Antepartum FH 2/11/2026

ANTEPARTUM NURS336 FAMILY HEALTH NURSING

Objectives

  • Relate physiological and psychological adaptations to pregnancy. (Course Outcome #2)

  • Differentiate between presumptive, probable, and positive signs of pregnancy. (Course Outcome #2)

  • Calculate gravida, para, and estimated date of delivery. (Course Outcome #4)

  • Interpret assessments and lab tests used during the care of the antepartum client. (Course Outcome #4)

  • Explain cardinal danger signs of pregnancy. (Course Outcome #3)

  • Analyze the nutritional needs of the antepartum client. (Course Outcome #2)

Goals

  • Develop a trusting relationship with clients.

  • Ensure optimum health for both mother and infant.

  • Identify mothers at risk.

  • Prevent complications and accidents associated with pregnancy.

  • Provide guidance and support for mothers.

  • Educate in self-care, childbirth preparation, and infant care.

  • Inform clients of available resources for additional support.

Signs & Symptoms of Pregnancy
Presumptive Signs (Subjective)

  • Amenorrhea (missed period)

  • Fatigue

  • Urinary frequency

  • Nausea/Vomiting (N/V)

  • Breast changes

  • Quickening (feeling of fetal movement)

  • Skin hyperpigmentation (e.g., linea nigra)

Probable Signs (Objective)

  • Hegar’s sign: Softening of the uterus

  • Goodell’s sign: Softening of the cervix

  • Chadwick’s sign: Deep violet-blue color of cervix

  • Uterine enlargement

  • Ballottement: A rebound of the fetus on palpation.

  • Braxton-Hicks contractions (irregular, temporarily tightening of the uterus)

Positive Signs (Diagnostic)

  • Visualization of the fetus by ultrasound

  • Detection of fetal heartbeat

  • Fetal movement palpable by a trained examiner

Estimated Date of Birth (EDB)

  • Methods to calculate EDB:

    • LMP (Last Menstrual Period)

    • Obstetrical Wheel

    • Nagele’s Rule: From LMP, subtract 3 months and add 7 days of the following year.

Common Pregnancy Terms in Practice
Gravida

  • Nulligravida: A woman who has never experienced pregnancy.

  • Primigravida: A woman pregnant for the first time.

  • Multigravida: A woman who has been pregnant at least three times.

Para

  • Primipara (Primip): A woman who has given birth at least once or is about to give birth at 20 weeks gestation or more.

  • Multipara (Multip): A woman who has had two or more pregnancies resulting in live offspring at 20 weeks gestation or more.

Gravida and Para Explained

  • Gravida: The total number of times a woman has been pregnant regardless of outcome or duration, which includes the current pregnancy.

  • Para: The birth of a fetus at least 20 weeks gestation, regardless of whether the infant was born alive or deceased. Multiple births are counted as one birth event.

TPAL Classification

  • T: Number of term pregnancies born (>37-42 weeks).

  • P: Number of preterm pregnancies delivered (greater than 20 weeks but before 37 weeks).

  • A: Number of pregnancies ending before 20 weeks (spontaneous or therapeutic abortion).

    • Risk Factor for abortion: HTN, Trauma, Substance abuse

    • Manifestation: Cervical Dilation

  • L: Number of children currently living.

Abortion Meds

Mifeprex (Mifepristone) 1st

  • Uses: Termination of pregnancy, by blocking progesterone(maintains pregnancy), usually < 10-11 weeks gestation

  • Adverse effect: vaginal bleeding, vertigo, N/V

Cytotec (Misoprostol) 2nd

  • Uses: Cervical ripening before labor, Stimulates contractions, Used when oxytocin not available, Used for uterine expulsion due to pregnancy loss.

  • Contraindicated: in cesarean births due to risk of uterine rupture

  • Adverse effect: vaginal bleeding, vertigo, N/V

**Notify provider if soak through 2 peri-pads in an hour

Fetal Development Stages
Preembryonic Stage

  • Lasts from fertilization through the second week.

  • Fertilization occurs in the fallopian tube when the sperm and egg unite to form a zygote (46 chromosomes).

  • Cell division begins to form a blastocyst, which develops into the embryo and surrounds itself with the amnion and chorion, the latter aiding in placenta formation.

  • Implantation occurs 7-10 days after conception.

Embryonic Stage

  • Lasts from the end of the second week through the eighth week.

  • Key features and organs develop: embryonic membranes, including the chorion and amnion, which protects the fetus.

  • Amniotic fluid surrounds the embryo, which is derived from maternal blood and fetal urine. Supports growth, maintains body temperature, and cushions against trauma.

  • The placenta and umbilical cord form, providing nutrient and waste exchange.

Fetal Stage

  • Lasts from the end of the eighth week until birth.

  • Further maturation and enlargement of fetal body.

Hormones Involved in Pregnancy

  • hCG (Human Chorionic Gonadotropin): Preserves the corpus luteum to maintain progesterone production and the endometrial lining.

  • Progesterone: Maintains the endometrium during pregnancy.

  • Relaxin: Works with progesterone to maintain pregnancy, relaxes pelvic ligaments, and softens the cervix.

  • Estrogen: Promotes enlargement of the breasts, uterus, and external genitalia.

Embryonic & Fetal Development Timeline

  • Weeks 3-4: Formation of brain, spinal cord, heart, gastrointestinal system(Urinary tract develops week 4), and neural tube.

    • Respiratory system form during week 3-5

  • Weeks 5-6: Development of eyes, ears, cranial nerves, and respiratory system begins.

    • Renal Pelvis and collecting tubules / Lobes of Kidneys form during week 6

    • Bone formation begins week 6-7

    • The Heart Begins to beat during weeks 6-7, FHR is 110-120min

  • Weeks 7-8: Hair follicles and diaphragm appear; the heart develops completely, and the placenta functions.

  • Weeks 9-12: Face and neck form (Facial Features by week 10), sexual differentiation occurs; fetal movements can begin (Breathing Movements week 9).

    • Toes and Fingers visible by week 9

    • Kidneys produce urine in week 10

  • Weeks 13-16: Covering on fetal skin (lanugo) develops, recognizable genitalia, weight quadruples.

    • Major organ systems have developed by week 13

    • Quickening Detected by week 13-16

    • Hearing is begings to develop by week 15-18

  • Weeks 17-20: Enhanced movement; formation of brown fat for temperature maintenance; rapid brain growth.

  • Weeks 21-24: Further development of lungs and start of (surfactant production by weeks 23-26).

  • Weeks 25-28: Eyes can open/close ( Eyes fully developed at week 26 ); subcutaneous fat forms.

  • Weeks 29-32: Increased body fat; establishment of CNS control.

  • Weeks 33-38: Development of reflexes; maternal antibodies supplied to the fetus.

    • Fetus develops sleep patterns during week 35-37

    • Fetus Bones are fully developed weeks 35-37

  • Cardiovascular is fully developed by 1st Trimester

  • FHR 110-160 or 180 if active by 2nd & 3rd Trimester.

Assessment During Pregnancy

Preterm: 20-37 weeks

Term: 37-42 weeks

Post: >42 weeks

  • Prenatal Visits: First visit includes screening, counseling, history, and physical examination. Follow-ups monitor fundal height, weight, urine dipsticks, and vital signs.

    • Schedule: Every 4 weeks up to 28 weeks; every 2 weeks from 29-36 weeks; every week from 37 weeks to birth.

    • Diastasis recti (Relaxin & Progesterone)

      • Seperation of abdomen muscles along linea alba near umbilicus

        • Manifestations: Urinary Incontinence, Back Pain

      • Post-Term Pregnancy >42 weeks

        • Complications

          • Oligohydramnios (Too little Amniotic Fluid) Test Via: AFI < 5 cm

            • Cord Compression

          • Meconium Aspiration Syndrome

          • Placental Insufficiency (Hypoxia, Acidosis)

          • Birth Injury

          • Infection

        • Fundal Check during 2nd prenatal Visit

          • Femur length= Gestational Age

          • Cervical length

          • Placental Location

          • Amniotic Fluid Volume

1Diagnostic Tests
Ultrasound

  • Used to measure blood flow via Doppler technology.

    • Types of Ultrasounds:

    • Transvaginal: Through the vagina.

    • Transabdominal: Using transducers on the abdomen.

Routine Laboratory Tests

  • Blood type, Rh factor, presence of irregular antibodies, CBC, rubella titer, hepatitis B, and Group B streptococcus (GBS).

  • Urinalysis and glucose tolerance tests assessed for general health.

  • Pap test, vaginal cultures, VDRL (syphilis screening) and maternal serum alpha-fetoprotein (MSAFP) for fetal health.

  • RhoGham

    • Rh-immune globulin, antibodies that destroys Rh+ fetal blood cells that enter Rh- Maternal bloodstream. Prevents maternal from making her own anibodies.

      • Helps Prevents Sensitization that causes Hemolytic disease of the newborn in future pregnancies

      • Given @ 28 weeks or 72 Hrs PP

Infection Screening (TORCH)

  • Includes testing for Toxoplasmosis, Other infections (like syphilis), Rubella, Cytomegalovirus, and Herpes.

    • Implications: Rubella can lead to congenital defects; herpes infections may cause severe neurological impairments.

    • Rubella (MMR)

      • Live VAccine

    • Syphallis (RVR)

      • Penicillin

    • Cytomegalovirus (CMV)

First Trimester Discomforts

  • Common symptoms during the first trimester include:

    • Fatigue

    • Nausea/Vomiting

    • Breast tenderness

    • Constipation

    • Nasal stuffiness; bleeding gums; nosebleeds

    • Cravings and vaginal discharge.

Second Trimester Discomforts

  • Common symptoms during the second trimester include:

    • Backache

    • Leg cramps

    • Varicosities (enlarged veins)

    • Hemorrhoids

    • Flatulence.

Third Trimester Discomforts

  • Common symptoms during the third trimester include:

    • Shortness of breath

    • Heartburn and indigestion

    • Edema (swelling due to fluid retention)

    • Braxton Hicks contractions.

Nutritional Needs

  • Increased folic acid intake is essential to prevent neural tube defects. Recommended:

    • Ferrous iron supplements of 27 mg.

    • Folic acid of 400-800 mcg/day.

    • Minimum 12 cups of water/ day

      • 1 cup= 240 mL

      • 1 cup= 8 oz

  • Eat a variety of food groups, focusing on fruits, vegetables, whole grains; increase vitamins, minerals, and dietary fiber.

  • Can eat Salmon, Shrimp, & Pollock for Omega-3

  • Decrease intake of saturated fats, trans fats, and cholesterol.

Foods to Avoid: Listeria, Toxoplasma, Salmonella, E.Coli

  • Fish with moderate to high levels of mercury (e.g., shark, swordfish, king mackerel, tilefish) can harm fetal development.

  • Avoid raw or unpasteurized foods that can lead to listeria infection, including:

    • Processed meats, hot dogs, soft cheeses (like Brie), refrigerated spreads, and prepared fresh salads from stores.

    • Raw Sprouts

    • Alcohol

Pica

  • Pica refers to the non-food cravings that may indicate anemia; cravings may include:

    • Dirt, clay, laundry starch, burnt matches, charcoal, stones, paint chips, coffee grounds, ice, soap, toothpaste.

Weight Gain Recommendations

  • Vary based on pre-pregnancy BMI:

    • Underweight (BMI < 18.5): Gain 28-40 lbs.

    • Normal weight (BMI 18.5-24.9): Gain 25-35 lbs.

    • Overweight (BMI 25-29.9): Gain 15-25 lbs.

    • Obese (BMI 30 or higher): Gain 11-20 lbs.

  • Rapid Fat Storage Occcurs by Placental Hormones During 1st & 2nd Trimesters

Danger Signs of Pregnancy
First Trimester

  • Burning on urination

  • Severe vomiting

  • Diarrhea

  • Fever or chills

  • Abdominal cramping and/or vaginal bleeding.

Second and Third Trimesters

  • Possible dangers include:

    • Gush of amniotic fluid;

    • Any vaginal bleeding;

    • Abdominal pain;

    • Changes in fetal activity;

    • Persistent vomiting;

    • Severe headaches;

    • Blurred vision;

    • Edema(Generalized)

    • Edema (Asymmetric “Unlateral”)

    • Varicose Vein Pain (DVT Risk)

    • Epigastric pain.

    • Preeclampsia

      • HTN after 20 weeks with symptoms

        • P- Proteinuria

        • R-Rising BP

        • E-Edema

        • Others

          • RUQ or Epigastric Pain

          • Changes in vision

          • Hyperreflexia

          • Rapid Weight Gain

          • Severe Headache

          • SOB

Other Symptoms to Monitor

  • Elevated temperature

  • Dysuria (painful urination)

  • Signs of dehydration or other systemic responses: dry skin, fruity breath, rapid breathing, increased thirst, pale/clammy skin, weakness, tremors, lightheadedness.

Adaptations to Pregnancy
Physiological Adaptations

  • Gastrointestinal System: Changes in digestion and metabolism produce symptoms like nausea.

  • Cardiovascular System: Increased blood volume and cardiac output.

  • Respiratory System: Increased oxygen demand leads to changes in breathing patterns.

  • Renal/Urinary System: Increased renal blood flow and filtration rate.

  • Musculoskeletal System: Altered center of gravity leading to discomfort.

    • Carpal Tunnel Syndrome

      • Pain, Weakness, Numbness, and Tingling

    • Lordosis

    • Low Back Pain

    • Calf Cramps

  • Integumentary System: Skin and hair changes.

  • Endocrine System: Hormonal changes stabilize pregnancy.

  • Immune System: Adaptations to tolerate foreign fetal tissue.

Psychological Adaptations

  • Ambivalence about pregnancy.

  • Introversion as a response to maternal changes.

  • Acceptance of the pregnancy and upcoming motherhood.

  • Experience of mood swings due to hormonal changes.

  • Body image adaptations as physical changes occur during pregnancy.