NORMAL PREGNANCY – CHAPTER
65
PREGNANCY
Pregnancy is a normal
physiologic process: Terms to
know
Gestation
Fertilization
Last normal menstrual period
Trimester
NORMAL PREGNANCY
Gravida Para
Gravida is Latin Parity = number of
term for pregnancy deliveries
1st Pregnancy she is
a Primigravida
Other births she is a
Multigravida
At least 5 times a
This Photo by Unknown Author is
Grand Multipara licensed under CC BY-NC-ND
GRAVIDA
Primigravida, multigravida, grand
multiparas
G= gravida, total number of pregnancies,
including this pregnancy if she is pregnant
P= para number of babies born at 20 or
more weeks gestation
Using this system, a woman who has had
only one previous pregnancy which resulted
in the birth of a baby at 38 weeks, and who
is now pregnant would be a G2 (two
pregnancies), P1 (one birth)
FPAL ???????????
Para (Para) the outcome of pregnancies classified
as follows FPAL defines outcome of pregnancies
in more detail
F =Full Term (37 wks or more)
P = Preterm (number of babies born between 20-
37 weeks gestation
A= Abortions (total number spontaneous and
elective abortions, including ectopic
pregnancies that ended before 20 wks gestation.
The earliest gestation that is considered viable is
20 weeks
L = Living children, as of today
QUESTION
Your client is now
pregnant, but has had
four pregnancies, two
babies born at term,
one preterm, and one
miscarriage (a
spontaneous
abortion).
How would you
record her pregnancy
history?
ANSWER
G4 P2113
PREGNANCY (cont’d)
Pregnancy also called Antepartum period
(making prenatal care, care before birth)
Provided in private practice, at a clinic, or at a home
Good prenatal care is one of the most important factors
in the health care of the clients and the babies.
Obstetrics
Branch of medicine concerned with pregnancy and birth
Obstetrician
Nurse midwife or CNM (certified nurse midwife)
Periconceptional Care
This is care of the
client before they are
pregnant
Goal is the have the
best possible
pregnancy outcome.
Some clients do not
realize they are even
pregnant – these
weeks are the most
critical in human
development!
This Photo by Unknown Author is licensed under CC BY
PRECONCEPTIONAL CARE 7 Areas
1. Eat healthy diet and include 400 mcg of folic
acid a day
2. Stop harmful or additive behaviors………
3. Stop use of prescription drugs that are known
to be harmful to a developing fetus
4. For the diabetic woman, change to insulin and
make sure blood sugar in under control
5. Refer a couple at risk of having a baby with
genetic defect for genetic testing and counseling
6. Test the mother-to-be for infectious diseases
7. Reduce psychosocial risk factors
Pregnancy Precautions
In Practice 65-1
Use caution with Rx
Avoid x-rays
Avoid substance use
Avoid exposure to
environmental toxins
Avoid exposure to
infections
Avoid hyperthermia-
productions
situations
STAGES OF HUMAN DEVELOPMENT
Conception and sex determination
Fertilization: the union of ovum and
sperm
STAGES OF HUMAN DEVELOPMENT
Period of the zygote
and implantation
Period of the embryo
(first 8 weeks)
Critical period of
development all
organs and structures
of the human are
formed
The embryo/fetus is
vulnerable to harmful
influences that could
result in congenital
(born with) defects
EARLY HUMAN DEVELOPMENT & IMPLANTATION
Stages of Human Development
Period of the fetus
Fetal blood
circulation
Membranes &
amniotic fluid
QUESTION
Is the following statement true of false”
The second trimester of pregnancy is the
critical period of human development
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 structure are formed and are most
susceptible to damage
Placenta and Umbilical Cord
Supplies the fetus
with food and oxygen
2. Carries waste away
for excretion by the
mother
[Link] the maternal
immune response so
that the mother’s
body does not reject
the fetal tissues
4 Produces hormones
that help maintain
the pregnancy
Fetal Blood Circulation
Fetal blood circulation differs from newborn and
adult circulation.
The placenta returns oxygenated blood to the fetus
via the umbilical vein. This process is an exception
to the usual pattern in which all arteries carry
oxygenated blood, and all vein carry deoxygenated
blood. Some oxygenated blood from the umbilical
vein passes through the fetal liver, but most enters
the fetus’ inferior vena cava through the ductus
venosus. This short duct is found ONLY in the
fetus and atrophies after birth. From the vena
cava, the blood flows into the fetus’ right atrium.
Fetal Blood Circulation (cont’d)
The fetal lungs are not functioning most of the
blood is shunted to the heart’s left atrium. This
shunt is called the foramen ovale, an opening
between the right and left atria. It permits most
of the blood to bypass the right ventricle.
A small amount passes from the right atrium to
the right ventricle and makes its way to the
pulmonary artery. It is then shunted through the
ductus arteriosus. It is a connection between
the pulmonary artery and the aorta that allows
shunting of blood around the fetal lungs
Fetal Circulation (cont’d)
Normally, the newborn’s first few breaths the
lungs expand as soon as pressure within the
chest alters. Then the foramen ovale closes,
the ductus arteriousus and the ductus
venosus shrivel and become fibrous
ligaments.
Congenital heart defects in a child occur
when these events do not take place.
Fetal Blood Circulation
PRESUMPTIVE SIGNS OF
PREGNANCY
Amenorrhea
Nausea
Frequent urination
Fatigue
Quickening
Breast changes
Pigment changes
PROBABLE SIGNS OF PREGNANCY
Basal body temp elevation
Positive urine pregnancy test
Cervical changes
Goodell’s sign
Chadwick’s sign
Uterine changes
Ballottement
Enlargement of the abdomen
POSITIVE SIGNS OF PREGNANCY
Visualization of the
fetus
Ultrasound
Fetal heartbeat
Doppler (an electronic
stethoscope)
Fetoscope
CHANGES IN MATERNAL ANATOMY & PHYSIOLOGY
External changes
Internal changes
Hormone levels
Anticipatory guidance
about changes
QUESTION
Is the following true or false
Is it normal for a client to experience nausea
well into her third trimester, along with
weight loss of about 10 pounds?
ANSWER
False
Nausea may begin soon after the first missed
period and usually resolves after the 3rd
month of pregnancy
If this condition last 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.
SIGNS OF POSSIBLE PROBLEMS
During the first
trimester
Vaginal bleeding or
spotting
Pelvic/abdominal
cramping
No longer feeling
pregnant
SIGNS OF POSSIBLE PROBLEMS
(con’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
HEALTHCARE DURING PREGNANCY
The goals of good
prenatal care are to
Promote physical &
mental wellness of the
mother during the
pregnancy and
afterward
Help the woman give
birth safely and
without complications
Ensure a healthy baby
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 treatments of physical, mental, and
social/economic problems
RISK ASSESSMENTS
Initial prenatal visit
Health history, physical
examination
Lab tests, other blood tests,
HIV testing
Urine is tested for albumin,
glucose, and the presence of
harmful bacteria
Mantoux tuberculin skin tests
(TST)
Genetic counseling and testing
Determining the baby’s due
date
Initial risk assessment
RISK ASSESSMENTS (con’t)
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
QUESTION
Is the following statement true or false?
A woman’s due date is based on her first day
of the her last menstrual period.
ANSWER
True
Pregnancy is dated from the first day of the
woman’s last 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 Nagele’s rule
HEALTH PROMOTION
Elimination and
hygiene
Breast Care
Rest
Exercise and posture
Activity
Sexual relations
Sexual needs
Touch needs
Comfort and
reassurance needs
HEALTH PROMOTION (con’t)
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
Travel and Safety
HEALTH PROMOTION (con’t)
Teratogenic factors
Diseases, prescribed medications
Substances of abuse
Ionizing radiation
Appetite
Pica
Weight gain during pregnancy
Common discomforts of pregnancy
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 enema
Use iodized salt and eat a
variety of foods
Include fiber in diet
Increase fluid intake
(water is the preferred
fluid)
MEDICAL INTERVENTIONS
The pregnant woman
should not take any
medications, herbs,
or nutritional
supplements unless
they are necessary
and ordered by you
healthcare provider
COMMON DISCOMFORTS OF PREGNANCY
Integument
Nervous
Musculoskeletal
Reproductive
Breasts
Nose
Mouth
Gastrointestinal
Neurologic
Urinary
Cardiovascular
ADAPTING TO PREGNANCY
Pregnancy validation: First trimester (weeks
1 to 13)
Fetal embodiment: Second trimester (14 to
27)
Fetal distinction: Third trimester (week 28 to
term)
Separation from the fetus: Labor and birth
Transition to motherhood: Postpartum
QUESTION
Is the following true or false?
Drugs are particularly dangerous to the fetus
in the second trimester.
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.
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
NURSING PROCESS
Overview of the nursing process during a
normal pregnancy
Nursing history
Physical examination
Laboratory and diagnostic tests
Possible nursing diagnosis
Planning
Implementation
Evaluation
END OF PRESENTATION
