OB | Nursing Management of Pregnancy
STAT Stitch Deep Dive Podcast Beyond The Bedside · Regular Guy
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Show Notes
Initial Assessment Folic acid (400-800 mcg/day) is vital to prevent neural tube defects. The initial prenatal visit establishes the Estimated Date of Delivery (EDD) using Naegele’s Rule: subtract 3 months from the first day of the last menstrual period (LMP), add 7 days, and add 1 year. Obstetric history uses the GTPAL acronym: Gravida (total pregnancies), Term (>38 weeks), Preterm (>20 but <37 weeks), Abortions (<20 weeks), and Living children. Physical assessment includes estimating pelvic adequacy by measuring the diagonal conjugate; a measurement ≥12.5 cm indicates the pelvic inlet is adequate.
2. Screenings & Diagnostic Tests Initial labs include blood typing, Rh factor, CBC, rubella, HIV, and STIs. Alpha-fetoprotein (MSAFP) screening occurs between 16 and 18 weeks; elevated levels indicate neural tube defects, while lower levels suggest Down syndrome. Invasive genetic diagnostic tests include Chorionic Villus Sampling (CVS) at 10-13 weeks and Amniocentesis at 15-20 weeks; both require administering anti-D immune globulin to Rh-negative patients. Gestational diabetes screening typically occurs between 24 and 28 weeks. Between 37 and 40 weeks, patients are screened for Group B Streptococcus.
3. Fetal Well-Being & Monitoring Fundal height corresponds to the weeks of gestation between 20 and 36 weeks (e.g., 24 cm equals 24 weeks). The normal fetal heart rate ranges from 110 to 160 bpm. Patients should perform daily fetal movement counts, as decreased movement strongly indicates fetal hypoxia. The Nonstress Test (NST) evaluates fetal heart rate accelerations; a "reactive" result shows at least two accelerations of ≥15 bpm lasting ≥15 seconds within 20 minutes. The Biophysical Profile (BPP) combines the NST with an ultrasound to evaluate fetal breathing, movement, tone, and amniotic fluid volume. A maximum score is 10; 8-10 is normal, while ≤6 is suspicious.
4. Discomforts & Danger Signs First-trimester discomforts include urinary frequency and nausea; nausea is mitigated by eating dry crackers before rising. Second-trimester issues include backache (relieved by pelvic tilt exercises) and leg cramps (relieved by dorsiflexing the foot). Third-trimester dependent edema is managed by elevating the legs. Patients must immediately report danger signs: early vaginal bleeding, severe vomiting, absent fetal movement, and symptoms of preeclampsia such as sudden facial edema, severe headaches, or visual changes.
5. Childbirth & Feeding Patients prepare for labor through education (e.g., Lamaze) focusing on breathing and relaxation. Breastfeeding is encouraged as it provides ideal nutrition, transfers antibodies, and promotes maternal uterine involution. For bottle-feeding, proper formula dilution is critical, and infants must be fed semi-upright to prevent choking and tooth decay