Nursing Care During the Antenatal Period Maria Rubolino, MSN, FNPc September 6 th, 2005

A & P of Pregnancy Terms to know Terms to know Gravida Gravida Parity Parity Nulliparous Nulliparous Multiparous Multiparous Term Term TPAL TPAL

Signs of Pregnancy Presumptive Signs/Symptoms Presumptive Signs/Symptoms Probable Probable Positive Positive

Uterine Growth Stimulated by hormones in the 1 st trimester Stimulated by hormones in the 1 st trimester Larger as it rises out of the pelvis Larger as it rises out of the pelvis Hegar’s Hegar’s Chadwick’s Chadwick’s

Contractility Braxton Hicks Braxton Hicks

Cervical Changes Goodell’s Sign Goodell’s Sign Friability Friability

Fundal Height Changes Changes from week to week Changes from week to week

Vaginal Changes Vaginal mucosa thickens Vaginal mucosa thickens Chadwick’s sign Chadwick’s sign Vaginal discharge Vaginal discharge Mucous plug Mucous plug Varicosities Varicosities

Breast Changes Fullness Fullness Areolar pigmentation Areolar pigmentation Colostrum Colostrum

Circulatory Changes CV- blood volume, cardiac hypertrophy CV- blood volume, cardiac hypertrophy Cardiac output increases Cardiac output increases Blood pressure changes Blood pressure changes

Circulatory changes Supine hypotension syndrome Supine hypotension syndrome

Renal Changes Renal pelvis and ureters dilate Renal pelvis and ureters dilate Urine rate is slowed Urine rate is slowed Bladder frequency Bladder frequency

GI Changes Appetite Appetite Gastric emptying Gastric emptying Absorption Absorption Bowel sounds Bowel sounds Blood flow to the pelvis Blood flow to the pelvis Morning sickness Morning sickness Pyrosis Pyrosis Constipation Constipation

Gallbladder and Liver Gallbladder with decreased tone Gallbladder with decreased tone PUPPS PUPPS

Skin Changes Increased subdermal fat Increased subdermal fat Hyperpigmentation Hyperpigmentation Striae Striae Linea nigra Linea nigra Chloasma Chloasma Angiomas Angiomas Pruritis Pruritis Palmar erythema Palmar erythema Increased perspiration Increased perspiration

Endocrine Changes Amenorrhea Amenorrhea Progesterone Progesterone Estrogen Estrogen Ant pituitary suppresses the FSH and LH causing to rise Ant pituitary suppresses the FSH and LH causing to rise Post pituitary produces oxytocin Post pituitary produces oxytocin

Neurological Changes Carpal Tunnel Syndrome Carpal Tunnel Syndrome Numbness/Tingling Numbness/Tingling HA’s HA’s Lightheadedness Lightheadedness Muscle Cramps Muscle Cramps

Musculoskeletal Changes Change in posture Change in posture Waddling Waddling Back Pain Back Pain

Nutrition Needs Folic Acid Folic Acid Calories increased to 300/day Calories increased to 300/day Increased protein Increased protein Iron requirements increased Iron requirements increased Increased fluid intake Increased fluid intake Limit caffeine Limit caffeine

Exercise Will produce benefits Will produce benefits Must consume fluid Must consume fluid Watching heart rate Watching heart rate No new activities No new activities

Weight Gain in Pregnancy pounds total weight gain pounds total weight gain With singleton pregnancy pound total weight gain with multiples

Nagele’s Rule LMP minus 3 calendar days LMP minus 3 calendar days Add 7 days and 1 year Add 7 days and 1 year

Tests in 1 st Trimester 1 hour post glucola if indicated 1 hour post glucola if indicated Blood type Blood type Antibody screen Antibody screen CBC CBC UA C/S UA C/S Hepatitis Hepatitis HIV HIV RPR RPR TSH TSH Toxoplasmosis if indicated Toxoplasmosis if indicated CVS if desired CVS if desired

Hyperemesis N/V N/V Small frequent meals Small frequent meals Avoid spicy foods Avoid spicy foods Antiemetics Antiemetics

1 st Trimester Hyperemesis Hyperemesis No menses No menses N/V N/V Fatigue Fatigue Breast Tenderness Breast Tenderness

20 Weeks Quickening Quickening Pelvic Pressure Pelvic Pressure Constipation Constipation Round ligament pain Round ligament pain

CVS Screening to detect fetal genetic abnormalities Screening to detect fetal genetic abnormalities Risks of miscarriage 1 in 100 Risks of miscarriage 1 in 100

Nuchal Fold Thickness Ultrasound and 9-13 weeks Ultrasound and 9-13 weeks Increased with down syndrome Increased with down syndrome Screening only!! Screening only!!

AFP Triple marker test/screening Triple marker test/screening weeks gestation weeks gestation If abnormal refer to specialist If abnormal refer to specialist

Amniocentesis Performed between weeks Performed between weeks Done with AMA, FH, +AFP Done with AMA, FH, +AFP Risks of miscarriage 1 in Risks of miscarriage 1 in

Testing in 3 rd Trimester 1 hour post glucola 1 hour post glucola CBC CBC UA UA Antibody screen Antibody screen Rhogam Rhogam TSH TSH

32-36 Weeks Fetal position Fetal position Descending into pelvis Descending into pelvis Placental location Placental location GBS GBS FKC’s FKC’s

36-42 Weeks Vaginal Exams Vaginal Exams Labor precautions Labor precautions PIH precautions PIH precautions

Childbirth Education Natural Natural Lamaze Lamaze Bradley Bradley

Birth Plan Hospital Hospital Birthing Center Birthing Center Home Home Bath Bath Pain Meds Pain Meds Epidural Epidural Natural Natural Lighting Lighting Ambulating Ambulating Doulas Doulas Hypnosis Hypnosis