Normal Pregnancy
Professor Burke
Terminology Used to Document an Obstetric History
Gravida: a pregnant woman
Gravida I (primigravida): first pregnancy Gravida II (secundigravida): second pregnancy, etc. Para: a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more Primapara: one birth after a pregnancy of at least 20 weeks (primip) Multipara: two or more pregnancies resulting in viable offspring (multip) Nullipara: no viable offspring; para 0
Obstetric History Terms
G (gravida) the current pregnancy
T (term births) the number of pregnancies ending > 37 weeks gestation, at term
P (preterm births) the number of preterm pregnancies ending > 20 weeks or viability but before completion of 37 weeks A (abortions) the number of pregnancies ending before 20 weeks or viability L (living children) number of children currently living
Calculating the Estimated Date of Birth (EDB) Using Nageles Rule
Use the first day of LNMP 11/21/99 Subtract 3 months 8/21/99 Add 7 days 8/28/99 Add 1 year 8/28/2000 = EDB
Signs and Symptoms of Pregnancy
Presumptive (time of occurrence)
Fatigue (12 weeks) Breast tenderness (3-4 weeks) Nausea and vomiting (4-14 weeks) Amenorrhea (4 weeks) Urinary frequency (6-12 weeks) Hyperpigmentation of the skin (16 weeks) Fetal movements (quickening) (16-20 weeks)
Signs and Symptoms of Pregnancy
Uterine enlargement (7-12 weeks) Breast enlargement (6 weeks)
Probable (time of occurrence)
Braxton-Hicks contractions (16 - 28 weeks) Positive pregnancy test (4-12 weeks) Abdominal enlargement (14 weeks) Ballottement (16-28 weeks) Goodells sign (5 weeks) Chadwicks sign (6-8 weeks) Hegars sign (6-12 weeks)
Physical Changes of the Cervix During Pregnancy
Chadwicks sign: Estrogen causes the cervix to become congested with blood (hyperemic), resulting in a bluish color that extends to include the vagina Goodells sign: Increased vascularity causes the cervix to soften Mucus plug: Increased mucus forms to seal off the cervix from outside bacteria
Signs and Symptoms of Pregnancy (cont.)
Positive (time of occurrence)
Ultrasound verification of embryo or fetus (4-6 weeks) Fetal movement felt by experienced clinician (20 weeks) Auscultation of fetal heart tones via Doppler (10-12 weeks)
Physical Changes of the Uterus During Pregnancy
Size increases to 20 times that of nonpregnant size
Weight increases from 2 ounces to approximately 2 pounds at term Walls thin to 1.5 cm or less from a solid globe to a hollow vessel Volume capacity increases from 2 teaspoons to 1 gallon 1/6 of total maternal blood volume is contained within the vascular system of the uterus by term
Hormones of Pregnancy
HCG
HPL Progesterone Estrogen
Relaxin
Physical Changes of the Breasts During Pregnancy
Breasts increase in size and nodularity to prepare for lactation Nipples increase in size, become more erect, and more pigmented Colostrum is produced
an antibody-rich, yellow fluid that can be expressed after the 12th week converts to mature milk after delivery
Cardiovascular Changes
Cardiac output increases Increase in plasma volume & RBC Increase in fibrin & plasma fibrinogen Decrease in Hb & HCT Increase in WBC
Physical Changes of the GI Tract During Pregnancy
Reflux of gastric contents common due to relaxation of smooth muscles by progesterone Ptyalism (excessive salivation) is a common condition of pregnant women Decrease in intestinal motility causes constipation Nausea and vomiting (morning sickness) is due to high hCG levels from 6 to 12 weeks
Psychological Response to Pregnancy
Ambivalence: initial response; no visible body change yet Acceptance: triggered by quickening in 2nd trimester Introversion: turning in on oneself Mood swings: from great joy to despair Body image change: the picture you have of your body and of yourself
Maternal Roles
Ensuring safe passage throughout pregnancy and birth Seeking acceptance of infant by others Seeking acceptance of self in maternal role to infant Learning to give of oneself 1st trimester: identifying what must be given up to assume new role 2nd trimester: identifying with infant, learning how to delay own desires 3rd trimester: questioning ability to become a good mother to infant (Rubin, 1984)
Focus of Preconception Care
Immunization status Underlying medical conditions Reproductive healthcare practices Sexuality and sexual practices Nutrition Lifestyle practices Psychosocial issues Medication and drug use Support system
Characteristics of the Initial Health History
Includes questions about three major areas: reason for seeking care past medical, surgical, and personal history patients reproductive history Establishes a trusting relationship Focuses on education for overall wellness Attempts to detect and prevent potential problems
Components of a Physical Examination of a Pregnant Woman
Head-to-toe assessment
head and neck chest abdomen Extremities
Pelvic examination
examination of external and internal genitalia
bimanual examination
pelvic shape pelvic measurements
Pelvic Shapes
Assessments Taken at Subsequent Prenatal Visits
Weight and blood pressure measurements; compared to the baseline values Urine testing for presence of protein, glucose, ketones, and nitrites Fundal height measurement to assess fetal growth Assessment for quickening/fetal movement to determine well-being Assessment of fetal heart rate; should range between 120160 bp
Fundal Height
Indicates uterine size by measuring from the top of the symphysis pubis to the top of the fundus
Correlates with weeks of gestation between 2030 weeks
20 weeks = 20 cm 24 weeks = 24 cm 30 weeks = 30 cm
Measuring fundal height
Nursing Management to Promote SelfCare of the Pregnant Woman
Personal hygiene Clothing Exercise Sleep and rest
Sexual activity and sexuality Employment Travel Immunizations and medications
First Trimester
Urinary frequency or incontinence Fatigue Nausea and vomiting Breast tenderness
Constipation Nasal stuffiness, bleeding gums and epistaxis Cravings Leukorrhea
Second Trimester
Blood volume continues to increase B/P drops slightly Oxygen consumption up 15-20% Pelvic ligaments relax May have gall bladder & urinary problems GFR increases up 50% Chloasma, striae gravidarum, linea nigra.
Postural Changes
Third Trimester
Change in balance Backache B/P drops slightly Slowing of peristalsis Fundus = Xiphoid = SOB Edema of LE Hemorrhoids & varicosities
Natural Childbirth Education Classes
Lamaze (psychoprophylactic) method
promotes the use of specific breathing and relaxation techniques
Bradley (partner-coached) method
uses various exercises and slow, controlled abdominal breathing to accomplish relaxation
Dick-Read method
is based on relaxation and breathing techniques
Sibling Class
