AntePartal Period

8/14/2019 AntePartal Period

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LIU.MAKAti

Positive Signs

- there are onty three positive signs:- fetal hearth tones- fetal movement felt by the examiner- ultrasound evidence of the fetus

Marlon Bernardo, N

Maternal ChildHealthNursing:NursingCare n the Antepartal eriod

DIAGNOSISF PREGNANCY

Presumptive Signs

- less ndicative f pregnancy- taken as single ntities- couldeasity ndicate ther conditions- largetySUBJECTTVE

Probable Signs- can be documented y he examiner- atthoughmore eliabte han he presumptive igns,

they are still not positive or true diagnosticof pregnancy

Breast hangesMorning icknessAmenorrheaUrinaryrequen-cy

Serum ab.tests

Chadwick's signGoodeltls signHegar's signSonographic

evidence ofgestationaI5ac

FatigueEntarging terus

QuickeningBatlotement

BraxtonHicks

Sonographicevidence offetal out-line

Fetal heartaudibte

Fetal move-ment ettby examiner


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MarlonBernardo, N

Matemal & ChildHealthNursing:NursingCare n the Antepartal Period

b. Constipation nd tatulence re due o disptace-ment of stomach nd ntestines, hus slowingperistalsis ndgastric mptyingime; may atso dueto increased rogesterone hich nhibits astricmotility.

> Increased luids and oughage n the diet.> Establlsh limination ime.> Avoid enemas may ead o habit forming.> Alineral il should not be taken becauie t

interferes with the absorption of fat-solublevitamins ADEK).

c. Hemorrhoids re due o pressure f entarged teruson he ntestine.> Coldcompress promotes asoconstriction).

3. Respiratory

a. Shortness f breath due to:- increased O, consumption and production of

COzby the product of conception during thefirst trimester.

- increased uterine size causes he diaphragm obe pushed or disptaced, hus crowding thechest cavity.

> Lateral expansion of the chest to compensatefor shortness of breathing increases O, supply

and vital lung capacity.

d. Heart burn, especially n the last trimestet is dueto.increased progesterone which decreased gastricmotitity, thereby causing everse peristaltic waves.This leads to regur gitation of acid in the stomachinto the esophagus, ausing rritation.> Avoid fried or fatty foods.> Sips of milk at frequent intervals.> Small frequent meals taken slowly.> Bend at the knees, not at the waist.> Take antacids. NEVER odium bicarbonate

(alkaseltzr or baking soda becau5e theypromote fl uid retention),

4. Urinqry

a. Urinary requenry s seen uring he 1 tand 3rdtrimesters.- 1 ttri is due o increased lood upplyn the

btood.- 3d tri is due o pressure f entarged terus n

btadder speciatty uring igthening.

b. Decreased enal treshold for sugar because of theincreased production of glucocorticoids that causelactose and dextrose to spi[[ into the urine ofpregnant women (glycosuria).' Since all pregnant women have sugar n their

urine, it woutd be difficutt to diagnose diabetegmettitus in pregnancy based on the urine samptea{one.

5. llusculoskeletal

a. Because f the woman's ttempt o change ercenter of gravity, she makes mbutation asier bystandingmore straight and atler (LORDOS|S/RIDEOFPREGMNCY). ue o production f relaxin,petvicbones ecome more movable, ncreasing heincidence of accidental fatts due to the whobty> Adviseto use low-heeled shoes

b. Lg cramps are caused by:- increased ressure f the gravid terus n he

lowersxtremities.- fatigueand muscle enseness.- tow catcium evel n the body.

> Frequent rest periods with legs elevated.> Increase calcium intake-> Do not massage legs.> Press knob of the affected leg and dorslflex

foot.

Temperature

Slight ncrease n basal ody emperature ue oincreased rogesterone, ut the body adapts after the4h month of pregnanry.

7. Endocrinea. Ptacenta roduces CG,HLBestrogen, nd

progesterone,b. i{oderateentargement f the thyroidgland ue

to hyperptasia f the grandutar issues ndincreased ascutarity.


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Weight

a. Average weight gain is 24-30 pounds, comprised of:- Fetus: 7 lbs- Amniotic ftuid: 2 lbs- Placenta and membranes: 1 14 bs- Uterus: 2 ,,1 bs- Breast: 3 lbs- Increased blood volume: 2-4 lbs- Extravascular tuid and fat: 4-9 tbs.

b. Water retention, about 7 titers, commontyoccursduring pregnancy.

- Fetus, placenta and amniotic fluid: 3,5 liters- Increased blood volume, interstitiat fluid, and

hypertrophid maternal organs: 3.5 liters

3. Ovories

Do not produce ova during pregnancy.

4. Ahdonpn

a. Striae gravidarum - increased uterine sizeresults n rupture and atrophy of connectivetissue ayers, seen as pink or reddish streaks.

b. Umbilicus s pushed ut .

MarlonBernardo, N

Maternal & ChildHeahh Nursing:NursingCare n the Antepartal eriod

LocalChanges1. Uterus

a. Change n shape pear like to ovoid.b, Change n consistency of lower uterine segment

causes extreme softening known as Hegar's sign,seen at about 6 weeks gestation.

c. Mucus ptugs n the cervix, catted operculum, areproduced o seal out the bacteria.

d. CeMx becomes more vascutar and edematousresembting he consistency of the eartobe knownas Goodel's sign.

e. Eraxton Hick's contractions (painlesscontractions) occur intermittentty throughoutpregnancy, and can be fett by the mother by the4B month.

Treatment:' Ftagyl metronidazote) r vaginat upptement f

trichomonicidat ompounds ex. Tricofuron,Vagisoc, nd Devogan).

> Treat male partner as we[[,> Avoid ntercourse d prevent einfection.

lvlONlLfASlSaused y fungus Condida albicans. Alsocatted CANDIDIASIS.S/S: - white, patchy, heeze-tike artictes hatadhere o vaginalwatts.

- irritatingly tchy, and oul smetling ischarges.Treatment:

> /r4ycostatin/l,lystatin> Ayoid ntercourse.. Monitiasiss seen s oral hrush n the newborn

when ransmitted uringdelivery hrough hebirth canal of the nfected mother.

5. Skin

a. Linea nigra brown ine running rom heumbiticuso the symphysis ubis.b. Chloasma extra pigmentation f the cheeks ndacross he nose due o increased roductionofmetanoqftes y he pituitarygland. Grown s heMASK FPREGMNCY.

6. Ereast

a. Estrogen ontributes n the deve{opment f thebreast n preparation or [actation.

b. Nipptes re more eret, areota ecomes arkerand arge6 and colostrum s formed.

2. Yagina

a. Increased vasarlarity causes change cotor fromtight pink to deep purpte or violet known asChadwick's

sign.b. pH of the vagina changes rom acidic to alkaline

because of estrogen. lt protects the vaginalenvironmentrom bacteria, ut avors heof trichomonas a protozoa r flagettate. t wittTCSUIIO TRICHOAAONASAGINALISOrTRICHOI,IONAS AGlNlTlS r TRtCHOilONtAStS.S/5: - frothy, cream-colored, rritatingty itchy

and foul smetling discharge.- vulvutar edema and hyperemia secondary

to irritation from discharges.


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PSYCHOLOGICALTASKSFPREGNANCY

First Trimeiter (Accepting the Pregnancy)

The fetus is an unidentified concept with a greatfuture imptications but without tangibte evidence ofreality. Some degree of rejection and disbetief, deniatand depression. lilother is ambivalent.

> When giving health teachings, emphasize thebodily changes n pregnancy.

THEPRENATALISIT

The provisionof.prenatal care is theprimary focus in the improvement of

matemal and infant morbidity and mortatityrateg. To ensure he success f prenatal careprograms, t shoutd be remembered hat theclient's understanding of the modatities ofcare is basic to cooperative action amonghealth professionals and pregnant womanand her famity.

MarlonBernardo, N

Maternal & ChildHealth Nursing:NursingCare n the Antepartal eriod

kcond Trimester (Accepting the Baby)

Fetus is perceived as a separate entity. Fantasizedthe appearance of the baby. Irlother accepts pregnancy.

Third Trimester (Preparing for Parenthood)

Has personal dentification with a real baby about tobe born and reatistic plans or future child careresponsibilities. This is the best time to tatk aboutinfant feeding method. Fear of death is prominent.

> Let the woman listen to the fetal heart sound.

1. HistoryToking

a. Personat atab- Obstetrical ata GP IPAL)

Gravida number f pregnancies woman asPara number of viabte pregnancy egardtess f

number ndoutcome.TPAL core number f fu[[Term babies,

Premature eliveries, bortions, iving hildren.Ti infantsborn at 37 weeks r afterP: infants bornbefore 37 weeksA: spontaneous r induced bortionsL: tivingchitdren

* ln US etting, t (muttipte regnancies)s also akenas part of the obstetrical data - GP TPALM).

Abortion is the medical term for any pregnancyterminated before the age of viabitity.

'Age of viability - the earliest age at which fetusescoutd survive f they were born at that time,generally accepted as 24 weeks, or fetuses weighimore han 400 g.' Today's ractice accepts 20 weeks as he age of

viabitity.

Terms related to preqndnc'r status:Primigrovida - pregnant for the first timePrimipara - has given birth to one chitd past age of

viabitityItultigravida - has been pregnant previoustyllultipara - has caried two or more pregnancies o

viabitity

Nulligravida - never been and is not currenttvpregnant

Mrs. Bemardo s pregnant or the sixth time.She s seen or her first prenatal check-up.She eported hat she has a girl born at 35weeks; 2 boys, both born at 39 weeks; and atwin born at 37 weeks, She also noted hatshe had one miscarriage t 18 weeks. Usingthe GP(TPAL) ystem o describe Mrs.Bernardo's, urrent obstetrica[ history thenurse woutd record:

G6P4(3-1,15)


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\Apregnant woman s seen or her Znd renatat

check-up. She etated hat she has 4children, She has a boy born at 35 week, agirl born at 37 weeks, and a fratemat twinbom at 40 week. She added hat she had amiscarriage t 12 weeks. Using heGP(TPALM)ystem, he nurse would record:

G5P3Q-1-1-4-1)

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Aside rom the GP (TPAL), he nurse shoutd also ask oPast preenancies

- method of delivery?- where?

- risk invotved?Present pregnan(t!- chief concern

Dancer Sienak- yaginal bteeding no matter how stight- swetting of face and fingers- severe and continuous headache- dimness or bturring of vision- flashing of light or dots before the eyes- persistent vomiting, chitts, and fever- sudden escape of ftuid from the vagina- absence of fetal heart sounds after they have been

auscuttated on the 4s and 56 month.Medicat Data

Marlon Bernardo, N

Maternal & ChildHealth Nursing:llursingCare n the Antepartal Period

- Petvic measurements are done after the 56month through X-ray pelvimetry, Thispreferabty done 2 weeks before EDB odetermine CPD cephato-petvic disproportion).

- Leopold's }lanuver - done to estimate fetalsize, [ocate fetal parts, and determinepresentation, position, engagement, andattitude.

Awoman s pregnant or the second ime. Herfirst pregnancy nded n a spontaneousabortion at 12 weeks. The correct term touse o describe his woman's obstetricalhistory woutd be:

Multigravida, nutlipara

2. Assessment

a. Physical xam

Revior of system i indicated, nctudinginspection f teeth because hey are common ociinfection.

b. Petvic Exam (Cardinal rule: Empty bladder firstt)- Internal Exam (lE) o determine Chadwicks,

Goodett's and Hegar's signs.' Ballotement - fetus will bounce when tower

uterine segment s tapped on the 5s month.

- Pap Smear Papanicotau Smear) cytotogicalstudy to diagnose cervical carcinoma.

- C[assification of findings n Pap Smear:Ctass 1 - absence of abnormal celtsClass 2 - presence of atypical cytotogy, but no

evidence of matignancyClass 3 - q/totogy suggestive of malignahcyCtass 4 - cytotogy strongty suggestive of

matignancyCtas 5 - cytology conctusive of ma[ignancy

- Clinicol Stqq*: reftects {ocalization or spread ofmalignant cervical changesStage 1 - CAconfined n the cervixStage 2 - CA extends nto vagina, but not in the

petvic waltStage 3 - metastasis n

thepetvic

wallStage 4 - metastasis beyond petvic wa[[ intobladder and rectum


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> lnstruct to empty btadder.> The examiner, based on his/her dominant hand,

should position on that side of the mother (Ateft-hand dominant examiner shoutd oosition onthe left side of the mother).

> Ptace he mother in dorsa( recumbent, to retaxthe abdominaI muscles knees stightty texed).

> Place a rolted towel or smatl pillow under theright side of the trunk to prevent supine

hypotensive syndrome.> Warm hands before palpating (cotd hands causemuscle ightening).

> Use he finger pads n palpating.

c. Vital Signs

TPR are important during the initiat visit. The

most important are BP and weight to serve asbasetine data during visits.

d. Urine Examination

Albumineria - ideally negative. Presence f thismust be reported because t is a sign oftoxemia.

Pyuria - signs of UTl. UTI s the most commoncause of premature delivery.

Glycosuria - specimen shoutd be taken beforebreakfast to avoid false positive resutts.

3. Bartholomew's Rule

estimates AOG (age of gestation) by the re{ativeposition of the uterus in the abdominal cavity

3d month - fundus s stightty above he symphysis ubis5b month - fundus s at the tevel. of umbilicus9b month - fundus below the xyphoid process86 and lOh monffis - same [eve[ because of t.igthening

4. Haase's Rule

calcutation of the feta[ l'ength n cm. For thefirst 5 months, square he month; 6 - 1 0 months,muttipty by 5.

Maternal &ChildHealth Nursing:NursingCare n the Antepartal eriod

lit (Fundal rip): Facing he head part, palpate orfetal part n the undus.

2d (Umbilical rip): Palpate ides f the uterus odetermine ocation f fetal back.

3rd Pawlick's rip): Grasp ower portionof theabdomen ust above ymphysis ubis odetermine egree f engagement.

4tr: Facing he feet part, cross ingers downwardon both sides f the uterus bove he nguinaltigaments o determine ttitude,

ESTIMATES F PREGNANCY1. Nagele's Rule

calcutation of EDB estimated date of birth) orEDD estimated date of detivery). Get the Wp(first day of the last mestrual period), count back 3months and add 7 days.

Z. AlcDonald's Rule

The first day of woman's last menstrual periodwas May 3, 2008 and t ended May 7. UsingNagetek rule, this woman's estimated date ofbirth woutd be:

February 0,2009


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Aftermeasuring woman's undus, nllrseusedMcDonatd'sute o estimate hegestational geof the pregnancyn weeks..Since he woman's undatheightwas 24 cm,the gestationat geof the pregnancy outdbeapproximatety owmanyweeks?\

Vitamins nd minerals:

.Protein for buitding up of fetal tissue. Vit. C - for blood ctotting activity of the motherand etus, whichenhances he production fcapittaries, hereby enhancing rygenationnecessary or tissue growth and wound heating.

. .Catcium necessary or lactation.

. lron-rich oods re especiatty mportant uring helast rimester or the etus o have nough ronstores o last him or 3 months of infancywhenintake s main(y milk(deficient n iron).

d. Steep

> lf a woman has roubte steeping, drinking aglass of warm milk may help. Relaxatlonexercises also may be effective.

> Avold restlng in a supine position to preventsupin6 hypotensive syndrome.

e. Exercise

- Exercise during pregnancy s important toprevent circulatory stasis n the towerextremities. Also, to strengthen the muscleused n tabor and delivery.

> Walking is the best exercise during

pregnancy, and women should beencouragd to tak6 a deily walk.

Matemal & ChildHealth Nursing:NursingCare n the Antepartal Period

HEALTHPRO,TAOTIONCTIVITIESDURING REGNANCYa. Nutrition

- currentty recommended as an averageweight gain n pregnancy s 25 to 40 tbs.

- Body mass ndex (BMl) s a more preciseestimation of ade quate weight gain.

- Women who need speciat attention are

pregnant adolescent, underweight, obese,low income, vegtarians.

b. Bathing

> daily tub baths or showers are recommended.During pregnancy, sweating tends to increasebecause the woman excretes waste productsfor herself and the fetus.

c. Dressing

> pregnantwoman should avoid garters, extre-mely firm $rdles with panty legs, and kneehigh stockings because these may impedelower-extremity circutation.

> suggest wearing 3hoes wlth a moderate to lowheel to minimize pelvic titt and possibtebackache.

f. Travel

- Earty n a normat pregnancy, here are norestrictions. Late in pregnancy, travel ptansshoutd ake into consideration he possibilityof early labor.

g. SexualActivity

- sexual desires continue during pregnancy butlevel changes.

' 1it tri: decreased; woman s preoccupiedwith the changes n her body.

' 2d tri: increased; woman has adapted topregnancy.

3d tri: decreased; woman is afraid of hurtingthe fetus.

MarlonBernardo, N


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LABORATORYXAMS

1. Urinary Pregnancy Test- presence f hCG n the urine s the basi s or

positive esult. hCG s prBent rom 40s day o the100s day of pregnancy, reaching the peak levet on60h day. hCG herefore is most correct 6 weeks afterLJ\{P.When cottecting urine for pregnancy est:

> NPO post 8 pm to concentrate urine> Flrst morning urine, midstream catch should be

collected.> hCG s unstable under room temperature;

refrigerate prn.

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Marlon Bernardo, N

Maternal & ChildHealth Nursing:NursingCare n the Antepartal Period

2. Gastrointestinal

a. Morning sickness nausea and vomiting duringpregnancy) s due to increased hCG, ncreasedproduction of gastric acid (heart burn) or due toemotionaI factors.> Eat dry toast or crackers 30 mlnutes before

arising In the moming.> Encourage to eat dry high carbohydrates, lowfat, and low spices n the diet.

' Flvperelnesis erovidorum - excessive nausea andvomiting which persists beyond 3 months mayresult in dehydration, starvation and acidosis.

2. Progesterone Withdrawal Test

- a contraceptive pitl is taken OD or TID x 3 days.lf menstruation ccurwithin 10 o I 5 days, heis not pregnant. lf pregnant, the corpus uteumproduces enough hormones to neutralize the effect ofwithdrawn synthetic progesterone and no bteedingoccurs.

CHANGES F PREGNANCY

Systemic Changes1. Cdrdiovascular or Circulatory

a. Beginning he end of the 1't trimester, there is agradua[ ncrease of 30%-50%n total cardiacvolume reaching ts peak during the 6s month ofpregnancy. This causes a drop in hemoglobin andhematocrit tevels (physiological anemia ofpregnanry or pseudoanemia).

Consequences f increased ardioc volume:

- easy atigabilityand shortness f breath due oincreased ardiac worktoad

- epistaxis/nose teeding due o increasedof the nasopharynx

b. Patoitations ue o increased ressure f uterusagainst he diaphragm uring he second alfofpregnancy,

c. Because f poor circulation esutting rom pressurethe graviduterus n he btood essets f the tower

extremities:

- edema of the tower extremities occur> Ralse legs above the hip level." Edema of the lower extremities is NOT a sign of

toxemia.- varicosities of the lower extremities can occur

> Use/wear elastic stockings to promote varicoseflow thus preyenting stasis in the lower ext.

> Elastic bandage should start from the distal endthe extremity and work oward he trunk tocongestion nd mpaired irculationat the distalpart.

> Avoid use of constricting garters.

d. Because f poor circutation n the btood essels fgenitatia ue o pressure f the graviduterus,varicosities f the vutva nd he rectum appear.> Side-lying position with hips elevated on

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AntePartal Period