Nursing Management During Pregnancy Ni Ketut Alit A Nursing Faculty Airlangga University Surabaya East Java

REFERENCES Bobak LM & Jensen MD (1993) Maternity & Gynecologyc Care, The Nurse and The Family 5th ed , St Luis : CV Mosby Company. Bobak LM , Lowdwrmilk D.L, Jensen. M.D, Perry J.E, (1993) Maternity Nursing, St Luis : CV Mosby Company. Mattson Susan & Smith Judi E (2000). Core Curriculum for Maternal – Newborn Nursing. 2nd ed. Philadelphia. W.B. Saunders Company. Wiknyosastro,H. Saifudin, A.B, Reachimhadhi, T.Eds ( 1997 ) Ilmu Kebidanan , Jakarta Yayasan Bina Pustaka Sarwono Prawiroharjo. Journals and article related to..

Conception, Fetal Development, Gestational Risk and Fetal Well-being Factors affecting fetal well-being: Quality of sperm or ovum Intrauterine environment First trimester exposure to hazardous agents Maternal nutrition, hyperthermia, chronic diseases including diabetes, thyroid, cardiac, and circulatory Substance abuse Known or unknown infections

Barriers to Prenatal Care Sociodemographics Insurance/finances Inadequate care providers for low income Delay in onset of prenatal care Cultural factors Transportation Attitudes

Preconception Care Immunization status Underlying medical conditions Reproductive health care practices Sexuality and sexual practices Nutrition Lifestyle practices Psychosocial issues Medication and drug use Support system

KSPR (Kartu Score Pudji Rohjati) Card for risk detection of Pregnacy

1st Prenatal Visit Establishment of trusting relationship Focus on education for overall wellness Detection and prevention of potential problems Comprehensive health history, physical examination, and laboratory tests

Comprehensive Health History Reason for seeking care Suspicion of pregnancy Date of last menstrual period Signs and symptoms of pregnancy Urine or blood test for hCG Past medical, surgical, and personal history Woman’s reproductive history: menstrual, obstetric, and gynecologic history

Menstrual History Menstrual cycle Age at menarche Days in cycle Flow characteristics Discomforts Use of contraception

Menstrual History Date of last menstrual period (LMP) Calculation of estimated or expected date of birth (EDB) or delivery (EDD) Nagele’s rule Use first day of LNMP 11/21/11 Subtract 3 months 8/21/11 Add 7 days 8/28/11 Add 1 year 8/28/12 = EDB Gestational or birth calculator.

Obstetric History Gravida: a pregnant woman Gravida I (primigravida): first pregnancy Gravida II (secundigravida): second pregnancy, etc. Para: a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more Primapara: one birth after a pregnancy of at least 20 weeks (“primip”) Multipara: two or more pregnancies resulting in viable offspring (“multip”) Nullipara: no viable offspring; para 0

Obstetric History Terminology G (gravida): the current pregnancy T (term births): the number of pregnancies ending >37 weeks’ gestation, at term P (preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks A (abortions): the number of pregnancies ending before 20 weeks or viability L (living children): number of children currently living

Physical Examination Vital signs Head-to-toe assessment Head and neck Chest Abdomen, including fundal height if appropriate Extremities Pelvic examination Examination of external and internal genitalia Bimanual examination Pelvic shape: gynecoid, android, anthropoid, platypelloid Pelvic measurements

Laboratory Tests Urinalysis Complete blood count Rh factor TORCH test Hepatitis B surface antigen HIV test Ultrasound

Follow-up Visits Visit schedule: Every 4 weeks up to 28 weeks Every 2 weeks from 29 to 36 weeks Every week from 37 weeks to birth

Follow-up Visits Assessments Weight & BP compared to baseline values Urine testing for protein, glucose, ketones, and nitrites Fundal height Quickening/fetal movement Fetal heart rate Teaching: danger signs

1st Trimester Discomforts Urinary frequency or incontinence Fatigue Nausea and vomiting Breast tenderness Constipation Nasal stuffiness, bleeding gums, epistaxis Cravings Leukorrhea

2nd Trimester Discomforts Backache Varicosities of the vulva and legs Hemorrhoids Flatulence with bloating

3rd Trimester Discomforts Return of 1st trimester discomforts Shortness of breath and dyspnea Heartburn and indigestion Dependent edema Braxton Hicks contractions

Nursing Management To Promote Self-Care Personal hygiene Avoidance of saunas and hot tubs Perineal care Dental care Breast care Clothing Exercise

Nursing Management To Promote Self-Care Sleep and rest Sexual activity and sexuality Employment Travel Immunizations and medications

Danger Signs Of Pregnancy !!! Assess and report immediately: Vaginal bleeding in any amount - May indicate placenta previa Premature rupture of membranes - Predisposes mom and baby to infection Edema of face or hands, abdominal pain, epigastric pain - Consider preeclampsia Severe, persistent headaches and visual disturbances - Consider preeclampsia

Danger Signs in Pregnancy Report any of the following immediately: Fever and/or chills Painful urination Persistent nausea & vomiting Change in, or absence of fetal movement for 6-8 hrs.

Preparation for Labor, Birth, and Parenthood Perinatal education Childbirth education Lamaze (psychoprophylactic) method: focus on breathing and relaxation techniques Bradley (partner-coached childbirth) method: focus on exercises and slow, controlled abdominal breathing Dick-Read (natural childbirth) method: focus on fear reduction via knowledge and abdominal breathing techniques

Preparation for Labor, Birth, and Parenthood Options for birth setting Hospitals: delivery room, birthing suite Birth centers Home birth Options for care providers Obstetrician Midwife Health provider

Preparation for Labor, Birth, and Parenthood Feeding choices Breastfeeding: advantages and disadvantages Bottle feeding: advantages and disadvantages Teaching Final preparation for labor and birth

Care For Better Health