Neonatal

T implement activities that promote healthy mothers and babies and ultimately families and population in general

Why is health promotion so important during childbearing period?

Preconception counceling: assess women prior to becoming pregnant that beneffits both reproductive aged women and their potential children

What is primary prevention for childbearing period?

1. Folic acid

2. Rubella vaccination

3. Smoking cessation

4. Screening and treatment of depression to reduce the risk of postpartum depression

Primary prevention examples for prenatal consideration: [4]

Prenatal care to improve health during prevention

What is secondary prevention for childbearing period?

1. Presumptive

2. Probable

3. Positive

Three kinds of signs of pregnancy:

1. Breast changes

2. Amenorrhea

3. Nausea and vomiting

4. Urinary frequency

5. Fatigue

6. Quickening

Presumptive signs of pregnancy [6]

1. Goodwell sign

2. Chadwick sign

3. Hegar sign

4. Positive pregnancy test serum 4-12 weeks

5. Positive pregnancy urine test 6-12 weeks

6. Braxon hicks 16 weeks

Probable signs of pregnancy:

1. Ultrasound

2. Fetal heart rate

3. Fetal movements

4. Palpating fetal body parts

Positive signs of pregnancy: [4]

Union of sperm and egg, called fertilization

When does pregnancy begin?

9 solar months, 10 lunar months, or 40 weeks

How long is pregnancy?

Implantation

Process of attachment and placental formation

Presumptive signs

Least reliable indicators of pregnancy because any one of them can be caused by conditions other than pregnancy

Probable signs of pregnancy

Signs of pregnancy objectively observed by a health care provider

Positive signs of pregnancy

Positive signs that verify that a pregnancy exists. (Ultrasound)

Softening of the uterine isthmus (6-12 weeks)

Hegar sign:

Bluish or cyanotic color of cervix and upper vagina (6-8 weeks)

Chadwick sign:

Softening of cervix (5 weeks)

Goodwell sign:

• A 50% increase in glomerular filtration rate occurs related to the influences of estrogen and progesterone.

• Ureters increase in diameter by 25% secondary to progesterone influence.

• Urinary output increases by approximately 80% related to the total body water increase.

• Bladder capacity increases to approximately 1500 mL to accommodate extra fluids.

Adaptive changes in reproducive system: [4]

Cardiac output increases by up to 50% to meet the demands of pregnancy.

• Total blood volume increases by up to 45% during pregnancy. Physiological anemia of pregnancy may result because of a greater increase in the volume of plasma compared with the volume of red blood cells.

• Heart rate increases by 10 beats per minute to compensate for the increase in blood volume.

Adaptive changes in cardiovascular system: [3]

Tidal volume (volume of air inspired) increases by 30% to 40%, to increase the effectiveness of air exchange. Total oxygen consumption increases by approximately 20%.

• The diaphragm is displaced upward secondary to the enlarging uterus and causes shortness of breath during the last trimester.

Adaptive changes in respiratory system: [2]

The joints relax, especially the pelvic joints that support the pregnancy and create pliability at the time of birth.

• Lumbar and dorsal curves of the spine increase late in pregnancy and contribute to low back pain and the waddle of pregnancy.

• Separation of the symphysis pubis occurs secondary to the influence of the hormone relaxin.

Adaptive changes in musculoskeletal system: [3]

Hormonal changes and stretching of the connective tissue of the abdomen, attributable to an enlarging uterus, lead to stretch marks (striae gravidarum).

• A narrow, brownish line (linea nigra) divides the abdomen, running from the umbilicus to the symphysis pubis. The linea nigra fades after the pregnancy ends.

An increase in pigmentation caused by melanocyte-stimulating hormone causes darkened areas on the face, termed the mask of pregnancy (chloasma).

Adaptive changes in integumentary system: [3]

The enlarging and space-occupying uterus cramps the intestinal region, causing a slowing of peristalsis and an increase in the emptying time of the stomach.

• Relaxin causes a decrease in gastric motility, leading to constipation.

• Frequent “heartburn” results from reflux of stomach contents into the esophagus secondary to upward displacement of the stomach and a relaxed gastroesophageal sphincter

Adaptive changes in GI system [3]

Preconception care

Primary intervention that benefits reproductive-age women and their potential children

Prenatal care

Secondary prevention to improve the health of women during the pregnancy. By the time this care has started, a considerable amount of fetal development has already occured

Dilation stage—lasts from the onset of true labour contractions to complete dilation of the cervix. It is divided into three phases: latent (0–3 cm dilation); active (4–7 cm dilation); and transition (8–10 cm dilation).

• Pushing stage—lasts from complete dilation (10 cm) of the cervix to birth.

• Placental stage—lasts from the time of birth of the newborn to delivery of the placenta and membranes, which can range from 2 to 15 minutes.

Recovery stage: immediate postpartum - 2 hours after birth

Four stages of labour:

1. Blood work

2. immunizations

3. sti testing

4. diabetes screening

5. vital sign/urine test/ weight

6. Weight gain and nutrition

7. exercise

8. fetal heart

Prenatal screening to be done during 1st and 2nd trimester

1. Lamaze/prenatal class

2. Childbirth preparation

3. include partner

4. vital signs including urine and weight

5. GRP B strep (35-36 weeks)

Care during the end of 2nd trimester and beginning of 3rd

Latent phase

Early labour

• not feeling herself

• bloody show/ mucous plug

• regular contractions and braxton hicks contractions

• Discomfort/pain in lower back may (or not} radiate to lower adomen

Signs and symptoms of latent phase

1. Early

2. active

two phases of 1st stage of labour

1. tumors

2. UTIs

What can cause a false positive pregnancy test? [2]

Relaxin

Hormone designed for muscles to relax

TORCH infections

Infections the mother can come into contact with during pregnancy that can impact the fetus

T: Toxoplasmosis (comes from cat feces)

O: other (chickenpox, etc.)

R: MMR rubella (can cause deafness in fetus)

C: CMV cytomegalovirus

H: Herpes (can be transferred during birth)

TORCH infections: