Preconception / Prenatal (Class 3 & 4)

pregnancy is _____ days

280

pregnancy is 3 trimesters consisting of ____ weeks each

13

pregnancy is ____ weeks from first day of LMP

40

Gravida

woman who is pregnant

Gravidity

pregnancy (e.g.,Gravida 3)

Parity

\# of pregnancies in which fetus(es) has reached 20 weeks gestation, not the number of fetuses born (e.g. Para 2). **Multiple fetuses only count as one pregnancy! Whether the fetus is born alive or stillborn does not affect parity.**

**Nulligravida**

woman who has never been pregnant

nullipara

woman who has not completed a pregnancy with a fetus or fetuses beyond 20 weeks of gestation

Primigravida

woman who is pregnant for the first time

primipara

woman who has completed one pregnancy with a fetus or fetuses who have reached 20 weeks of gestation

multigravida

woman who has had two or more pregnancies

multipara

woman who has completed two or more pregnancies to 20 weeks of

gestation or more

viability

capacity to live outside the uterus occurring about 22 to 25 weeks gestation

when does viability occur

22-25 weeks gestation

a pregnancy that is terminated less than 20 weeks gestation is considered an _________

abortion

post term

a pregnancy after 42 weeks

late term

a pregnancy in the 41st week

full term

39-40 weeks + 6 days

early term

37 weeks - 38 + 6 day \n

preterm

Infant is more than 20 weeks gestation to the completion of 36 weeks gestation (less than 37 weeks)

term

infant is 37 - 40 weeks plus 6 days gestation

GP

**G**  Gravidity

**P**  Parity

GTPAL

GGravidity

T  Term Births

P  Preterm Births

AAbortions

LLiving Children

health and preconception

D/C alcohol and drug use


D/C smoking


Reduce caffeine


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Check med use with Dr


Avoid radiation etc.


Physical exam


Dental check up


Good nutrition


Avgere weight for height


Exercise


D/C OCP & have 2-3 normal periods or remove IUD and wait a month
Don’t get over zealous

**Antepartum Care**

* Prenatal care from health professionals should be consistent throughout the pregnancy
* Nurses play a key role
* Barriers to receiving prenatal care must

be addressed

Initital anteoartum care

Diagnosis and Assessment involves:

• Pregnancy testing

* Thorough Health History and Physical
* Lab tests – CBC, infectious diseases, HIV, Hep B, VDRL, Immunization status


* Risk factors (psychosocial, economic,

nutrition, family related considerations)
* Education

pregnancy tests detects presence of __

human chroionic gonadotrophin (hCG)

Nageles rule

Add 7 days to first day of LMP and add 9 months

prenatal vistis schedule

Up to 28 weeks-Q4 weeks

28 to 36 weeks- Q 2 weeks

After 36 weeks - Q 1 week

**Follow up Antepartal Health Assessment**

• Vital signs, weight, FHR when audible

• Urine (leukocytes/ glucose/protein/ketones)

• Symphysis – fundal height

• Position of fetus

• Assessment of risk factors

• Discomforts of pregnancy

• Psychological adaptation to pregnancy

indicators of fetal well being / fetal assessment

**Fetal activity and well-being must also be checked throughout the pregnancy on a regular basis.**

**Fetal heart tones will be checked at every visit**

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**If fetal concerns are identified at any time, other indicators will be performed. They may include:**

* Fetal movement counting; 6 per 2 hours
* Non Stress test
* Biophysical profile using ultrasound: fetal breathing movements,

gross body movements, fetal tone, amniotic fluid volume, fetal heart

reactivity
* Uterine or umbilical artery Doppler: identify flow volume, resistance

to flow
* Contraction stress test

Ongoing assessment

Monitoring of pregnancy health involves: o U/S as recommended, \n o Glucose Tolerance Test, \n o Group B Strep (later in pregnancy)

o PV (vaginal) exam (late in pregnancy) o Leopold’s Maneuvers

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Other tests (Non – routine) – discussed later o Amniocentesis (if indicated) \n o Maternal Serum Screening (if requested) o Fetal well being screening (BPP/NST)

(if indicated)

fertilization and implantation

Spermfertilizesovum;zygoteimplantson

the uterine cavity wall

pre-embryonic development

Placenta, amnion and chorion begin to form

embryonic development is weeks *.____ to* _____

3-8

embryonic development

\-weeks 3-8

\-period of rapid organogenesis

Fetal development is weeks ___ to ____

9-38

fetal development

\-weeks 9-38

\-growth and maturation of organs and systems

\-CNS remains sensitive to teratogens

20 week fetus is ___ % of its final crown-heel length

50

between weeks 29-36, fetus gains ___ % of its birth weight

50

weeks *? to ? : physiologic processes develop to enhance neonates survival*

32-40

First trimester

up to 12 weeks

First trimester Milestones (fetal development up to 12 weeks)

•**Heart beats at a regular rhythm (5-7 weeks)** \n •**Lungs begin to form (6 weeks)** \n • **Fetal circulation established (6 weeks)** \n • **Arms and legs movable (7 weeks)** \n • **Resembles a human being (8 weeks)** \n • **Heart development COMPLETED! (8 weeks)** \n • **Sexual differentiation continues (9 - 12 weeks).** \n •**Fetal gender can be determined by week 12** \n • **Urine begins to be produced and excreted (9 -12 weeks)**

Fetal development:

When does the heart beat at a regular rhythm?

5-7 weeks

Fetal development:

when do lungs begin to form

6 weeks

Fetal development:

when is fetal circulation established

6 weeks

Fetal development:

when are the arms and legs moveable

7 weeks

Fetal development:

when does the fetus resemble a human being

8 weeks

Fetal development:

when is heart development completed?

8 weeks

Fetal development:

when can fetal gender be determined

week 12

Fetal development:

when does urine begin to be produced and excreted

9-12 weeks

first trimester screening

•Maternal serum screening for biochemical markers

•Ultrasonography to confirm pregnancy and gestational age, rule out ectopic pregnancy, detect multiple gestation \n •Non-invasive Prenatal Testing (Harmony)- 8-10 weeks \n •Chorionic Villus Sampling (CVS) -10-13 weeks \n •Ultrasound examination for nuchal translucency (11 -14 weeks )

fetal development during weeks 13-16

* A fine hair called lanugo develops on the head
*   Fetal skin is almost translucent
*   Bones become harder
*   Fetus makes active movements (quickening - 16 weeks)


*   Sucking motions are made with the mouth
*   Amniotic fluid is swallowed
*   Fingernails and toenails presen

When is quickening felt

16 weeks

Fetal development weeks 17-20

**-Rapid brain growth occurs** \n  -**Eyebrows and head hair appear** \n  -**Vernix begins to form** \n  -**Brown fat begins to be deposited** \n  -**Muscles are well developed** \n

fetal development weeks 25-28

**-Eyelids open and close (eyelids fused until week**

**23)** \n - **Fingerprints are set**

routine screening during second trimester

\-Ultrasound (18 -20 weeks) \n Routine screen for gestational age, fetal growth, fetal anatomy

\-Glucose Tolerance Test (24-28 weeks) Routine screen for gestational diabetes

non routine screening second trimester

\-Maternal serum alpha fetoprotein (15 – 22 weeks) \n screens for NTD and open abdominal wall defects

\-Amniocentesis \n (after 15 weeks – 38 weeks) Lung maturity, genetic d/o’s, congenital anomalies

\-Percutaneous umbilical blood sampling (after 16 - 18 weeks) Inherited blood disorders, infection, karyotyping

Amniocentesis

During amniocentesis, an ultrasound wand (transducer) is used to show a baby's position in the uterus on a monitor. A sample of amniotic fluid, which contains fetal cells and chemicals produced by the baby, is then taken for testing.

Chorionic villus sampling

Chorionic villus sampling (CVS), or chorionic villus biopsy, is a prenatal test that involves taking a sample of tissue from the placenta to test for chromosomal abnormalities and certain other genetic problems.

Percutaneous umbilical blood sampling

This quick test — also called cordocentesis, fetal blood sampling, or umbilical vein sampling — takes fetal blood directly from the umbilical cord. Doctors use it to check for disorders in the fetus.

fetal develop weeks 29-32

• Rapid increase in amount of body fat \n • Rhythmic breathing occurs \n • Lungs are not fully mature (32 weeks may have enough surfactant to be functional) \n • Fetus begins to store iron, calcium and phosphorus

fetal development weeks 33-38

• Testes descend into scrotum of males \n • Lanugo begins to disappear \n • Increase in body fat \n • Mother supplies fetus with antibodies against disease

third trimester screening

• Fetal movement counting – kick counts

• Non-stress test (NST)

• Contraction stress test

• Ultrasound – Biophysical profile, amniotic fluid volume, Doppler blood flow analysis

• Group B Strep (35 – 37 weeks)

Maternal, Cognitive & Emotional Reactions to Pregnancy

* First trimester-Accepting the pregnancy- ambivalence common, emotional lability, physical concerns

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* Second trimester - Accepting the baby – often coincides with quickening, increasing excitement, fantasizes about being a mother

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* Third trimester - Preparing for the baby and end of pregnancy- nesting, wanting pregnancy to be over

4 major developmental tasks of pregnancy (rubin)

1. Ensuring safe passage through pregnancy,
labour and birth
2. Seeking acceptance of baby by others
3. Binding in - Seeking commitment & acceptance of herself as mother to the infant
4. Giving of Oneself - Learning to give of
herself on behalf of her child

developmental task of pregnancy trimester 1 :

accepting the pregnancy

Developmental task of pregnancy :

Trimester 1:

Accepting the pregnancy.

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Maternal Emotional responses to pregnancy:


Ambivalence \n
Introspection \n
Acceptance


Mood swings


Change in body image

developmental task of pregnancy:

second trimester:

accepting the baby

Developmental task of pregnancy : Second Trimester: Accepting the baby:

• Pregnancy becomes real

• Positive signs of pregnancy felt

• Often coincides with quickening, increasing excitement, fantasizes about being a mother

developmental task of pregnancy: third trimester:

preparing for baby and end of pregnancy

Developmental task of pregnancy :

Third Trimester: Preparing for baby

and end of pregnancy

Physical discomforts increase

May want pregnancy to be over

Education regarding what to expect during childbirth

Nesting

couvade syndrome

\-AKA Sympathetic Pregnancy

\-Partner experiences similar symptoms and behavior as the expectant mother.

\- Ex.) weight gain, GI symptoms, Backache, fatigue