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First Trimester Emotional Responses
Ambivalence is normal (the state of having mixed feelings or contradictory ideas about something or someone.)
even in planned pregnancies. Financial and career concerns may arise.
Second Trimester Emotional Changes
Quickening (fetal movement) makes pregnancy feel more real. Some ambivalence may persist.
Third Trimester Emotional Responses
Mothers may become more introverted. Relationship strain is possible.
Prenatal Visit Schedule
First visit in the first trimester, monthly visits until 28 weeks, biweekly visits until 36 weeks, weekly visits until birth.
Gravida & Para System
G = total pregnancies, P = number of births after 20 weeks.
GTPAL System
G = total pregnancies, T = term births, P = preterm births, A = abortions (spontaneous or induced), L = living children.
Calculating Due Date (Naegele’s Rule)
EDB = First day of last period + 7 days - 3 months.
Routine Prenatal Lab Values
Hgb ≥11 g/dL (1st & 3rd trimesters), ≥10.5 g/dL (2nd trimester); Hct ≥33% (1st & 3rd), ≥32% (2nd).
Vital Sign Changes in Pregnancy
BP: Slight/no decrease in systolic; diastolic decreases mid-pregnancy then returns to normal. HR: Increases by 15-20 bpm.
First Prenatal Visit Assessments
Includes medical history, mental health screening, substance use screening, sexual health history, IPV screening, and full obstetric history.
Methods to Determine Pregnancy Status
Two-digit system (Gravida/Para) and five-digit system (GTPAL).
Routine Labs in Pregnancy
Includes CBC, HIV, Hep B & C, rubella, syphilis, blood type & Rh, STI screening, varicella, TB test, genetic screening, urine analysis.
Fundal Height Growth in Pregnancy
20 weeks: At umbilicus; 24 weeks: 2-4 fingerbreadths above umbilicus; 27 weeks: Halfway between umbilicus and xiphoid; 36-38 weeks: 1 fingerbreadth below xiphoid.
Fetal Heart Rate (FHR) Detection
Detectable by Doppler at 10-12 weeks; Normal range: 110-160 bpm.
Iron Needs in Pregnancy
27 mg/day. Best absorbed with vitamin C. Avoid taking with tea, coffee, or milk.
Common First Trimester Symptoms
Nausea, vomiting, breast tenderness, constipation, fatigue, urinary frequency.
Management of First Trimester Symptoms
Nausea: Eat small, frequent meals; Fatigue: Increase rest; Constipation: Increase fiber and water intake.
Second Trimester Maternal Adaptations
Uterus rises above pelvic brim; fundus at umbilicus by 20 weeks; fetal movements (quickening) felt between 16-20 weeks.
Skin Changes in Pregnancy
Areolas darken, veins become more visible, striae gravidarum (stretch marks) appear.
Common Second Trimester Symptoms
Gas, nasal congestion, ligament pain, back pain, varicose veins, increased GFR, increased insulin resistance.
Third Trimester Maternal Adaptations
Thoracic breathing replaces abdominal breathing, cardiac output increases 30-50%, BP increases slightly.
Common Third Trimester Symptoms
Dyspnea, heartburn, swollen ankles, Braxton Hicks contractions, lightening (baby dropping).
Kick Counts
Mothers should monitor fetal movements. Report decreased movement.
Signs of Pre-Eclampsia
Severe headache, vision changes, swelling of face/hands, high BP.
Preterm Labor Symptoms
Regular contractions, pelvic pressure, lower back pain, cramping, watery discharge.
Labor Warning Signs
Vaginal bleeding, rupture of membranes, contractions increasing in intensity and frequency, decreased fetal movement.
Postpartum Education
Teach newborn care, warning signs of postpartum complications, mental health support, contraception options.
Postpartum Warning Signs
Severe vaginal bleeding, fever, leg pain, chest pain, shortness of breath, swelling.
Contraceptive Counseling
Discuss postpartum birth control options before discharge.