Nursing Management during Pregnancy

Nursing Management during Pregnancy

Chapter 12 Overview

  • Emphasis on nursing management practices during pregnancy and the role of healthcare providers.

Preconception and Interconception Care

  • Purpose: To promote health and well-being of women and partners before pregnancy.

  • Objectives: Identify and modify biomedical, behavioral, and social risks to women's health or pregnancy outcomes through prevention and management interventions.

Preconception Care

  • Definition: Period between pregnancies where women can enhance their health status, particularly if previous pregnancies had adverse outcomes.

  • Focus Areas:

    • Immunization status

    • Underlying medical conditions

    • Reproductive health care practices

    • Sexuality and sexual practices

    • Nutrition

    • Lifestyle practices

    • Psychosocial issues

    • Medication and drug use

    • Support system

Risk Factors for Adverse Pregnancy Outcomes

  • Drugs and Medications:

    • Isotretinoin

    • Alcohol misuse

    • Antiepileptic drugs

    • Oral anticoagulants

  • Health Conditions:

    • Diabetes (preconception)

    • Folic acid deficiency

    • HIV/AIDS

    • Hypothyroidism

    • Maternal phenylketonuria

    • Obesity

    • Rubella seronegativity

  • Lifestyle Factors:

    • Smoking, linked to preterm birth and stillbirth

    • Sexually transmitted infections (STIs)

Prenatal Care: First Prenatal Visit

  • Focus: Reduction of risk for woman, fetus, and newborn.

  • Key Components:

    • Detection and prevention of potential problems

    • Establishment of a trusting relationship between healthcare provider and patient

    • Education regarding pregnancy and care options.

Prenatal Care: Health History

  • Essential Information Gathered:

    • Reason for seeking care

    • Suspicion of pregnancy

    • Date of last menstrual period (LMP)

    • Signs and symptoms of pregnancy

    • Urine or blood test for human chorionic gonadotropin (hCG).

  • Past Medical & Reproductive History:

    • Past medical, surgical, and personal history

    • Menstrual, obstetric, and gynecologic history.

Menstrual History Considerations

  • Age at menarche

  • Length of menstrual cycle

  • Flow characteristics and associated discomforts

  • Contraceptive usage

  • Date of last menstrual period (LMP).

NAEGELE'S RULE

  • Calculation of Estimated Date of Confinement (EDC):

    • Begin with first day of last menstrual period

    • Subtract 3 months

    • Add 7 days

    • Adjust the year as necessary.

    • For example, if LMP is January 1, the EDC would be approximately October 8 of the same year.

Prenatal Care: Obstetric History

  • Definitions:

    • Gravida: a pregnant woman; Gravida I: first pregnancy; Gravida II: second pregnancy, etc.

    • Para: a woman who has produced one or more viable offspring, with viable defined as carrying a pregnancy of at least 20 weeks.

    • Primipara: one birth after at least 20 weeks; Multipara: two or more pregnancies resulting in viable offspring; Nullipara: no viable offspring.

  • Components of Obstetric History:

    • G (Gravida): total number of pregnancies.

    • T (Term births): pregnancies ending >37 weeks.

    • P (Preterm births): pregnancies ending after >20 weeks but before 37 weeks.

    • A (Abortions): pregnancies ending before 20 weeks.

    • L (Living children): number of currently living children.

Prenatal Care: Physical Exam

  • Vital Signs and Assessment:

    • Comprehensive head-to-toe assessment including:

    • Head and neck examination

    • Chest

    • Abdomen (including fundal height)

    • Extremities

    • Gynecological examination

    • Pelvic Measurements: Assessing pelvic shapes (gynecoid, android, anthropoid, platypelloid).

Prenatal Care: Laboratory Tests

  • Essential Tests:

    • Urinalysis

    • Complete blood count

    • Blood typing (Rh factor)

    • Rubella titer

    • Hepatitis B surface antigen

    • HIV, VDRL, and RPR testing

    • Cervical smears

    • Ultrasound.

Prenatal Care: Follow-up Visits

  • Schedule:

    • Every 4 weeks until 28 weeks gestation

    • Every 2 weeks from 29 to 36 weeks

    • Weekly from 37 weeks to birth.

  • Assessments:

    • Weight and blood pressure compared to baseline values

    • Urine testing for protein, glucose, ketones, and nitrates

    • Monitoring fundal height (using McDonald method)

    • Quickening (fetal movement) and fetal heart rate assessment.

  • Education on Danger Signs:

    • Recognizing warning signs during pregnancy for maternal and fetal well-being.

Assessment of Fetal Well Being

  • Methods and Studies:

    • Ultrasonography: Visual assessment of fetus.

    • Doppler flow studies: Evaluating blood flow to the fetus.

    • Alpha-fetoprotein analysis: Screening for certain fetal defects.

    • Marker screening tests: Identifying potential genetic issues.

    • Nuchal translucency screening: Assessing risk for chromosomal abnormalities.

    • Amniocentesis and Chorionic villus sampling (CVS): Genetic testing methods.

    • Percutaneous umbilical blood sampling (PUBS): Checking blood from umbilical cord.

    • Nonstress test and contraction stress test: Monitoring fetal heart rate responses.

    • Biophysical profile: Comprehensive assessment of fetal health.

Discomforts during Pregnancy

First Trimester Discomforts

  • Fatigue

  • Urinary frequency/incontinence

  • Nausea and vomiting

  • Breast tenderness

  • Constipation

  • Nasal stuffiness or bleeding gums

  • Cravings and leukorrhea (increased discharge).

Second Trimester Discomforts

  • Backache

  • Varicosities of vulva and legs

  • Hemorrhoids

  • Flatulence with bloating.

Third Trimester Discomforts

  • Recurrence of first-trimester discomforts

  • Shortness of breath and dyspnea

  • Heartburn and indigestion

  • Dependent edema

  • Braxton Hicks contractions.

Nursing Management to Promote Self Care

  • Key Areas:

    • Personal hygiene

    • Avoidance of saunas and hot tubs

    • Perineal care

    • Dental care

    • Breast care

    • Appropriate clothing

    • Regular exercise

    • Sleep and rest

    • Considerations regarding sexual activity

    • Employment policies and travels during pregnancy

    • Guidance on immunizations and medications.

Preparation for Labor, Birth, and Parenthood

Perinatal Education

  • Childbirth Education Methods:

    • Lamaze Method: Focuses on breathing and relaxation techniques.

    • Bradley Method: Emphasizes partner-coached childbirth with exercises and controlled abdominal breathing.

    • Dick-Read Method: Aims at reducing fear associated with childbirth through knowledge and breathing techniques.

Birth Setting Options

  • Locations:

    • Hospitals: Delivery room and birthing suite

    • Birth centers

    • Home birth options.

Care Providers

  • Options:

    • Obstetrician

    • Midwife

    • Doula for additional support during labor and delivery.

Feeding Choices

  • Breastfeeding: Considered beneficial with various advantages and disadvantages.

  • Bottle Feeding: Evaluating pros and cons in context of maternal and infant needs.

Final Preparation for Labor and Birth

  • Preparing expecting parents with the necessary information and support for impending labor and delivery.