1. MATERNAL AND CHILD NURSING (NUR 362)
Pregnancy
Lecture 4
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2. MATERNAL AND CHILD NURSING (NUR 362)
The Whole Period of Pregnancy Can Be Divided Into Three Stages (Trimesters ):
Trimesters
Weeks
First trimester (early pregnancy)
1-12
Second trimester (middle pregnancy)
13-27
Third trimester (late pregnancy)
28-40
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3. GESTATIONAL AGE Nagele’s Rule
Add 7 days to the first day of the last normal menstrual period, subtract 3 months and add 1 year.
Example:
1st day of LNMP=December
add 7 days = Dec
subtract 3 months = Sept
add 1 year =Sept , estimated due date (EDD)
Johnson’s Rule: estimates the weight of the fetus in grams.

4. Sign and symptoms of pregnancy
MATERNAL AND CHILD NURSING (NUR 362)
Sign and symptoms of pregnancy
A. Cessation of menstruation This is the first frequent symptom of pregnancy, although a few women may have slight bleeding after conception. But amenorrhea is not only due to pregnancy but also other reasons. Women of breast feeding may be pregnant before the recovery of menses.
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5. Sign and symptoms of pregnancy
MATERNAL AND CHILD NURSING (NUR 362)
Sign and symptoms of pregnancy
B. Nausea and vomiting
Also called morning sickness because they occur upon arising. These symptoms appear one or two weeks after the period is missed and last until 10th to 12th week, its severity varies from mild nausea to persistent vomiting (e.g. Hyperemesis gravidarum).
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6. MATERNAL AND CHILD NURSING (NUR 362)
Sign and symptoms of pregnancy
C. Urinary symptoms
Increased frequency of urination is due to increased circulation associated with the effect of estrogen and progesterone on the bladder, combined with pressure by the gradually enlarged uterus on the bladder.
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7. MATERNAL AND CHILD NURSING (NUR 362)
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8. Sign and symptoms of pregnancy
MATERNAL AND CHILD NURSING (NUR 362)
Sign and symptoms of pregnancy
d. Breast changes Breast enlargement and vascular engorgement. Nipple and areola become blacker. Enlargement of the accumulated sebaceous glands of the areolas may be noted. e. Fatigue and dizziness
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9. MATERNAL AND CHILD NURSING (NUR 362)
Sign and symptoms of pregnancy
J . Pregnancy test The laboratory test for pregnancy are based on the identification of human chorionic gonadotrophin (hCG), which can be detected as early as 7-9 days after fertilization by high sensitive technique. The samples may be blood or urine.
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10. MATERNAL AND CHILD NURSING (NUR 362)
Sign and symptoms of pregnancy
h. Basal body temperature (BBT)
A persistent elevation of BBT for longer than 18 days may be presumptive evidence of pregnancy.
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11. Call the doctor if any of the following occur:
Vaginal bleeding
Sharp abdominal pain or cramping
Loss of fluid from the vagina
Severe or prolonged nausea or vomiting
Frequent dizzy
Painful urination
High fever.
Vaginal discharge that is irritating

12. Changes of the reproductive organs
MATERNAL AND CHILD NURSING (NUR 362)
Changes of the reproductive organs
Vagina: The vaginal wall become discoloration as the pelvic blood vessel becomes congested.
Cervix: Cyanosis and a gradual softening due to congestion.
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13. Changes of the reproductive organs
MATERNAL AND CHILD NURSING (NUR 362)
Changes of the reproductive organs
Uterus: enlargement and softening. The isthmus of the uterus is also soft and can be compressed between the fingers palpating vagina and abdomen (Hegar’s sign). After the 12th week, the fundus of the uterus is usually palpable above the symphysis pubis.
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14. MATERNAL AND CHILD NURSING (NUR 362)
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15. MATERNAL AND CHILD NURSING (NUR 362)
Ultrasonography
There are trans-vaginal and abdominal Ultrasonagraphys.
A gestational sac can usually be identified at 5-6 weeks after the beginning of the last period.
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16. MATERNAL AND CHILD NURSING (NUR 362)
Picture of gestational sac
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17. MATERNAL AND CHILD NURSING (NUR 362)
Ultrasonography
Fetal heart beating can be detected by about 7th week and the fetus itself can be seen by about the 8th week.
Doppler is also an ultrasound technique, which diagnoses the pregnancy by revealing the heart beating.
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18. MATERNAL AND CHILD NURSING (NUR 362)
Picture of normal fetus
a．Pregnancy of 8w；b．Pregnancy of 18w
BL-bladder；UT-uterus；GS-gestational sac
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19. Height of the uterine top
MATERNAL AND CHILD NURSING (NUR 362)
Height of the uterine top
xiphoid
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20. Different methods of pregnancy diagnosis
MATERNAL AND CHILD NURSING (NUR 362)
Different methods of pregnancy diagnosis
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21. 1 Month First Trimester At the end of four weeks:
Baby is 1/4 inch in length
Heart, digestive system, backbone and spinal cord begin to form.
Placenta begins to develop
The single fertilized egg is now 10,000 times larger than size at conception

22. Month 2 First Trimester At the end of 8 weeks:
Baby is 1-1/8 inches long
Heart is functioning
Eyes, nose, lips, tongue, ears and teeth are forming
Penis begins to appear in boys
Baby is moving, although the mother can not yet feel movement

23. Month 3 Baby is 2 1/2 to 3 inches long Weight is about 1/2 to 1 ounce
First Trimester At the end of 12 weeks:
Baby is 2 1/2 to 3 inches long
Weight is about 1/2 to 1 ounce
Nails start to develop and earlobes are formed
Arms, hands, fingers, legs, feet and toes are fully formed
Eyes are almost fully developed
Baby has developed most of his/her organs and tissues
Baby's heart rate can be heard at 10 weeks with a special instrument called a Doppler

24. Month 4 Baby is 6 1/2 to 7 inches long Weight is about 6 to 7 ounces
Second Trimester At the end of 4 months:
Baby is 6 1/2 to 7 inches long
Weight is about 6 to 7 ounces
Baby is developing reflexes, such as sucking and swallowing and may begin sucking his/her thumb
Tooth buds are developing
Sweat glands are forming on palms and soles
Fingers and toes are well defined
Sex is identifiable
Skin is bright pink, transparent and covered with soft, downy hair
Although recognizably human in appearance, the baby would not be able to survive outside the mother's body

25. Month 5 Second Trimester At the end of 5 months:
Baby is 8 to 10 inches long
Weight is about 1 pound
Hair begins to grow on baby's head
Soft woolly hair called lanugo will cover its body.
Mother begins to feel fetal movement
Internal organs are maturing
Eyebrows, eyelids and eyelashes appear

26. Month 6 Second Trimester At the end of 6 months:
Baby is 11 to 14 inches long
Weight is about 1 3/4 to 2 pounds
Eyelids begin to part and eyes open sometimes for short periods of time
Skin is covered with protective coating called vernix

27. Month 7 Third Trimester At the end of 7 months:
Baby is 14 to 16 inches long
Weight is about 2 1/2 to 3 1/2 pounds
Fat layers are forming
Organs are maturing
Skin is still wrinkled and red
If born at this time, baby will be considered a premature baby and require special care

28. Month 8 Third Trimester At the end of 8 months:
Baby is 16 1/2 to 18 inches long
Weight is about 4 to 6 pounds
Overall growth is rapid this month
Tremendous brain growth occurs at this time
Most body organs are now developed with the exception of the lungs
Movements or "kicks" are strong enough to be visible from the outside
Kidneys are mature
Skin is less wrinkled
Fingernails now extend beyond fingertips

29. Month 9 Third Trimester At the end of 9 months:
Baby is 19 to 20 inches long
Weight is about 7 to 7 1/2 pounds
The lungs are mature
Baby is now fully developed and can survive outside the mother's body
Skin is pink and smooth
Baby settles down lower in the abdomen in preparation for birth and may seem less active

30. AMNIOTIC FLUID
Clear, yellowish fluid surrounding the developing fetus.
Average amount 1000 ml.
< 300ml – Oligohydramnios, associated with fetal renal abnormalities.
> 2 L – Hydramnios, associated with GI and other malformations.

31. AMNIOTIC FLUID functions
Protects Fetus
Controls Temperature
Supports Growth
Prevents Adherence to amnion
Allows Movement
Source of oral fluid
Acts as a excretion

32. MATERNAL AND CHILD NURSING (NUR 362)
Health education during pregnancy
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33. Regular visits during pregnancy
MATERNAL AND CHILD NURSING (NUR 362)
Regular visits during pregnancy
Prenatal visits
Q 4 weeks for 1st 28 weeks
Q 2 weeks until 36 weeks, then
Q 1 week until childbirth
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34. Normal Pregnancy Weight Gain
MATERNAL AND CHILD NURSING (NUR 362)
Normal Pregnancy Weight Gain
Breast
1-1.5 lbs
Blood
3-4.5 lbs
Extra water
4-6 lbs
Uterus
lbs
Placenta/amniotic fluid
lbs
Baby
7-8 lbs
Fat stores
4-6.5 lbs
Total
25-35 lbs
Normal weight gain is important to the development of the baby. Impaired intrauterine growth and development of the infant may result in cardiovascular, metabolic, or endocrine disease in adult life.
Maternal obesity increases the risk of gestational diabetes, cesarean deliveries, complications during delivery, congenital defects, and childhood obesity.
Women who gain excessive amounts of weight are more likely to be overweight or obese after the baby is born.
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35. Risks of Low Weight Gain
MATERNAL AND CHILD NURSING (NUR 362)
Risks of Low Weight Gain
Low weight gain in second or third trimester increases risk of intrauterine growth retardation
Low weight gain in third trimester increases risk of preterm delivery
The timing of weight gain during pregnancy is also important.
Regardless of pre-pregnancy weight, women with low weight gain in the second or third trimester increases the risk of growth retardation of the fetus.
Low weight gain in the third trimester is also associated with an increased risk of a preterm delivery.
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36. MATERNAL AND CHILD NURSING (NUR 362)
Proper nutrition
Major Nutrients
Carbohydrates
Protein
Fat
Vitamins
Minerals
Water
These nutrients, consumed in the correct amounts, help make a healthy baby.
Eating nutritious foods from MyPyramid supplies these nutrients.
Your doctor may prescribe a multi-vitamin and mineral supplement during pregnancy which you will need to take as directed in addition to eating a nutritious diet. Supplements are not a substitute for a healthful diet. However, they may be especially beneficial for teenagers, women who smoke or abuse alcohol or drugs, and strict vegetarians.
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37. Nursing Process Nursing Diagnosis Health-seeking behaviors Anxiety
Risk for deficit fluid
Constipation
Disturbed body image
Risk for altered sexuality patterns
Disturbed sleep pattern
Fatigue
Risk for fetal injury

38. Health Promotion During Pregnancy
Self-care needs
Bathing
Breast care
Dental care
Perineal hygiene
Sexual activity
Exercise
Sleep

39. Health Promotion During Pregnancy First-Trimester Discomforts
Breast tenderness
Constipation
Nausea, vomiting
Fatigue
Muscle cramps
Hypotension
Varicosities
Hemorrhoids
Heart palpitations
Frequent urination
Abdominal discomfort

40. Health Promotion During Pregnancy
Middle to Late Pregnancy Discomforts
Backache
Headache
Dyspnea
Ankle edema

41. Discomforts associated with pregnancy 1. First trimester
Nausea and vomiting (“morning sickness”) related to altered hormone levels and metabolic changes; advise small snacks of dry crackers before arising, small feedings of bland food, milk
Urinary frequency and urgency without dysuria; fluid intake should not be restricted
Increased vaginal discharge; manage with good hygiene (but no douching) and loose-fitting cotton underwear; report signs or symptoms of vaginitis

42. Breast soreness due to hormonal changes; suggest wearing a well-fitting, supportive brassiere
Headache due to tension from emotional and physical stresses at any time during pregnancy; provide reassurance, suggest relaxation techniques; inform patient to report persistent and/or severe episodes

43. Second and third trimester
Heartburn may be related to tension and vomiting in early pregnancy, progesterone-induced decreased motility and relaxation of the cardiac sphincter; displacement of the stomach by the growing uterus; encourage small, frequent meals and discourage overeating, ingesting fried/fatty foods, lying down soon after eating, use of sodium bicarbonate (would interfere with sodium balance)

44. Constipation related to progesterone-induced hypoperistalsis, compression/displacement of the bowel by the enlarging uterus, poor food choices, lack of fluids, and/or iron supplementation; advise bulk foods, fruits and vegetables, exercise, and generous fluid intake; avoid laxatives
Hemorrhoids due to pelvic congestion related to pressure from enlarged uterus; suggest regulation of bowel habits, gentle reinsertion into rectum with use of lubricant, relief measures, e.g., ice packs, topical ointments, sitz baths, lying down with legs elevated

45. Uterine contractions (Braxton-Hicks) due to tension on the round ligaments as a result of displacement of the uterus; instruct patient to rest, change position or activity
Backache due to increased spinal curvature; educate the patient on the importance good posture
Faintness related to vasomotor lability or postural hypotension; instruct the patient to use slow, deliberate movements when rising, avoid prolonged standing and warm, stuffy environments; elastic hose may be needed

46. Leg cramps related to pressure on the nerves supplying the lower extremities aggravated by poor peripheral circulation or fatigue; instruct the patient to increase calcium and decrease phosphorus intake; encourage dorsiflexion of feet
Ankle edema related to decreased venous return from lower extremities, instruct the patient to avoid wearing anything that constricts blood flow, elevate legs when sitting or resting, and dorsiflex feet when sitting or standing for any length of time; medical management if edema persists in AM, is pitting, involves the face, or associated with elevated BP, proteinuria, persistent headaches

47. Varicosities of extremities or vulva related to uterine compression of venous return, increased vein wall distensibility from progesterone-initiated relaxation, or inherited tendency; suggest elevating legs frequently, avoid sitting with legs crossed, standing/sitting for long periods of time, or wearing constrictive clothing; support/elastic stockings may be helpful.

48. Danger Signs of Pregnancy
Abdominal or chest pain
Pregnancy-induced hypertension
Increase or decrease in fetal movement
Vaginal bleeding
Persistent vomiting
Chills and fever
Ruptured membranes

49. Teratogens
Any factor that adversely affects fertilized ovum, embryo or fetus

50. Teratogenic Fetal Exposure
Maternal infections: Toxoplasmosis, Rubella, Cytomegalovirus
Herpes simplex virus, Syphilis
Vaccines
Drugs
Alcohol
Cigarettes

51. Teratogenic Fetal Exposure
Environmental
chemical
Radiation
Hyperthermia and hypothermia
Maternal stress

52. MATERNAL AND CHILD NURSING (NUR 362)
The End
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