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

2. 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..

3. 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

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

5. 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

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

8. 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

9. 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

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

11. 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 /21/11
Subtract 3 months /21/11
Add 7 days /28/11
Add 1 year /28/12 = EDB
Gestational or birth calculator.

12. 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

13. 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

14. 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

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

16. 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

17. 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

18. 1st Trimester Discomforts
Urinary frequency or incontinence
Fatigue
Nausea and vomiting
Breast tenderness
Constipation
Nasal stuffiness, bleeding gums, epistaxis
Cravings
Leukorrhea

19. 2nd Trimester Discomforts
Backache
Varicosities of the vulva and legs
Hemorrhoids
Flatulence with bloating

20. 3rd Trimester Discomforts
Return of 1st trimester discomforts
Shortness of breath and dyspnea
Heartburn and indigestion
Dependent edema
Braxton Hicks contractions

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

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

23. 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

24. 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.

25. 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

26. 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

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

28. Care For Better Health