labor and delivery module 2 &3
Signs of Pregnancy
Presumptive:
Breast tenderness/enlargement, amenorrhea, urinary frequency, hyperpigmentation (mask of pregnancy), uterine enlargement, fetal movement (quickening)
Probable:
Braxton Hicks’s contractions, Goodell’s signs, positive pregnancy test, abdominal enlargement, Hegar sign, softening of the lower uterine segment
Positive:
HCP can see the baby via US or another radiological means, HCP can hear the fetal heart sounds using a doppler, US or fetoscope, HCP can FEEL the fetal outline and fetal movements
Prenatal Visits:
What are we looking for?
Medical overview: health history, immunizations, underlying cardiovascular, respiratory, endocrine conditions
Sexual Health: Use of contraceptives, STI/STD history, safe sex practice, body image concerns
Diet/Well-being: nutrition, lifestyle practices (work & recreational)
Mental & Emotional Health: psychosocial issues like stress, abuse/violence exposure
Substances/Meds: illicit drugs, alcohol, drugs, tobacco products, OTC meds, prescription meds
Social Surroundings: do they have a support system, family, friends, community
Assessment & Guidance:
Prenatal classes, education and assessment
Diabetes screening and management: family history of diabetes, over 25 with PCOS history, overweight pts
Diabetes during pregnancy can cause: spontaneous abortion, neonatal hypoglycemia, macrosomia, preeclampsia, fetal demise, hyperbilirubinemia
Insulin can be given because it does not cross the placenta
Frequency of prenatal visits:
Conception to 28 weeks:
Visits every 4 weeks
Screening for neural tube defects at 16 weeks
Gestational diabetes at 24-28 weeks
RhoGAM shot for Rh-negative mothers (think of ninin): routine at 28 weeks but is given after any episode of bleeding or invasive procedure that risks maternal/fetal blood mixing
29 to 36 weeks: Visit every 2 weeks
37 weeks to birth: Visit every week
Health Behaviors/Education for Moms:
Bathing, breast care, clothing, exercise, sleep and rest, sexual activity, nutrition, travel, exposure to teratogens, travel, immunizations, alternative therapies, tobacco, alcohol, street drugs, potential testing, kick counts (10 movements in 2 hours during 3rd trimester)
Danger signs when pregnant:
Vaginal bleeding
Severe unilateral lower abdomen pain
Painful urination
Cramping with lower backache and bleeding
No fetal movement
Severe headache with vision change or dizziness
Rapid weight gain
Severe leg pain
First trimester
Psychological responses:
Uncertainty
Ambivalence
Focus on self
Changes in sexuality
Changes in body systems:
Amenorrhea (GU): the progesterone and estrogen maintain the uterine lining, considerations for diagnosis include age and exposure
Urinary frequency (GU): causes include hormonal shifts, fluid volume changes, uterine growth which causes pressure on the bladder due to limited space in the true pelvis. CHECK URINE AND ENSURE HYDRATION.
Nausea and vomiting (GI): triggered by increased hormones and decreased gastric motility. Can be managed by frequent dry meals, consuming crackers, avoiding strong odors, using ginger as a remedy, medication is last resort, and be cautious of teratogens (medications, drugs, chemicals, MMR, varicella and other live vaccines. ONLY acceptable are TDAP, flu and covid)
Breast and skin changes (MS): hormonal causes- elevated estrogen, melanocyte-stimulating hormone and progesterone. Use a supportive bra and apply lotion for itching.
Fatigue, headache (neuro): Hormonal shifts and body adjustments. Ensure rest and relaxation, engage in mild exercise, report any severe or unrelenting fatigue, avoid over-the-counter medications WITHOUT HCP approval.
Vaginal, vulvar and cervical color changes and discharge (GU): Increased vascularity of pelvic organs. Wear a pad and change it frequently, report any itching, odor or other concerns.
Cervical changes are triggered by progesterone - it causes thick mucus plug to stop the invasion of bacteria.
Chorionic Villus Sampling (10-13 weeks)
Detects down syndrome, cystic fibrosis and fetal gender. THIS CAN BE THROUGH THE ABDOMEN - placental tissue is removed
Amniocentesis (15-20 weeks)
Through the amniotic sac - amniotic fluid is drawn
Surveillance and Interventions
Prenatal visits: Assess history, medications, lifestyle, risk factors, age
Doppler: Detect fetal heart rate at 10-12 weeks
Growth pattern: Regular measurements to track progress
Ultrasound: visual imaging of fetus and uterus
Laboratory Work: blood typing, CBC, HIV, Hep B, Rubella titer, Diabetes screening for high risk
Cervical examination: pap smear, STI screening
Nutritional Adjustments: dietary recommendations or corrections based on individual needs
Testing options: chorionic villus sampling, amniocentesis, genetic screenings
Embryo (week 3-week 8)
HIGH risk for teratogenic damage
High mortality rate
BY week 4: all organs are present in some form, heart starts beating at days 18-21, neural tube is closed by the end of week 4, heartbeat can be viewed by week 5.
By week 8, embryo becomes a fetus, all organ systems are present, some movement is observable
Second Trimester
Psychological responses
Physical evidence of pregnancy
Fetus is the primary focus
Narcissism and introversion: “the world revolves around me”
Body image concerns: “Do I look fat in these jeans?”
Changes in sexuality- increased interest.
Surveillance and Testing
Monthly visits include: weight gain check, BP monitoring, Urine tests for protein, BS and bacteria, bloodwork for Hgb, Hct and CBC, uterine growth measurements
Fetal Heart monitoring:
US detection by 5 weeks
Doppler deception by 9-12 weeks
Alpha-fetoprotein (12-14 weeks)
Blood draw for neural tube defects
Optimal time: 16-18 weeks
THIS IS SCREENING ONLY
Ultrasound
Monitors growth and progression
Identifies potential abnormalities
BPP (Biophysical profile)
Desired score 8/10
Diabetic Screening:
Recommended between 24-28 weeks
Additional tests if indicated:
Amniocentesis
Percutaneous umbilical cord sampling
Non-stress test (NST)
Administered 2x weekly after 28 weeks of gestation
Seeks an increase of 15 bpm for 15 seconds over a 20-minute period
Biophysical profile
Ultrasound checks for: fetal muscle tone, breathing movements, HR, amniotic fluid pockets, NST
Discomforts:
Backache: caused by uterus pulling forward the abdomen
Varicosities of the vulva and legs: results from growing uterus exerting pressure, slowing down venous return. This is more problematic for women who stand all day.
Hemorrhoids: due to uterine growth pressure combined with constipation
Flatulence with bloating: slowing the GI tract because of progesterone
Straie: stretch marks
Linea Nigra: dark line down the middle of the stomach
Fetal development: (weeks 14-28)
16 weeks: fetus is more active, measures 6 inches, external genitalia is more discernible, meconium is produced
18 weeks: mother can feel the fetus move (16-18 weeks), appearance of lanugo (soft hair that covers the fetus)
24 weeks: fetus measures about 12 inches, protective vernix forms on the skin, the fetus accumulates fat. The possibility of survival outside the uterus is more possible because the alveoli and capillaries support gas exchange
28 weeks: fetus is 15 inches, approx. 90% chance of survival if born, skin becomes thicker
Mom needs to lay on her side to prevent supine hypotension syndrome
Third Trimester
Psychological Responses
Vulnerability: feeling limited due to increased size and decreased mobility
Increasing dependence: Physical and Mental concerns: concerns about receiving adequate care during childbirth and in the immediate postpartum period, experiencing unusual or vivid dreams
Preparation for Birth: attending childbirth classes, engaging in nesting behaviors to ready the home for the baby
Changes in Sexuality: Intimacy may become uncomfortable, sex is still generally safe but is essential to discuss safe and suitable positions, partners may also have concerns and anxieties
Changes in Body systems:
Uterine changes: uterus becomes larger and its walls get thinner, changes in the cervix
GI (gastrointestinal
Signs of Pregnancy
Presumptive:
Breast tenderness/enlargement, amenorrhea, urinary frequency, hyperpigmentation (mask of pregnancy), uterine enlargement, fetal movement (quickening)
Probable:
Braxton Hicks’s contractions, Goodell’s signs, positive pregnancy test, abdominal enlargement, Hegar sign, softening of the lower uterine segment
Positive:
HCP can see the baby via US or another radiological means, HCP can hear the fetal heart sounds using a doppler, US or fetoscope, HCP can FEEL the fetal outline and fetal movements
Prenatal Visits:
What are we looking for?
Medical overview: health history, immunizations, underlying cardiovascular, respiratory, endocrine conditions
Sexual Health: Use of contraceptives, STI/STD history, safe sex practice, body image concerns
Diet/Well-being: nutrition, lifestyle practices (work & recreational)
Mental & Emotional Health: psychosocial issues like stress, abuse/violence exposure
Substances/Meds: illicit drugs, alcohol, drugs, tobacco products, OTC meds, prescription meds
Social Surroundings: do they have a support system, family, friends, community
Assessment & Guidance:
Prenatal classes, education and assessment
Diabetes screening and management: family history of diabetes, over 25 with PCOS history, overweight pts
Diabetes during pregnancy can cause: spontaneous abortion, neonatal hypoglycemia, macrosomia, preeclampsia, fetal demise, hyperbilirubinemia
Insulin can be given because it does not cross the placenta
Frequency of prenatal visits:
Conception to 28 weeks:
Visits every 4 weeks
Screening for neural tube defects at 16 weeks
Gestational diabetes at 24-28 weeks
RhoGAM shot for Rh-negative mothers (think of ninin): routine at 28 weeks but is given after any episode of bleeding or invasive procedure that risks maternal/fetal blood mixing
29 to 36 weeks: Visit every 2 weeks
37 weeks to birth: Visit every week
Health Behaviors/Education for Moms:
Bathing, breast care, clothing, exercise, sleep and rest, sexual activity, nutrition, travel, exposure to teratogens, travel, immunizations, alternative therapies, tobacco, alcohol, street drugs, potential testing, kick counts (10 movements in 2 hours during 3rd trimester)
Danger signs when pregnant:
Vaginal bleeding
Severe unilateral lower abdomen pain
Painful urination
Cramping with lower backache and bleeding
No fetal movement
Severe headache with vision change or dizziness
Rapid weight gain
Severe leg pain
First trimester
Psychological responses:
Uncertainty
Ambivalence
Focus on self
Changes in sexuality
Changes in body systems:
Amenorrhea (GU): the progesterone and estrogen maintain the uterine lining, considerations for diagnosis include age and exposure
Urinary frequency (GU): causes include hormonal shifts, fluid volume changes, uterine growth which causes pressure on the bladder due to limited space in the true pelvis. CHECK URINE AND ENSURE HYDRATION.
Nausea and vomiting (GI): triggered by increased hormones and decreased gastric motility. Can be managed by frequent dry meals, consuming crackers, avoiding strong odors, using ginger as a remedy, medication is last resort, and be cautious of teratogens (medications, drugs, chemicals, MMR, varicella and other live vaccines. ONLY acceptable are TDAP, flu and covid)
Breast and skin changes (MS): hormonal causes- elevated estrogen, melanocyte-stimulating hormone and progesterone. Use a supportive bra and apply lotion for itching.
Fatigue, headache (neuro): Hormonal shifts and body adjustments. Ensure rest and relaxation, engage in mild exercise, report any severe or unrelenting fatigue, avoid over-the-counter medications WITHOUT HCP approval.
Vaginal, vulvar and cervical color changes and discharge (GU): Increased vascularity of pelvic organs. Wear a pad and change it frequently, report any itching, odor or other concerns.
Cervical changes are triggered by progesterone - it causes thick mucus plug to stop the invasion of bacteria.
Chorionic Villus Sampling (10-13 weeks)
Detects down syndrome, cystic fibrosis and fetal gender. THIS CAN BE THROUGH THE ABDOMEN - placental tissue is removed
Amniocentesis (15-20 weeks)
Through the amniotic sac - amniotic fluid is drawn
Surveillance and Interventions
Prenatal visits: Assess history, medications, lifestyle, risk factors, age
Doppler: Detect fetal heart rate at 10-12 weeks
Growth pattern: Regular measurements to track progress
Ultrasound: visual imaging of fetus and uterus
Laboratory Work: blood typing, CBC, HIV, Hep B, Rubella titer, Diabetes screening for high risk
Cervical examination: pap smear, STI screening
Nutritional Adjustments: dietary recommendations or corrections based on individual needs
Testing options: chorionic villus sampling, amniocentesis, genetic screenings
Embryo (week 3-week 8)
HIGH risk for teratogenic damage
High mortality rate
BY week 4: all organs are present in some form, heart starts beating at days 18-21, neural tube is closed by the end of week 4, heartbeat can be viewed by week 5.
By week 8, embryo becomes a fetus, all organ systems are present, some movement is observable
Second Trimester
Psychological responses
Physical evidence of pregnancy
Fetus is the primary focus
Narcissism and introversion: “the world revolves around me”
Body image concerns: “Do I look fat in these jeans?”
Changes in sexuality- increased interest.
Surveillance and Testing
Monthly visits include: weight gain check, BP monitoring, Urine tests for protein, BS and bacteria, bloodwork for Hgb, Hct and CBC, uterine growth measurements
Fetal Heart monitoring:
US detection by 5 weeks
Doppler deception by 9-12 weeks
Alpha-fetoprotein (12-14 weeks)
Blood draw for neural tube defects
Optimal time: 16-18 weeks
THIS IS SCREENING ONLY
Ultrasound
Monitors growth and progression
Identifies potential abnormalities
BPP (Biophysical profile)
Desired score 8/10
Diabetic Screening:
Recommended between 24-28 weeks
Additional tests if indicated:
Amniocentesis
Percutaneous umbilical cord sampling
Non-stress test (NST)
Administered 2x weekly after 28 weeks of gestation
Seeks an increase of 15 bpm for 15 seconds over a 20-minute period
Biophysical profile
Ultrasound checks for: fetal muscle tone, breathing movements, HR, amniotic fluid pockets, NST
Discomforts:
Backache: caused by uterus pulling forward the abdomen
Varicosities of the vulva and legs: results from growing uterus exerting pressure, slowing down venous return. This is more problematic for women who stand all day.
Hemorrhoids: due to uterine growth pressure combined with constipation
Flatulence with bloating: slowing the GI tract because of progesterone
Straie: stretch marks
Linea Nigra: dark line down the middle of the stomach
Fetal development: (weeks 14-28)
16 weeks: fetus is more active, measures 6 inches, external genitalia is more discernible, meconium is produced
18 weeks: mother can feel the fetus move (16-18 weeks), appearance of lanugo (soft hair that covers the fetus)
24 weeks: fetus measures about 12 inches, protective vernix forms on the skin, the fetus accumulates fat. The possibility of survival outside the uterus is more possible because the alveoli and capillaries support gas exchange
28 weeks: fetus is 15 inches, approx. 90% chance of survival if born, skin becomes thicker
Mom needs to lay on her side to prevent supine hypotension syndrome
Third Trimester
Psychological Responses
Vulnerability: feeling limited due to increased size and decreased mobility
Increasing dependence: Physical and Mental concerns: concerns about receiving adequate care during childbirth and in the immediate postpartum period, experiencing unusual or vivid dreams
Preparation for Birth: attending childbirth classes, engaging in nesting behaviors to ready the home for the baby
Changes in Sexuality: Intimacy may become uncomfortable, sex is still generally safe but is essential to discuss safe and suitable positions, partners may also have concerns and anxieties
Changes in Body systems:
Uterine changes: uterus becomes larger and its walls get thinner, changes in the cervix
GI (gastrointestinal