Normal pregnancy (Chapter 10 Fetal Development and Genetics)

Genes:

individual units of heredity of all traits (23 from mom 23 from dad)

genes are organized

-Organized into long segments of deoxyribonucleic acid (DNA) that occupies a specific location on a chromosome

genes determine

a particular characteristic in an organism; physical and mental characteristics of humans

chromosome

long, continuous strands of DNA carrying genetic information

PATTERNS OF INHERITANCE•

-Mendelian or monogenic disorders

-Autosomal dominant inheritance

-Autosomal recessive inheritance

-X-linked inheritance

-X-linked recessive inheritance

-X-linked dominant inheritance

-Multifactorial disorders

- Nontraditional inheritance

mom carries

xx

dad carries

xy

normal mom and affected dad (autosomal dominant)

-2 affected kids male and female

-2 normal kids male and female

carrier mom and carrier dad (autosomal recessive inheritance)

-normal male

-carrier female

-carrier male

-affected female

x-linked recessive inheritance

-No male to male transmission (mutation is only on the X chromosome).

-Son of heterozygous mothers have a 1/2 chance of being affected.

X-linked dominant inheritance

All females of the affected father are diseased.

Affected mother can pass on the disease to both male and female offspring.

NURSING ROLES AND RESPONSIBILITIES

-Beginning the preconception counseling process and referring for further genetic information

-Taking a family history

-Scheduling genetic testing

-Explaining the purposes, risks/benefits of all screening and diagnostic tests

-Answering questions and addressing concerns

-Discussing costs, benefits, and risks of using health insurance, and potential risks of discrimination

-Recognizing ethical, legal, and social issues

-Safeguarding privacy and confidentiality

-Monitoring emotional reactions after receiving information

-Providing emotional support

-Referring to appropriate support groups

Time Span of fertilization

-Ovum released from ovary

-Passes into open fallopian tube

-Starts journey downward toward the sperm for fertilization

Zygotic stage:

fertilization of sperm and egg (conception)

Blastocyst stage:

zygote divides into a solid ball of cells and attaches to uterus

Embryonic stage:

-end of second week through eighth week

-Basic structures of major body organs and main external features

Fetal stage:

-differentiation and structures specialize by end of the eighth week until birth

placenta serves as the

-Serving as the interface between the mother and fetus

FUNCTIONS OF THE PLACENTA

-Making hormones to control the physiology of the mother to ensure fetus is supplied with nutrients and oxygen needed for growth

-Protecting the fetus from immune attack by the mother

-Removing waste products from the fetus

-Inducing the mother to bring more food to the placenta

-Producing hormones that mature into fetal organs

HORMONES PRODUCED BY THE PLACENTA

-Chorionic gonadotropin

-Prolactin

-Human placental lactogen (hPL) or human chorionic somatomammotropin (hCS)

-Estrogen

-Progesterone

-Relaxin

UMBILICAL cord formed from the

amnion

umbilibal cord is lifeline from the mother to the

embryo

umbillical cord structure

-Contains one large vein and two small arteries

-Wharton jelly

what is purpose of whartons jelly

surrounds the vein and arteries to prevent compression

average umbillical cord size at term

At term, the average umbilical cord is 22 in long and about 1 in wide17

ROLE OF AMNIOTIC FLUID

-Helps maintain a constant body temperature for the fetus

-Permits symmetric growth and development

-Cushions the fetus from trauma

-Allows the umbilical cord to be relatively free of compression

-Promotes fetal movement to enhance musculoskeletal development

FETAL CIRCULATION

-Blood from the placenta to and through the fetus and then back to placenta (seeFigure 10.9)

Ductus venosus:

connects the umbilical vein to the inferior vena cava (by passes the liver)

Ductus arteriosus:

connects the main pulmonary artery to the aorta (by passes lungs)

Foramen ovale:

anatomic opening between the right and left atrium (by passes right ventricle)

PRECONCEPTION CARE AND DIAGNOSTIC TESTING

-Amniocentesis

-Biophysical profile

-Chorionic villus sampling (CVS)

-Natural childbirth

-Perinatal education

-Preconception care

-Biophysical profile

Physical of baby in utero to make sure they are growing good and have all their limbs

how do you prep a woman who wants to get preggo

-folic acid

-prenatal vitamins

-healthy eating

-excersize

-track menstrual cycle

lack of folic acid causes

neural tube defects in babies

GOALS OF PRECONCEPTION CARE

-Promote the health and well-being of a woman and her partner before pregnancy

-Identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management intervention

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

FIRST PRENATAL VISIT

-Establishment of trusting relationship

-Focus on education for overall wellness

-Detection and prevention of potential problems

-Comprehensive health history

-physical examination

-laboratory tests

what med cant be given to hypertensive young girls

lisinopril

-can cause issues to baby

-give hydrochlorothiazide instead

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

-past children

what can cause pregnancy suspcion

-missed period

-nausea

-tender breasts

MENSTRUAL HISTORY

-Menstrual cycle

-Age at menarche

-Days in cycle

-Flow characteristics

-Discomforts

-Use of contraception

you get your period ___ days before ovuloation

14 days

Calculation of estimated or expected date of birth (EDB) or delivery (EDD)• Nagele's rule

-Use first day of LNMP 11/21/23

-Subtract 3 months 8/21/23

-Add 7 days 8/28/23

-Add 1 year 8/28/24 = EDB• Gestational or birth calculator or wheel (see Figure 12.3)•

best method of dating a pregnancy

Ultrasound is the

Gravida:

pregnant woman

gravida I

first pregnancy

Gravida II

a woman who has had two pregnancies

PARA

a woman who has given birth one or more viable offspring carrying a pregnancy (at least 20 weeks) in the past.

PRIMAPARA

A person who has given birth once after a pregnancy of at least 20 weeks, commonly referred to as a "primip" in clinical practice

Multipara

two or more pregnancies lasting at least 20 weeks resulting in viable offspring ("multip")

nullpara

0 viable offspring; para

T (term births):

the number of pregnancies ending >37 weeks' gestation, at term

must be greater then 37 even by

1 day

-if it is just at 37 weeks its premi

-must be 37 and 1

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

physical exam

-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: diagonalconjugate, true (obstetric) conjugate,and ischial tuberosity

Lab tests

-Urinalysis

-Complete blood count

-Blood typing

-Rh factor

-Rubella titer

-Hepatitis B surface antigen

-HIV, VDRL, and RPR testing

-Cervical smears

-Ultrasound

up to 28 weeks

follow up every 4 weeks

from 29 to 36 weeks

follow up every two weeks

From 37 Weeks to Birth

follow up every week

ASSESSMENT OF FETAL WELL-BEING

-Ultrasonography (see Figure 12.6)

-Doppler flow studies

-Alpha-fetoprotein analysis

-Marker screening tests

-Nuchal translucency screening

-Amniocentesis

-Chorionic villus sampling (CVS)

-Percutaneous umbilical blood sampling (PUBS)

-Nonstress test; contraction stress test

-Contraction stress test• Biophysical profile38

FIRST TRIMESTER DISCOMFORTS 1-3

-Urinary frequency or incontinence (see Teaching Guidelines 12.1)

-Fatigue

-Nausea and vomiting

-Breast tenderness

-Constipation

-Nasal stuffiness, bleeding gums, epistaxis

-Cravings

-Leukorrhea

SECOND TRIMESTERDISCOMFORTS 3-6

-Backache

-Varicosities of the vulva and legs

-Hemorrhoids

-Flatulence with bloating

THIRD TRIMESTER DISCOMFORTS 6-9

-Return of first trimester discomforts

-Shortness of breath and dyspnea

-Heartburn and indigestion

-Dependent edema

-Braxton Hicks contractions

-Braxton Hicks contractions

-contractions in the 3rd trimester that prep you for delivery

-not a real contraction, these are much shorter

Nursing Management to Promote Self-Care

-Personal hygiene

-Avoidance of saunas and hot tubs

-Perineal care

-Dental care

-Breast care

-Clothing

-Exercise

-Sleep and rest

-Sexual activity and sexuality

-Employment

-Travel

-Immunizations and medications

Avoidance of saunas and hot tubs why

-UTI

-preterm labor: can rupture protective membranes like mucous plugs

dental during preggo

-can get cleanings

-may have gingival hyperplasia

-no hard core dental work or xray

clothing during pregnancy

loose fitting

exercise during pregnancy

don't start if you didn't this whole time

Preparation for Labor, Birth, and Parenthood

-perinatal education

-childbirth education

can you have sex while pregnant

yes

what do you need to ask about employment

-what work do you do?

- cant lift more then 15 lbs

traveling while pregnant

consult dr

vaccines for a pregnant woman

-no live vaccines

Lamaze method

-focus on breathing and relaxation techniques

-Psychoprohylactic

Bradley method

-focus on exercises and slow, controlled abdominal breathing

-(partner-coached childbirth)

Dick-Read method:

-focus on fear reduction via knowledge and abdominal breathing techniques

-(natural childbirth)

options for birth setting

-Hospitals: delivery room, birthing suite

-Birth centers

-Home birth

Options for care providers

-Obstetrician

-Midwife

-Doula (does not deliver)

do doulas deliver

-no

-coach

Feeding choices

- Breast-feeding

- Bottle feeding

breast feeding advantage

-nutrient dense

-immunity

-bonding

-less blood loss post-partum

-cancer prevention

formula ask parents

-do you wanna come with your formula

-do you want hospital formula

Chadwick sign:

-bluish-purple coloration of the vaginal mucosa and cervix

-sign of pregnancy

-bimanual exam

-probable sign

goodell sign

-softening of the cervix

-sign of pregnancy

-probable sign

hegar sign

-softening of the lower uterine segment or isthmus

-pregnancy sign

-probable sign

Presumptive signs (subjective)

-Fatigue (12 weeks)

-Breast tenderness (3 to 4 weeks)

-Nausea and vomiting (4 to 14 weeks)

-Amenorrhea (4 weeks)

-Urinary frequency (6 to 12 weeks)

-Hyperpigmentation of skin (16 weeks)

-Fetal movements (quickening) (16 to 20 weeks)

-Uterine enlargement (7 to 12 weeks)

-Breast enlargement (6 weeks)

-what mama says she feels

Probable (objective) signs

-Braxton Hicks contractions (16 to 28 weeks)

-Positive pregnancy test (4 to 12 weeks)

-Abdominal enlargement (14weeks)

-Ballottement (16 to 28 weeks)

-Goodell sign (5 weeks)

-Chadwick sign (6 to 8 weeks)

-Hegar sign (6 to 12 weeks)

-objective what I can see when doing an assessment

positive signs

-Ultrasound verification of embryo or fetus (4 to 6 weeks)

-Fetal movement felt by experienced clinician (20 weeks)

-Auscultation of fetal heart tonesvia Doppler (10 to 12 weeks)

how do you confirm pregnancy

ultrasound

ballottement

-a palpation technique used in detecting or examining a flow in the body

-like smth flowing through a balloon

-compared to a bruit

Uterus adaptations

-Increase in size, weight, length, width, depth, volume, and overall capacity

-Pear shape to ovoid shape

-positive Hegar sign

-Enhanced uterine contractility

-Braxton Hicks contractions

-Ascent into abdomen after first 3 months

-Fundal height by 20 weeks' gestation at level of umbilicus; 20 cm; reliable determination of gestational age until 36 weeks' gestation

uterus shape change

pear shape to ovoid shape

uterus increases in

-Increase in size, weight, length, width, depth, volume, and overall capacity

what happens in uterus

-Enhanced uterine contractility

-BH contractions

baby asent into abdomen

after first 3 months

Fundal height by 20 weeks' gestation at

level of umbilicus is 20 cm

-every week=1 cm