📚 Reading: ch. 11 — grouped under Exam 1 by the recording
A free assessment at every visit — no equipment beyond a tape measure.
💡 The one idea
Every antenatal test is asking one question: is the placenta still doing its job?Accelerations mean a healthy fetus. Late decelerations mean the placenta is failing.
Test
What it measures
Reassuring result
Non-stress test
FHR accelerations with movement
Reactive — 2 accels of 15 bpm × 15 s in 20 min
Biophysical profile
5 areas, 2 points each
8–10 reassuring · ≤4 deliver
Contraction stress test
FHR response to contractions
Negative = good (no late decels)
Amniocentesis
Genetics; later, lung maturity
L/S ratio 2:1 = mature lungs
🖼️ Fetal heart rate decelerations.Swipe it sideways if it is cut off, or tap to open it full size.
🚨 The naming that catches everyone
On a contraction stress test, NEGATIVE is the good result and POSITIVE is the bad one.
It is backwards from every other test you know. Reactive NST = good; Negative
CST = good.
⭐ Rh — the one that must not be missed
An Rh-negative mother carrying an Rh-positive baby can make antibodies that
attack a future pregnancy.
RhoGAM is given at 28 weeks and again
within 72 hours of birth — and after any bleeding event:
miscarriage, amniocentesis, abdominal trauma, ectopic.
RhoGAM prevents sensitization. It cannot undo it once it has happened.
✅ Fundal height, a free assessment
From 20 to 36 weeks, fundal height in centimeters roughly equals gestational age in weeks.
Landmarks: 12 weeks at the symphysis · 20 weeks at the umbilicus.
More than 2 cm off suggests growth restriction, macrosomia, multiples, or a fluid problem.
⭐ High-yield — what the exam actually asks
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GTPAL: Gravida (all pregnancies including this one), Term (≥37 wk), Preterm (20 to <37 wk), Abortions (<20 wk), Living children.
Visit schedule: every 4 weeks to 28 weeks, every 2 weeks to 36 weeks, weekly thereafter.
Naegele's rule: LMP + 7 days − 3 months + 1 year. Her worked example: LMP 11/12/2024 → EDD 8/19/2025.
McDonald's rule: fundal height in cm ≈ gestational age in weeks, most reliable 18–30 weeks. 25 cm at 24 weeks is expected — document only.
Screening timeline: MSAFP 15–20 wk, glucose challenge 24–28 wk, GBS culture 36–37 wk, indirect Coombs and Tdap per protocol.
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Reportable danger signs: severe headache, visual disturbance, facial or finger swelling, rapid weight gain, epigastric pain, decreased fetal movement.
Which client first: a third-trimester headache with visual spots (preeclampsia) beats first-trimester nausea, end-of-day ankle edema, and late-pregnancy back pain after walking — those three are all expected.
Reactive NST: at least 2 accelerations of ≥15 bpm lasting ≥15 seconds within 20 minutes, at ≥32 weeks → document, routine care.
Non-reactive NST: no accelerations in 40 minutes, especially with minimal variability → notify the provider for a biophysical profile (tone, movement, breathing, amniotic fluid volume). Try a snack, fluids and repositioning first.
Decreased fetal movement suggests hypoxia or placental insufficiency → NST and ultrasound. Kick counts: fewer than 10 movements in 2 hours warrants a call.
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Leopold maneuvers establish lie, presentation and position, and locate the point for FHR auscultation.
Amniocentesis: empty the bladder, monitor FHR before and after, RhoGAM if she is Rh-negative.
📕 From your ATI review book
Covered by ch. 4 & 6.
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Visit cadence: q4 weeks through the second trimester, q2–4 weeks in the third, weekly from 36 weeks.
Timed labs — memorize the windows. Urine culture 12–16 wk · indirect Coombs repeat 24–28 wk if Rh-negative unsensitized · 1-hr 50 g glucose screen 24–28 wk, no fasting, ≥140 means go to the 3-hr · MSAFP 15–22 wk, quad screen best 16–18 · GBS culture 36 0/7–37 6/7 · Tdap 27–35 wk.
Rho(D) at 26–28 weeks, and also after amniocentesis, after external version, and within 72 h of birth of an Rh-positive newborn.
AFP direction is the trap: high = neural tube or open abdominal defect (or unrecognized twins); low = trisomy 21.
Abdominal ultrasound needs a FULL bladder; transvaginal does not — and transvaginal is better in the first trimester, for ectopic, and with obesity.
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BPP scores 5 variables 2 or 0: NST, fetal breathing, gross movement, tone, amniotic fluid (a pocket ≥2 cm in two planes). 8–10 normal, 4–6 equivocal, under 4 strongly abnormal.
CST reads backward from every other test: NEGATIVE is the good result. Positive = late decelerations with ≥50% of contractions = uteroplacental insufficiency. Contraindicated in previa, vasa previa, preterm labor, multiples, classical scar, cervical insufficiency.
Amniocentesis bladder rule flips at 20 weeks: full before 20 weeks to lift the uterus, empty after 20 weeks to avoid puncturing it.
L/S ratio 2:1 = mature lungs — but 2.5:1 or 3:1 if she has diabetes. Absent phosphatidylglycerol predicts distress.
CVS at 10–13 weeks; limb-reduction risk is highest before 10 weeks.
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CVS and amniocentesis are diagnostic. MSAFP and the quad screen are only screens — an abnormal result needs confirmation.
Vibroacoustic stimulation wakes a sleeping fetus. It is not for starting contractions.
📚 From your Maternal & Child textbook
Pillitteri, Maternal and Child Health Nursing — ch. 11 (assessment of a pregnant family) · ch. 14 (preparing for childbirth).
Parity counts pregnancies reaching 20 weeks, not babies. Twins born at term are para 1. A loss at 12 weeks counts as a gravida but not a para.
Only three positive signs of pregnancy: an audible fetal heart, a fetus seen on ultrasound, and fetal movement palpated by an examiner. Everything the patient reports herself is presumptive.
⚠️ Exam traps
GTPAL trips people on twins: a twin pregnancy is one gravida but counts each baby under Living.
Increased fetal movement is reassuring. Decreased is the red flag. Do not let the word "change" fool you.
🧠 Mind maps 3
One per disorder, built from the structure of your ATI chapter.
ATI Active Learning Template — System DisorderPrenatal Care
Filled from ATI chapter 4, row by row from that chapter’s own sections — 12 of 12 rows have content.
7 rows came from outside your ATI chapter — 5 cite a source, 2 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Prenatal care uses scheduled visits, screening, and education to catch problems early and reduce maternal-fetal illness and death; most birth defects arise between weeks 2 and 8. Visits address history, physical changes, and self-care teaching throughout pregnancy.
Health Promotion & Disease Prevention
Avoid all OTC drugs, supplements, and prescription meds unless the provider approves.
Avoid tobacco and alcohol; linked to anomalies, preterm birth, and growth restriction.
Encourage moderate exercise 30-45 min/day, about 150 min/week, unless contraindicated.
Avoid hot tubs and saunas during pregnancy.
Give influenza and COVID-19 vaccines per CDC guidance; give Tdap at 27-35 weeks gestation.
Emotional lability and ambivalence about the pregnancy are normal and often resolve by the third trimester.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from NICHD.
Maternal age under 20 raises risk for pregnancy-related hypertension, anemia, preterm labor, and untreated sexually transmitted infections.
Pre-pregnancy conditions such as uncontrolled hypertension, diabetes, kidney disease, and autoimmune disorders increase pregnancy risk.
No amount of alcohol is considered safe during pregnancy, and marijuana or illegal drug use roughly doubles stillbirth risk.
NICHD · What are some factors that make a pregnancy high risk? · open the source →
Assessment — Expected Findings
From this module — built from the notes above on this page, not a section of the ATI chapter.
Fundal height in cm roughly equals gestational age in weeks from about 18–30 weeks.
Fetal heart rate 110–160/min.
Quickening at 16–20 weeks in a first pregnancy, earlier in later ones.
Blood pressure falls in the second trimester and returns to baseline by term — a rise is the abnormal finding.
Physiological anemia of pregnancy: plasma volume rises more than red cell mass, so hemoglobin dilutes.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Indirect Coombs' test repeated at 24-28 weeks gestation for Rh-negative, unsensitized clients.
CBC with differential, Hgb, and Hct detect infection and anemia.
GBS vaginal/rectal culture obtained at 36 0/7 to 37 6/7 weeks gestation.
Urine culture recommended at 12-16 weeks gestation or at the first prenatal visit.
Diagnostic Procedures
Not in your ATI chapter — filled from USPSTF, 2019; StatPearls.
Rh(D) blood typing and antibody screening are done at the first prenatal visit for every pregnant patient.
If the biological father's Rh status is unknown, an unsensitized Rh-negative patient gets a repeat antibody check around week 24 to 28.
Group B strep culture is collected as a universal screen once the pregnancy reaches roughly the 36-week to 37 6/7-week mark.
Gestational diabetes screening is recommended for all pregnant patients at 24 weeks gestation or later.
USPSTF / StatPearls · Rh(D) Incompatibility: Screening; Gestational Diabetes: Screening; Group B Streptococcus and Pregnancy · open the source →
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Perform or assist with Leopold maneuvers to check fetal presentation and position.
Assist provider with the pelvic exam and pelvic measurements to gauge birth canal fit.
Have client empty bladder and breathe deeply during pelvic exam to ease discomfort.
Give Rho(D) immune globulin IM around 26-28 weeks gestation for Rh-negative clients.
Medications
Not in your ATI chapter — filled from USPSTF, 2019; StatPearls.
Unsensitized Rh-negative patients receive a 300 microgram dose of Rh immunoglobulin after 28-week antibody testing.
A second Rh immunoglobulin dose is given within 72 hours after birth if the newborn is Rh-positive.
Patients with a positive GBS culture receive intravenous penicillin in labor: a 5-million-unit loading dose, then 2.5 to 3 million units every 4 hours.
USPSTF / StatPearls · Rh(D) Incompatibility: Screening; Group B Streptococcus and Pregnancy · open the source →
Therapeutic Procedures
Not in your ATI chapter — filled from StatPearls, 2024.
Once a pregnancy reaches 15 weeks, amniocentesis becomes an option, done with a thin needle under constant ultrasound guidance.
During amniocentesis, about 18 to 20 mL of amniotic fluid is withdrawn after the first 1-2 mL is discarded.
In experienced hands, amniocentesis carries an estimated procedure-related pregnancy loss risk around 0.1% to 0.13%.
💬 Around the patientClient Education · Interprofessional Care
Client Education
Prenatal teaching covers health promotion, birth preparation, common discomfort relief, and danger signs to report.
Interprofessional Care
From this module — built from the notes above on this page, not a section of the ATI chapter.
Provider or midwife for the visit schedule and any deviation from it.
Ultrasonographer for dating and anatomy scans.
Laboratory for the timed screening panel — the windows matter more than the tests.
Dietitian if weight gain is outside the expected range.
Childbirth educator and lactation consultant in the second and third trimesters.
⚠️ What goes wrongComplications
Complications
Not in your ATI chapter — filled from StatPearls, 2024.
Amniocentesis carries a 1% to 2% risk of amniotic fluid leakage, most cases resolving with reduced activity.
Vaginal bleeding occurs in about 2% to 3% of amniocentesis procedures, with infection risk under 0.1%.
About 60% of early-onset newborn GBS infections occur even after a negative screen during the recommended window.
StatPearls (NCBI Bookshelf) · Amniocentesis; Group B Streptococcus and Pregnancy · open the source →
📋 Assessment of Fetal Well-Being6 parts
ATI Active Learning Template — System DisorderAssessment of Fetal Well-Being
Filled from ATI chapter 6, row by row from that chapter’s own sections — 12 of 12 rows have content.
8 rows came from outside your ATI chapter — 3 cite a source, 5 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
This chapter covers tests used to check fetal well-being: abdominal, transvaginal, and Doppler ultrasound, biophysical profile, nonstress and contraction stress testing, amniocentesis, and additional screening for high-risk pregnancies such as CVS and quad markers.
Health Promotion & Disease Prevention
From this module — built from the notes above on this page, not a section of the ATI chapter.
Teach daily kick counts from about 28 weeks — a consistent time each day, after a meal.
Fewer than 10 movements in 2 hours warrants a call.
Reinforce that decreased movement is always reported, never waited out overnight.
Attendance at scheduled surveillance matters most in exactly the pregnancies most likely to miss it — address transport and childcare.
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
Not in your ATI chapter — filled from StatPearls, 2024.
Chronic hypertension, pregestational diabetes, and maternal age 35 or older are indications to begin antenatal fetal surveillance.
Decreased fetal movement, fetal growth restriction, and multiple gestation are fetal indications for antenatal testing.
A prior stillbirth, postterm pregnancy, and oligohydramnios are obstetric history factors that prompt fetal surveillance.
Surveillance is typically started at 32, 36, or 39 weeks gestation, depending on the specific indication.
StatPearls (NCBI Bookshelf) · Antenatal Fetal Surveillance · open the source →
Assessment — Expected Findings
From this module — built from the notes above on this page, not a section of the ATI chapter.
Reactive NST: at least 2 accelerations of ≥15 bpm lasting ≥15 seconds within 20 minutes, at 32 weeks or more.
Baseline fetal heart rate 110–160/min with moderate variability.
Biophysical profile scores 2 points each for tone, movement, breathing, amniotic fluid and NST — 8–10 is reassuring.
Negative contraction stress test — no late decelerations — is the reassuring result. Negative is good here, which catches people out.
Non-reactive NST is not a diagnosis — the fetus may be asleep. Try stimulation, food, repositioning first.
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
From this module — built from the notes above on this page, not a section of the ATI chapter.
MSAFP at 15–22 weeks: high suggests neural tube or open abdominal wall defect, or unrecognized twins; low suggests trisomy 21.
Quad screen best at 16–18 weeks.
Cell-free fetal DNA from 10 weeks — a screening test, not diagnostic.
ATI Active Learning Template — System DisorderInfections
Filled from ATI chapter 8, row by row from that chapter’s own sections — 12 of 12 rows have content.
5 rows came from outside your ATI chapter — 5 cite a source, 0 are built from this page’s own notes. Each one is labeled.
🧭 What it isAlterations in Health (Diagnosis) · Health Promotion & Disease Prevention
Alterations in Health (Diagnosis)
Covers infections screened for during pregnancy—HIV, chlamydia, gonorrhea, syphilis, hepatitis B, GBS, HPV, trichomoniasis, bacterial vaginosis, candidiasis, COVID-19, and TORCH infections—including risk factors, testing, and medications used to protect the fetus and newborn.
Health Promotion & Disease Prevention
Not in your ATI chapter — filled from CDC.
Avoid sharing food, drinks, utensils, or pacifiers with young children to reduce CMV transmission risk in pregnancy.
Careful handwashing right after diaper changes or toileting help with a toddler lowers the pregnant caregiver's CMV exposure.
Change cat litter boxes daily and wear gloves when gardening to reduce exposure to Toxoplasma from cat feces.
Fully cooking meat, or holding it frozen at 0°F for several days beforehand, cuts down on toxoplasmosis exposure.
Centers for Disease Control and Prevention · About Cytomegalovirus; About Toxoplasmosis · open the source →
👀 How it shows upAssessment — Risk Factors · Assessment — Expected Findings
Assessment — Risk Factors
IV drug use, multiple partners, and a history of STIs raise HIV risk
Multiple partners and unprotected sex raise chlamydia and gonorrhea risk
Being under age 25 and sexually active raises gonorrhea risk
Multiple partners and unprotected sex raise syphilis risk
Healthcare needlestick exposure and IV drug use raise hepatitis B risk
Multiple blood transfusions add to hepatitis B risk
GBS vaginal/rectal cultures are collected at 36 0/7 to 37 6/7 weeks
Rupture of membranes lasting 18 hr or more, or maternal fever, raise GBS transmission risk
Assessment — Expected Findings
HIV often causes no symptoms, or fatigue, diarrhea, and flu-like illness
Chlamydia and gonorrhea are frequently silent (asymptomatic) in pregnancy
Gonorrhea can cause yellow-green purulent discharge, dysuria, and pelvic pain
Chlamydia can cause gray-white discharge, dysuria, and postcoital spotting
Syphilis manifestations occur in stages and often go unrecognized
Hepatitis B can cause flu-like tiredness, malaise, abdominal discomfort, and anorexia
HPV warts look cauliflower-like; cervical changes may show up on a Pap test
Trichomoniasis causes frothy, yellow-green, malodorous discharge with a strawberry-spotted cervix
🧪 How it is confirmedLaboratory Tests · Diagnostic Procedures
Laboratory Tests
Chlamydia is diagnosed by endocervical swab culture, or urine culture as an alternative
Gonorrhea is diagnosed via endocervical, urine, or anal/oral cultures
Syphilis screening starts with nontreponemal tests (VDRL, RPR), confirmed with treponemal tests
Darkfield microscopy of a genital lesion can confirm active syphilis
Hepatitis B screening checks for the HBsAg antibody
Diagnostic Procedures
Not in your ATI chapter — filled from CDC.
CDC recommends universal HIV, hepatitis B, hepatitis C, and syphilis testing for every pregnant woman at the first prenatal visit.
Women with ongoing risk factors may need repeat HIV and syphilis testing between 28 and 36 weeks gestation.
Chlamydia and gonorrhea screening is recommended for pregnant women under age 25 or with other risk factors.
Tuberculosis testing is targeted, not universal, reserved for women with known TB exposure or conditions like HIV or diabetes.
Centers for Disease Control and Prevention · Screening and Testing for HIV, Viral Hepatitis, STD & Tuberculosis in Pregnancy · open the source →
🩺 What you doNursing Care · Medications · Therapeutic Procedures
Nursing Care
Not in your ATI chapter — filled from CDC.
CDC recommends giving Tdap during the 27th through 36th week of every pregnancy, earlier in that window when possible.
Timing Tdap early in the third trimester maximizes the maternal antibody level transferred to the baby before birth.
Tdap given in this window lowers the risk of whooping cough in infants younger than 2 months by about 78%.
Centers for Disease Control and Prevention · Tdap Vaccination for Pregnant Women · open the source →
Medications
ART combines multiple drug classes (cART) for the best transmission prevention
All HIV-positive clients get combination ART regardless of CD4 count, before birth
ART can suppress bone marrow—monitor Hgb, platelets, and WBC
Chlamydia: single-dose azithromycin preferred; avoid doxycycline or levofloxacin in pregnancy
Gonorrhea: ceftriaxone IM, plus azithromycin if chlamydia isn't ruled out
Erythromycin ointment is given to every newborn within 24 hr to prevent ophthalmia neonatorum
Syphilis: benzathine penicillin G IM single dose, or three doses if duration is unclear
Penicillin-allergic syphilis clients need desensitization rather than doxycycline during pregnancy
Therapeutic Procedures
Hepatitis B treatment is mostly supportive; antivirals may be used if needed
HBIG plus the hepatitis B vaccine is given after recent unvaccinated exposure
Cryotherapy is the preferred provider-performed treatment for genital warts in pregnancy
Colposcopy for HPV changes may be postponed until after birth
💬 Around the patientClient Education · Interprofessional Care
Client Education
Not in your ATI chapter — filled from CDC.
If a pregnant patient is HBsAg-positive, teach her that her newborn needs the hepatitis B vaccine and HBIG within 12 hours of birth.
Explain that these two newborn injections are given in different limbs so both are properly absorbed.
Centers for Disease Control and Prevention · Clinical Overview of Perinatal Hepatitis B · open the source →
Interprofessional Care
Not in your ATI chapter — filled from CDC.
A copy of a positive HBsAg lab result should be sent to the birthing hospital and to the clinician who will care for the newborn.
Every HBsAg-positive pregnant patient should be referred to the jurisdiction's Perinatal Hepatitis B Prevention Program for case management.
This program follows exposed infants for up to 24 months to confirm they complete the recommended vaccine series.
Centers for Disease Control and Prevention · Clinical Overview of Perinatal Hepatitis B · open the source →
⚠️ What goes wrongComplications
Complications
HPV raises the risk of IUGR, preterm rupture of membranes, and preterm birth
Large HPV lesions can block the vaginal canal and complicate delivery
HPV can pass to the newborn during birth
HPV increases the mother's risk for cervical cancer
📝 Notes & key concepts
The lines from this module that carry a number, a dose or an absolute rule — the ones that decide questions. Everything else is on the cards above.
GTPAL: Gravida (all pregnancies including this one), Term (≥37 wk), Preterm (20 to <37 wk), Abortions (<20 wk), Living children.
Visit schedule: every 4 weeks to 28 weeks, every 2 weeks to 36 weeks, weekly thereafter.
Naegele's rule: LMP + 7 days − 3 months + 1 year. Her worked example: LMP 11/12/2024 → EDD 8/19/2025.
McDonald's rule: fundal height in cm ≈ gestational age in weeks, most reliable 18–30 weeks. 25 cm at 24 weeks is expected — document only.
Screening timeline: MSAFP 15–20 wk, glucose challenge 24–28 wk, GBS culture 36–37 wk, indirect Coombs and Tdap per protocol.
Which client first: a third-trimester headache with visual spots (preeclampsia) beats first-trimester nausea, end-of-day ankle edema, and late-pregnancy back pain after walking — those three are all expected.
Reactive NST: at least 2 accelerations of ≥15 bpm lasting ≥15 seconds within 20 minutes, at ≥32 weeks → document, routine care.
Non-reactive NST: no accelerations in 40 minutes, especially with minimal variability → notify the provider for a biophysical profile (tone, movement, breathing, amniotic fluid volume). Try a snack, fluids and repositioning first.
Decreased fetal movement suggests hypoxia or placental insufficiency → NST and ultrasound. Kick counts: fewer than 10 movements in 2 hours warrants a call.
Visit cadence: q4 weeks through the second trimester, q2–4 weeks in the third, weekly from 36 weeks.
Timed labs — memorize the windows. Urine culture 12–16 wk · indirect Coombs repeat 24–28 wk if Rh-negative unsensitized · 1-hr 50 g glucose screen 24–28 wk, no fasting, ≥140 means go to the 3-hr · MSAFP 15–22 wk, quad screen best 16–18 · GBS culture 36 0/7–37 6/7 · Tdap 27–35 wk.
Rho(D) at 26–28 weeks, and also after amniocentesis, after external version, and within 72 h of birth of an Rh-positive newborn.
AFP direction is the trap: high = neural tube or open abdominal defect (or unrecognized twins); low = trisomy 21.
Abdominal ultrasound needs a FULL bladder; transvaginal does not — and transvaginal is better in the first trimester, for ectopic, and with obesity.
🎯 Module quiz
Questions for this module. They also feed the Mega Quiz.
