Nursing Management During Pregnancy — Chapter 12

Preconception Care and Diagnostic Testing

  • Preconception care and diagnostic testing include: Amniocentesis, Biophysical profile, Chorionic villus sampling (CVS), Natural childbirth, Perinatal education, Preconception care.

Goals of Preconception Care

  • Promote the health and well-being of a birthing person and their partner before pregnancy.
  • Identify and modify biomedical, behavioral, and social risks to health or pregnancy outcome through prevention and management interventions.

Risk Factors for Adverse Pregnancy Outcomes

#1

  • Isotretinoin
  • Alcohol misuse
  • Antiepileptic drugs
  • Diabetes (preconception)
  • Folic acid deficiency
  • HIV/AIDS

#2

  • Hypothyroidism
  • Maternal phenylketonuria
  • Rubella seronegativity
  • Obesity
  • Sexually transmitted infections (STI)
  • Smoking
  • Hypertension

Preconception Care Components

  • Immunization status
  • Underlying medical conditions
  • Reproductive health care practices
  • Sexuality and sexual practices
  • Nutrition
  • Lifestyle practices
  • Psychosocial issues
  • Medication and drug use
  • Support system

First Prenatal Visit

  • Establishment of trusting relationship
  • Focus on education for overall wellness
  • Detection and prevention of potential problems
  • Comprehensive health history, physical examination, and laboratory tests

Comprehensive Health History

  • Reason for seeking care: suspected pregnancy, date of last menstrual period (LMP), signs/symptoms, hCG test
  • Past medical, surgical, and personal history
  • Reproductive history: menstrual, obstetric, and gynecologic history

Menstrual History

  • #1: Details of cycle
    • Age at menarche, cycle length, flow characteristics, discomforts, contraception
  • #2: LMP and dating
    • Calculation of estimated/expected date of birth (EDB/EDD)
    • Naegele’s rule: use first day of LMP, subtract 3 months, add 7 days, add 1 year
    • Ultrasound is the best method of dating a pregnancy
  • Naegele’s rule (formula):
    EDB=LMP−3 months+7 days+1 year\text{EDB} = \text{LMP} - 3 \text{ months} + 7 \text{ days} + 1 \text{ year}

Obstetric History

  • Gravida: number of pregnancies
  • Para: number of pregnancies carried to viability (≥20 weeks)
  • Primipara: one birth at ≥20 weeks
  • Multipara: two or more pregnancies with viable offspring
  • Nullipara: no viable offspring

Obstetric History: Terminology

  • G (gravida): current pregnancy
  • T (term births): ≥37 weeks
  • P (preterm births): >20 weeks but <37 weeks
  • A (abortions): pregnancies ending before 20 weeks or viability
  • L (living children): number living now

Quick Recall: Term Definition

  • Q: Is the statement "A multipara refers to a person who is pregnant for the first time" true or false?
  • A: False

Physical Examination

  • Vital signs
  • Head-to-toe assessment: head/neck, chest, abdomen (including fundal height when appropriate), extremities

Pelvic Examination

  • External and internal genitalia examination
  • Bimanual examination
  • Pelvic shape: gynecoid, android, anthropoid, platypelloid
  • Pelvic measurements: diagonal conjugate, true (obstetric) conjugate, ischial tuberosity diameter

Pelvic Measurements

  • Visuals include: Diagonal conjugate vs true conjugate and ischial tuberosity diameter

Laboratory Tests

  • Urinalysis
  • Complete blood count
  • Blood typing and Rh factor
  • Rubella titer
  • Hepatitis B surface antigen
  • HIV, VDRL/RPR
  • Cervical smears
  • Ultrasound

Follow-Up Visits: Schedule

  • Every 4 weeks up to 28 weeks
  • Every 2 weeks from 29 to 36 weeks
  • Every week from 37 weeks to birth

Follow-Up Visits: Assessments & Teaching

  • Weight and blood pressure compared to baseline
  • Urine testing for protein, glucose, ketones, nitrites
  • Fundal height
  • Quickening/fetal movement
  • Fetal heart rate
  • Teaching: danger signs

Assessment of Fetal Well-Being

  • #1: Ultrasonography, Doppler flow studies, AFP, marker screening, nuchal translucency, amniocentesis
  • #2: CVS, PUBS, nonstress test, contraction stress test, biophysical profile

Discomforts of Pregnancy

  • First Trimester: urinary frequency, fatigue, nausea/vomiting, breast tenderness, constipation, nasal symptoms, cravings, leukorrhea
  • Second Trimester: backache, varicosities, hemorrhoids, flatulence with bloating
  • Third Trimester: return of earlier discomforts, shortness of breath, heartburn, edema, Braxton Hicks

Nursing Management to Promote Self-Care

#1

  • Personal hygiene
  • Avoid saunas and hot tubs
  • Perineal care
  • Dental care
  • Breast care
  • Clothing
  • Exercise

#2

  • Sleep and rest
  • Sexual activity and sexuality
  • Employment
  • Travel
  • Immunizations and medications

Preparation for Labor, Birth, and Parenthood

#1

  • Perinatal education
  • Childbirth education methods:
    • Lamaze (psychoprophylactic): breathing and relaxation
    • Bradley (partner-coached): exercises and slow abdominal breathing
    • Dick-Read (natural childbirth): fear reduction via knowledge and abdominal breathing

#2

  • Birth setting options: hospitals with delivery room/birthing suite, birth centers, home birth
  • Care providers: obstetrician, midwife, doula

#3

  • Feeding choices: breastfeeding (pros/cons) vs bottle-feeding (pros/cons)
  • Teaching; final preparation for labor and birth