Ob - Prenatal Period

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3 trimesters

Back 1

1st trimester: weeks 1-12
2nd trimester: weeks 13-27
3rd trimester: weeks 28-42

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Naegles rule

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1ST DAY OF LAST MENSTRUAL PERIOD MINUS 3 MONTHS AND THEN ADD 7 DAYS and ONE YEAR WILL GIVE YOU THE
ESTIMATED DATE OF DELIVERY (EDD)

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Gravida

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# of pregnancies

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Para

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# of pregnancies that end after 20 weeks
(regardless of alive or still birth)

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Frequency of Antenatal Visits

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Every 4 weeks for the first 28-32 weeks of
gestation
Every 2 weeks until 32-36 weeks gestation
After 36 weeks, every week until childbirth

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Nursing Care - First Trimester
Education for Self care

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exercise- 30 minutes (abdominal, perineal, inner thigh)
sexuaity- no limit
Diet-decrease caffeine, increase fluids
Sleep-do not sleep flat on back.

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Nursing Care - First Trimester
Education for Self care (cont)

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Safety - correct seat belt, proper body mechanics.
Smoking give until week 20 to stop.
Drugs, ETOH, abuse

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Discomforts during first trimester

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-Nausea and vomiting
Eat dry crackers before getting out of bed
Small frequent meals
Drink carbonated beverages
Need to stay hydrated
-Increased vaginal discharge
Proper hygiene
Cotton underpants

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Nursing Care During the 2nd
Trimester

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-Assess for risk factors
-Fundal ht - used to indicate uterine size and correlates well with gestation 22-34
-Quickening - mothers perception of fetal movement 18-20 weeks

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Nursing Care During the 3rd
Trimester

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-Assess for risk factors

-Fetal well being
Fetal movement
NST
-Prepare for breast feeding
Breast shells
-Signs of preterm labor

Braxton Hicks
-Signs of labor

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Nutrition During Pregnancy

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„ Requires 340/462 kcal/day above
usual intake during the 2nd and 3rd
trimester, respectively
„ Underweight or has a physically strenuous
lifestyle may require more Kcal/day.
„ Inadequate weight gain can cause
Intrauterine Growth Restriction (IUGR)

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Causes of Excessive Weight Gain

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multiple gestation
PIH - associated with edema
Overeating

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Problems Associated with Excessive Weight gain

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-Increased risk of developing PIH and gestational
diabetes
- Macrosomia- “Big Baby”

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Macrosomia- “Big Baby”

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„ 4000 grams or greater
„ Increased rate of c-sections
„ Birth trauma
Shoulder dystocia
Asphyxia at birth
„ Intrauterine fetal death
„ Infant mortality
„ Risk of congenital defects doubles

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Nutrition - Adolescents

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Need extra calcium/iron
Increase risk of complications during preg/birth
support moms growth as well as baby

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Nutrition - Short stature

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-less than 62 in
-HR for fetal-pelvic disposition (birth trauma/inc. incidence of c-section

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Nutrition during pregnancy

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-body image crisis
-educate about weight distribution
-emphasize benefits of good nutrition vs. # of kcal

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Fluid needs

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2000 ml/day
avoid caffeine - assoc w/ IUGR r/t vasoconstriction in placenta; acts as diuretic

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Physiologic anemia

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plasma volume increases more than RBC mass during pregnancy which decreases hgb concentration and hct
-greatest during 2nd trimester
-Fe supplements

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Pica

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assoc with low levels of hgb
cultural

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HR Pregnancy

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-substance abuse
-STIs - (trichomoniasis, chlamydia, syphilis, herpes, HPV)

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TORCH

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T-toxoplasmosis
O- Other (gonorrhea, syphilis, varicella, HBV, HIV)
R- Rubella
C- cytomegalovirus
H- Herpes

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HIV

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AZT during pregnancy, labor and birth. Also given to newborn for 1st 6 weeks.
-c/s reduces transmission to 2%

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Group Beta Streptococcus (GBS)

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-normal flora of non pregnant
- common cause of neonatal sepsis and meningitis in US
-screened at 35-37 weeks
-IV Abx prophylaxis (IAP) given who test positive

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Iron deficiency anemia

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recommended supplementation 60-120 mg/day

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Genetic blood dyscrasias

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pregnancy can worsen sickle cell disease crisis
complications- pylonephritis, strokes, CHF, PIH, leg ulcers, fetal demise due to placental infarcts

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Heredity anemias

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thalassemia major - low birth wt, fetal distress due to hypoxia, PIH/preeclampsia
thalassemia minor - doesnt respond to Fe therapy, uncomplicated pregnancy

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Asthma

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-effect on pregnancy unpredictable. Some improve, stay the same or worsen
-goal - prevent attacks, relieve bronchospasm; reduce allergen exposure

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Cholecystitis

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pressure of uterus interferes w/ normal circulation and drainage of gall bladder
delay surgery

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choletithiasis (gallstones)

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increase progesterone levels increase cholesterol
reduce dietary fat to 40-50 kcal/day
avoid fried foods

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Appendicitis

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appendix is pushed upward and to the right of its usual location and inc. risk of rupture
Dx is often delayed in pregnancy

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Maternal heart disease

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-leading cause of maternal death from non-OB sources
-4th leading cause of maternal deaths overall
-miscarriage, preterm labor, premature delivery, IUGR, congenital heart disease

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Cardiovascular changes of pregnancy

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„ Increased intravascular volume
„ Decreased peripheral vascular resistance
„ Increases cardiac output
If the heart can not tolerate the increased workload than cardiac failure results

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Peripartum cardiomyopathy

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-development of CHF in last month of pregnancy or within the first 5 PP months
-assoc w/ twin gestation, preeclampsia, Gest. HTN, AA race

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Signs of cardiac decompensation

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„ Increasing Fatigue even at rest
„ Orthopnea; Increasing dyspnea
„ Sensation of smothering
„ Moist, Frequent Cough
„ Palpitations
„ Progressive, Generalized Edema
„ Pulse 100 or more, RR 25 or more
„ Crackles
„ Cyanosis

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Cardiac Decompensation Nursing mgmt
Antepartum care

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-goal is to maintain cardiac function by minimizing stress on the heart
-prevent fetal hypoxia
-Antepartum
adequate nutrition
rest
prevent emotional stress
monitor drug therapy
vaccinate against flu and pneumococcus

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Cardiac Decompensation Nursing mgmt
(cont)
Intrapartum care

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routine assessment for all laboring women
ekg
proper positioning-head and shoulder elevated or side lying
-Interventions-
con't BP and pulse Ox
pain relief (epidura)
psycho support
monitor drug therapy

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Cardiac Decompensation Nursing mgmt
(cont)
Postpartum care

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essential to monitor
hemorrhage or infection can worsen the condition
bedrest
stool softeners
education on self care