her vagina She grabbed a towel and wiped herself off She felt achiness in her lower pelvis and back

It wasn't painful, but much like a menstrual cramp Dan was at work, but kept his cell phone close to him as he had been on call for this event for over two weeks He received a call from Betty and answered it immediately She explained to him what had happened He asked her to hold on the line while he told his boss he was leaving

Very soon, he was in the driveway and kept the car idling while he ran inside Betty was crying softly and was sitting down hanging on to her previously packed hospital bag She was shaking but smiling, telling Dan that she thinks this will be the day when their little girl will arrive Dan took the bag from her hand and escorted his wife to the car He ran back inside to get the car seat and lock up the house

They were on their way to the hospital Betty continued to have cramping in her lower pelvis and back She noticed the cramping was getting stronger But still she felt comfortable enough to talk to Dan through them He offered to help her with breathing techniques that they learned in class, but she declined


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