Prenatal and Intrapartum Care

Prenatal Care of the Mother

  • Definition: Preventive healthcare aimed at ensuring the health of both mother and child during pregnancy.
  • Goals: Regular check-ups to treat and prevent health issues, promote healthy lifestyles.
Initial Interview
  • Establish rapport: Gain trust and discuss feelings/fears about pregnancy in a private setting.
  • Environment: Ensure comfort to encourage open communication.
Health History
  • Assess health history: Identify baseline health data to monitor pregnancy-related changes.
  • Key Elements:
    • Previous infections, medical conditions, medications, allergies.
Demographic Data
  • Collect superficial details:
    • Name, Age, Address, Telephone number, Health insurance.
Chief Concern
  • Determine: First day of last menstrual period (LMP), any home pregnancy tests taken.
History of Past Illnesses
  • Review medical history for potential complications:
    • Past illnesses that may reactivate during pregnancy.
Family Illnesses
  • Evaluate family medical history for conditions like:
    • Hypertension, diabetes, asthma.
Social Profile
  • Nutrition assessment: 24-hour dietary recall.
  • Exercise: Frequency and suitability during pregnancy.
  • Substance use: Investigate smoking and drinking habits.
Gynecologic History
  • Collect data on:
    • Age of menarche, menstrual cycle, contraception history, sexual history.
Obstetric History
  • Use GTPAL system:
    • G: Total pregnancies (Gravid classification)
    • T: Full-term births
    • P: Preterm births
    • A: Abortions (spontaneous or therapeutic)
    • L: Living children.
Systemic Assessment
  • Conduct head-to-toe assessment.
  • Review last dental examination.
Blood Studies
  • Crucial tests include:
    • Complete blood count: Identify anemia/infections.
    • Blood typing & Rh factor.
    • Maternal serum alpha-fetoprotein: Check for birth defects.
    • Antibody titers: Rubella, hepatitis B screening, syphilis screening.

Estimating Gestational Age and EDD

  • Importance: To anticipate labor onset and fetal development.
  • Naegele's Formula: Calculate EDD based on LMP.
  • McDonald’s Rule: Measures uterine growth.
    • AOG in months = FH in cm × 2/7
    • AOG in weeks = FH in cm × 8/7
Age of Gestation (AOG) Based on Fundal Height:
  • 12 weeks: Fundus at symphysis pubis.
  • 16 weeks: Between symphysis pubis and umbilicus.
  • 20 weeks: At umbilicus.
Labor Classification (Gravida/Para/Abortus)
  • Gravida (G): Total number of pregnancies.
  • Para (P): Number of viable births.
  • Abortus (A): Lost pregnancies.

Prenatal Visits Schedule

  • General Schedule:
    • 1st Visit: As soon as pregnancy is suspected.
    • After 32 weeks: Every two weeks until delivery.
  • Detailed Schedule:
    • Up to 32 weeks: Monthly.
    • 32-36 weeks: Every two weeks.
    • 36-40 weeks: Weekly visits.

Leopold’s Maneuvrs (for Fetal Positioning)

  • 1st Maneuver (Fundal Grip): Determine the fetal position.
  • 2nd Maneuver (Umbilical Grip): Locate the fetal back.
  • 3rd Maneuver (Pawlik’s Grip): Check engagement of presenting part.
  • 4th Maneuver (Pelvic Grip): Assess fetal head flexion.

Intrapartum Care

  1. Emergency Signs: Unconsciousness, severe headache, bleeding, significant pain.
  2. Comfort: Ensure privacy, obtain informed consent.
  3. Labor Assessment: Monitor contraction patterns, rupture of membranes, and any bleeding.
  4. History Review: Check for possible complications from previous pregnancies.
  5. Examinations: Conduct abdominal exams, assess fetal heart rate.
  6. Stage of Labor: Monitor progress and record findings due to potential complications.

Stages of Labor

  • First Stage: True labor begins till full dilation (10 cm).
    • Phases: Latent, Active, Transition.
  • Second Stage: Dilation to delivery of the baby.
  • Third Stage: Delivery of the placenta.
  • Fourth Stage: Recovery phase post-delivery.

Perineal Care

  • Lacerations: Classification into degrees (1st to 4th).
  • Episiotomy: Indications and types (median versus mediolateral).

Newborn Care and Resuscitation

  • Signs for Resuscitation: Apnea, bradycardia, cyanosis.
  • APGAR Score: Measures newborn health immediately after birth based on five criteria.
  • Monitoring: Key for vital signs post-resuscitation; document all procedures.

Postpartum Assessment and Nursing Care

  • Breast: Assessment for engorgement, soft tissue condition.
  • Uterus: Firmness, height, position relative to midline.
  • Bladder: Assess urinary output.
  • Bowles: Frequency of bowel movements, and constipation signs.
  • Lochia: Assess type and volume of vaginal discharge post-delivery.
  • Emotional Well-being: Monitor for postpartum blues vs. depression.

Key Terms & Abbreviations

  • DOH: Department of Health
  • EDD/EDC: Estimated Date of Delivery/Confinement
  • NSVD: Normal Spontaneous Vaginal Delivery
  • RPR: Rapid Plasma Reagin (syphilis screening)
  • PPH: Postpartum Hemorrhage

Conclusion

  • Regular monitoring and proper education for mothers during and post-pregnancy are essential for the health of both mother and baby. Continuous assessment, proactive care, and emotional support are critical to navigate the complexities of maternal care effectively.