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
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
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
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
Second trimester - Accepting the baby – often coincides with quickening, increasing excitement, fantasizes about being a mother
Third trimester - Preparing for the baby and end of pregnancy- nesting, wanting pregnancy to be over
4 major developmental tasks of pregnancy (rubin)
Ensuring safe passage through pregnancy, labour and birth
Seeking acceptance of baby by others
Binding in - Seeking commitment & acceptance of herself as mother to the infant
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.
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