Chapter 65 Normal Pregnancy Copyright 2012 Wolters Kluwer

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Chapter 65 Normal Pregnancy Copyright © 2012 Wolters Kluwer Health | Lippincott Williams &

Chapter 65 Normal Pregnancy Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pregnancy • Pregnancy is a normal physiologic process. – Gestation- sperm fertilization till birth

Pregnancy • Pregnancy is a normal physiologic process. – Gestation- sperm fertilization till birth 40 wks – Fertilization-2 w after a woman’s last norm period – These 2 weeks are considered part of the gestation – Last normal menstrual period (LMP or LNMP) – Trimester 1 st is fisrst day of woman last period ends at 13 weeks, 14 -27, 28 -40 – Conditions for fertilization mature egg and sperm, timing>ovum 24>sperm 72>secretions of vagina Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pregnancy – Gravida – Primigravida, multigravida, grand multipara Antepartum period or prenatal care GPFull

Pregnancy – Gravida – Primigravida, multigravida, grand multipara Antepartum period or prenatal care GPFull Preterm Abortion living Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pregnancy (cont’d) • Obstetrics – Branch of medicine concerned with pregnancy and birth •

Pregnancy (cont’d) • Obstetrics – Branch of medicine concerned with pregnancy and birth • Obstetrician • Nurse midwife or CNM (certified nurse midwife) Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Preconceptional Care • Eat a healthy diet and include 400 mcg of folic acid

Preconceptional Care • Eat a healthy diet and include 400 mcg of folic acid a day. • Stop harmful or addictive behaviors and use of prescription drugs that are known to be harmful to a developing infant. • For the diabetic woman, change to insulin and make sure blood sugar is under excellent control. • Refer a couple at risk of having a baby with a genetic defect for genetic testing and counseling. • Test the mother-to-be for infectious diseases. • Reduce psychosocial risk factors. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stages of Human Development Fertilization /and or Conception • Conception and sex determination-otter 3

Stages of Human Development Fertilization /and or Conception • Conception and sex determination-otter 3 rd of tube(oviduct)-sperm decides sex give Y-boy or x -girl • Period of the zygote and implantation-Morula >blastocyst>embryo>implantation(decidua) • Period of the embryo – Critical period of development-8 weeks – Period of the fetus • Fetal blood circulation • Membranes and amniotic fluid Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Process of fertilization 7 -10 days • Ovulation occurs • Ovum travels to fallopian

Process of fertilization 7 -10 days • Ovulation occurs • Ovum travels to fallopian tube • Sperm travels to fallopian tube • Zygote forms • Zygote migrates to uterus • Zygote implants in uterine wall • Progesterone(thermogenic) and Estrogen are secreted by te corpus luteum and maintain hormones until placenta starts producing hormone sufficiently approximately 13 weeks Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Placental development • Chorionic Villi secrete chorionic gonadotropin (hcg) this stimulates progesterone and estrogen

Placental development • Chorionic Villi secrete chorionic gonadotropin (hcg) this stimulates progesterone and estrogen form the corpus luteum • HCG begins with implantation and can be detected day 6 and doubles every 2 hours till approximately 13 weeks Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? The second trimester of pregnancy is

Question Is the following statement true or false? The second trimester of pregnancy is the critical period of human development. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False The first 8 weeks of pregnancy are the critical period of human

Answer False The first 8 weeks of pregnancy are the critical period of human development; during this time, all major systems of the embryo develop. During these weeks, all the organs and structures are formed and are most susceptible to damage. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Development • Umbilical cord- 2 A carrying deoxygenated blood -1 V carry oxygenated blood;

Development • Umbilical cord- 2 A carrying deoxygenated blood -1 V carry oxygenated blood; no pain receptors • Amniotic Fluid – replaced q 3 hr 800 -1200 ml Fetal and maternal blood do not mix Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Development • 4 weeks-chorionic villi form – placenta • 8 weeks- sex differential begins;

Development • 4 weeks-chorionic villi form – placenta • 8 weeks- sex differential begins; heart beat – Cephalocaudal – 2. 2/ 1000 g (pounds) immature – 20 weeks =viable some chance – Placenta >bullets on pg 975 (1/6 weight of baby) – When is blood not contained in a blood vessel? Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Development • 12 weeks =fetal circulation and organs is complete • 16 sex is

Development • 12 weeks =fetal circulation and organs is complete • 16 sex is differentiated; kidneys secrete urine; nasal spectrum/palate close • 20 lanugo covers the entire body; fetal movements; auscultation of heart sounds • 24 vernix caseosa appears; eyebrows and fingernails develop • 28 excellent chance of survival; eyes open and close • 32 fetus is viable; finger prints, movement Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Development • 36 weeks placenta starts to deteriorates fat deposits – Lanugo disappears; amniotic

Development • 36 weeks placenta starts to deteriorates fat deposits – Lanugo disappears; amniotic fluid decreases 40 skin is smooth, eyes are slate colored Bones are ossified and nearly together at sutures Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Fetal blood circulation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Fetal blood circulation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Membranes and Amniotic fluid • Amniotic fluid function bullet >977 • Late pregnancy made

Membranes and Amniotic fluid • Amniotic fluid function bullet >977 • Late pregnancy made up of fetal urine and fetal lung fluid • Fetus swallows 400 ml each day creating urine Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Presumptive Signs of Pregnancy (hormonal) changes subjective • Amenorrhea • Nausea>4 mon or 8

Presumptive Signs of Pregnancy (hormonal) changes subjective • Amenorrhea • Nausea>4 mon or 8 pounds • Frequent urination • Fatigue • Quickening>18 -20 weeks • Breast changes early as 14 week • Pigment changes>melasa>linea nigra Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Probable Signs of Pregnancy objective • Basal body temperature elevation • Positive urine pregnancy

Probable Signs of Pregnancy objective • Basal body temperature elevation • Positive urine pregnancy tests • Cervical changes – Goodell’s sign >softening – Chadwick’s sign>discoloration • Vulvar and vaginal changes • Uterine changes • Ballottement>bounce • Enlargement of the abdomen Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Positive Signs of Pregnancy- proof • Visualization of the fetus – Ultrasound • Fetal

Positive Signs of Pregnancy- proof • Visualization of the fetus – Ultrasound • Fetal heartbeat. 120 -60 – Doppler (an electronic stethoscope) – Fetoscope Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Changes in Maternal Anatomy and Physiology • External changes – lordosis • Internal changes

Changes in Maternal Anatomy and Physiology • External changes – lordosis • Internal changes • Hormone levels HCH double q 24 till approx. 34 weeks • Anticipatory guidance about changes – Bleeding – Dizzy – Palpatation – Round ligament pain Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? It is normal for a client

Question Is the following statement true or false? It is normal for a client to experience nausea well into her third trimester, along with weight loss of about 10 pounds. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False Nausea may begin soon after the first missed menstrual period and usually

Answer False Nausea may begin soon after the first missed menstrual period and usually disappears after the third month of pregnancy. If this condition lasts beyond the fourth month, results in a weight loss of 8 pounds or more, or affects the woman’s general health, it is considered a complication of pregnancy, hyperemesis gravidarum. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Signs of Possible Problems • During the first trimester – Vaginal bleeding or spotting

Signs of Possible Problems • During the first trimester – Vaginal bleeding or spotting – Pelvic/abdominal cramping – No longer feeling pregnant Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Signs of Possible Problems (cont’d) • During the second and third trimesters – Vaginal

Signs of Possible Problems (cont’d) • During the second and third trimesters – Vaginal bleeding, with or without cramping, pressure, or pain – Bleeding with severe abdominal pain – Vaginal or lower abdominal pressure – PTL, PPROM/PROM, decreased fetal movement – Severe headache, visual changes – Sudden edema or swelling – Epigastric pain Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Healthcare During Pregnancy • The goals of good prenatal care to – Promote physical

Healthcare During Pregnancy • The goals of good prenatal care to – Promote physical and mental wellness of the mother during the pregnancy and afterward. – Help the woman give birth safely and without complications. – Ensure a healthy baby. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Components of Prenatal Care • Basic components of adequate prenatal care – Early and

Components of Prenatal Care • Basic components of adequate prenatal care – Early and regular prenatal care – Maintenance of maternal health; promotion of good health habits – Recognition and treatment of physical, mental, and social/economic problems Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Risk Assessments • Initial prenatal visit – Health history, physical examination – Laboratory tests,

Risk Assessments • Initial prenatal visit – Health history, physical examination – Laboratory tests, other blood tests, HIV testing – Urine is tested for albumin, glucose, and the presence of harmful bacteria – Mantoux tuberculin skin test (TST) – Genetic counseling and testing – Determining the baby’s due date – Initial risk assessment Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Risk Assessments (cont’d) • Return prenatal visits – Weight, blood pressure, urine – Uterus,

Risk Assessments (cont’d) • Return prenatal visits – Weight, blood pressure, urine – Uterus, fetal heart tones – Edema, continuing risk assessments • Additional tests performed during pregnancy – Maternal serum alpha fetoprotein (MSAFP) – Triple marker screen Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? A woman’s due date is based

Question Is the following statement true or false? A woman’s due date is based on her first day of the last menstrual period. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer True Pregnancy is dated from the first day of the woman’s last normal

Answer True Pregnancy is dated from the first day of the woman’s last normal menstrual period (LNMP), and if this cannot be recalled accurately, the first day of her previous menstrual period (PMP) is used. Once an accurate date for her last period is determined, the due date for the baby, estimated date of confinement (EDC) or the estimated date of delivery (EDD) is determined either by using a gestational wheel or by applying Nägele’s rule. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Health Promotion • Elimination and hygiene • Breast care • Rest • Exercise and

Health Promotion • Elimination and hygiene • Breast care • Rest • Exercise and posture • Activity • Sexual relations – Sexual needs – Touch needs – Comfort and reassurance needs Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Health Promotion (cont’d) • Sexual safety during pregnancy – Risk due to penetration –

Health Promotion (cont’d) • Sexual safety during pregnancy – Risk due to penetration – Risk due to possible infection – Risk due to arousal – Risk due to orgasm – Risk due to sexual behaviors • Clothing • Travel and employment Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Health Promotion (cont’d) • Teratogenic factors – Diseases, prescribed medications – Substances of abuse

Health Promotion (cont’d) • Teratogenic factors – Diseases, prescribed medications – Substances of abuse – Ionizing radiation • Appetite – Pica • Weight gain during pregnancy • Common discomforts of pregnancy Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Health Promotion (cont’d) • Nutrition during pregnancy – Increase caloric intake. – Increase calcium,

Health Promotion (cont’d) • Nutrition during pregnancy – Increase caloric intake. – Increase calcium, protein, and vitamin intake. – Maintain iron and folic acid intake. – Avoid empty calories, laxatives, and enemas. – Use iodized salt and eat a variety of foods. – Include fiber in diet. – Increase fluid intake (water is the preferred fluid). Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medical Interventions • The pregnant woman should not take any medications, herbs, or nutritional

Medical Interventions • The pregnant woman should not take any medications, herbs, or nutritional supplements unless they are necessary and ordered by her healthcare provider. • Drugs rated by FDA – Category B – Category C – Category D – Category X Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Common Discomforts of Pregnancy • Integument • Neurologic • Nervous • Urinary • Musculoskeletal

Common Discomforts of Pregnancy • Integument • Neurologic • Nervous • Urinary • Musculoskeletal • Cardiovascular • Reproductive • Breasts • Nose • Mouth • Gastrointestinal Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Adapting to Pregnancy • Pregnancy validation: First trimester (weeks 1 to 13) • Fetal

Adapting to Pregnancy • Pregnancy validation: First trimester (weeks 1 to 13) • Fetal embodiment: Second trimester (weeks 14 to 27) • Fetal distinction: Third trimester (week 28 to term) • Separation from the fetus: Labor and birth • Transition to motherhood: Postpartum Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? Drugs are particularly dangerous to the

Question Is the following statement true or false? Drugs are particularly dangerous to the fetus in the second trimester. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False Drugs are particularly dangerous to the fetus in the first and third

Answer False Drugs are particularly dangerous to the fetus in the first and third trimesters. In the first trimester, the fetus is being formed and is particularly sensitive to teratogens. Drugs administered in the third trimester are dangerous to the fetus because when the fetus is born, the woman’s circulatory system is no longer available to help metabolize or excrete drugs, and the newborn’s immature circulatory and excretory systems must take over. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Preparing for Labor and Birth • Approaches to childbirth preparation – Common methods of

Preparing for Labor and Birth • Approaches to childbirth preparation – Common methods of childbirth preparation – The Lamaze method of childbirth – Current childbirth preparation trends • Responses to fatherhood • Preparing for the expanding family • Preparing for the newborn – Client education: Infant care and infant feedings Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nursing Process • Overview of the nursing process during a normal pregnancy – Nursing

Nursing Process • Overview of the nursing process during a normal pregnancy – Nursing history – Physical examination – Laboratory and diagnostic tests • Possible nursing diagnoses • Planning • Implementation • Evaluation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

End of Presentation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

End of Presentation Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins