1. Chapter 12 Nursing Management During Pregnancy
Maternity and Pediatric Nursing
Chapter 12 Nursing Management During Pregnancy

2. Risk Factors for Adverse Pregnancy Outcomes
See Table 12.1

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

4. 1st 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

5. Comprehensive Health History
Reason for seeking care
Suspicion of pregnancy
Date of last menstrual period
Signs and symptoms of pregnancy
Urine or blood test for hCG
Past medical, surgical, and personal history
Woman’s reproductive history: menstrual, obstetric, and gynecologic history

6. Menstrual History Menstrual cycle Age at menarche Days in cycle
Flow characteristics
Discomforts
Use of contraception

7. Menstrual History (cont.)
Date of last menstrual period (LMP)
Calculation of estimated or expected date of birth (EDB) or delivery (EDD)
Nagele’s rule
Use first day of LNMP /21/12
Subtract 3 months /21/12
Add 7 days /28/12
Add 1 year /28/13 = EDB
Gestational or birth calculator or wheel
Ultrasound

8. Obstetric History Gravida: a pregnant woman
Gravida I (primigravida): first pregnancy
Gravida II (secundigravida): second pregnancy, etc.
Para: a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more
Primipara: one birth after a pregnancy of at least 20 weeks (“primip”)
Multipara: two or more pregnancies resulting in viable offspring (“multip”)
Nullipara: no viable offspring; para 0

9. Obstetric History (cont.)
Terminology
G (gravida): the current pregnancy
T (term births): the number of pregnancies ending >37 weeks’ gestation, at term
P (preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks
A (abortions): the number of pregnancies ending before 20 weeks or viability
L (living children): number of children currently living

10. Question Is the following statement True or False?
A woman who is “para 1” is a woman who has given birth once after 20 weeks' gestation

11. Answer
True
Rationale: Primipara (para 1) is a woman who has given birth once after 20 weeks' gestation.

12. Physical Examination Vital signs Head-to-toe assessment Head and neck
Chest
Abdomen, including fundal height if appropriate
Extremities

13. Physical Examination (cont.)
Pelvic examination
Examination of external and internal genitalia
Bimanual examination
Pelvic shape: gynecoid, android, anthropoid, platypelloid
Pelvic measurements: diagonal conjugate, true (obstetric) conjugate, and ischial tuberosity

14. Laboratory Tests Urinalysis Complete blood count Blood typing
Rh factor
Rubella titer
Hepatitis B surface antigen
HIV, VDRL, and RPR testing
Cervical smears
Ultrasound

15. Follow-up Visits Visit schedule: Early pregnancy: every 4 to 6 weeks
After 30 weeks’ gestation: every 2 to 3 weeks
After 36 weeks’ gestation: every 1 to 2 weeks

16. Follow-up Visits (cont.)
Assessments
Weight & BP compared to baseline values
Urine testing for protein, glucose, ketones, and nitrites
Fundal height (see Figure 12.3)
Fetal movement
Fetal heart rate (see Nursing Procedure 12.1)
Teaching: danger signs

17. Question Is the following statement True or False?
A woman who is 24 weeks pregnant would arrange for a follow-up visit every 2 weeks.

18. Answer
False
Rationale: A woman who is 24 weeks pregnant would have follow-up visits scheduled every 4 to 6 weeks until she reaches 30 weeks’ gestation.

19. Assessment of Fetal Well-Being
Ultrasonography (see Figure 12.4)
Alpha-fetoprotein analysis
Marker screening tests
Amniocentesis (see Figure 12.5 and Table 12.3)
Chorionic villus sampling (CVS)
Percutaneous umbilical blood sampling (PUBS)
Nonstress test; contraction stress test
Biophysical profile
Doppler flow studies

20. 1st Trimester Discomforts
Urinary frequency or incontinence
Fatigue
Nausea and vomiting
Breast tenderness
Constipation
Nasal stuffiness, bleeding gums, epistaxis
Cravings
Leukorrhea

21. 2nd Trimester Discomforts
Backache
Varicosities of the vulva and legs
Hemorrhoids
Flatulence with bloating

22. 3rd Trimester Discomforts
Return of 1st trimester discomforts
Shortness of breath and dyspnea
Heartburn and indigestion
Dependent edema
Braxton Hicks contractions

23. Nursing Management to Promote Self-Care
Personal hygiene
Avoidance of saunas and hot tubs
Perineal care
Dental care
Breast care
Clothing
Exercise (see Table 12.4)

24. Nursing Management to Promote Self-Care (cont.)
Sleep and rest
Sexual activity and sexuality
Employment (see Teaching Guidelines 12.3)
Travel (see Teaching Guidelines 12.4)
Immunizations
Medications

25. Question
While assessing a woman at 18 weeks’ gestation, which of the following would the nurse report as unusual?
Urinary frequency
Backache
Leukorrhea
Flatulence with bloating

26. Answer A. Urinary frequency
Rationale: During the second trimester, urinary frequency typically improves when the uterus becomes an abdominal organ and moves away from the bladder region. Backache and flatulence with bloating are common during the second trimester. Leukorrhea begins in the first trimester and continues throughout pregnancy.

27. Preparation for Labour, Birth, and Parenthood – Perinatal Education
Childbirth education
Lamaze (psychoprophylactic) method: focus on breathing and relaxation techniques
Bradley (partner-coached childbirth) method: focus on exercises and slow, controlled abdominal breathing
HypnoBirthing: aims for a trance-like state in the woman, decreasing need for medications and minimizing her stress during childbirth
Birthing From Within: stresses self-discovery as the essence of childbirth preparation.

28. Preparation for Labour, Birth, and Parenthood – Perinatal Education (cont.)
Options for birth setting
Hospitals: delivery room, birthing suite
Birth centres
Home birth
Options for care providers
Obstetrician
Midwife
Doula

29. Preparation for Labour, Birth, and Parenthood – Perinatal Education (cont.)
Feeding choices
Breastfeeding: advantages and disadvantages
Bottle feeding: advantages and disadvantages
Teaching
Final preparation for labour and birth