1. Preconception Care Promotion of health before pregnancy
Identify areas that might unfavorably affect pregnancy.

2. Risk Factors for adverse pregnancy outcomes
Smoking
Alcohol
Folic Acid
Obesity
Drugs
Medical conditions

3. Nursing Management Assessment History
Health promotion activities and education

4. Prenatal Care
Essential for ensuring the overall health of newborns and their mothers.
Ideally, begins during the mother’s childhood.
Includes balanced nutrition, adequate immunizations, positive attitudes and education.
Choosing a health care provider
clinic
HMO
nurse midwife
obstetrician
family practitioner

5. Preconceptual Visit
Before becoming pregnant to obtain accurate reproductive life planning.
First Prenatal Visit
Establish a baseline
Treat any health problems

6. First Prenatal Visit Interview provide privacy
when scheduling the appointment caution the woman that it may be a long session
establish your role
provide face to face interview
Components of Health History:
Establish rapport
Gain data on physical and psychosocial health

7. First Prenatal Visit
Obtain basis for anticipatory guidance for the pregnancy
Demographic data
Chief concerns
Family profile
History of past illnesses
History of family illnesses
Day history/social profile
Gynecologic history
Review of systems

8. Obstetric History

9. Terms Viability: Abortion: Term: Preterm Living
24 weeks: earliest age fetal survival
Abortion:
Pregnancy terminated before viability (spontaneous or elective)
Term:
Infants born > 37 weeks
Preterm
Infants born weeks
Living

10. First Prenatal Visit Support Person’s Role:
Partners, children, best friends come to prenatal visits.
Also allow time for privacy at each visit.
Physical Examination:
woman should undress, put on a patient gown, and empty her bladder.
Obtain urine specimen (clean catch)
bacteriuria, protein, glucose, ketones
VS, height, weight baseline

11. Physical Examination Assessment of systems:
general appearance and mental status
head and scalp
eyes
nose
ears
sinuses
mouth, teeth and throat
neck
lymph nodes
breasts
heart
lungs
back
rectum
extremities and skin

12. Measurement of Fundal Height/FH
Palpate the fundus at 12 weeks
measure the fundal height
plot on graph
auscultate fetal heart with doppler at 10 to 12 weeks
palpate fetal outline at 28th week

13. Pelvic Examination:
Reveals health information on internal and external reproductive organs.
Equipment - speculum, brush/broom for cervical scrapings, slide/medium for PAP, culture tube, gloves, lubricant, 2-3 cotton tipped applicators, light and stool.
Support is needed during this exam

14. Pelvic Examination External Genitalia
Check for signs of infection, inflammation, irritation, redness, ulceration, discharge or herpes.
Check Skene and Bartholin glands for infection.
Check for rectocele or cystocele.

15. Pelvic Examination Internal Genitalia
Cervix - purple if pregnant, check for lesions, ulcerations, or discharge.
Nulligravida - a woman who is not or never has been pregnant. Cervical os is round and small.
In a woman with previous pregnancy the os will be more slitlike.
Pap Smear
Sample from cervical os or vaginal pool.

16. Pelvic Examination Vaginal Inspection
Culture for gonorrhea, chlamydia or group B strep
Dark blue to purple color.
Examination of Pelvic Organs
Bimanual exam to assess position, contour, consistency and tenderness of pelvic organs.
Palpate uterus, ovaries and check Hegar’s sign.
Rectovaginal Examination
Assess strength and irregularity of posterior vaginal wall.

18. Pelvic Examination Types of pelvis
Android - male pelvis, the pubic arch forms an acute angle, making the lower dimensions of the pelvis extremely narrow.
Anthropoid - ape like pelvis, the transverse diameter is narrow and the anteroposterior diameter of the inlet is larger than normal.
Gynecoid - normal female pelvis, inlet is well rounded forward and backward, the pubic arch is wide. Ideal for childbirth.
Platypelloid - flattened pelvis, inlet is an oval, smoothly curved, but the anteroposterior diameter is shallow. A fetal head might not be able to rotate to match the curves of the cavity.

19. Pelvic Examination
Diagonal conjugate - distance between anterior surface of sacral prominence and anterior surface of inferior margin of symphysis pubis.
Most useful measurement for estimation of pelvic size.
Anteroposterior diameter of the pelvic inlet.
Sacral prominence to symphysis pubis.
Pelvimeter
If measurement is more than 12.5 cm it is adequate (average is 11cm in diameter).

20. Pelvic Examination
Ischial tuberosity - measures is the distance between the ischial tuberosities, or the transverse diameter of the outlet.
The narrowest diameter at that level.
Medial and lowermost aspect of the ischial tuberosities at the level of the anus.
Pelvimeter or ruler is used.
11 cm is adequate because it will allow the widest part of the fetal head, or 9 cm, pass freely through the outlet.

21. Laboratory Assessment
Blood studies
CBC, H&H and red cell index (anemia), platelet count, sickle cell trait.
VDRL or RPR
Blood typing (include Rh factor)
AFP at 16 to 18 weeks
Indirect Coombs’ test (Rh antibodies) repeat at 28 weeks.
Antibody titers for rubella and hepatitis

22. Blood Studies Antibodies for varicella
Obtain consent for HIV screening (ELISA) Western blot (Can start AZT).
50-g oral 1-hour glucose loading or tolerance test to R/O diabetes if she has a previous history or symptoms of diabetes.
Urinalysis
test for albuminuria, glycosuria and pyuria.

23. Laboratory Assessment
Tuberculosis Screening
PPD (purified protein derivative) tuberculin test to screen for tuberculosis.
Positive requires a chest X-ray
Ultrasonography
Confirms pregnancy length or document healthy fetal growth.
Risk Assessment
Previous surgery, health history, meds, etc

24. Signs Indicating Complications of Pregnancy
Vaginal Bleeding
Persistent Vomiting
Chills and Fever
Sudden escape of clear fluid from vagina
Abdominal or chest pain
PIH signs
Increase or decrease fetal movement