Gravity and Parity

Gravida– a woman who is pregnant

Multigravida– a woman who has had 2 or more pregnancies

Multipara– a woman who has completed 2 or more pregnancies to the stage of fetal viability.

Nulligravida­- a woman who has never been pregnant

Nullipara– a woman who has not completed a pregnancy with a fetus who has reached the stage of fetal viability.

Parity– the number of pregnancies in which the fetus has reached viability when they are born, not the number of fetuses (i.e.: Twins) born. Whether the fetus is born alive or is stillborn after viability is reached does not affect parity.

Postdate or Postterm– a pregnancy that goes beyond 42 weeks of gestation

Preterm– a pregnancy that has reached 20 weeks of gestation but before 37 weeks of gestation

Primigravida- a woman who is pregnant for the first time.

Primipara- a woman who has completed one pregnancy with a fetus who have reached the stage of fetal viability.

Term– a pregnancy from the beginning of week 38 of gestation to the end of week 42 of gestation.

Viability– capacity to live outside the uterus; about 22-24 weeks since last menstrual period, or fetal weight >500 grams.

 

System using Five-Digit (GTPAL) system

Condition	Pregnancies	Term Births	Preterm Births	Abortions or Miscarriages	Living Children
Jamilla is pregnant for the first time	1	0	0	0	0
She carries the pregnancy to 35 weeks, and the neonate survives	1	0	1	0	1
She becomes pregnant again	2	0	1	0	1
Her second pregnancy ends in miscarriage at 10 weeks	2	0	1	1	1
During her 3rd pregnancy, she gives birth at 38 weeks	3	1	1	1	2

 

 

 

Lab Values:

 

Lab	Non-Pregnant Value	Pregnant Value
Hemoglobin	12-16 g/dl	>11 g/dl
Hematocrit	37-47	>33
WBC	5-10,000	5-15,000
Platelets	150,000-400,00	No change
Fibrinogen	200-400	Increases by 50% in late pregnancy (increased risk for clots)
Bladder Capacity	1300	>1500
Renal Plasma blood flow	490-700	Increases by 25-30%
Glomerular filtration rate		Increases by 30-50%
Creatnine	0.5-1.1	Decreases
BUN	10-20	Decreases
Uric Acid	2.7- 7.3	Decreases

 

Rubella Status

– Rubella causes birth defects and woman is likely miscarry if @1-3 weeks pregnant, @ 3-8 weeks- causes cardiac and neuro defects, >8 weeks- likely IUGR.

– Rubella titer test is given at first prenatal visit.  If the titer is negative- the woman will need to get vaccinated after she gives birth.

– Rubella vaccine is a live vaccine

– It is important for women who have had a negative titer to know that they have to wait 3 months after end of pregnancy to get vaccinated. Important that they use birth control during this time.

– Preg. women who have had a negative titer should not be around children who have received the vaccine.

 

Beta Strep (Group B Step)

– All pregnant women should have rubella titer. Women are screened at 36 weeks via a vaginal swab to rule out Rubella. If positive- antibiotics are given during labor.

– Will cause pneumonia in the newborn.

 

Hemolytic Disease (Rh factor disease)

-Most frequently occurs when an Rh negative mother has a baby with an Rh positive father. When the baby’s Rh factor is positive, like the father’s, problems can develop if the baby’s red blood cells cross to the Rh negative mother. This usually happens at delivery when the placenta detaches. However, it may also happen anytime blood cells of the two circulations mix, such as during a miscarriage or abortion, with a fall, or during an invasive prenatal testing procedure (i.e., an amniocentesis or chorionic villus sampling).

– The mother’s immune system sees the baby’s Rh positive red blood cells as “foreign.” Just as when bacteria invade the body, the immune system responds by developing antibodies to fight and destroy these foreign cells. The mother’s immune system then keeps the antibodies in case the foreign cells appear again, even in a future pregnancy. The mother is now “Rh sensitized.”

– Although it is not as common, a similar problem of incompatibility may happen between the blood types (A, B, O, AB) of the mother and baby in the following situations:

Mother’s Blood Type	O	A	B
Baby’s Blood Type	A or B	B	A

 In a first pregnancy, Rh sensitization is not likely. Usually it only becomes a problem in a future pregnancy with another Rh positive baby. During that pregnancy, the mother’s antibodies cross the placenta to fight the Rh positive cells in the baby’s body. As the antibodies destroy the red blood cells, the baby can become sick.

Baby’s response:

– Anemia and subsequent CHF

– As the red blood cells break down, a substance called bilirubin is formed. Babies are not easily able to get rid of the bilirubin and it can build up in the blood and other tissues and fluids of the baby’s body. This is called hyperbilirubinemia. Because bilirubin has a pigment or coloring, it causes a yellowing of the baby’s skin and tissues. This is called jaundice.

Prevention: Because of the advances in prenatal care, nearly all women with Rh negative blood are identified in early pregnancy by blood testing. If a mother is Rh negative and has not been sensitized, she is usually given a drug called RhoGAM. This is a specially developed blood product that can prevent an Rh negative mother’s antibodies from being able to react to Rh positive cells. Many women are given RhoGAM around the 28th week of pregnancy. After the baby is born, a woman should receive a second dose of the drug within 72 hours.

 

 

 

Dating

– Nagele’s Rule= 1^st day of LMP + 7 days -3 months

            ex: LMP 8/1 +7 days= 8/8-3 months= 5/8/next year will be due date

– Ultrasound- accurate to within 5 days in 1^st trimester

– Doppler FHT- heard with Doppler at 10 weeks

– Fetal movement/ quickening- felt @ 16-20 weeks

– Fundal height- starting at 20 weeks- expect cm to match weeks

– wheel