1. Nursing Care During the Antenatal Period Maria Rubolino, MSN, FNPc September 6 th, 2005

2. A & P of Pregnancy Terms to know Terms to know Gravida Gravida Parity Parity Nulliparous Nulliparous Multiparous Multiparous Term Term TPAL TPAL

3. Signs of Pregnancy Presumptive Signs/Symptoms Presumptive Signs/Symptoms Probable Probable Positive Positive

4. Uterine Growth Stimulated by hormones in the 1 st trimester Stimulated by hormones in the 1 st trimester Larger as it rises out of the pelvis Larger as it rises out of the pelvis Hegar’s Hegar’s Chadwick’s Chadwick’s

5. Contractility Braxton Hicks Braxton Hicks

6. Cervical Changes Goodell’s Sign Goodell’s Sign Friability Friability

7. Fundal Height Changes Changes from week to week Changes from week to week

8. Vaginal Changes Vaginal mucosa thickens Vaginal mucosa thickens Chadwick’s sign Chadwick’s sign Vaginal discharge Vaginal discharge Mucous plug Mucous plug Varicosities Varicosities

9. Breast Changes Fullness Fullness Areolar pigmentation Areolar pigmentation Colostrum Colostrum

10. Circulatory Changes CV- blood volume, cardiac hypertrophy CV- blood volume, cardiac hypertrophy Cardiac output increases Cardiac output increases Blood pressure changes Blood pressure changes

11. Circulatory changes Supine hypotension syndrome Supine hypotension syndrome

12. Renal Changes Renal pelvis and ureters dilate Renal pelvis and ureters dilate Urine rate is slowed Urine rate is slowed Bladder frequency Bladder frequency

13. GI Changes Appetite Appetite Gastric emptying Gastric emptying Absorption Absorption Bowel sounds Bowel sounds Blood flow to the pelvis Blood flow to the pelvis Morning sickness Morning sickness Pyrosis Pyrosis Constipation Constipation

14. Gallbladder and Liver Gallbladder with decreased tone Gallbladder with decreased tone PUPPS PUPPS

15. Skin Changes Increased subdermal fat Increased subdermal fat Hyperpigmentation Hyperpigmentation Striae Striae Linea nigra Linea nigra Chloasma Chloasma Angiomas Angiomas Pruritis Pruritis Palmar erythema Palmar erythema Increased perspiration Increased perspiration

16. Endocrine Changes Amenorrhea Amenorrhea Progesterone Progesterone Estrogen Estrogen Ant pituitary suppresses the FSH and LH causing to rise Ant pituitary suppresses the FSH and LH causing to rise Post pituitary produces oxytocin Post pituitary produces oxytocin

17. Neurological Changes Carpal Tunnel Syndrome Carpal Tunnel Syndrome Numbness/Tingling Numbness/Tingling HA’s HA’s Lightheadedness Lightheadedness Muscle Cramps Muscle Cramps

18. Musculoskeletal Changes Change in posture Change in posture Waddling Waddling Back Pain Back Pain

19. Nutrition Needs Folic Acid Folic Acid Calories increased to 300/day Calories increased to 300/day Increased protein Increased protein Iron requirements increased Iron requirements increased Increased fluid intake Increased fluid intake Limit caffeine Limit caffeine

20. Exercise Will produce benefits Will produce benefits Must consume fluid Must consume fluid Watching heart rate Watching heart rate No new activities No new activities

21. Weight Gain in Pregnancy 25-35 pounds total weight gain 25-35 pounds total weight gain With singleton pregnancy 35-45 pound total weight gain with multiples

22. Nagele’s Rule LMP minus 3 calendar days LMP minus 3 calendar days Add 7 days and 1 year Add 7 days and 1 year

23. Tests in 1 st Trimester 1 hour post glucola if indicated 1 hour post glucola if indicated Blood type Blood type Antibody screen Antibody screen CBC CBC UA C/S UA C/S Hepatitis Hepatitis HIV HIV RPR RPR TSH TSH Toxoplasmosis if indicated Toxoplasmosis if indicated CVS if desired CVS if desired

24. Hyperemesis N/V N/V Small frequent meals Small frequent meals Avoid spicy foods Avoid spicy foods Antiemetics Antiemetics

25. 1 st Trimester Hyperemesis Hyperemesis No menses No menses N/V N/V Fatigue Fatigue Breast Tenderness Breast Tenderness

26. 20 Weeks Quickening Quickening Pelvic Pressure Pelvic Pressure Constipation Constipation Round ligament pain Round ligament pain

27. CVS Screening to detect fetal genetic abnormalities Screening to detect fetal genetic abnormalities Risks of miscarriage 1 in 100 Risks of miscarriage 1 in 100

28. Nuchal Fold Thickness Ultrasound and 9-13 weeks Ultrasound and 9-13 weeks Increased with down syndrome Increased with down syndrome Screening only!! Screening only!!

29. AFP Triple marker test/screening Triple marker test/screening 16-20 weeks gestation 16-20 weeks gestation If abnormal refer to specialist If abnormal refer to specialist

30. Amniocentesis Performed between 16-20 weeks Performed between 16-20 weeks Done with AMA, FH, +AFP Done with AMA, FH, +AFP Risks of miscarriage 1 in 200-300 Risks of miscarriage 1 in 200-300

31. Testing in 3 rd Trimester 1 hour post glucola 1 hour post glucola CBC CBC UA UA Antibody screen Antibody screen Rhogam Rhogam TSH TSH

32. 32-36 Weeks Fetal position Fetal position Descending into pelvis Descending into pelvis Placental location Placental location GBS GBS FKC’s FKC’s

33. 36-42 Weeks Vaginal Exams Vaginal Exams Labor precautions Labor precautions PIH precautions PIH precautions

34. Childbirth Education Natural Natural Lamaze Lamaze Bradley Bradley

35. Birth Plan Hospital Hospital Birthing Center Birthing Center Home Home Bath Bath Pain Meds Pain Meds Epidural Epidural Natural Natural Lighting Lighting Ambulating Ambulating Doulas Doulas Hypnosis Hypnosis