2. Maternal & Newborn: Antepartum Assessment & Discomforts of pregnancy

Obstetric History: Trimester Length

1. Gestation is the length of pregnancy, which is

generally 40 weeks from the last menstrual period

(LMP), divided into trimesters.

-First trimester: 1-13 weeks

-Second trimester: 14-26 weeks

-Third trimester: 27-40 weeks

Obstetric History: Estimated date of delivery (EDD)

1. (EDD) can be calculated based on the first day of the woman's LMP using Naegele rule.

**NAEGELE RULE = 1st day of LMP - 3 months + 7 days + 1 year

-For LMP February 15, 2024:

1. Subtract 3 months- November 15, 2023

2. Add 7 days - November 22, 2023

3. Add 1 year - EDD = November 22, 2024

Obstetric History: GRAVIDITY & PARITY

**Gravidity (G) = number of pregnancies.

-Nulligravida: Never pregnant

-Primigravida: First pregnancy

-Multigravida: ≥ 2 past pregnancies

Parity (P) = Number of births at ≥ 20 weeks

-Nullipara: No births ≥ 20 weeks

-Primipara: First birth ≥ 20 weeks

-Multipara: ≥ 2 births ≥ 20 weeks

**"GTPAL" provides a detailed obstetric history in

which parity (P) is broken down as "TPAL" (Term,

Preterm, Abortion, Living)

GTPAL

1. Gravity: Total pregnancies, including the current one

2. Term: births at > 37 weeks

3. Preterm: births between 20 & 36 completed weeks

4. Abortion (miscarriage): pregnancies ending

NCLEX STAR POINTS: GTPAL

Obstetric history is recorded as Gravidity (total pregnancies including current), Term births (≥ 37 weeks), Preterm births (20-36 completed weeks), Abortions (spontaneous or elective < 20 weeks), and Living children.

TYPES OF SIGNS OF PREGNANCY

1. Presumptive ("might be pregnant")

2. Probable ("probably pregnant")

3. Positive ("definitely pregnant")

Signs of Pregnancy: Presumptive

1. Presumptive signs are subjective signs felt by the

mother and are not definitive.

**Missed period

-Nausea, vomiting

-Breast tenderness

**Quickening: First fetal movement, usually felt

around 16-20 weeks

Signs of Pregnancy: Probable

1. Probable signs are objective findings observed by the HCP but could still be false positives.

**Positive pregnancy test (urine or serum)

-Goodell sign: Softening of the cervix

-Chadwick sign: Bluish coloration of the cervix

and vagina

-Hegar sign: Softening of the lower uterine segment

Signs of Pregnancy: Positive Signs

1. Positive signs are definitive indicators of pregnancy.

**Fetal heartbeat heard by auscultation or doppler

**Fetus visualized on ultrasound

-Fetal movement palpated by HCP

Adaptations to Pregnancy

1. Hormonal changes help the body adapt to support

INCREASE metabolic demands and fetal growth and prepare for childbirth.

2. Estrogen INCREASE vascularity and blood flow to promote uterine growth and nutrient supply.

3. Progesterone relaxes smooth muscles to prevent

uterine contractions and slow digestion for INCREASE nutrient absorption.

adaptations to pregnancy: cardiovascular system

**Blood volume INCREASE by 30-45% -> INCREASE cardiac output.

**Physiologic anemia (from dilution)

- INCREASE HR of 15-20 beats/min

- Systolic murmur from INCREASE intravascular volume

** INRCEASE clotting factors: Protects mother from excessive bleeding during childbirth, but INCREASE risk for blood clots (hypercoagulability)

adaptations to pregnancy: SUPINE HYPOTENSION

1. After the first trimester, lying supine causes the

gravid uterus to compress the inferior vena cava

and aorta -> DECREASE perfusion and BP.

**Teach client to not lie flat (supine).

-Encourage side-lying position (preferably left)

to INCREASE circulation.

adaptations to pregnancy: RESPIRATORY

- Slight INCREASE in RR

**Dyspnea in later trimesters as uterine enlargement

causes upward pressure on the diaphragm

adaptations to pregnancy: RENAL

- INCREASE glomerular filtration rate (GFR) from INCREASE blood flow to the kidneys.

**Urinary frequency from INCREASE blood volume in first trimester and INCREASE pressure on the bladder in the third trimester.

-Urinary incontinence is common.

adaptations to pregnancy: GI

DECREASE intestinal motility ->Constipation, heartburn, nausea, and vomiting

NCLEX STAR POINT: SUPINE HYPOTENSION

To prevent supine hypotension, teach clients to never lie flat on their back after the first trimester.

NCLEX STAR POINTS: FUNDAL HEIGHT AND COMPLICATIONS

Fundal height indicates gestational age and fetal growth. In the second trimester, fundal height should align with gestational age (+/- 2 weeks). If the measurement differs by more than 2 cm from the expected gestational age, assess for abnormalities, like fetal macrosomia or intrauterine

growth restriction.

Discomforts of Pregnancy & Teaching: FIRST TRIMESTER

1.Avoid an empty or overly full stomach.

**Suggest eating crackers or toast upon

waking to prevent nausea from sudden blood

sugar drops.

**Encourage small, frequent meals.

**Drink fluids separately from meals.

**Severe, persistent nausea and vomiting

(hyperemesis gravidarum) can cause dehydration

and electrolyte imbalances. **Notify HCP if unable to keep fluids or food down.

2. FATIGUE- **Encourage rest and naps as needed.

3. URINARY FREQUENCY: **Report painful urination, which can indicate UTI.

Discomforts of Pregnancy & Teaching: SECOND TRIMESTER

1. Dependent, non-pitting edema in lower

extremities

**Notify HCP of suddenin edema as it could

indicate preeclampsia.

**Elevate legs when sitting and avoid

prolonged standing.

-Wear compression stockings to promote

venous return.

Discomforts of Pregnancy & Teaching: THIRD TRIMESTER

**Encourage small, frequent meals.

**Instruct client to avoid lying down immediately

after eating (wait at least 1-2 hours).

** Avoid trigger foods (caffeine, spicy or fatty

foods, citrus).

CONSTIPIATION & HEMORRHOIDS: ** Encourage high-fiber foods (fruits, vegetables) and adequate fluid intake.

NCLEX STAR POINTS: MORNING SICKNESS

Small, frequent meals; ginger; and plain crackers can relieve nausea. Persistent vomiting (hyperemesis gravidarum) requires medical attention due to the risk for dehydration and electrolyte imbalances.

ADDITIONAL PREGNANCY TRACHING: NUTRITION

**Folic acid: Crucial for neural tube development

**Take prenatal vitamins daily.

-Encourage leafy greens, fortified cereals,

and legumes.

**Harmful foods

-Alcohol: Completely avoid, as it can cause fetal

alcohol syndrome

-Certain fish: Limit fish high in mercury (e.g.,

swordfish, tuna) Safe options include cooked salmon

and shrimp.

-Undercooked or raw foods: Avoid undercooked

steaks, sushi, and runny eggs.

-Unpasteurized foods: Avoid unpasteurized milk,

cheeses, and deli meats to reduce the risk of

foodborne illness. Lunch meats are safe to eat only if

microwaved first.

ADDITIONAL PREGNANCY TRACHING: WEIGHT GAIN PER BMI

1. First-trimester weight gain Expected weight gain during the first trimester is typically 1-4 lb (1-2 kg).

Clients' pre-pregnancy BMI determines goal for

healthy overall weight gain. healthy overall weight gain.

Normal BMI: 25-35 lb (11.5-16 kg)

Underweight: 28-40 lb (12.5-18 kg)

Overweight: 15-25 lb (7-11.5 kg)

NCLEX STAR POINTS: EXPECTED WEIGHT GAIN

Expected weight gain for clients with a normal BMI is 25-35 lb (11.5-16 kg), with a gain of 1-4 lb (0.5-1.8 kg) typically occurring in the first trimester.

NCLEX TOP 5 TARGETS: Obstetric history is recorded using GTPAL

notation. Gravidity is the total count of pregnancies, including the current one. Term is the number of births ≥ _____ weeks. Preterm is

the number of births between _____ and _____ completed weeks. Abortion is the number of pregnancies that ended <_____ weeks.

37; 20-36; 20

NCLEX TOP 5 TARGETS: To prevent supine hypotension, teach clients to never lie ____ after the _____ trimester.

flat, first

NCLEX TOP 5 TARGETS: Fundal height equals the approximate _____

beginning in the second trimester. Name some abnormalities that could cause fundal height to not align with gestational age.

gestational age; Fetal macrosomia, intrauterine growth restriction

NCLEX TOP 5 TARGETS: What are some ways to relieve nausea in

pregnancy? Persistent vomiting (hyperemesis gravidarum) requires medical attention due to the risk for _____ and _____ imbalances.

Eat crackers before rising; eat small, frequent meals; ginger; drink fluids separately; avoid triggers (strong odors, greasy, spicy foods); dehydration and electrolyte imbalances

NCLEX TOP 5 TARGETS: Expected weight gain for clients with a normal pre-pregnancy BMI is _____ lb (kg), with a typical gain of _____ lb (kg) during the first trimester.

25-35 lb (11.5-16 kg), 1-4 lb (1-2 kg)