+ Pregnancy Highlights Chapters 13, 14, & 15 Maternity & Women’s Health Care, 11 th Edition By Lowdermilk, Perry, Cashion, and Alden

+ Chpt 13: Anatomy and Physiology of Pregnancy Gravidity, Parity, and Nullipara…OH MY!!! Terminology basics for pregnancy Obstetric History Two digit system G1P0, G1P1, G2P1 Five digit system GTPAL Signs of Pregnancy Presumptive signs (3-20wks gestation) Noticeable by the woman Probable signs (5-28wks gestation) Changes observed by the examiner Positive signs (5wks gestation to late pregnancy) Attributable only to the presence of the fetus 2

+ Chpt 13: Anatomy and Physiology of Pregnancy Pregnancy tests Most rely on the presence of the biochemical marker human chorionic gonadotropin (hCG) Types of tests Serum – Usually only 7-10mL of venous blood required Urine – First voided morning urine specimen as it contains the approx. the same volume of hCG as would be found in serum Typically used because it is the least expensive test and provides immediate results. Enzyme-linked immunosorbent assay (ELISA) technology is the basis for the OTC tests – A simple color change False positives or negatives can occur Anticonvulsants and tranquilizers may cause false positives Diuretics and promethazine may cause false negatives 3

+ Chpt 13: Anatomy and Physiology of Pregnancy Adaptations to Pregnancy Reproductive System and Breasts – Estrogen and Progesterone 4

+ Chpt 13: Anatomy and Physiology of Pregnancy QuickeningBallottementLigtheningHegar sign Braxton- Hicks contraction Leukorrhea Chadwick sign Operculum Goodell signFriabilityColostrum Montgomery tubercles Adaptations to Reproductive System and Breasts Terms to know… 5

+ Chpt 13: Anatomy and Physiology of Pregnancy Cardiovascular System Meets metabolic demands Promotes Fetal Growth and Development Blood volume increases approx. 1500mL which promotes change Respiratory System Structural and ventilatory adaptations occur Increased vascularity can lead to congestion and inflammation of resp tract Diaphragm displacement leading to thoracic breathing instead of abdominal breathing Abdominal Structure Displacement Internal Structure Adaptations 6

+ Chpt 13: Anatomy and Physiology of Pregnancy Renal Changes Bladder irritability, urgency and frequency Physiologic (dependent) edema occurs Tubular reabsorption of glucose is impaired and may lead to glucosuria (glycosuria) Integumentary Changes Hyperpigmentation as a result of anterior pituitary hormone melanotropin Striae gravidarum as an action of adrenocorticosteroids Abdominal Structure Displacement Internal Structure Adaptations 7

+ Chpt 13: Anatomy and Physiology of Pregnancy HyperpigmentationChloasmaLinea nigra Stria gravidarumAngiomasPalmar erythema EpulisPruitis Adaptations to Integumentary System Terms to know… 8

+ Chpt 13: Anatomy and Physiology of Pregnancy Musculoskeletal Changes Postural changes Separation of the diastasis recti abdominis Neurologic Changes Hypothalamic-pituitary neurohormonal changes occur Sensory changes in legs Pain due to lordosis Carpal tunnel syndrome Acroesthesia Tension headaches Light-headedness, syncope Muscle cramping Abdominal Structure Displacement Internal Structure Adaptations 9

+ Chpt 13: Anatomy and Physiology of Pregnancy Morning Sickness Cravings and PICA Epulis PtyalismPyrosisConstipation Gallstones Pruitis gravidarum Adaptations to Gastrointestinal System Terms to know… 10

+ Chpt 13: Anatomy and Physiology of Pregnancy Endocrine Changes Essential hormone to maintain pregnancy is Progesterone Oxytocin release allows for uterine contraction as well as milk let down Thyroid is often enlarged and may be palpable in the pregnant woman but hyperthyroidism does not usually develop during this period of time. Fetus will deplete maternal stores of glucose and mom’s ability to synthesize glucose therefore decreasing mom’s blood glucose level. Mom’s insulin does not cross the placenta, so the maternal pancreas will decrease production. The added demand for insulin by mom continues until term. Abdominal Structure Displacement Internal Structure Adaptations 11

+ Chpt 14: Nsg Care of the Family During Pregnancy Estimating Date of Birth/Confinement/Delivery Ultrasound Dating Naegle’s Rule Determine 1 st day of LMP; subtract 3 calendar months and add 7 days OR Determine 1 st day of LMP; add 7 days then count forward 9 calendar months Maternal Adaptation Cognitive restructuring Emotional attachment to fetus Identifying with the maternal role Emotional lability Increase in anxiety Physical changes – yes, sex drive may increase by 2 nd semester Reordering personal relationships 12

+ Chpt 14: Nsg Care of the Family During Pregnancy Paternal Adaptations Couvade’s Syndrome Announcement phase Moratorium phase – pregnancy becomes real Focusing phase – last trimester Tries to determine the new role Personal relationship changes Supportive or feels a rivalry with fetus Increase in abusive relationships during pregancy Actively or passively prepares for a role in the birthing process Sibling Adaptation Tips provided 13

+ Chpt 14: Nsg Care of the Family During Pregnancy Care Management Prenatal visit schedule Initial visit includes: Prenatal interview and a complete health history Observe for s/s of abuse or reports of abuse Physical Examination – establish a baseline Laboratory tests Follow-up visits include: Interview Focused physical assessment Fetal assessment Fetal heart tones Fundal height Gestational age Fetal position (Leopold’s maneuver covered in Chpt 19) Additional lab tests 14

+ Chpt 14: Nsg Care of the Family During Pregnancy Nutrition Personal hygiene Prevention of urinary tract infections Kegel exercises Dental care Physical activity Preparation for breastfeeding “Pinch” test Education for Self-Management Terms to know… 15

+ Chpt 14: Nsg Care of the Family During Pregnancy Education components: Discomforts related to pregnancy Related to physiological adaptations discussed in Chpt 13 Sexuality in Pregnancy Posture and body mechanics Exercise tips for pregnancy women Supine Hypotension Perinatal Care Choices Physicians Nurse-Midwives Direct-Entry Midwives Doulas BIRTH PLANS Encourage Childbirth and Perinatal Education Knowledge is POWER!!! 16

+ Chpt 15: Maternal and Fetal Nutrition 17

+ Chpt 15: Maternal and Fetal Nutrition A focus on nutrition: Adequate Folic Acid intake to prevent neural tube defects Quality weight gain NORMAL weight gain for a woman with a NORMAL BMI is lbs during pregnancy Weight gain, at a minimum, should be equal to the weight associated with the products of conception Fluid intake Caffeine in excess can contribute to miscarriage, and IUGR Recommended amount 8-10 glasses daily of water, milk or decaffeinated tea Dehydration can lead to cramping, contractions, and preterm labor 18

+ Chpt 15: Maternal and Fetal Nutrition A focus on nutrition: Minerals and Vitamins Iron – physiologic anemia occurs normally Supplement of 30mg of ferrous iron daily Calcium – no need to increase intake unless normal intake is less than the DRI Sodium – essential due to increase in blood volume Potassium – adequate intake reduces risk of HTN Zinc deficiency can lead to CNS malformation Absorption is inhibited with large intake of iron and folic acid commonly increased during preg. Therefore a zinc supplement may be needed. Encourage water-soluble vitamins instead of fat-soluble to decrease likelihood of toxicity Folate/Folic Acid Vitamin B6 (pyridoxine) – less pre-eclampsia, decreases N/V Vitamin C – enhances iron absorption 19

+ Chpt 15: Maternal and Fetal Nutrition Cultural Influences Encourage a diet typical for the culture Vegetarian Diets Plant proteins are often “incomplete” Vitamin B12 is found in meat origin only Encourage B12 fortified foods Fortified soy milk Vitamin B12 supplement Education Components related to Maternal and Fetal Nutrition Weight Gain during pregnancy Food Sources of Folate Iron Supplementation Suggestions for Managing Nausea and Vomiting 20