Overview of the lesson: ▪ MULTIGRAVIDA – a woman who is in year if appropriate.

Alternatively, add 7 days to

her second or any subsequent pregnancy the last menstrual period and count forward 9 
Most women who are pregnant will have an uncomplicated ▪ PARA – birth after 20 weeks’ gestation months. 
pregnancy, giving  birth to a healthy baby at full term. However, regardless of whether the infant is born Note: Bases calculation on a woman who has a 28 day
problems during pregnancy (such as  miscarriage, fetal growth alive or dead ▪ NULLIPARA – a woman cycle (most women vary) with typical  gestation period of
restriction and preterm birth) remain common, and stillbirth  rates who has had no births at more than 20 280 days (40 weeks). It varies in 1 st time mothers usually
have changed little in recent years. Maternal complications such week’s gestation  slightly longer.  Remember the months that have 30 vs. 31
as gestational  hypertension, diabetes mellitus, haemorrhage and ▪ PRIMIPARA – a woman who has had one birth days and 28 days (February), 30 DAYS: April,  June,
sepsis are also still encountered, with  the most extreme cases at more than 20 weeks’ gestation, September and November
contributing to a maternal mortality rate. This module deals with  regardless  of whether the infant was born
caring of mothers in the antepartum stage. The aim of antenatal alive or dead 
Example:
care are to optimize maternal and fetal health, to offer women ▪ MULTIPARA – a woman who has had two or more births at
A. First day of the last menstrual period: September 12, 2018
maternal and fetal screening, to make medical  or social more than 20 weeks’ gestation Subtract 3 months: June 12, 2018
interventions available to women where indicated, to improve Add 7 days: June 19, 2018
▪ STILLBIRTH – an infant born dead after 20 weeks’ gestation
women's  experience of pregnancy and birth and to prepare Add 1 year: June 19, 2019
women for motherhood whatever their  risk status Estimated Date of Delivery: June 19, 2019
1. BIOGRAPHICAL DATA 
The antenatal Mother - It consists of the following history of emotional B. First day of the last menstrual period: March 7, 2016
problems, support systems available to Add 7 days: March 14, 2016
DEFINITION OF TERMS:  Add 9 months: December 14, 2016
her,  personal preferences about the birth
▪ GESTATION – the number of weeks of Estimated Date of Delivery: December 14, 2016
(expectations of both the woman and her
pregnancy since the first day of the last
partner,  presence of others, and so on),
menstrual cycle ▪ ABORTION – birth that 3. PREVIOUS PREGNANCIES/PAST PREGNANCIES
and plans for the care of child following
occurs before the end of 20 weeks’ gestation  - Are the number of pregnancies, number of abortions,
birth, feeding  preference for the baby
▪ TERM – the normal duration of pregnancy (38 to 42 spontaneous or induced, number of living
(breast milk or formula?). 
weeks’ gestation)  children, history of previous pregnancies, length of pregnancy,
▪ ANTEPARTUM – the time between conception and 2. CURRENT PREGNANCY 
length of labor and birth, type of birth (vaginal, forceps or vacuum-
the onset of labor; usually used to describe  the - It is the first day of last normal menstrual assisted birth, cesarean), type of anesthesia used (if any),
period during which a woman is pregnant; used period (LMP), are there presence of
woman’s
interchangeably with prenatal  cramping,  bleeding, or spotting since
perception of the experience, and complications (antepartal,
▪ INTRAPARTUM – time from the onset of true labor until the LMP, woman’s opinion about the time
intrapartal, postpartal).
birth of the infant and placenta  when conception  occurred and when
- The neonatal status of previous children (Apgar Scores, birth
▪ POSTPARTUM – time from the delivery of infant is due, woman’s attitude towards
weights, general development,
the placenta and membranes until the pregnancy (Is this pregnancy  planned? complications, and feeding patterns [breastmilk or formula]
woman’s  body returns to a nonpregnant Wanted?, results of pregnancy tests, - Loss of a child ( miscarriage, elective or medically indicated
condition  any discomforts since LMP such as  abortion, stillbirth, neonatal death,
▪ PRETERM OR PREMATURE nausea, vomiting, urinary frequency, relinquishment, or death after the neonatal period.) What was the
LABOR – labor that occurs after fatigue or breast tenderness.  experience like for her? What coping
20 weeks’ but before  completion ▪ Expected Date of Confinement (EDC)/Expected skills helped? How did her partner, if involved, respond?
of 37 week’s gestation  - If RH negative, was medication received after birth to prevent
Due Date (EDD) 
▪ POSTTERM LABOR – labor that occurs after 42 weeks’ sensitization?
gestation  *Nagele’s Rule – used for
- Prenatal education classes and resources (books)
▪ GRAVIDA – any estimating the date of delivery, also
pregnancy, regardless of known as date of birth based  on  Describing Pregnancy Outcome with GTPAL
duration, including present last menstrual period (LMP).  Use of GTPAL:
pregnancy ▪ - The result is approximately 280 days (40 weeks) 1. G is gravidity, the number of pregnancies, including the present
NULLIGRAVIDA – a one.
woman who has never 1. It requires that the woman have a regular 28-day menstrual 2. T is term births, the number of born at term ( longer than 37
been pregnant cycle.  weeks of gestation )
▪ PRIMIGRAVIDA – a woman who is pregnant for the first 2. Subtract 3 months and add 7 days to the first day 3. P is preterm births, the number of born before 37 weeks of
time  of the last menstrual period (LMP); then add  1 gestation.
4. A is abortions or miscarriages, the number of abortions or diseases or deformities, occurrence of cesarean births and cause, part of the day
miscarriages (included in gravida if if known - in reality the symptoms may occur at any time and can range
before 20 weeks gestation; included in parity if past 20 weeks of 7. OCCUPATIONAL HISTORY from a more favorable
gestation). - It includes the occupation of the mother, physical demands, pregnancy outcome than those who do not.
5. L is the number of current living children. exposure to chemicals or other 3. Excessive Fatigue
*NOTE: Gravidity includes miscarriages, abortions, twins and harmful substances, opportunity for regular meals and breaks for - may be noted within a few weeks after the first missed menstrual
triplets count as one, and a termination of the nutritious snacks, provision period and may persist
pregnancy after 20 weeks is referred to as a “therapeutic for maternity or family leave. throughout the first trimester.
termination.” 4. Urinary Frequency
Example: *A woman is pregnant for the fourth time. She had 1 8. PARTNER’S HISTORY - experienced during the first trimester as the enlarging uterus
elective abortion in the first - It includes the partner’s presence of genetic conditions or presses on the bladder.
trimester, a daughter who was born at 40 weeks of gestation, and diseases, age, significant health 5. Changes in the Breasts
a son who was born at 36 problems, previous or present alcohol intake, drug use, or - frequently noted in the early pregnancy
weeks of gestation. tobacco use, blood type and Rh - changes include tenderness and tingling sensation, increased
Answer: *She is gravida (G), 4; term (T), 1 (the daughter born at factor. pigmentation of the areola and
40 weeks); preterm (P), 1 (the son born at 36 weeks; abortion (A) 9. RELIGIOUS, SPIRITUAL, AND CULTURAL HISTORY nipple, and changes in Montgomery's glands
1 (the abortion is counted in the gravidity, but is not - Are the religious preference, belief or practices, practices - the veins also become more visible more visible and form a
included in the parity because it occurred before 20 weeks); living important to maintain her spiritual bluish pattern beneath the skin
children (L), 2. Parity is well-being, and her practices and culture or that of her partner. 6. Quickening: The first perception of fetal movement by the
the number of births (not the number of fetuses) carried past 20 *How do you obtain these data? mother may occur at the sixteenth (16th)
weeks of gestation, whether  Questionnaire - A questionnaire is used in many instances to to twentieth (20th) week of gestation.
or not the fetus was born alive. Therefore, the parity for this obtain information. The woman - the mother’s first perception of fetal movement
woman is 2. GTPAL = 4,1,1,1,2 should complete the questionnaire in a quiet place with a - occurs about 18 to 20 weeks after LMP for first time pregnant
minimum of distractions. woman
4. GYNECOLOGIC HISTORY  Interview - The nurse can get further information in an interview, - 16 weeks in a woman who has been pregnant before
- Is the date of last Pap smear; any history of abnormal Pap which allows the pregnant - is a fluttering sensation in the abdomen that gradually increases
smear, previous infections: woman to clarify her responses to question and gives the nurse in intensity and frequency
vaginal, cervical, tubal, or sexually transmitted, previous surgery, and client the opportunity to 2. OBJECTIVE (PROBABLE) CHANGES
age at menarche, and the develop rapport. The partner can be encouraged to attend the - An examiner can perceive the objective changes that occur in
regularity, frequency, and duration of menstrual flow, the history prenatal examinations. The pregnancy. These changes can
of dysmenorrhea, sexual partner is often able to contribute to the history and may use the have other causes, they do not confirm pregnancy.
history, contraceptive history (If birth control pills were used, did opportunity to ask questions or Examples:
pregnancy occur immediately express concerns. 1. Changes in the pelvic organs
following cessation of pills? If not, how long after? DIAGNOSIS OF PREGNANCY - the only physical changes detectable during the first 3 months of
5. CURRENT MEDICAL HISTORY 1. SUBJECTIVE (PRESUMPTIVE) CHANGES pregnancy and are caused
- It includes the weight, blood type and Rh factor, if known, the - The subjective changes of pregnancy are the symptoms the by increased vascular congestion
general health, including woman experiences and reports. - these changes are noted on pelvic examination
nutrition, normal dietary practices, and regular exercise program, Because they can be caused by other conditions, they cannot be A. Goodell’s Sign
any medications presently considered proof of - softening of the cervix that occurs at the beginning of the second
being taken or taken since the onset of pregnancy, previous or pregnancy. Several subjective signs can be diagnostic clues month
present use of alcohol, tobacco, when other signs and symptoms B. Chadwick’s Sign
or caffeine. Illicit drug use or abuse, drug allergies and other of pregnancy are also present. - bluish, purple, or deep red discoloration of the mucous
allergies, potential teratogenic Examples: membranes of the cervix, vagina, and
insults to this pregnancy, presence of disease conditions, record 1. Amenorrhea vulva that occurs at about week 6
of immunizations, presence of - the absence of menses C. Hegar’s Sign
any abnormal symptoms. - the earliest symptom of pregnancy - missing more than one - compressibility and softening of the isthmus of the uterus that
6. FAMILY MEDICAL HISTORY menstrual period, especially in a woman whose cycle is ordinarily occurs at about week 6
- Presence of diabetes, cardiovascular disease, cancer, regular, is an especially useful diagnostic rule. D. McDonald’s Sign
hypertension, hematologic disorders, 2. Nause and vomiting in pregnancy (NVP) - is an ease in flexing the body of the uterus against the cervix
tuberculosis, or preeclampsia-eclampsia, occurrence of multiple - occur frequently during first trimester E. Uterine Enlargement
births, history of congenital - commonly referred to as morning sickness because these - can be noted after the 8th week of pregnancy
symptoms often occur in the early
- the fundus of the uterus is palpable just above the symphysis Hcg in the serum.  After 20-36 weeks fundal height will reflect weeks of pregnancy
pubis at about 10 to 12 weeks’ c. Enzyme – linked immunosorbent assay (ELISA) (Model + or minus 2cm, example 26
gestation and at the level of the umbilicus at 20 to 22 weeks’ Sensichrome, Quest Confidot) – weeks anywhere bet 24 to 28
gestation can detect Hcg levels as early as 7 to 9 days after ovulation and  At 36 weeks at xiphoid process issues in breathing
2. Enlargement of the abdomen conception, which is 5 days  Around 37-40 weeks moves down at about 4cm why? To
- during the childbearing years is usually regarded as evidence of before the first missed period. prepare for delivery for birth, pelvic
pregnancy d. Fluoroimmunoassay (FIA) (Opus Hcg, Stratus Hcg) – uses an cavity
3. Braxton Hicks Contractions antibody tagged with a Measuring Fundal Height
- irregular painless contractions fluorescent label to detect serum Hcg. 1. Place the client in supine position.
- can be palpated most commonly after the 28th week and may e. Over-the-Counter-Pregnancy Tests – these enzyme 2. Place the end of the tape measure at the level of the symphysis
occur intermittently throughout immunoassay tests, performed on urine, pubis.
pregnancy are quite sensitive and detect even low levels of Hcg. 3. Stretch the tape to the top of the uterine fundus.
- often called as false labor 3. DIAGNOSTIC (POSITIVE) CHANGES 4. Note and record the measurement.
4. Uterine Souffle - Are completely objective, cannot be confused with a pathologic Note: This is the height of the fundus by weeks of normal
- is a soft, blowing sound that occurs the same rate as the state, and is conclusive proof gestation with a single fetus. Dashed line,
maternal pulse of pregnancy height after lightening (descent of the fetus toward the pelvic inlet
- caused by the increased uterine blood flow and blood pulsating Examples: before labor).
through the placenta 1. Fetal Heartbeat Note: WATCH FOR HYPOTENSION THERE ARE MAJOR
5. Changes in Pigmentation of the Skin - can be detected with an electronic device (Doppler) as early as BLOOD VESSELS THAT MAY BE
- these are common in pregnancy 10 to 12 weeks of pregnancy and by COMPRESS
- the nipples and areolae may darken, and the linea nigra may nonelectronic device (Fetoscope) at 20 weeks of gestation.
develop 2. Fetal Movement PHYSIOLOGICAL MATERNAL CHANGES
- Facial melasma (chloasma) may be noticeable, and striae may - is actively palpable by a trained examiner after about the 20th A. Cardiovascular System
appear week of pregnancy 1. Circulating blood volume increases, plasma increases, and
6. Fetal Outline 3. Visualization of the fetus by Ultrasound Examination total red blood cell volume
- may be identified by palpation after 24 week’s gestation - confirms a pregnancy increases (total volume increases by approximately 40% to 50%).
7. Ballottement - the gestational sac be observed by 4 to 5 weeks’ gestation ( 2 to 2. Physiological anemia occurs as the plasma increase exceeds
- is the passive fetal movement elicited when the examiner inserts 3 weeks after conception). the increase in production of red
two gloved fingers into the FUNDAL HEIGHT blood cells.
vagina and pushes against the cervix - Is measured to evaluate the gestational age of the fetus. 3. Iron requirements are increased.
- rebounding of the fetus against the examiner’s fingers on - During the second and third trimesters (weeks 18 to 30), fundal B. Respiratory System
palpation height in centimeters 1. Oxygen consumption increases by approximately 15% to 20%.
8. Pregnancy Tests approximately equals fetal age in weeks +2cm -2cm. 2. Diaphragm is elevated because of the enlarged uterus.
- detect the presence of Hcg in the maternal blood or urine. - At 16 weeks, the fundus can be found approximately halfway 3. Shortness of breath may be experienced.
*Techniques to detect Hcg during early pregnancy: between the symphysis pubis and C. Gastrointestinal System
 Hemagglutination-inhibition test (Pregnosticon R test) - an the umbilicus. 1. Nausea and vomiting
immunoassay, is based on the - At 20 to 22 weeks, the fundus is approximately at the location of 2. Poor appetite may occur
fact that no clumping of cells occurs when the urine of a pregnant the umbilicus. 3. Alterations in taste and smell may occur.
woman is added to the hcg – - At 36 weeks, the fundus is at the xiphoid process. 4. Constipation may occur
sensitized red blood cells of sheep. Note: D. Renal System
 Latex agglutination test (Gravindex and Pregnosticon Slide Purpose: Assesses if baby is growing properly. 1. Frequency of urination increases in the first and third
tests) - also an immunoassay, Measure: Remember the symphysis pubis – is a cartilage joint trimesters.
is based on the fact that latex particle agglutination is inhibited in found in between the pubic bones 2. Decreased bladder tone may occur ; bladder capacity
the presence of urine Fundus of the uterus – top part of the uterus increases.
containing hcg. Measure in CM 3. Renal threshold for glucose may be reduced.
Several pregnancy tests are done on maternal serum, include the During Pregnancy E. Endocrine System
following:  Above symphysis pubis – 12 weeks 1. Basal metabolic rate increases and metabolic function
a. B-subunit radioimmunoassay (RIA) – uses an antiserum with  At belly button – 20 weeks increases.
specificity for the B- subunit of 2. The anterior lobe of the pituitary gland enlarges and produces
Hcg in maternal blood.  In between belly button and symphysis pubis – 12-20 weeks serum prolactin needed for the
b. Immunoradiometric assay (IRMA) – uses a radioactive antibody halfway point 16 weeks lactation process.
to identify the presence of
3. The posterior lobe of the pituitary gland produces oxytocin, 1. Changes in the center of gravity begin in the second trimester 2. These emotional change are common, but the mother may
which stimulates uterine and are caused by the hormones think that these changes are
contractions. relaxin and progesterone. abnormal.
4. The thyroid enlarges slightly, and thyroid activity increases. 2. The lumbosacral curve increases. 2. Second Trimester
F. Reproductive System 3. Aching, numbness, and weakness may result; walking A. Body Image changes
1. Uterus becomes more difficult, and the woman 1. The changes in a woman’s perception of her image during
a) Uterus enlarges, increasing in mass from approximately 60 to develops a waddling gait and is at risk for falls. pregnancy occur gradually and may
1000 grams as a result of 4. Relaxation and increased mobility of pelvic joints occur, which be positive or negative.
hyperplasia (influence of estrogen) and hyperthrophy. permit enlargement of pelvic 2. The physical changes and signs and symptoms that the woman
b) Size and number of blood vessels and lymphatics increase. dimensions. experiences during pregnancy
c) Irregular contractions occur, typically beginning after 16 weeks 5. Abdominal wall stretches with loss of tone throughout contribute to her body image.
of gestation. pregnancy, regained postpartum. *Positive – pride of a woman and her partner
2. Cervix 6. Umbilicus flattens or protrudes. *Negative – change in body size and shape, coupled with
a) Cervix becomes shorter, more elastic, and larger in diameter. PSYCHOLOGICAL MATERNAL CHANGES hyperpigmentation of the skin and striae gravidarum (stretch
b) Endocervical glands secrete a thick mucous plug, which is 1. First Trimester marks), changes in body function, such as altered balance, less
expelled from the canal when A. Uncertainty physical endurance, and discomfort in the pelvis and lower back
dilation begins. - During the early weeks, the woman is unsure whether she is areas
c) Increased vascularization and an increase in estrogen cause pregnant and tries to confirm it. B. Acceptance
softening and a violet She observes her body carefully for changes indicating 1. Factors that may be related to acceptance of the pregnancy are
discoloration known as Chadwick’s sign. pregnancy. She may use an over the the woman’s readiness for the
3. Ovaries counter pregnancy test kit for validation. A woman may be eager experience and her identification with the motherhood role.
a) A major function of the ovaries is to secrete progesterone for to find confirming signs, or 2. Specific developmental tasks must be accomplished
the first 6 to 7 weeks of she may dread the possibility. Usually, she seeks confirmation successfully for positive maternal role
pregnancy. from a physician, certified adaptation.
b) The maturation of new follicles is blocked. midwife and nurse within 12 weeks of the first missed menstrual 3. These tasks include accepting the pregnancy, identifying with
c) The ovaries cease ovum production. period. the mothering role, solidifying her
4. Vagina B. Ambivalence relationship with her partner, establishing a relationship with her
a) Hypertrophy and thickening of the muscle occur. 1. It occurs early in pregnancy, even when the pregnancy is unborn infant, and preparing for her
An increase in vaginal secretions is experienced; secretions are planned. birth experience.
usually thick, white and acidic. 2. The mother may experience a dependence-independence C. Relationship with the fetus
5. Breasts conflict and ambivalence related to 1. The woman may daydream to prepare for motherhood and
a) Breast size increases, and breasts may be tender. role changes. think about the maternal qualities that she
b) Nipples become more pronounced. 3. The partner may experience ambivalence related to the new would like to possess.
c) The areolae become darker in color. role being assumed, increased 2. The woman first accepts the biological fact that she is
G. Skin financial responsibilities, and sharing the mother’s attention with pregnant.
1. Some changes occur because the levels of melanocyte- the child. 3. The woman next accepts the growing fetus as distinct from
stimulating hormone increase as a result of C. The Self as Primary Focus herself and a person to nurture.
an increase in estrogen and progesterone levels; these changes -Throughout the 1st trimester, the woman’s primary focus is on 4. Finally, the woman prepares realistically for the birth and
include the following: herself, not the fetus. Early parenting of the child.
a) Increased pigmentation physical responses to pregnancy confirm that something is D. The Fetus as a Primary Focus
b) Dark streak down the midline of the abdomen (linea nigra) happening to her, but the fetus - The woman’s major focus during the second trimester becomes
c) Chloasma (mask of pregnancy) – a blotchy brownish remains vague and unreal. Physical changes and increased the fetus. The woman is now
hyperpigmentation, over the forehead, hormone levels may cause concerned about how she can produce a healthy infant.
cheeks, and nose emotional lability (unstable moods). Nurses should concentrate on E. Narcissism and Introversion
d) Reddish purple stretch marks (striae gravidarum) on the the mother’s physical and -Women become increasingly concerned about their ability to
abdomen, breasts, thighs, and upper psychological feelings during this period of maternal self-focus. protect and provide for the fetus.
arms Teaching should be aimed at 3. Third Trimester
2. Vascular spider nevi may occur on the neck, chest, face, arms the common early changes in pregnancy and their normality. A. Vulnerability
and legs. D. Emotional lability -Often feel that the precious baby may be lost or harmed if not
3. Rate of hair growth may increase. 1. It may be manifested by frequent changes of emotional states protected at all
H. Musculoskeletal System or extremes in emotional states. times.
-They may avoid crowds because they feel unable to protect the infants, fetal mortality, CPD, and increased risk of maternal
infant in infectious diseases or complications such as
physical dangers that may be present. hypertension, anemia, prolonged labor and infections.
B. Increasing Dependence 3. The role of the nurse in reducing risks and consequences of
-Dependent on partners for the last weeks of pregnancy adolescent pregnancy is twofold –
-May rely on others more at this time and seek their help in first to encourage early and continued prenatal care and second
making decisions. to refer the adolescent if
-Need for love and attention is even more pronounced.
necessary for appropriate assistance, which can help to counter
the effects of a negative socio-
economic environment.

C. German measles (Rubella)

- Maternal infection during the first 8 weeks of gestation carries
the highest fetal infection.
D. Sexually Transmitted Infections
1. Syphilis
- Organism may cross the placenta.
- Infection usually leads to spontaneous abortions and increases
DISCOMFORTS OF PREGNANCY the incidence of mental subnormality
I. FIRST TRIMESTER and physical deformities.
a) Nausea and Vomiting 2. Condyloma acuminatum (human papillomavirus)
b) Urinary Frequency - Transmission may occur during vaginal birth.
c) Fatigue PRENATAL EXERCISES - Infection is associated with the development of epithelial tumors
d) Breast Tenderness 1. PELVIC TILT/PELVIC ROCKING of the mucous membranes of
e) Increased Vaginal discharge -Helps prevent or reduce back strain the larynx in children.
f) Nasal stuffiness and nosebleed (epistaxis) 2. ABDOMINAL EXERCISES 3. Gonorrhea
g) Ptyalism (excessive, often bitter salivation) - A basic exercise to increase abdominal muscle tone is tightening - Fetus is contaminated at the time of birth.
abdominal muscles with each - Maternal infections may result in postpartum infection of the
breath. neonate.
3. KEGEL’S EXERCISE - Risks to the neonate include ophtalmnia nenonaturum,
- Strengthens the pubococcygeus muscle and increases its pneumonia and sepsis.
elasticity. 4. Chlamydial infection
4. INNER THIGH EXERCISES - Transmission may occur during vaginal birth and can result in
- This “tailor sit” stretches the muscle of the inner thighs in neonatal conjunctivitis or
preparation for labor and birth. pneumonitis
- Infection can cause premature rupture of membranes,
MATERNAL RISK FACTORS premature labor, and postpartum
A. Maternal Age endometritis.
- Women younger than 20 years old and older than 35 years are 5. Trichomoniasis
at risk for perinatal outcomes. - Associated with premature rupture of the membranes and
B. Adolescent Pregnancy postpartum endometritis.
1. Factors that result in adolescent pregnancy include the early 6. Genital Herpes Simplex
onset of menarche, changing - Characterized by painful lesions, fever, chills, malaise and
sexual behaviors in this age group, problems with family severe dysuria and may last 2 to 3
II. SECOND & THIRD TRIMESTERS relationships, poverty, and lack of weeks
a) Heartburn (pyrosis) knowledge of reproduction and birth control E. Human Immunodeficiency Virus (HIV)
b) Ankle edema 2. The major concerns related to adolescent pregnancy include - Is transmitted through blood; blood products and other bodily
c) Varicose veins poor nutritional status; emotional products such as urine, semen, and
d) Hemorrhoids and behavioral difficulties; lack of support systems; increased risk vaginal secretions, the virus is also transmitted through exposure
e) Constipation of stillbirth, low birth weight to infected secretions during birth and
f) Backache through breast milk.
- Repeated exposure to the virus during pregnancy through
unsafe sex practices or IV drug use can
increase the risk of transmission to the fetus
- Perinatal admin of zidovudine may be recommended to
decrease the risk of transmission of HIV from
mother to fetus.
F. Substance Abuse
- Threatens normal fetal growth and successful term completion
of the pregnancy.
DIAGNOSTIC STUDIES
*Blood type and Rh Factor
1. ABO typing is performed to determine the woman’s blood type
in the ABO antigen system.
2. Rh typing is done to determine the woman’s blood type in the
rhesus antigen system. (Rh
positive indicates the presence of the antigen; Rh negative
indicates the absence of the
antigen.)
3. If the client is Rh negative and has a negative antibody screen,
she will need repeat antibody
screens and should receive Rh0 (D) immune globulin (RhoGAM)
at 28 weeks of gestation.
*Rubella titer
1. If the client has a negative titer (less than 1:8), indicating the
susceptibility to the rubella virus,
she should receive the appropriate immunization postpartum.
2. The client must be using effective birth control at the time of the
immunization and must be
counseled not to become pregnant for 1 to 3 months after
immunization and must be
counseled not to become pregnant for 1 to 3 months after
immunization (as specified by the
HCP) and to avoid contact wit anyone who is
immunocompromised.
3. If the rubella vaccine is administered at the same time as Rh0
(D) immune globulin, it may not
be effective.
4. Rubella vaccine is administered postpartum (before discharge)
via the subcutaneous route if
the titer is less than 1:8; inquire about sensitivity to eggs.
-Rubella vaccine is not given during pregnancy because the live
attenuated virus may cross over the
placenta and present a risk to the developing fetus.
*Hemoglobin and Hematocrit Levels
1. Hematocrit and hemoglobin levels decline during gestation as a
result of increased plasma
volume.
2. A decrease in the hemoglobin level to less than 10g/dL or in
the hematocrit level less than 30%
indicates anemia.
*Papanicolaou’s Smear is done during the initial prenatal
examination to screen for cervical neoplasia.
*Sexually Transmitted Infections like Gonorrhea, Syphilis,
Chlamydia, Trichomoniasis, Herpes
Simplex Virus 2, HIV (Western blot and ELISA)
*Tuberculin Skin Test – HCP may refer this to be done after birth.
A positive skin test indicates the
need for chest radiograph (using an abdominal lead shield) to rule
out active disease, in pregnant client
, chest radiography would not be performed until after 20 weeks
of gestation. (after the fetal organs are
formed.) Converters to positive may be referred for treatment with
medication after birth.
*Hepatitis B surface antigens
-Testing for hepatitis antigens are recommended for all women
because of the prevalence of the
disease in the general population.
-Not contraindicated during pregnancy
*Urinalysis & Urine Culture
-a urine specimen for glucose and protein determinations should
be obtained at every antepartum
visits.
-Glycosuria is a common result of decreased renal threshold that
occurs during pregnancy
- If glycosuria persists, it may indicate diabetes.
- WBC in the urine may indicate infection
- Ketonuria may result from insufficient food intake or vomiting
- Levels of 2+ to 4+ protein in the urine may indicat infection or
preeclampsia.
*Ultrasonography
-Outlines and identifies fetal and maternal structures.
- Assist in conforming gestational age and estimated date of
delivery and evaluating amniotic
fluid volume, which is done via special measurements.
- May be done abdominally and transvaginally during pregnancy.
- Can be used determine the presence of premature dilatation of
the cervix. A transvaginal
ultrasound is used during the first trimesters to check the length of
the cervix.
Interventions:
1. If an abdominal ultrasound is being performed, the woman may
need to drink water to fill the bladder
before the procedure to obtain a better image of the fetus.
2. If a transvaginal ultrasound is being performed, a lubricated
probe is inserted into the vagina.
3. The client should be informed that the test presents no known
risk to the fetus or the client.
*Biophysical Profile
-Noninvasive assessment of the fetus that includes fetal breathing
movements, fetal movements, fetal
tone, amniotic fluid index, and fetal heart rate patterns via a
nonstress test. A normal fetal biophysical
activity indicates that the central nervous system is functional and
that the fetus is not hypoxemic.
*Doppler Blood Flow Analysis
- Noninvassive ultrasonography method of studying the blood flow
in the fetus and placenta.
*Percutaneous umbilical blood sampling
- Is performed if fetal blood sampling is necessary, it involves
insertion of a needle directly into the fetal
umbilical vessel under ultrasound guidance.
- Fetal heart rate monitoring is necessary for 1 hour after the
procedure, and a follow-up ultrasound to
check for bleeding or hematoma formation is done 1 hour after
the procedure.
*à-Fetoprotein screening
- Assesses the quantity of fetal serum proteins; abnormal protein
levels are associated with open neural
tube and abdominal wall defects.
- Assists in screening for spina bifida and down syndrome
- If abnormal, repeat test, false positive is common.
Interventions:
1. à-Fetoprotein level is determined by a maternal sample drawn
between 16 and 18 weeks
gestation.
2. If the level is abnormal and the gestation is less than 18 weeks,
a second sample is drawn and
screened.
3. An ultrasound is performed for elevated levels to rule out fetal
abnormalities or multiple
gestation.
*Deoxyribonucleic acid (DNA) Genetic Testing
- Can be used to detect abnormalities related to an inherited
condition.
- Assists in determining if the woman is at risk for having a fetus
with down syndrome (trisomy 21),
Edwards syndrome (trisomy 18), or Patau Syndrome (trisomy 13)
Interventions:
-This type of testing can be done as early as 7 weeks of gestation
and a blood sample is used.
*Chorionic Villus Sampling
- Performed for the purpose of detecting abnormalities; the HCP
aspirates a small sample of chorionic
villus tissue at 10 to 13 weeks of gestation.
Interventions:
1. Ensure informed consent was obtained.
2. The client may need to drink water to fill the bladder before the
procedure to aid in the
visualization of the uterus for catheter insertion.
3. Obtain baseline vital signs and fetal heart; monitor frequently
after the procedure.
4. Rh negative women may be given Rh0 (D) immune globulin
because chorionic villus sampling
increases the risk of Rh sensitivity.
*Amniocentesis
- Aspiration of amniotic fluid; best performed between 15 and 20 *Nitrazine Test seconds from the beginning of the acceleration to the end, in
weeks of pregnancy because amniotic - A nitrazine test is used to detect the presence of amniotic fluid in association with fetal movement,
fluid is adequate and many viable fetal cells are present in the vaginal secretions. during a 20 minute period.
fluid by this time. - Vaginal secretions have a pH of 4.5 to 5.5 and do not affect the *Nonreactive Nonstress Test (Abnormal)
- Performed to determine genetic disorders, metabolic defects, nitrazine strip or swab. - No accelerations or accelerations of less than 15 beats/minute
and fetal lung maturity. - Amniotic fluid has a Ph 7.0 to 7.5 and turns the nitrazine strip or or lasting less than 15 seconds
Risks: swab blue. in duration occur during during a 40-minute observation
a. Maternal hemorrhage Interventions: *Unsatisfactory
b. Infection a. Position the client in the dorsal lithotomy positions. - The result cannot be interpreted because of the poor quality of
c. Rh isoimmunization b. Touch the test tape to the fluid. the FHR tracing.
d. Abruptio placentae c. Assess the test tape for a blue-green, blue-gray, or deep blue *Contraction Stress Test
e. Amniotic fluid emboli color, which indicates that the - Test assesses placental oxygenation and function.
f. Premature rupture of the membranes membranes are ruptured, causing leakage of amniotic fluid. - Test determines fetal ability to tolerate labor and determines
Interventions: *Fibronectin Test fetal well-being.
a. Ensure informed consent was obtained. - Sampling of cervical and vaginal secretions for fetal fibronectin - Fetus is exposed to the stress of contractions to assess the
b. If less than 20 weeks of gestation, the client should have a full ( a protein present in fetal tissues adequacy of placental perfusion under
bladder to support the uterus; if normally found in the cervical and vaginal secretions until 16 to 20 simulated labor conditions.
performed after 20 weeks of gestation, the client should have an weeks of gestation and again at or - Test is performed if nonstress test is abnormal.
empty bladder to minimize the near term. Interventions:
chance of puncture. - Positive results may indicate the onset of labor in 1 to 3 weeks, - External fetal monitor is applied to the client , and a 20-30
c. Prepare the client for ultrasonography, which is performed to negative test results are more minute baseline striped is recorded.
locate the placenta and avoid predictive that preterm labor will not begin. - The uterus is stimulated to contract by the administration of a
puncture. - Test used if at risk for preterm labor, before 37 weeks of dilute dose of oxytocin or by having the
d. Obtain baseline vital signs and fetal heart rate; monitor every gestation. client use nipple stimulation until 3 palpable contractions with a
15 minutes. Interventions: duration of 40 seconds or more in a 10
e. Position the client supine during the examination and on the left a. Client is placed in lithotomy position for sterile speculum exam. minute period have been achieved.
side after the procedure. b. Cervical secretions are obtained with cotton swab. - Frequent maternal blood pressure readings are done, and the
Note: After chorionic villus sampling and amniocentesis, instruct c. Laboratory tests are done for the presence of fibronectin. mother is monitored closely while
the client if chills, fever, *Nonstress Test increasing doses of oxytocin are given.
bleeding, leakage of fluid at the needle insertion site, decreased - Test is performed to assess placental function and oxygenation. Results:
fetal movement, uterine - Test determines fetal well-being *Negative Contraction Stress Test (Normal)
contractions, or cramping occurs, she must notify the HCP. Interventions: -is represented by no late decelerations of the fetal heart rate
*Kick counts (fetal movement counting) a. An external ultrasound transducer and tocodynamometer are (FHR)
- The client sits quietly or lies down on her side and counts fetal applied to the client, and a tracing for at *Positive Contraction Stress Test (Abnormal)
kicks as instructed. least 20 minutes’ duration is obtained so that FHR and uterine - represented by late decelerations of the FHR, with 50% more of
- Instruct the client to notify the HCP of there are fewer than 10 activity can be observed. the contractions in the absence of
kicks in 2 hour period as instructed by b. Baseline blood pressure is obtained, and blood pressure is hyperstimulation of the uterus
the HCP. monitored frequentlyTest evaluates the *Equivocal
*Fern test fetal heart rate (FHR) response to fetal movement. - Contains decelerations, but with less than 50% of the
- The fern test is a microscopic slide test to determine the c) The client is placed in the lateral (side-lying) position to avoid contractions, or uterine activity shows a
presence of amniotic fluid leakage. the vena cava compression. hyperstimulated uterus.
- Using a sterile technique, a specimen is obtained from the d) The client may be asked to press a button every time she feels *Unsatisfactory
external os of the cervix and vaginal pool fetal movement; the monitor records - adequate uterine contractions cannot be achieved, or the FHR
and is examined on a slide under a microscope. a mark at each point of fetal movement, which is used as a tracing is of insufficient quality for
- A fernlike pattern produced by the effects of salts of the amniotic preference point to assess the FHR adequate interpretation.
fluid indicates the presence of response. NUTRITION
amniotic fluid. Results: - The average expected weight gain during pregnancy is 25 lb to
Interventions: *Reactive Nonstress (Normal, Negative) 35 lb ( 11kg to 16kg) for a woman with
a. Position the client in the dorsal lithotomy positions. - Reactive indicates a healthy fetus a normal prepregnancy weight.
b. Instruct the client to cough, which causes the amniotic fluid to - The result requires 2 or more FHR accelerations of at least 15 - An increase of about 300 calories/day
leak from the uterus if the beats/minute, lasting at least 15 - Calorie needs are greater in the last 2 trimesters than in the first.
membranes are ruptured. - An increase of about 500 calories is needed during lactation.
- Diet high in folic acid or folid acid supplements is necessary to
prevent neural tube defects and
orofacial clefts in the fetus.
- At least 8 to 10 oz (8 oz) glasses of fluid are needed each day of
which 4-6 glasses should be water.
- Sodium is not restricted unless specifically prescribed by the
Health Care Provider (HCP).
*Maternal Weight Gain
 Underweight woman: 28 to 40 lb (12.5 to 18 kg)
 Normal weight woman: 25 to 35 lb ( 11.5 to 16 kg)
 Overweight woman: 15 to 25 lb ( 7 to 11.5 kg)
 Obese woman: less than 15 lb ( less than 7 kg)
Note: For a normal weight woman, the ideal pattern of weight gain
during pregnancy is a gain of
3.5 to 5 lb (1.6 to 2.3 kg) during the first trimester, followed by a
weight gain of about 1 lb (0.5kg)
per week during the second and third trimesters. A normal weight
woman who is expecting twins
should gain about 1.5 lb per week during the second and third
trimesters.
The average maternal weight gain is distributed as follows:
• 11 lb (5kg) - fetus, placenta, amniotic fluid
• 2 lb (0.9kg) - uterus
• 4 lb (1.8kg) - increased blood volume
• 3 lb (1.4kg) - breast tissue
• 5 to 10 lb (2.3 to 4.5kg) - maternal stores
*Vegan and Vegetarian Diets
1. Ensure that the client eats a sufficient amount of varied foods
to meet normal nutrient and energy
needs.
2. Client should be educated about consuming complementary
proteins over the course of each day to
ensure that all essential amino acids are provided.
3. Potential deficiencies in vegetarian diets include energy,
protein, vitamins B12, zinc, iron, calcium,
omega – 3 fatty acids, and vitamin D.
4. Protein consumption can be increased by consumption of a
variety of vegetable protein sources
based on whole grains, legumes, seeds, nuts, and vegetables
combined to provide all essential amino
acids.
5. To enhance absorption of iron, vegetarians should include a
good source of iron and vitamin C with
each meal.
6. Foods commonly eaten include tofu, soy milk and soy products,
meat analogs, legumes, nuts and
seeds, sprouts, and a variety of fruits and vegetables.
*Lactulose intolerance
1. Lactose consumed by an individual with lactose intolerance can
cause abdominal distention,
discomfort, nausea, vomiting, cramps, and loose stools.
2. Clients need to incorporate sources of calcium other than dairy • Dizziness, blurring of vision,
products into their dietary patterns double vision, spots before
regularly. the eyes
3. Milk may be tolerated in cooked form, such as in custards or • Hypertension, preeclampsia
fermented dairy products. • Persistent vomiting
4. Cheese and yogurt are sometimes tolerated. • Hyperemesis gravidarum
5. Lactase, an enzyme, may be prescribed and is taken before • Severe headache
ingesting milk or milk products. • Hypertension, preeclampsia
6. Lactase – treated milk or lactose – free products are also • Edema of hands, face, legs, and feet
available commercially. • Preeclampsia
*Pica
1. It refers to eating nonfood substances, such as dirt, clay, PROMOTION OF SELF – CARE DURING PREGNANCY
starch, and freezer frost. 1. Fetal Activity Monitoring – assessing fetal well being by
2. The cause is unknown; cultural values, such as beliefs regularly assessing fetal activity beginning at 28 weeks’ gestation.
regarding the effect of material on the mother Virgorous activity generally provides reassurance of fetal well –
or fetus, may make a pica common being, but a marked decrease in activity or cessation of
3. Iron deficiency anemia may occur as a result of pica. movement may indicate a problem that needs immediate
evaluation. Fetal activity is affected by fetal sleep, sound, time of
CHILDBIRTH PREPARATION METHODS the day, blood glucose levels, cigarette smoking, and some illicit
drugs such as crack and cocaine. At times a healthy fetus may be
minimally active or inactive. Mother should do a fetal movement
record (FMR) Fetal kick counts – a count that an unborn baby
does such as punch, rolls, twist, and turns, do not include
hiccups. Not normal means a baby has a fetal distress. By doing
fetal kick counts you will know when will your baby is active or
asleep. At least 10 kick counts for 2 hours. Once a day to perform
fetal kick counts in order to monitor and do journal.
2. Breast Care – wear a well fitting, supportive bra with the ff
qualities:
a. the straps are wide and do not stretch (elastic straps soon lose
their tauntness with the weight of the breasts and frequent
washing).
b. the cups hold all breast tissue comfortably.
c. the bra has tucks or other devices that allow it to expand and
accommodate the enlarging chestcircumference.
d. the bra supports the nipple line approximately midway between
DANGER SIGNS OF PREGNANCY the elbow and shoulder but it is not pulled up in the back by the
Danger Signs Possible Cause weight of the breasts. Use warm water, no using of soap because
• Sudden gush of fluid from of its drying effect.
vagina 3. Clothing – should be loose and nonconstricting. Avoid high
• Premature rupture of membranes heeled shoes as this can aggravate back discomfort by increasing
• Vaginal Bleeding the curvature of the lower back. Shoes should fit properly and feel
• Abruptio placentae, placenta previa comfortable.
• Lesions of cervix or vagina 4. Bathing - Hygiene is important because of perspiration and
• “Bloody show” mucoid vaginal discharge increase during pregnancy. It also differ
• Abdominal pain with cultural norms and influence. Advise the woman to be careful
Premature labor, abruptio placentae in tub because balance becomes a problem in late pregnancy.
• Temperature above 38.3 Rubber mats and hand grips are important safety devices.
degrees Celsius (101 5. Employment – low risk pts can continue to work until the start
degrees Fahrenheit) and of labor. Pregnant women whose jobs require prolonged standing
chills have a higher incidence of preterm birth. Similarly women who
• Infection engage in strenuous physical activity during pregnancy tend to
have babies with lower weight, possibly caused by decreased
placental blood flow. Overfatigue, excessive physical strain,
fetotoxic hazards in the environment, and medical or obstetric
complications are the major deterrents to certain types of
employment during pregnancy.
6. Travel – Pregnant women without complications can travel as
usual. Pregnant women should avoid travel if they have a history
of bleeding or preeclampsia or if multiple births are anticipated.
Travel by automobile can be tiring, aggravating many of the
discomforts in pregnancy. The pregnant woman needs frequent
opportunities to get out of the car and walk. A good pattern is to
stop every 2 hrs and walk around for about 10 minutes. She
should wear both lap and shoulder belts; the lap belt should fit
snugly and be positioned under the abdomen and across the
upper thighs. Seat belts save the lives of mothers and fetuses.
Fetal death in car accidents is sometimes caused by placental
separation as a
result of uterine distortion. Shoulder belts reduce the risk of
traumatic flexion of the woman’s body, making placental
separation less likely. As pregnancy progresses, long distance
trips are best taken by plane or train. Remind near term women
who travel to think about the availability of medical care at the
destination.
7. Activity and rest – Exercise during pregnancy helps maintain
maternal fitness and muscle tone, leads to improve self-image.
Woman with an uncomplicated pregnancy can and should
continue
participation in exercise. Certain conditions contraindicate these
exercises. These conditions include ROM, Pre-eclampsia,
incompetent cervix or cerclage placement, persistent vaginal
bleeding, history of preterm labor in the client in the present and
past pregnancies. Regular exercise daily within 30 minutes. After
first tri avoid exercising in supine position because this is
associated with decrease cardiac output.
COMPLICATIONS OF PREGNANCY
1. Hyperemesis Gravidarum
A. Description: Intractable nausea and vomiting during the first
trimester
B. Assessment:
1. Nausea most pronounced on arising; may occur at other times
during the day
2. Persistent vomiting
3. Weight loss
4. Signs of dehydration
5. Fluid and electrolyte imbalances
C. Interventions
1. Initiate measures to alleviate nausea, including medication
therapy; if unsuccessful, and weight
loss and fluid and electrolyte imbalances occur, intravenously
administered fluid and electrolyte replacement or parenteral
nutrition may be necessary.
2. Monitor vital signs, intake and output, weight and calorie count.
3. Monitor laboratory data and for signs of dehydration and
electrolyte imbalances.
4. Monitor urine for ketones
5. Monitor fetal heart rate, activity, and growth.
6. Encourage intake of small portions of food
7. Encourage the intake of liquids between meals to avoid
distending the stomach and triggering
vomiting.
8. Encourage the client to sit upright after meals.
2. Bleeding in Pregnancy
I. Abortion – first trimester bleeding
A. Description: A pregnancy that ends before 20 weeks’ gestation,
spontaneously or electively Types of Abortions
1. Spontaneous: pregnancy ends because of natural causes.
2. Induced: therapeutic or elective reasons exist for terminating
pregnancy.
3. Threatened: Spotting and cramping occur without cervical
change.
4. Inevitable: Spotting and cramping occur and cervix begins to
dilate and efface.
5. Incomplete: Loss of some of the products of conception occurs,
with part of the products
retained (most often placenta is retained).
6. Complete: Loss of all products of conception.
7. Missed: Products of conception are retained in utero after fetal
death.
8. Habitual: Spontaneous abortions occur in 3 or more successive
pregnancies.
B. Assessment
1. Spontaneous vaginal bleeding
2. Low uterine cramping or contractions
3. Blood clots or tissue through the vagina
4. Hemorrhage and shock can result if bleeding is excessive
C. Interventions
1. Maintain bed rest as prescribed.
2. Monitor vital signs.
3. Monitor for cramping and bleeding.
4. Count perineal pads to evaluate blood loss, and save expelled
tissues and clots.
5. Maintain intravenous (IV) fluids as prescribed; monitor for signs
of hemorrhage or shock.
6. Prepare the client for dilatation and curettage as prescribed for
incomplete abortion.
7. Administer Rh°(D) immune globulin, as prescribed, for an Rh-
negative woman.
8. Provide psychological support.
NOTE: -Signs of Shock: Hypotension, tachycardia, tachypnea
-Prior to D and C perform ultrasound to confirm.
3. Ectopic Pregnancy
A. Description: Implantation of the fertilized ovum outside of the
uterine cavity, most common location
is ampulla of the fallopian tube
B. Assessment
1. Missed menstrual period
2. Abdominal pain
3. Vaginal spotting or bleeding that is dark, red or brown
4. Rupture: Increased pain, referred shoulder pain, signs of shock
C. Interventions
1. Obtain assessment data and vital signs.
2. Monitor bleeding and initiate measures to prevent rupture and
shock.
3. Methotrexate, a folic acid antagonist, may be prescribed to
inhibit cell division in the developing embryo.
4. Prepare the client for laparotomy and removal of pregnancy
and tube, if necessary, or repair of the tube.
5. Administer antibiotics; Rh 0 (D) immune globulin is prescribed
for Rh negative women.
4. Hyatidiform Mole (H.Mole)
– Second Trimester Bleeding
A. Description: is a form of gestational trophoblastic disease that
occurs when the throphoblasts, which are the peripheral cells that
attach the fertilized ovum to the uterine wall, develop abnormally.
- the mole manifests as an edematous grapelike cluster that may
be nonmalignant or may develop into choriocarcinoma
B. Assessment
1. Fetal heart rate not detectable
2. Vaginal bleeding, which may occur by the fourth week or not
until the second trimester, may be bright red or dark brown in
color and may be slight, profuse or intermittent.
3. Signs of preeclampsia before the 20th week of gestation
4. Fundal height greater than expected for gestational age
5. Elevated HCG levels
6. Characteristic snowstorm pattern shown on ultrasound.
C. Interventions
1. Prepare the client for uterine evacuation.
2. Evacuation of the mole is done by vacuum aspiration; oxytocin
is administered after evacuation.
3. Monitor for postprocedure hemorrhage and infection.
4. Tissue is sent to the laboratory for evaluation.
5. HCG levels are monitored every 1 to 2 weeks until normal
prepregancy levels are attained.
6. Instruct the client and her partner about birth control measures
so that the pregnancy can be
prevented during the 1 – year follow – up period.
5. Incompetent Cervix
A. Description: refers to premature dilation of the cervix
B. Assessment:
1. Vaginal bleeding
2. Fetal membranes visible through the cervix.
C. Interventions
1. Provide bed rest, hydration, and tocolysis, as prescribed, to
inhibit uterine contractions.
2. Prepare for cervical cerclage
3. After cervical cerclage the client is told to refrain from
intercourse and to avoid prolonged
standing and heavy lifting.
4. The cervical cerclage is removed at 37 weeks of gestation or
left in place and a cesarean birth is performed.
5. After placement of the cervical cerclage, monitor for
contractions, rupture of membranes, and signs of infection.
6. Instruct the client to report to the HCP any postprocedure
vaginal bleeding or increased uterine contractions.
6. Placenta Previa
– Third Trimester Bleeding
- Abnormal placental implantation
- Low lying placenta
7. Abruptio Placenta
- Premature placental separation
8. Preterm Labor
- Labor than occurs after 20 weeks but less than 37 weeks of
gestation
- Risk Factors: Medical condition, infection, dehydration, stress
Management:
- Increase OFI
- Bethamethasone – hasten fetal lung maturity
- Tocolytics (Terbutaline, Ritodrine)
- Surfactant replacement therapy – lung expansion via
endotracheal tube
9. Diabetes Mellitus
A. Description: pregnancy places demands on carbohydrate
metabolism and causes insulin
requirements to change.
- Maternal glucose crosses the placenta, but insulin does not.
- The fetus produces its own insulin and pulls glucose from the
mother.
- Newborn from these mothers may be large in size
- The newborn of a diabetic mother is at risk for hypoglycemia,
hyperbilirunemia, respiratory
distress syndrome, hypocalcemia, and congenital anomalies.
- Occur in pregnancy (during 2nd or 3rd trimester) in clients not
previously diagnosed as diabetic
and occurs when the pancreas cannot respond to the demand for
more insulin.
- Pregnant woman should be screened for GDM between 24 to 28
weeks of gestation.
- a 3 – hour oral glucose test tolerance test is performed to
confirm gestational diabetes mellitus.
- Can be treated by diet alone, however some clients may need
insulin
- Most women return to a euglycemic state after birth
B. Predisposing Factors:
1. Older than 35 years
2. Obesity
3. Multiple gestation
4. Family history of diabetes mellitus
5. Large for gestational age fetus 5. Diabetes Mellitus
C. Assessment 6. Rh incompatibility
1. Excessive thirst 7. History of or family history of gestation hypertension.
2. Hunger C. Complications of Gestational Hypertension
3. Weight loss 1. Abruptio placenta
4. Frequent urination 2. Disseminated intravascular coagulation
5. Blurred vision 3. Thrombocytopenia
6. Recurrent UTI and vaginal yeast infections 4. Placental insufficiency
7. Glycosuria and ketonuria 5. Intrauterine growth restriction
8. Signs of gestational hypertension 6. Intrauterine fetal death
9. Polyhydramnios 7. HELLP syndrome ( a laboratory diagnosis for severe
10. Large for gestational age fetus preeclampsia characterized by hemolysis,
D. Interventions elevated liver enzyme levels, and low platelet count.
1. Employ diet, medications, exercise and blood glucose D. Interventions for mild hypertension
determinations to maintain blood glucose 1. Monitor blood pressure.
levels. 2. Monitor fetal activity an growth.
2. Observe for signs of hyperglycemia, glycosuria, and ketonuria, 3. Encourage frequent rest periods, instructing the client to lie in
and hypoglycemia. the lateral position.
3. Monitor weight 4. Administer antihypertensive medications as prescribed.
4. Increase calorie intake as prescribed 5. Monitor intake and output.
5. Assess for signs of maternal complications such as 6. Evaluate renal function through prescribed studies such as
preeclampsia blood urea nitrogen, serum
6. Monitor for signs of infection creatinine, 24 hour urine levels for creatinine clearance and
7. Instruct the client to report burning and pain on urination, protein.
vaginal discharge or itching, or any other D. Interventions for mild preeclampsia
signs of infection to the HCP. 1. Provide bed rest and place the client in the lateral position.
8. Assess fetal status and monitor for signs of fetal compromise. 2. Monitor blood pressure and weight.
E. Interventions during labor 3. Monitor neurological status.
1. Monitor fetal status continuously for signs of distress and if, 4. Monitor deep tendon reflexes
noted, prepare the client for immediate 5. Provide adequate fluids.
Cesarean Section. 6. Monitor intake and output.
2. Carefully regulate insulin and provide glucose intravenously as 7. Increase dietary protein and carbohydrates with no added salt.
prescribed because labor depletes 8. Administer medications as prescribed.
glycogen. D. Interventions for severe preeclampsia
F. Interventions during postpartum period 1. Maintain on bedrest
1. Observe the mother closely for hypoglycemic reaction because 2. Administer magnesium sulfate as prescribed to prevent
a precipitous decline in insulin seizures.
requirements normally occurs. 3. Monitor for signs of magnesium toxicity
2. Regulate insulin needs as prescribed after the first day, 4. Administer antihypertensives as prescribed.
according to blood glucose testing. 5. Prepare for the induction of labor.
3. Assess dietary needs, based on blood glucose testing and D. Assessment for eclampsia
insulin requirements. -Characterized by generalized seizures
4. Monitor for signs of infection or postpartum hemorrhage. 1. Seizures typically begins with twitching around the mouth.
10. Gestational Hypertension 2. Body then becomes rigid in a state of tonic muscular
A. Description and types: Hypertension can be mild or severe, contractions that last 15 to 20 seconds.
leading to preeclampsia and then 3. Facial muscles and then all body muscles alternately contract
eclampsia (seizures). and relax in rapid succession.
B. Predisposing Factors 4. Respiration ceases during seizure.
1. Primigravida 5. Postictal sleep occurs.
2. Women younger than 19 years old or older than 40 years D. Interventions for eclampsia
3. Chronic renal disease 1. Remain with the client and call for help.
4. Chronic hypertension
2. Ensure an open airway, turn the client on her side, and Classroom on October 2 at 8am. Save it on a PDF format using 9. A client arrives at the clinic for the first prenatal assessment.
administer oxygen by face mask at 8 to the file name: Last name, ID She tells the nurse that the first
10L/minute. number underscore subject, year and section day of her last normal menstrual period was April 24, 2015. Using
3. Monitor fetal heart rate patterns. (Francisco157_MCN2A/B). Naegele’s rule, what
4. Administer medications to control the seizures as prescribed. 1. A client arrives at the clinic for the first prenatal assessment. expected date of delivery should the nurse document in the
5. After the seizure has ended, insert an oral airway and suction She tells the nurse that the first client’s chart? Answer:
the client’s mouth as needed. day of her last normal menstrual period was October 19, 2018. 10. A client arrives at the clinic for the first prenatal assessment.
6. Prepare for delivery of the fetus after stabilization of the client, Using Naegele’s rule, what She tells the nurse that the first
if warranted. expected date of delivery should the nurse document in the day of her last normal menstrual period was November 10, 2017.
7. Document occurrence, client’s response, and outcome. client’s chart? Answer: Using Naegele’s rule, what
*Assessment of Reflexes: 2. A client arrives at the clinic for the first prenatal assessment. expected date of delivery should the nurse document in the
Patellar: Position client on with her legs dangling over the edge of She tells the nurse that the first client’s chart? Answer:
the examining table or lying on her day of her last normal menstrual period was January 5, 2017. B. Directions: Describe the GTPAL of the mother. Pass it via our
back with her legs slightly flexed. Strike patellar tendon just below Using Naegele’s rule, what MCN Google Classroom on
kneecap with percussion hammer expected date of delivery should the nurse document in the October 2 at 8am.
Normal response: Extension or kicking out of the leg. client’s chart? Answer: 1. The nurse is collecting data during an admission assessment of
*Grading Response 3. A client arrives at the clinic for the first prenatal assessment. a client who is pregnant with
0 = Reflex absent She tells the nurse that the first twins. The client has a healthy 5-year-old child who was delivered
1 + = Reflex present day of her last normal menstrual period was September 28, 2016. at 38 weeks and tells the
2 + = Normal reflex Using Naegele’s rule, what nurse that she does not have a history of any type of abortion or
3 + = Hyperactive reflex expected date of delivery should the nurse document in the fetal demise. Using GTPAL,
4 + = Hyperactive reflex wit clonus present client’s chart? Answer: what should the nurse document in the client’s chart? Answer:
11. Multiple Gestation 4. A client arrives at the clinic for the first prenatal assessment. 2. A 30 year old female is 25 weeks pregnant with twins. She has
A. Description: results from the fertilization of 2 ova (fraternal or She tells the nurse that the first 5 living children. Four of the 5
dizygotic) or a splitting of 1 fertilized day of her last normal menstrual period was July 15, 2018. Using children were born at 39 weeks gestation and one child was born
ovum (identical or monozygotic) Naegele’s rule, what at 27 weeks gestation. Two
-Complications include spontaneous abortion, anemia, congenital expected date of delivery should the nurse document in the years ago she had a miscarriage at 10 weeks gestation. What is
anomalies, hyperemesis gravidarum, client’s chart? Answer: her GTPAL? Answer:
intrauterine growth restriction, gestation hypertension, 5. A client arrives at the clinic for the first prenatal assessment. 3. A 27 year old female is currently 16 weeks pregnant. She has 2
polyhydramnios, postpartum hemorrhage, She tells the nurse that the first year-old twins that were born
PROM, and preterm labor and delivery. day of her last normal menstrual period was February 28, 2018. at 39 weeks gestation and a 5 year-old who was born at 40 weeks
B. Assessment Using Naegele’s rule, what gestation. She had no
1. Excessive fetal activity expected date of delivery should the nurse document in the history of miscarriage or abortion. What is her GTPAL? Answer:
2. Uterus large for gestational age client’s chart? Answer: 4. A 20 year old female is currently 8 weeks pregnant. She had a
3. Palpation of 3 or 4 large parts in the uterus 6. A client arrives at the clinic for the first prenatal assessment. miscarriage at 12 weeks
4. Auscultation of more than 1 fetal heart rate She tells the nurse that the first gestation two years ago. She has no living children. What is her
5. Excessive weight gain day of her last normal menstrual period was March 7, 2019. Using GTPAL? Answer:
C. Interventions Naegele’s rule, what 5. A 26 year old female is currently 26 weeks pregnant. She had a
1. Monitor vital signs. expected date of delivery should the nurse document in the miscarriage at 10 weeks
2. Monitor fetal heart rates, activity, and growth client’s chart? Answer: gestation five years ago. She has a three year old who was born
3. Monitor for cervical changes. 7. A client arrives at the clinic for the first prenatal assessment. at 39 weeks. What is her
4. Prepare the client for ultrasound as prescribed. She tells the nurse that the first GTPAL? Answer:
5. Monitor for anemia; administer supplemental vitamins as day of her last normal menstrual period was May 5, 2019. Using 6. A 35 year old female is currently pregnant with twins. She has
prescribed. Naegele’s rule, what 10 year old triplets who were
6. Monitor for preterm labor, and treat preterm labor promptly. expected date of delivery should the nurse document in the born at 32 weeks gestation, and a 16 year old who was born at 41
7. Prepare for cesarean delivery for abnormal presentations. client’s chart? Answer: week gestation. Twelve
8. Prepare to administer oxytocic medications after delivery to 8. A client arrives at the clinic for the first prenatal assessment. years ago she had a miscarriage at 19 weeks gestation. What is
prevent postpartum hemorrhage She tells the nurse that the first her GTPAL? Answer:
from uterine overdistention. day of her last normal menstrual period was October 21, 2018. 7. A 29 year old female is currently 9 weeks pregnant. She has no
Using Naegele’s rule, what living children. Two years
Compute for the Expected Date of Confinement. Pass it via our expected date of delivery should the nurse document in the ago she had 2 miscarriages at 10 and 12 weeks gestation. What
MCN Google client’s chart? Answer: is her GTPAL? Answer:
8. A 30 year old female is 20 weeks pregnant with twins. She has
a 6 year-old who was born at
40 weeks gestation. She has no history of miscarriage or
abortion. What is her GTPAL?
Answer:
9. A 39 year old female is currently 18 weeks pregnant. She has
two sets of twin daughters that
were born at 38 and 39 weeks gestation and an 11 year-old son
who was born at 32 weeks
gestation. She has no history of miscarriage or abortion. What is
her GTPAL? Answer:
10. A 26 year old female is 26 weeks pregnant. She had a
miscarriage at 10 weeks gestation five
years ago. She has a 3 year old who was born at 39 weeks. What
is her GTPAL? Answer: