Fetal Development, Adaption to Pregnancy, Prenatal Care

Presumptive signs of pregnancy

Makes client think they might be pregnant

- Nausea, vomiting, fatigue, missed period

Probable signs of pregnancy

Makes examiner suspect client is pregnant

- Positive pregnancy test

- Goodell sign: soft cervix, increased vascularity

- Chadwick sign: voilet-blue vaginal mucosa and cervix

- Hegar sign: softening of lower uterine segment

Positive signs of pregnancy

Signs only explained by pregnancy

- Fetal heart sounds, visualizing fetus, fetal movement palpated by examiner

Uterus adaptations

high levels of estrogen and progesterone stimulate growth in 1st trimester

- May show by 14 weeks

- After 3rd month, growth is result of pressure of growing fetus

Cardiovascular adaptations

- Slight cardiac enlargement due to increased blood volume and CO

- pulse increase 10-15 bpm between 14-20 wks

- Arterial BP highest when sitting, lowest when lying left lateral

- Diastolic BP decreased in 1st and 2nd trimester, then gradually increase

- Blood volume increase 40-50%

- RBCs increase 20-30% (less proportionally to plasma)

- Increased clotting factors

Cardiovascular discomforts

- Varicose veins and LE edema: elevate legs, support hose, no leg crossing

- Supine hypotension: left lateral or semi-sitting position

- Faintness: avoid sudden position change and hypoglycemia, compression hose

Respiratory adaptations

- Rib cage relaxes for chest expansion

- Diaphragm displaces as much as 4cm

- Increased oxygen consumption due to uterine-placental-fetal unit

Respiratory discomforts

- Gingivitis, nasal stuffiness, nosebleeds: brush teeth gently, humidifier, saline nose drops

- SOB and dyspnea: good posture, small meals, no smoking

Renal adaptations

- Muscle relaxation and dilated ureters

- Increased UTI risk and urinary frequency

- Side lying position increases renal perfusion, which increases urine output and decreases edema

- Glycosuria

- Proteinuria during labor or after birth

Renal discomforts

- Urgency and frequency: pee often, kegels, pad, limit fluid before bed

- UTI: wipe front to back, pee after sex

Integumentary adaptations

- Hyperpigmentation (nipple, areolae, vulva)

- Melasma

- Linea nigra

- Striae gravidum

Melasma

hyperpigmentation of cheeks, nose, and forehead

Linea nigra

pigmented line on stomach's midline

Striae gravidum

stretch marks

Musculoskeletal adaptations

- As abdomen grows, center of gravity shifts

- Increased lumbosacral curve

- Increased mobility of pelvic joints

- Rectus abdominis muscles may seperate

Musculoskeletal discomforts

- Round ligament pain (sharp stabbing pain in upper leg/lower abdomen): rest and good posture

- Joint pain and backache: good posture and low heels

- Leg cramps: dorsiflex foot

Neurologic adaptations

- Compression of pelvic nerves --> sensory leg changes

- Carpal tunnel

- Hypocalcemia causing muscle cramps

GI adaptations

- Constipation due to increased progesterone causing smooth muscle relaxation and decreased peristalsis

- Pica

- Heartburn from decreased smooth muscle tone and motility

GI discomforts

- Nausea and vomiting: dry crackers or toast 30 min before rising in morning, avoid empty stomach, fluid between meals

- Constipation: Fiber and water, exercise, apples

- Heartburn: small frequent meals, sit up for 30 min after meals

Visit schedule

Monthly until 7 months

Every 2 weeks until 36 weeks, then weekly

Gravida

women who is pregnant

Parity

number of pregnancies in which fetus reached 20 weeks gestation

Gravidity

all pregnancies including current one

Term

pregnancies reached 38 weeks

Preterm

babies born <36 weeks

Abortion

miscarriage or planned abortion

Living

assume all mentioned pregnancies are living unless told otherwise

GTPAL

Gravida, Term, Preterm, Abortions, Living

Nagele's rule

Determine first day of last period

- Subtract 3 months

- add 7 days and 1 year

Fundal height

height of the fundus from the top of the symphysis pubis to the highest point at the top of the uterus; used to estimate the size of the fetus between 18 and 32 weeks

Initial visit

Comprehensive health history

- Current and previous pregnancy

- Family history

- Psychosocial profile

- Physical assessment including pelvic exam and pap smear

- Diagnostic testing (H&H, blood type, rubella, HIV, urinalysis and culture, RPR/VDRL (syphilis test), folate, CF screen, sickle cell

- Risk assessment

Follow-up visits

Physical exam, fetal assessment, follow up labs.

Routine lab: clean-catch urine

11-14 weeks: screen for chromosomal abnormalities

18-24 weeks: ultrasound for fetal anatomy

35-37 weeks: group B strep test

Weight gain

25-35 pounds

Underweight: 28-40 lbs

Overweight: 15-25 lbs

Nutrition needs

- extra 340 cal/day during 2nd trimester

- extra 450 cal/day during 3rd trimester

- Protein

- Iron

- Calcium

- Folic acid

- Fluid

Ovum or preembryonic stage

conception to 14 days

embryo stage

day 14 to 8 weeks

- most crucial time of development

- ectoderm, mesoderm, endoderm

fetus stage

9 weeks to birth

chorion

fetal side of placenta

amnion

covering umbilical cord and chorion of fetal surface of placenta

amniotic fluid

initially diffuse from maternal blood, then fluid secreted by fetus

- Increased weekly

- 700-1000mL at term

- Functions: filtering waste through placenta, testable fluid, temp, symmetrical growth

Cardiac - 3rd week

heart starts beating

Umbilical cord - 5th week

connecting stalk becomes compressed from both sides and forms umbilical cord

umbilical cord structure

2 arteries and 1 vein

Circulatory - 4th and 5th week

four chambers form

Respiratory - 4-17th week

development of respiratory tract

Respiratory - 32 weeks

Alveolar cells secrete surfactant

Lecithin/sphingomyelin (L/S) ratio

2:1 ratio indicates fetal lung maturity

GI - 5th month

fetus begins swallowing amniotic fluid

GI - 36 weeks

GI system mature

Renal - 5th week

kidneys form

Renal - 9th week

kidneys begin to function

Neuro - 5th week

forebrain, midbrain, and hindbrain form

Neuro - 8th week

Brainwaves and nerve fibers run throughout body

Neuro - 24th week

all hearing loss is permanent

Neuro - 5th month

able to distinguish taste

Neuro - 20th week

insulin produced