Uncomplicated/Healthy Pregnancy

Human chorionic gonadotropin (hCG)

Basis for pregnancy testing and is produced by the corpus luteum. HCG rises quickly very early in pregnancy until placenta function takes over.

Progesterone

Establishes placenta, maintains health of uterine wall, supports blood vessel growth, prevents uterine contractions.

Estrogen

Promotes blood vessel growth, maintains uterine lining, and aids in fetal organ development.

Prolactin

Stimulates breast growth and breastmilk production.

Relaxin

Promotes uterine relaxation, cervical softening, and maternal vasodilation.

Oxytocin

Stimulates uterine contractions and the release of prostaglandin.

Increase in Cardiovascular & Hematologic

maternal blood volume, maternal heart rate, clotting factor, venous pressure in lower extremities

decreases in cardiovascular & hematologic

peripheral vascular resistances - blood pressure

hematocrit values - blood viscosity leads to hematocrit leads to blood thickness

musculoskeletal system

the gravid uterus increases in size the center of gravity shifts forward which causes the body to compensate with lumbar lordosis and anterior pelvic tilt

Diastasis recti

where the abdominal muscles become separated due to abdominal wall weakness, resulting in widening and thinning of the linea alba, and a bulging area in the abdomen

Striae gravidarum

is one of the most common integumentary changes in pregnancy, as the skin stretches to accommodate the growing uterus.

Linea nigra

running vertically down the midline of the abdomen is an expected finding

Melasma

appears on the face and can span across the bridge of the nose to the cheeks or onto the forehead and chin

Respiratory System

Increased maternal and fetal oxygen demand results in increased maternal respiratory rate

Gastrointestinal System

Delayed gastric emptying

Genitourinary System

Urinary frequency and nocturia are common due to hormones early in pregnancy and due to fetus lying on bladder later in pregnancy

Presumptive Signs

Felt or experiences by client

ex. amenorrhea, breast tenderness, nausea, fatigue, POSITIVE PREGNACY TEST

Probable Signs

Detected by provider

Lab results, such as a positive serum hCG pregnancy test.

Ballottement

The gloved finger of the provider pushes upward on the cervix, pushing the fetus upward in the uterus, then the fetus returns back down to the cervix and the provider feels the movement of the fetus.

Chadwick’s sign

A blue discoloration of the cervix, vagina, and vulva due to increased vascularity.

Goodell’s sign

Cervical softening that occurs in pregnancy.

Hegar’s sign

Softening of the lower portion of the uterus.

Positive Signs

Associated with the Fetus

visualization of the fetus and fetal heart activity on an ultrasound

LOOK, LISTEN, AND FEEL

Estimated Date of Birth (EDB) Calculation

take the first day of the last menstrual period (LMP), subtract three months and add seven days

fundal height

measured several times between 20-36 weeks

Substance Use

Ask direct questions about the use of substances in a nonjudgmental approach using therapeutic communication

Sexually Transmitted Infection (STI)

Gather accurate and thorough sexual history including sexual practices and any risky sexual behaviors

Partner Violence

Economic, physical, social, and emotional changes during pregnancy place the client at increased risk for partner violence

Mental Health History

Depression in pregnancy increases the risk of preterm birthing, low birth weight, and increased hospitalization duration.

First Prenatal Visit

Physical Examination

Laboratory Tests - Prenatal Panel , Urine Culture, Rh Factor Screening (Rh- factor)

Diagnostic Screening - Ultrasound, Chorionic villus sampling (CVS)

Pregnancy Education: 1st Trimester

Weight Gain & Nutrition, Nausea, Vomiting & Heartburn, Mental Health, Exercise, Sleep , Pets avoid changing litter boxes due to toxoplasmosis, Sexual Intercourse, Travel in the first trimester is acceptable, Vaccinations

Weight gain & Nutrition:

Remain nonjudgmental and use unbiased language to encourage a positive nurse-client relationship

Nausea, Vomiting & Heartburn:

Common term used to describe manifestations is “morning sickness." Manifestations usually begin early in pregnancy and subside at around 14 weeks of gestation

BRATT

bananas, rice, applesauce, toast, tea, ginger supplements

Exercise

Mild to moderate exercise three times per week is recommended and customizable based on the regular exercise performed by the client prior to pregnancy

Pets

Cats can be a source of toxoplasmosis is a serious infection that, if contracted by a client who is pregnant, can be passed on to the fetus, leading to complications later in life, such as cognitive disabilities or blindness.

Travel & Vaccinations

Travel in the first trimester is acceptable in uncomplicated pregnancies.

Vaccinations

NO LIVE VACCINES SUCH as LIVE FLU OR RUBELLA

What is Rh incompatibility?

The client’s body produces antibodies against and begins attacking Rh-positive fetal blood, treating it as an invader similar to a viral or bacterial infection

How does Rh incompatibility impact the mother and fetus?

It can cause fetal anomalies.

Describe the treatment for Rh incompatibility?

Intramuscular administration of RhoD immune globulin (RhIG) (Rhogam) is given at approximately 28 weeks to prevent sensitization

delivers an Rh-positive neonate, Rhogam will be administered within 72 hours of birth

Rh incompatibility occurs when an Rh-negative mother carries an Rh-positive baby, causing

immune system to produce antibodies that attack the baby's red blood cells, leading to anemia, jaundice, and severe complications like organ failure (hydrops fetalis) or brain damage (kernicterus) in the newborn

Pregnancy Care: 2nd Trimester Begins when?

14 weeks

Prenatal Visits 2nd Trimester

Every four weeks

Ensure pregnancy is progressing

Identify any possible complication

Physical Examination 2nd Trimester

Client weight, Client blood pressure & Urine sample, Fundal height and, Fetal heart rate.

Laboratory Testing 2nd Trimester

Maternal serum screening, Glucose Challenge, Clients who have a negative Rh factor and who have not been Rh-sensitized

Diagnostic Testing 2nd Trimester

Ultrasound

Amniocentesis screens amniotic fluid, assessing for proteins that could indicate chromosomal or genetic concerns, such as Down syndrome or cystic fibrosis

Body Changes & Discomfort 2nd Trimester

reduced nausea vomiting -> increased appetite

Increased weight gain

increased heart burn

difficulty sleeping, constipation, urinary frequency and edema, stretch marks forming on their abdomen, legs, or breasts

maybe some edema

Fetal Movement 2nd trimester

quickening - fetal movement

Birth & Newborn Care 2nd trimester

hospital or birthing center tour, choosing a newborn provider, birth experience.

Classes topics may include birth, breastfeeding and newborn care

Travel

ideal time to travel is between 14 to 28 weeks gestation due to increased energy and decreased nausea and vomiting.

Traveling longer than 4 hr. more than doubles the risk of DVTs, so full length or knee length compression socks may be worn

Braxton Hicks contractions

sometimes are called ‘false labor’ and are actually ‘practice’ contractions.

True labor contractions

increase in duration, frequency and intensity and dilates the cervix

Pregnancy Care: 3rd Trimester

Prenatal Care every 2-4 weeks until 36 weeks then weekly, physical Examination, Laboratory Testing, Post term Pregnancy-beyond 42 weeks

Laboratory Testing 3rd trimester

Group B streptococcus

Postterm Pregnancy 3rd trimester

any pregnancy extending beyond 42 weeks

Higher risk for complications such as placental insufficiency, oligohydramnios, and birth injury.

Pregnancy Care 3rd TrimesterPregnancy Education

Body Changes and Discomfort, Fetal Movement

Travel and Vaccines, Sexual Activity, Differentiate between labor and Braxton Hicks

Body Changes and Discomfort 3rd trimester

Hemorrhoids

Physiological Edema

Review of warning manifestation of preterm labor, preeclampsia, Deep Vein Thrombosis (DVT)

Fetal Movement 3rd trimester

Kick Counts:

Clients encouraged to monitor fetal movement and patterns

Done over 2 to 3 hr.

If the client feels less than 10 movements during the time frame, they are instructed to notify their health care provider

Travel and Vaccines

international travel may be restricted after 36 weeks

Vaccines not previously given before or during earlier pregnancy such as hepatitis B, influenza, and Tdap vaccines should be given

Manifestations of Labor

increasingly strong, regular uterine contractions, which may be accompanied by amniotic fluid leaking from the vagina and vaginal bleeding.

Report to provider, noting fluid leaking, the color and amount

Pregnancy Education: 3rd TrimesterPreparing for Birth & Newborn Care

Birth Plan & During Labor Process

Preparing for Birth & Newborn Care - Birth Plan

preference for pain management, IV fluids, support people during the birth, umbilical cord blood storage, and episiotomy

Preparing for Birth & Newborn Care - Alternative Plan

Ensure the client is aware that the birth plan may be altered based on the events during the labor and birth process to ensure the safety of both the client and the newborn. Cesarean Birth – may be planned

Preparing for Birth & Newborn Care - Neonatal care

including feeding method, use of a pacifier, rooming-in or nursery usage, and circumcision for male infants

During Labor

Use and choose of labor assistive devices

Environment

Plan on who is to cut the umbilical cord, whether pictures or videos will be taken of the birth.

Engaging in skin-to-skin contact

Feeding preferences