Felmer P.

Roda
MN-1
Essential concepts of antepartum
1. Antepartum care refers to the medical and nursing care given to the pregnant woman
between conception and the onset of labor.
2. Consideration is given to the physical, emotional, and social needs of the woman, the
unborn child, her partner, and other family members.
3. Pregnancy is viewed as a normal physiologic process, not a disease process. Nevertheless, at
no other time in life does a woman need such intense, regular care as during pregnancy.
4. With the evident of highly sophisticated instrumentation and monitoring. The nurse must be
particularly alert that these techniques are used to augment practice and should never
replace the therapeutic process.
5. Although the value of prenatal care in terms of maternal-fetal outcome is well documented,
prenatal care, even of the highest quality, does not guarantee a positive outcome.
6. The process of data gathering and analysis is going: the nurse cannot expect to cover all
areas during the initial antepartum visit and, therefore, should focus on trimester specific
issues.
7. Every woman who has been menstruating and then misses a menstrual period is usually
considered pregnant until proven otherwise. Pregnancy must be ruled out in any instance of
amenorrhea, even though the woman insists that she is not pregnant.
8. The other methods are commonly used to determine pregnancy:
a. Pregnancy test (urine or serum) at home or in the health care facility
- Pregnancy tests are not infallible.
- A negative result may occur when pregnancy exists or there may be positive
result when there is no pregnancy.
b. Presumptive evidence of pregnancy ( for example, amenorrhea, nausea, breast
tenderness)
c. Probable evidence of pregnancy (enlarge abdomen and quickening)
d. Positive evidence of pregnancy ( fetal heartbeat and ultrasound visualization)

Goals of antepartum care

1. The expectant mothers and familys knowledge of pregnancy increases.
2. The expectant mother and family members lear about actions they can take to facilitate a
positive birth outcome.
3. Family members experience pregnancy in a positive way.
4. The newborn is successfully integrated into the family.

Factors affecting the antepartum experience

1. Previous experience with pregnancy

2.
3.
4.
5.
6.
7.
8.
9.

Cultural and personal expectations

Pregnant health and biophysical preparedness for childbearing
Motivation for childbearing
Socioeconomic status
Mothers age and partnered versus unpartnered status
Accessibility of prenatal care
Level of education
Availability of resources

Evaluation of fetal well-being

a. Fatal heart rate (FHT)
1. FHR usually is auscultated at the midline suprapubic region with the
Doppler ultrasound transducer at 10-12 weeks gestation
2. FHR can be auscultated with the fetoscope, a specially designed
stethoscope, at about 20 weeks gestation.
3. An FHR of 120 to 160 beats per minute can be distinguish from the
slower maternal heart rate by palpating the mothers pulse while
auscultating the FHR.
4. A regular heartbeat is normal; irregularity is abnormal
5. The heartbeat will be muffled when the mothers abdominal wall is
thick. If she is obese, or if there is a large volume of amniotic fluid.
6. Fundic souffl, caused by blood rushing through the umbilical
arteries, is synchronous with the FHR: uterine souffl, the sound of
blood passing through the uterine blood vessels, is synchronous
with the maternal pulse.
7. Failure to hear FHR may result from one or more of the following
a. Inexperience with the Doppler ultrasound transducer of
fetoscope
b. Defective Doppler ultrasound transducer or fetoscope
c. Early pregnancy or miscalculation of gestational age
d. Obesity
e. Loud placental souffl obscuring the FHR
f. Posterior position of the fetus
g. Hydramnios
h. Small for gestational age fetus
i. Fetal death
Antepartum care
Ultrasonography
1. Serial sonograms provide useful information when assessing fetal growth and well-being.
2. Ultrasonography provides direst information about the fetus during each trimester.
a. First trimester

3.
4.
5.
6.

Assessment of gestational age

Evaluation for congenital anomalies
Diagnostic evaluation of suspected multiple gestation
Confirmation of suspected multiple gestation
Evaluation of fetal growth
Adjunct to prenatal testing such as amniocentesis or chorionic villus
sampling
b. Second trimester
- Assessment of gestational age
- Evaluation for congenital anomalies such as hydrocephaly
- Assessment of fetal growth
- Guidance of procedures, such as amniocentesis and fetoscopy
- Assessment of placental location
- Diagnosis of multiple gestation
c. Third trimester
- Determination of fetal position
- Estimation of fatal size
A second trimester sonogram is recommended as a baseline for all clients considered to be
at risky for complications.
A full bladder may improve ultrasonic resolution before 20 weeks gestation. Clients may be
instructed to drink a quart or more of fluid 1- 2 hours before the procedure.
When used as an adjunct to prenatal diagnoses, ultrasonic visualization of the fetus may
support the difficult decision of whether or not to terminate the pregnancy.
Depending on the skill of the technician, it may be possible to visualize the sex of the fetus in
addition to other structures. The parents should be ask whether they want to know the sex
of the child before the information is provided.

Measurement of fundic height McDonalds rule

1. Assessment begins during the second trimester, when the fundus is
palpable at the level of the umbilicus ( at 20 weeks), and continues
until it reaches the xyphoid process ( at 36 weeks)
2. Measurements involves using a nonelastic, flexible measuring tape,
placing the zero point on the superior border of the symphysis
pubis, and stretching the tape across the abdomen at the midline to
the top of the fundus.
3. After 20-22 weeks gestation, the fundic height in centimeters
normally approximates the gestational age in weeks until the 36th
week. After this time, the fetus is gaining weight rather than height
and near the onset of labor settles into the mothers pelvis in
preparation for birth. For these reasons, a fundus that is truly 40
weeks may be the same height as it was at 36 weeks.
4. Possible causes of greater than expected fundal height include
multiple gestation, polyhydramnios, and fetal macrosomia.

5. Possible causes of greater than expected fundal height include

abnormal fetal presentation, fetal growth restriction, congenital
anomalies, and oligohydramnios.

Fetal movement counting is an evaluation method which pregnant women quantify the fetal
movements they feel. In theory, decreased movement alerts the mother of a deteriorating fetal
condition. She can then bring this to the attention of health care providers who can evaluate further
and intervene as needed to prevent fetal death. Because it can be performed each day, or multiple
times daily, it has advantages over other fetal tests that cannot practically be performed this
frequently.
Women who report decreased fetal movement have an incidence of stillbirth that is 60 times higher
than women without this complaint. Although decreased fetal movement commonly precedes fetal
death, it does not necessarily indicate fetal death is imminent. Many factors other than worsening
fetal condition can influence the perception of movement, including maternal activity, position,
obesity, medications, gestational age, placental location, and amniotic fluid volume. Fetal movement
also varies normally over the course of the day, peaking between 9pm and 1 am when maternal
glucose levels are falling.
The most commonly recommended counting technique is the count-to-ten method where the
woman is instructed each day to count and record the time she feels the 10th fetal movement.
Studies use a variety of definitions of the alarm, the time when a woman should seek evaluation
immediately if she has not felt 10 kicks. What constitutes a clinically important change in the
maternal perception of fetal movement is unknown, although most experts currently recommend
that women seek care after 2 hours. A later alarm has a low sensitivity to identify compromised
fetuses, whereas an earlier alarm generates an unacceptably high false-positive rate

Electronic Fetal Heart Monitoring

Electronic fetal heart monitoring is done during pregnancy, labor, and delivery to keep track of the
heart rate of your baby (fetus) and the strength and duration of the contractions of your uterus.
Your baby's heart rate is a good way to tell whether your baby is doing well or may have some
problems.
Two types of monitoringexternal and internalcan be done.
External monitoring
You may have external monitoring camera.gif at different times during your pregnancy, or it may be
done during labor.
Internal monitoring can be done only after your cervix has dilated to at least 2 centimeters (cm) and
your amniotic sac has ruptured. Once started, internal monitoring is done continuously.
For internal monitoring, a sensor is attached to your thigh with a strap. A thin wire (electrode) from
the sensor is inserted through your vagina and cervix into your uterus. The electrode is then
attached to your baby's scalp. Your baby's heartbeat may be heard as a beeping sound or printed
out on a chart. Internal monitoring does not use reflected sound waves (ultrasound) for monitoring.
A small tube that measures uterine contractions may be placed in your uterus next to your baby. The
strength and timing of your uterine contractions is usually printed out on a chart.
Internal monitoring is more accurate than external monitoring for keeping track of your baby's heart
rate and your contractions.
Why It Is Done
External fetal heart monitoring
External fetal heart monitoring is done to:

Keep track of your baby's heart rate.

Measure how often you have a contraction and how long your contractions last during labor and
delivery.
Find out whether you are having preterm labor.
Check on your baby's health if problems are suspected. External fetal heart monitoring will be done
during a nonstress test to check your baby's heart rate while at rest and while moving. If your baby
does not move during this test, more testing will be needed.
Check on your placenta to make sure that it is giving your baby enough oxygen. A contraction stress
test that shows that your baby is not getting enough oxygen helps your doctor make decisions about
the safest delivery method. If the test shows that your baby may be in danger, your doctor may
recommend starting (inducing) labor early or may talk to you about doing a cesarean section (Csection).
Check your baby's health if your baby has not been growing normally (delayed fetal growth) or if you
have diabetes or high blood pressure (hypertension) or if you are over 41 weeks pregnant.
Internal fetal heart monitoring

Internal fetal heart monitoring is done to:

Find out if the stress of labor is threatening your baby's health.

Measure the strength and duration of your labor contractions.
Results
Electronic fetal heart monitoring is done during pregnancy, labor, and delivery to keep track of the
heart rate of your baby (fetus) and the strength and duration of the contractions of your uterus. The
results of electronic fetal heart monitoring are usually available immediately.
Electronic fetal monitoring
Your baby's heart rate is 110 to 160 beats per minute.
Your baby's heart rate increases (accelerates) when he or she moves and when
your uterus contracts.
Normal:
Your baby's heart rate drops during a contraction but rapidly returns to normal after
the contraction is over.
Uterine contractions during labor are strong and regular.
Your baby's heart rate is less than 110 beats per minute.
Your baby's heart rate is more than 160 beats per minute.
Abnormal:

During a nonstress test, your baby's heart rate does not increase by 15 beats per
minute or drops far below its baseline rate (deceleration) after he or she moves.
Uterine contractions are weak or irregular during labor.

What Affects the Test

Reasons you may not be able to have the test or why the results may not be helpful include:

o
o
o

Smoking cigarettes or using other tobacco products and drinking or eating large amounts
of caffeine (such as from several cups of strong coffee), which can falsely raise your baby's heart rate.
Extra noises such as your heartbeat or your stomach rumbling.
Your baby is sleeping during a nonstress test.
Problems with the placement of the external monitoring device. These problems may include:
Your baby is moving a lot during the test.
You are pregnant with more than one baby, such as twins or triplets.
You are overweight.