Nursing Management during Pregnancy

Preconception Care

The goal of care is to identify and modify biomedical, behavioral, and social risks to a woman’s health or pregnancy outcome through prevention and management interventions.

These interventions focus on risk factors that can be modified and/or eliminated prior to conception to optimize birth outcomes.

Risk Factors for Adverse Pregnancy Outcomes

• Smoking & alcohol use 

• Lack of folic acid supplementation

• Obesity ---> HTN, DM, thrombophlebitis, increased risk for cesarean birth 

• Medications (RX & OTC)

• Hep B, HIV/AIDS, Rubella, STI's 

• Preexisting medical condition 

• Risks are greatest for the embryo the first 2-8 weeks of pregnancy 

Nutrition in Pregnancy

• Increased calorie needs

  • 300-450 cal/day in 2nd & 3rd trimester 

  • Need more protein and iron 

• Prenatal vitamins

• Folic acid supplements

Pica

intense craving and eating of non-food items

• Soil, clay, ice, laundry starch 

• Can cause iron-deficiency anemia and constipation 

First Prenatal Visit

• General physical assessment & VS

• History

  • Reproductive 

  • Family history, partner's history

  • Social history: smoking, alcohol, drug use, nutrition, exercise, living situation, support system 

  • Teratogens are substances that can harm the embryo/fetus 

• Pelvic exam and Pap smear if appropriate

• Blood work (CBC, blood type and Rh factor, A1c/glucose)

Nulligravida

A woman who has never experienced pregnancy

Primigravida

A woman pregnant for the first time

Multigravida

pregnant multiple times

GPTAL

G, gravida;
T, term births;
P, preterm births;
A, abortions;
L, living children

• G—the current pregnancy to be included in count

• T—the number of term gestations delivering between 38 and 42 weeks

• P—the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks

• A—the number of pregnancies ending before 20 weeks or viability

• L—the number of children currently living

Nagele's Rule for Calculating the Estimated Due Date (EDD) 

1. Use the first day of the last normal menstrual period 10/14/22 

2. Subtract 3 from the number of months             7/14/22 

3. Add 7 to the number of days                               7/21/22 

4. Adjust the year by adding 1 year                        7/21/23 

5. Estimated due date (+ or − 2 weeks) =  July 21, 2023  

Nuchal Translucency Screening

done in the first trimester between 11 and 14 weeks. This allows for early detection and diagnosis of some fetal chromosomal and structural abnormalities.

Amniocentesis

involves a transabdominal puncture of the amniotic sac to obtain a sample of amniotic fluid for analysis. The fluid contains fetal cells that are examined to detect chromosomal abnormalities and several hereditary metabolic defects in the fetus before birth.

After the procedure, assist the woman into a position of comfort and administer RhoGAM intramuscularly if the woman is Rh-negative to prevent potential sensitization to fetal blood. Assess maternal vital signs and fetal heart rate every 15 minutes for an hour after the procedure. Observe the puncture site for bleeding or drainage. Instruct the client to rest after returning home and remind her to report fever, leaking amniotic fluid, vaginal bleeding, or uterine contractions or any changes in fetal activity (increased or decreased) to the health care provider.