NCLEX Maternity Review

Reproductive Organs

• Ovaries

• Fallopian tubes

• Uterus

• Cervix

• Vagina

Conception / Fertilization

Union of sperm and ovum

Condition needed for Fertilization

• Mature egg and sperm

• Timing

  • Lifetime of ovum is 24 hr.

  • Lifetime of sperm in female genital's tract is 72 hr.

  • Menstruation begins approximately 14 days after ovulation if conception has not occurred.

• Vaginal and cervical secretions

  • Less acidic during ovulation (sperm cannot survive in a highly acidic environment)

  • Thinner during ovulation (sperm can penetrate more easily)

Process of fertilization (7 to 10 days)

1. Ovulation occurs.

2. Ovum travels to fallopian tube.

3. Sperm travels to fallopian tube.

4. One sperm penetrates the ovum.

5. Zygote forms (i.e., fertilized egg).

6. Zygote migrates to uterus.

7. Zygote implants in uterine wall.

8. Progesterone and estrogen are secreted by the corpus luteum to maintain the lining of the uterus and prevent menstruation until the placenta starts producing these hormones (Progesterone is a thermogenic hormone that raises body temperature, an objective sign that ovulation has occurred.)

Placental development: Chronic Villi

• Secrete human chorionic gonadotropin (hCG), which stimulates production of estrogen and progesterone from the corpus luteum.

  • a) Production of hCG begins on the day of implantation and can be detected by day 6.

• Burrow into the endometrium, forming the placenta.

Placental development: Placental hormones

• hCG

• Human chorionic somatomammotropin (hCS):

  • Acts as growth hormone and insulin antagonist

• Estrogen and progesterone

• Fetal membranes develop and surround the fetus

  • Amnion: Inner membrane

  • Chorion: Outer membrane

Umbilical Cord

• Two arteries carry deoxygenated blood to the placenta.

• One vein carries oxygenated blood to the fetus.

• No pain receptors

• Encased in Wharton's jelly (thick substance that surrounds the umbilical cord and acts as a buffer, preventing pressure on the vein and arteries in the umbilical cord)

• Covered by chorionic membrane

Amniotic fluid

• Replaced every 3 hr

• 800 to 1,200 mL at end of pregnancy

• Functions

  • Temperature regulation

  • Protection

  • Promotes musculoskeletal development of the fetus

Pregnancy: Anatomy and Physiology

• Female

  • Hormones

  • Ovulation

  • Organs

• Male

  • Sperm

  • Vas deferens

  • Seminal fluid

• Fetal/Maternal Circulation

  • Fetal and maternal blood do not mix

Psychological and Physiological Adaptations of Pregnancy: 1st Trimester

• Ambivalence

  • Assess meaning of pregnancy to the client/partner and socioeconomic supports; refer if needed.

• Breasts: size, striae, tenderness

  • Teach fullness and sensitivity is hormone-related.

  • Instruct about supportive bra and that over-the counter products do not reduce stretch marks.

Psychological and Physiological Adaptations of Pregnancy: 2nd Trimester

• Accepting

  • Assess if ambivalence is increased and how the client views the fetus

• Skin

  • Striae, Linea Nigra, Chloasma

  • Discuss that commercial treatments are not useful; pigmentation usually disappears after pregnancy

  • Striae may fade.

Psychological and Physiological Adaptations of Pregnancy: 3rd Trimester

• Preparing for birth

  • Teach manifestations of onset of labor, newborn care, feeding methods, birth control, and home preparations for baby. Review birthing plan.

• Skin: striae, linea nigra, chloasma

  • Discuss that commercial treatments are not useful

  • Pigmentation usually disappears after pregnancy

  • Striae may fade.

Pregnancy Symptoms: Breasts - Colostrum

• During the 2nd and 3rd trimester

• Education

  • Expressed as early as 16 weeks.

  • Discuss breast care: pads

  • Nipple care: keep dry.

Pregnancy Symptoms: Respiratory - Dyspnea

• Occurs during the 2nd and 3rd trimester

• Education

  • Sleep propped or sitting up.

  • Lightening (fetus begins

    descent into pelvis) between 38 to 40 weeks;

• Can breathe easier.

Pregnancy Symptoms: Cardiovascular - Faintness and Syncope

• Occurs during the 2nd trimester

• Education

  • Encourage moderate exercise

  • Deep breathing

  • Sidelying position

  • Avoid sudden changes in position.

Pregnancy Symptoms: Cardiovascular - Varicose Veins

• Occurs during the 2nd and 3rd trimester

• Education

  • Assess activity:

  • Sitting/standing

  • Constrictive clothing

  • Crossing legs

  • Teach leg elevation

  • Position changes

  • Support hose

  • Exercise

Pregnancy Symptoms: Gl: Nausea/Vomiting

• Occurs during the 1st trimester

• Education

  • Dry crackers

  • Five to six small meals

  • Ginger

  • Raspberry

  • Avoid fried, odorous, spicy foods and foods with strong smells.

  • Assess weight, urine output (UO), and signs of hyperemesis.

  • Call OB

    • Cannot eat/drink for more than 24 hr

    • Urine becomes scant and dark

    • Heart pounds

    • Patient becomes dizzy.

Pregnancy Symptoms: GI - Constipation

• Occurs during the 2nd and 3rd trimester

• Education

  • Teach about activity, fluids, fiber.

Pregnancy Symptoms: GI - Heartburn

• Occurs during the 2nd and 3rd trimester

• Education

  • Encourage small meals

  • sit upright for 30 min or more after eating

  • Avoid spicy, fatty foods

  • Drink hot herbal tea.

Pregnancy Symptoms: GU - Frequency

• Occurs during the 1st and 3rd trimester

• Assess for urinary tract infection (UTI).

• Education

  • Frequent voiding

  • Do not decrease fluids.

  • Urinate after intercourse.

  • Kegel exercises.

• Call provider

  • dysuria, cloudy or foul-smelling urine

  • flank pain.

Pregnancy Symptoms: GU - Leukorrhea

• thick or thin, white-to-yellowish vaginal

• Occurs during the 2nd and 3rd trimester

• Education

  • Teach this is normal

  • Do not douche

  • Maintain good hygiene

  • Wear perineal pads

• Call OB

  • if accompanied by pruritus, foul odor, or change in character.

Pregnancy Symptoms: GU - Braxton Hicks

• Occurs during the 2nd and 3rd trimester

• Education

  • Teach difference between Braxton Hicks and true labor. (See table on false vs. true labor in this unit.)

Nutrition: 1st, 2nd & 3rd trimester

• Assess/teach weight gain patterns

• Average weight gain 25 to 35 lb

• Caloric increase 300 to 400 kcal/day

• Protein increase by 25 g/day

• Iron intake 30 mg/day

• Folate intake 600 mcg/day

• Prenatal vitamins

• Limit caffeine intake.

Probable: Objective signs of Pregnancy

• Cervical changes

• Hegar's sign:

  • Softening and compressibility of lower uterus

• Chadwick's sign

  • Deepened violet-bluish color of vaginal mucosa

• secondary to increased vascularity of the area

• Goodell's sign:

  • Softening of cervical tip

• Ballottement: rebound of unengaged fetus

• Braxton Hicks contractions

  • False contractions, painless, irregular, and usually relieved by walking

• Positive pregnancy test

Calculating Delivery Date: Nägele's Rule

Subtract 3 months and add 7 days to the first day of the last menstrual period.

Calculating Delivery Date: McDonald's Rule

• Measure uterine fundal height in centimeters from the symphysis pubis to the top of the uterine fundus

• Between 18 and 32 weeks of gestation the fundal height measurement should approximate gestational age.

Non-stress test (NST)

• Most widely used test for evaluating fetal well-being

• Noninvasive

• Monitors response of the fetal heart rate (FHR) to fetal movement

Non-stress test (NST): Indications for use

• Assess for fetal well-being and an intact CNS during the third trimester.

• Assess fetus of clients with high-risk pregnancies

  • Maternal diabetes mellitus

  • Hypertension

  • Heart Disease

  • IUGR

  • Postdates

  • History of Previous Stillbirth

  • Decreased fetal movement

Non-stress test (NST): Normal Finding

• Reactive

  • Two or more fetal heart rate accelerations (increase in FHR of at least 15/min above the baseline and last 15 seconds) within a 20-min period.

  • Before 32 weeks gestation, acceleration is defined as increase of at least 10 beats/min lasting at least 10 seconds in FHR.

Non-stress test (NST): Abnormal Finding