Nurse Arcade
Obstetric +
Antenatal
Track the pregnancy. Recognize the pattern. Protect two patients.
Part 1 – Timeline + dating
Pregnancy is organized by gestational age
Gestational age is counted from the first day of the last menstrual period.
First trimester
Through 13 weeks 6 days. Organ development, early screening, dating, and initial prenatal labs are major themes.
Second trimester
14 weeks through 27 weeks 6 days. Anatomy evaluation, fetal growth, and continued maternal screening.
Third trimester
28 weeks to birth. Growth, fetal well-being, birth preparation, and surveillance for complications.
Estimated due date
Classic Naegele approach: LMP + 7 days − 3 months + 1 year. Electronic tools and ultrasound dating follow clinical criteria.
Dating caution
Irregular cycles, uncertain LMP, fertility treatment, and ultrasound findings may change the best obstetric estimate.
Part 1 – Obstetric shorthand
GTPAL compresses the obstetric history
Count pregnancies and outcomes carefully; twins do not increase para counts twice.
G – Gravida
Total number of pregnancies, including the current pregnancy, regardless of outcome.
T – Term
Pregnancies ending at term, commonly 37 weeks or later. Follow course definitions.
P – Preterm
Pregnancies ending after the viability threshold but before term; exact threshold follows course or policy.
A – Abortion
Pregnancies ending before the defined viability threshold, spontaneous or induced.
L – Living
Number of currently living children. Multiple gestation can increase this count by more than one.
Para
Number of pregnancies reaching the defined viability threshold, not number of infants born.
Part 2 – Assessment + screening
Prenatal care builds a changing risk picture
Timing and exact panels vary with history, gestational age, shared decisions, and local guidance.
Initial history
Prior pregnancies, medical and surgical history, medications, substances, mental health, safety, social needs, and genetic history.
Baseline labs
ABO/Rh, antibody screen, CBC, urine testing, and infection screening are common components.
Genetic options
Carrier and aneuploidy screening or diagnostic testing require informed, patient-centered counseling.
Midpregnancy
Anatomy ultrasound and other testing are scheduled by gestational age and clinical indication.
Later screening
Glucose screening, repeat CBC or antibody testing, and group B strep screening occur according to current guidance.
Each contact
Maternal vital signs, symptoms, fetal status as appropriate, education, medications, and new risks.
Part 2 – Maternal changes
Expected adaptations still need assessment
Normal physiology can overlap with signs of complications.
Cardiovascular
Blood volume and cardiac output rise. Mild heart-rate increase may occur; supine positioning can reduce venous return later in pregnancy.
Hematologic
Plasma volume rises more than red-cell mass, contributing to physiologic dilution. Pregnancy is also hypercoagulable.
Respiratory
Oxygen demand and minute ventilation rise. Mild dyspnea may occur, but sudden or severe breathlessness is not routine.
Renal
Renal blood flow and filtration increase. Urinary frequency is common; dysuria, fever, or flank pain need evaluation.
GI + musculoskeletal
Nausea, reflux, constipation, ligament discomfort, and back strain may occur; severity and associated symptoms matter.
Skin + endocrine
Pigment changes and altered insulin sensitivity occur. Screening identifies when adaptation becomes disease.
Part 3 – Fetal well-being
Fetal assessment asks different questions
Gestational age changes what can be measured and how findings are interpreted.
Fetal heart rate
A common baseline reference is 110–160 bpm. Interpret baseline, variability, accelerations, decelerations, and clinical context.
Fundal height
After the midpoint of pregnancy, serial measurement can screen growth trends. Dating, body habitus, fibroids, fluid, and multiples affect it.
Fetal movement
Movement patterns are individualized. A meaningful decrease or stopping compared with usual activity requires prompt contact and evaluation.
Nonstress test
Assesses fetal heart-rate response over time. Reactive criteria depend on gestational age and current protocol.
Biophysical profile
Combines ultrasound observations with fetal heart-rate assessment to evaluate well-being when indicated.
Ultrasound
Dating, anatomy, growth, placental location, fluid, and other questions guide the type and timing of examination.
Part 4 – High-risk patterns
Hypertensive disorders are pattern plus timing
Confirm blood-pressure technique and assess symptoms, labs, urine, and fetal status.
Gestational hypertension
New hypertension after 20 weeks without the defining features of preeclampsia at that time.
Preeclampsia
New hypertension after 20 weeks with proteinuria or other maternal organ dysfunction; severe features change urgency.
Chronic hypertension
Hypertension predating pregnancy, diagnosed before 20 weeks, or persisting postpartum under clinical criteria.
Superimposed preeclampsia
Preeclampsia develops in a patient with chronic hypertension; look for new symptoms, labs, proteinuria, or worsening control.
Part 4 – Metabolic + blood group
Screen, interpret, then coordinate follow-up
Antenatal management protects maternal and fetal health now and after pregnancy.
Gestational diabetes
Pregnancy-related insulin resistance can uncover hyperglycemia. Management may include nutrition, activity, glucose monitoring, medication, fetal surveillance, and postpartum testing.
Why glucose matters
Poor control can increase maternal and fetal risks. Teach the specific monitoring targets and treatment plan rather than using one universal number.
Rh + antibody screen
Rh-negative status is not itself disease. The antibody screen determines sensitization risk; Rh immune globulin timing depends on the clinical situation.
Infection prevention
Vaccination, STI testing, urine screening, group B strep planning, and exposure counseling follow gestational timing and individual risk.
Part 5 – Labor + membranes
Labor recognition begins with change over time
Contractions alone do not establish labor; cervical change and the whole assessment matter.
True labor pattern
Contractions become more regular, stronger, and closer together and are associated with progressive cervical change.
Braxton Hicks
Often irregular and may ease with rest, hydration, or position change; they do not cause progressive cervical change.
Rupture of membranes
Report suspected fluid leakage promptly. Note time, amount, color, odor, contractions, movement, and symptoms.
Vaginal bleeding
Small blood-tinged mucus may accompany cervical change, but bleeding like a period or heavier is an urgent warning sign.
Part 5 – Escalation
Urgent maternal warning signs require action
These can occur during pregnancy and through the year after birth.
Neuro
Headache that will not go away or worsens, vision changes, dizziness, fainting, or seizure.
Cardiopulmonary
Chest pain, fast or irregular heartbeat, trouble breathing, or inability to lie flat.
Bleeding + fluid
Vaginal bleeding more than spotting during pregnancy, fluid leakage, heavy postpartum bleeding, or foul discharge.
Pain + swelling
Severe belly pain; extreme face or hand swelling; or unilateral arm/leg swelling, redness, or pain.
Systemic + mental health
Fever 100.4°F (38°C) or higher, severe vomiting, overwhelming weakness, or thoughts of harming self or baby.
Fetal movement
Baby movement stopping or slowing compared with the patient’s usual pattern.
Apply
Practice recognition and priority
Answer before checking your course resources.
- A patient is currently pregnant after one term birth and one early loss. What is gravida?
- Why can a twin birth change L by two but T or P by only one?
- What does an antibody screen add beyond ABO/Rh typing?
- Which common prenatal test is a screen rather than a diagnosis?
- What fetal heart-rate baseline range is commonly referenced?
- Which symptom cluster raises concern for preeclampsia with severe features?
- What is most important about a change in fetal movement?
- How does true labor differ from Braxton Hicks contractions?
- What details should be collected with suspected membrane rupture?
- Which postpartum symptoms still require urgent maternal evaluation?
Reference notes
Sources + clinical boundaries
Use current local standards and prenatal records.
- CDC Hear Her – Urgent Maternal Warning Signs
- ACOG Patient Education
- CDC Pregnancy
- NIH MedlinePlus – Pregnancy
- OpenStax Maternal-Newborn Nursing