Obstetric Terminology
Obstetric Terminology
Specific terms are used in obstetrics to describe the number of times a woman has been pregnant and has given birth. Gravida (from the Latin root gravidus, “heavy”) indicates a pregnant woman. Latin numeric prefixes are added to this term to indicate number of pregnancies, such as primigravida (one), nulligravida (none), and multigravida (multiple). Similarly, prefixes are added to the Latin root para (“to bring forth”) to indicate the number of births, such as nullipara (none), primipara (one), and multipara (multiple). Shorthand for noting the patient’s overall obstetric status is GP with the correct numerals included.
A four-point or five-point description may be used to provide obstetric history. The four-part description, referred to as TPAL or FPAL, is sometimes used (Box 25-6). The first digit represents the total number of term pregnancies (or in the FPAL notation, full-term), including the present one. A term pregnancy is one that results in delivery after conclusion of the 37th week of gestation through the 42nd week of gestation. The second digit indicates the number of preterm deliveries. A preterm delivery is one that takes place from the 20th week of gestation through the end of the 37th week of gestation. The third notation indicates the number of abortions. The abortion may be spontaneous, as in a miscarriage, or an elective procedure. Multifetal pregnancies are recorded as singular events when calculating the number of abortions and preterm and term pregnancies. The last number indicates the number of living children. In one case, if a woman has experienced normal pregnancies and deliveries but all of her children have died in a fire, the last number is 0. For example, a descriptive number such as 3-1-0-3 indicates that a woman has delivered three term pregnancies, had one preterm pregnancy and no abortions, and has three living children The more detailed five-point method includes information about the total number of pregnancies a woman has had. It is denoted as GTPAL.
Box 25-6 Defining Parity
Five-Digit System: GTPAL
- G: Gravidity
- T: Term births
- P: Preterm births
- A: Abortions
- L: Living children
Four-Digit System: TPAL
- T: Term births (may also be noted as F)
- P: Preterm births
- A: Abortions
- L: Living children
Antepartal Care
Health Promotion
Most pregnant women want to learn more about pregnancy, childbirth, and motherhood. Pregnancy is a time in life when most women see the importance of regular medical supervision and are willing to make changes in their habits. They think of their baby first and do everything that is best for the infant.
A checklist for antepartal needs throughout pregnancy is a valuable teaching tool. It provides the team of care providers with a communication tool to prevent gaps and to identify areas of repeated concerns for patients. Sharing the checklist with patients reassures them that other pregnant women and their families face the same issues. Reading the checklist also reminds patients of information they might otherwise forget (Box 25-7).
Box 25-7 A Trimester Checklist
- • Schedule and events of visits
- • Counseling for self-care
- • Adaptations and discomforts
- • Dyspnea
- • Insomnia
- • Psychosocial responses and family dynamics
- • Gingivitis
- • Urinary frequency
- • Perineal discomfort and pressure
- • Braxton Hicks contractions
- • Leg cramps
- • Ankle edema
- • Safety (balance)
- • Exercise and rest
- • Relaxation
- • Nutrition
- • Sexuality
- • Personal hygiene
- • Danger signs, general
- • Danger signs, preterm labor
- • Fetal growth and development
- • Preparation for baby
- • Feeding method
- • Nipple preparation
- • Preparation for labor
- • Recognition: false versus true
- • Prenatal classes
- • Control of discomfort
- • Hospital tour
- • Provision for other family members
- • Preparation for homecoming
- • Diagnostic tests (specify)
- • Other
Once pregnancy is determined, prenatal care is instituted. Nursing interventions follow the nursing process: assessment, analysis, formulation of nursing diagnoses, planning, implementation, and evaluation.
Pregnancy is an excellent time to establish good general health practices. Until they become pregnant, many women do not have regular physical examinations or Papanicolaou (Pap) smears and do not do home screening tests such as breast self-examination (BSE). The high motivation level makes this a good time to teach patients about health maintenance practices.
Early in pregnancy, the woman often begins to seek information and make choices regarding how and where she wishes to give birth. Information should be provided regarding the options available in a particular community (see Chapter 26).
Routine care during pregnancy begins with the initial examination and history, as previously described. Appointments are recommended once a month
through the 7th month, once every 2 weeks for the next month, and then once every week until delivery. If any problems occur or the health care provider suspects anything unusual, such as a multiple pregnancy, the schedule of visits may be altered. Dental care should continue during pregnancy. Any major dental work, such as oral surgery or extractions, is usually delayed until after delivery.
Smoking during pregnancy can be dangerous to the developing fetus. Oxygen deprivation can lead to decreased intrauterine growth and low birth weight. Preterm delivery is also linked to maternal smoking. Drinking of alcoholic beverages during pregnancy is also contraindicated. Fetal alcohol syndrome is discussed in Chapter 28.
Ideally, women should avoid taking any medication or drugs during pregnancy. The use of both over-the-counter drugs and prescription medications must be reviewed with the health care provider (Box 25-8). Most drugs are able to cross the placenta and are transmitted to the fetus. Street drugs, such as marijuana and cocaine, are dangerous to both mother and fetus and must be avoided. Although complementary and alternative therapies may be safely used before pregnancy, certain elements may be dangerous to the developing fetus. To ensure safety, the nurse must be vigilant in assessing for their use and in subsequent reporting to the primary health care provider (Box 25-9).
Embryonic and fetal development is vulnerable to environmental teratogens. Many potentially dangerous chemicals are present in the home, yard, and workplace, including cleaning agents, paints, sprays, herbicides, and pesticides. The soil and water supply may be unsafe. Therefore, the woman should: (1) read all labels for ingredients and proper use of product; (2) ensure adequate ventilation with clean air; (3) dispose of wastes appropriately; (4) wear gloves when handling chemicals and gardening; and (5) change job assignments or workplace as necessary.
Today many women continue to work throughout pregnancy. The work environment must be checked for chemicals and other hazards. The Occupational Safety and Health Administration has numerous guidelines for hazards in the workplace. Address working conditions such as lifting and standing or sitting for long periods. Encourage the woman to take frequent rest periods.
Danger Signs during Pregnancy
Although pregnancy involves many changes and normal discomforts, certain conditions signal the need for immediate medical attention (Box 25-10). Teach the pregnant woman these danger signs and how to monitor fetal movements (see Patient Teaching box for guidelines for counting fetal movements). Stress the importance of contacting the primary care practitioner promptly if any of these signs are present.
Box 25-8 U.S. Food and Drug Administration Drug Categories
The rational use of any medication requires a risk-versus-benefit assessment. Among the many risk factors that complicate assessment, pregnancy is one of the most perplexing. The U.S. Food and Drug Administration has established five categories to indicate the potential of a systemically absorbed drug for causing birth defects. The key differences among the categories are the degree (reliability) of evidence and the risk : benefit ratio. Pregnancy category X is particularly notable; it is assigned to a drug if any data indicate the drug is a teratogen and the risk : benefit ratio does not support use of the drug. Category X drugs are contraindicated during pregnancy.
Pregnancy Category and Definition
- A: Adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester of pregnancy, and no evidence of risk is found in later trimesters.
- B: Animal studies have not demonstrated a risk to the fetus, but no adequate studies are found in pregnant women; or animal studies have shown an adverse effect, but adequate studies in pregnant women have not demonstrated a risk to the fetus during the first trimester of pregnancy, and no evidence of risk is found in later trimesters.
- C: Animal studies have shown an adverse effect on the fetus, but no adequate studies are found in humans; the benefits from the use of the drug in pregnant women may be acceptable despite its potential risks; or no animal reproduction studies and no adequate studies in humans are found.
- D: Evidence is seen of human fetal risk, but the potential benefits from the use of the drug in pregnant women may be acceptable despite its potential risks.
- X: Studies in animals or humans demonstrate fetal abnormalities, or adverse reaction reports indicate evidence of fetal risk. The risk of use in a pregnant woman clearly outweighs any possible benefit.
- NR: Not rated.
Regardless of the designated pregnancy category or presumed safety, no drug should be administered during pregnancy unless it is clearly needed and potential benefits outweigh potential risks.
Modified from Skidmore-Roth L: Mosby’s 2013 nursing drug reference, ed 26, St. Louis, 2013, Mosby.
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Patient Teaching: Guidelines for Counting Fetal Movements (Kick Counts)
- • Kick count monitoring should begin at 28 weeks gestation.
- • The expectant mother should pick a time of day when she can sit or lie quietly. If deciding to lie down, a left side–lying position should be selected.
- • Each fetal movement or kick should be counted. The goal is to experience 10 to 12 movements/kicks in a 1- to 2-hour period.
If inadequate movements are felt, the health care provider should be notified.
Box 25-9 Complementary and Alternative Therapies Used in Pregnancy
Morning Sickness and Hyperemesis
- • Acupuncture
- • Acupressure
- • Shiatzu
- • Motion sickness bracelets (Sea Bands)
- • Aromatherapy with lavender or rose scents
- • Herbal remedies*
- • Lemon balm
- • Peppermint
- • Spearmint
- • Ginger root
- • Raspberry leaf
- • Fennel
- • Chamomile
- • Hops
- • Meadowsweet
- • Wild yam root
Relaxation and Muscle-Ache Relief
- • Yoga
- • Biofeedback
- • Reflexology
- • Therapeutic touch
- • Massage
* Some herbs can cause miscarriage, preterm labor, or fetal or maternal injury. Pregnant women should discuss use in pregnancy and during lactation with the health care provider.
Data from Lowdermilk DL, Perry SE, Cashion K, et al.: Maternal and women’s health care, ed 10, St. Louis, 2012, Mosby; and Edgren AR: Hyperemesis gravidarum. In Gale encyclopedia of medicine, 2008, The Gale Group, Inc.
Box 25-10 Danger Signs and Symptoms During Pregnancy
- • Visual disturbances: diplopia (double vision), blurring, or spots
- • Headaches: severe, sudden, or continuous
- • Edema: swelling of the face, presacral area, or fingers
- • Rapid weight gain, in excess of normal gain for gestation
- • Pain: severe abdominal or epigastric pain
- • Signs of infection: fever, chills, diarrhea, changes in vaginal drainage, pain or burning with urination
- • Vaginal bleeding (no matter how slight)
- • Vaginal drainage (aside from normal mucus)
- • Persistent vomiting
- • Muscular irritability or convulsions
- • Absence or decrease in fetal movement once felt