MIDTERM MATERNAL

CU 5 - CARE OF THE MOTHER DURING THE PERINATAL PERIOD

Juvy G. Reyes, MAN, RN

1. Confirmation of Pregnancy

• A medical diagnosis not only dates the birth but also predicts potential high-risk status.

• Diagnosis based on reported symptoms and signs examined by a healthcare provider.

2. Signs of Pregnancy

2.1 Types of Signs

1. Presumptive Signs (Subjective Symptoms)

2. Probable Signs (Objective Symptoms)

3. Positive Signs

2.2 Presumptive Signs

• Generally subjective, experienced by the woman and not documentable by an examiner:

  • Breast Changes: Tenderness, fullness, enlargement, and darkening of areolas.

  • Nausea and Vomiting: Often upon waking or during fatigue.

  • Amenorrhea: Absence of menstruation.

  • Fatigue: General tiredness.

  • Frequent Urination: Increased urge to void.

  • Uterine Enlargement: Detectable over the symphysis pubis.

  • Quickening: Fetal movements perceived by the woman.

  • Linea Nigra: Dark line on the abdomen.

  • Melasma: Darkened facial areas.

  • Striae Gravidarum: Stretch marks.

  • Palmar Erythema: Redness of palms.

2.3 Probable Signs

• Objective signs that can be verified by examination:

  • Chadwick’s Sign: Color change of the vagina.

  • Goodell’s Sign: Softening of the cervix.

  • Hegar’s Sign: Softening of the lower uterine segment.

  • Sonographic Evidence: Detectable gestational sac in ultrasound.

  • Braxton Hicks Contractions: Practice contractions without dilation.

  • Fetal Outline: Felt during palpation.

  • Ballottement: Fetus bounces against examiner’s hand.

  • Laboratory Tests: Detection of serum/urine hCG.

2.4 Positive Signs

• Definitive signs of pregnancy:

  • Sonographic Evidence of Fetal Outline

  • Fetal Movement Felt by Examiner

  • Fetal Heart Audible by Doppler

3. Physiological Changes of Pregnancy

3.1 Reproductive System Changes

• Changes include:

  • Uterine Growth: Size, weight, and capacity increases to accommodate the fetus.

  • Cervical Changes: Softening and increased vascularity.

  • Vaginal Changes: Increased vascularity and reduced pH for protection against bacteria.

  • Ovarian Changes: Ovulation ceases, with progesterone produced by corpus luteum then by the placenta.

  • Breast Changes: Increased size and tenderness, darkening of areola, production of colostrum.

3.2 Endocrine System Changes

• Placenta produces key hormones:

  • Estrogen: Promotes breast and uterine growth.

  • Progesterone: Maintains endometrium and inhibits contractions.

  • hCG: Supports estrogen and progesterone.

  • Relaxin: Facilitates cervical dilation and relaxes pelvic joints.

3.3 Cardiovascular Changes

• Blood Volume: Increases by 30%-50% to meet nutritional needs.

• Heart Rate: Increases by 10 beats/minute, cardiac output rises by 25%-50%.

• Blood Pressure: Slight decrease during the second trimester, rises in the third.

3.4 Urinary System Changes

• Increased frequency due to fetal pressure and effects of hormones.

3.5 Gastrointestinal Changes

• Morning Sickness: Linked to hCG levels; managed through diet.

• Constipation: Due to hormonal influences declining peristalsis; management via increased fibers and fluids.

3.6 Musculoskeletal Changes

• Backache and Leg Cramps: Due to weight gain and posture changes.

3.7 Skin Changes

• Linea Nigra, Melasma, and Striae Gravidarum: Skin pigmentation changes.

4. Assessing Events Contributing to Psychological Changes

• Understand the influences of family, cultural background, and personal experiences on the mother's psychological state during pregnancy.

5. Nursing Care Considerations

• Assess psychological adaptation, provide health teaching regarding pregnancy changes.

• Support nursing interventions that acknowledge cultural beliefs and practices.

6. Normal Diagnostic Laboratory Findings

6.1 Pregnancy Testing

• hCG detection through urine or blood tests to confirm pregnancy.

6.2 Monitoring and Assessing

• Regular laboratory assessments to predict outcomes of the pregnancy and potential complications.