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• The usual schedule for antepartum health care visits is every 4 weeks for the first 28 to 32 weeks, every 2 weeks from 32 to 36 weeks, and every week from 36 to 40 weeks.
• ABO typing is performed to determine the woman’s blood type in the ABO antigen system.
• Rh typing is done to determine the woman’s blood type in the rhesus antigen system.
• Baseline blood pressure is obtained, and blood pressure is monitored frequently.
• An external ultrasound transducer and tocodynamometer are applied to the client, a duration of 20 minutes is obtained so that the FHT and uterine activity and tracing of at least can be observed.
• The client may be asked to press a button every time the client feels fetal movement, the monitor records a mark at each point of fetal movement, which is used as a reference point to assess the FHT.
• The client is placed in the lateral (sidelying) position to avoid vena cava compression.
• Rh positive indicates the presence of the antigen.
• Rh negative indicates the absence of the antigen.
• If the client is Rh negative and has anegative antibody screen, the client will need repeat antibody screens and should receive Rho (D) immunoglobulin (RhoGAM) at 28 weeks of gestation.
• The client will also requireRhoGAM within 72 hours after delivery if the infant is Rh positive.
• RhoGAM may also be prescribed following termination of pregnancy: such as following a miscarriage.
• White blood cells ( WBC) can be slightly increased during pregnancy.
• Leukocytosis can be a normal finding in pregnancy.
• Hemoglobin and hematocrit levels decline during gestation as a result of increased plasma volume.
• A decrease in the hemoglobin level to less than 10g/dl ( 100mmol/L) or in the hematocrit level to less than 30% indicates anemia.
• Screening for gestational diabetes mellitus begins at the initial prenatal visit and is diagnosed by a fasting blood glucose greater than 126mg/dl (7.0 mmol/L), HbA1c greater than 6.5% or a random plasma glucose level greater than 200mg/dl ( 11.1 mmol/L) then subsequently confirmed by another elevated fasting glucose level or HbA1c.
• The glucose challenge test is performed between 24 and 28 weeks gestation.
• According to the American Congress of Obstetricians and Gynecologist (ACOG) a GCT using a two-step approach should be used in screening for gestational diabetes mellitus (GDM).
• A 50-g oral glucose load without regard to time of day is given.
• Nonstress test is performed to assess placental function and oxygenation, determine fetal being, and evaluate the fetal heart rate (FHT) response to fetal movement.
• Doppler blood flow analysis is a non-invasive method of studying the blood flow in the fetus and placenta.
• Risk factors for amniocentesis include hemorrhage in the birthing parent, miscarriage, fetal injury, infection, Rh isoimmunization, abruptio placentae, amniotic fluid emboli, and premature rupture of the membranes.
• Deoxyribonucleic acid (DNA) genetic testing can be used to detect abnormalities related to an inherited condition and assists in determining if the client is at risk for having a fetus with down syndrome (trisomy 21), Edward’s syndrome (trisomy 18), or Pataus syndrome (trisomy 13).
• Chorionic villus sampling (CVS) is a non-invasive method of studying the blood flow in the fetus and placenta.
• Interventions for amniocentesis include ensuring informed consent was obtained, having the client drink water to fill the bladder before the procedure to aid in the visualization of the uterus for catheter insertion, obtaining baseline vital signs and fetal heart rate, monitoring frequently after the procedure, and Rh-negative individuals may be given Rho(D) immune globulin, because chorionic villus sampling increases the risk of Rh sensitization.
• Amniocentesis is performed to determine genetic disorders, metabolic defects, and fetal lung maturity.
• A lubricated probe is inserted into the vagina for fetal heart rate (FHR) monitoring.
• After 1 hour a plasma or serum glucose level is drawn and is considered elevated if it is greater than 140 mg/dl ( 7.8 mmol/L).
• Biophysical profile is a non-invasive assessment of the fetus using ultrasound and electronic fetal monitoring (EFM) that includes fetal breathing movement, fetal movements, amniotic fluid index, and fetal heart rate patterns via nonstress test.
• After amniocentesis, the client is instructed to rest for 24 hours and to avoid exercise, heavy lifting, and sexual intercourse for the amount of time prescribed.
• Amniocentesis is the aspiration of amniotic fluid by insertion of a needle into the abdomen, guided with ultrasound imaging, performed between 15 and 20 weeks of pregnancy because amniotic fluid volume is adequate and many viable fetal cells are present in the fluid by this time.
• If the 3- hour GCT is above 130 to 140 mg/dl ( 7.2 to 7.8 mmol/L), it is considered a positive result and be indicative of GDM.
• The GCT has 86% sensitivity and some false positives may be noted.
• A urine specimen for glucose and protein determinations should be obtained at every antepartum visit.
• Glycosuria is a common result of decreased renal threshold that occurs during pregnancy.
• If glycosuria persist, it may indicate diabetes.
• White blood cells in the urine may indicate infection.
• Outlines and identifies fetal and birthing parent structures.