stillbirths and pregnancy complications and

PERINATAL PERIOD give women a positive pregnancy experience

 Pertaining to the period immediately before By focusing on a positive pregnancy
and after birth experience, these new guidelines seek to
ensure not only a healthy pregnancy for the
ANTENATAL CARE mother and the baby, but also an effective
Definition transition to positive labor and childbirth and
 Prenatal care also known as antenatal care ultimately to a positive experience of
 Type of preventive healthcare you get from motherhood.
health professionals during pregnancy o As soon as you know you are
 Comprehensive health supervision of a pregnant, seek antenatal care for:
pregnant woman during pregnancy and  Emotional support and advice
before delivery  Medical care
 Relevant and timely pregnancy
PREGNANCY information
 State of carrying a developing embryo or o Respectful care throughout pregnancy
fetus within the female body from conception will help protect you and your baby’s
to birth health
After the egg is fertilized by sperm and then o Regular contact with health services
implanted in the lining of the uterus, it throughout pregnancy will protect you
develops into placenta and embryo or fetus. and your baby’s health
 Can be filled with mans joys and wonders as o Quality antenatal care should be
well as concerns and fears, thus it is available for all women to ensure a
important for the mother to take care of positive pregnancy experience;
herself and her baby with prenatal care quality antenatal care will:
 Most pregnant women are otherwise healthy  Encourage women to work
and prenatal care is aimed at monitoring the seek skilled care at childbirth
baby’s growth and the mother’s well-being  Reduce stillbirths, childbirth
 Any concerns or previous health conditions complication, and newborn
will be carefully managed with both the deaths
mother’s and the baby’s health in mind  Help women get care and
counseling for HIV, malaria, TB,
 Antenatal care – periodic and regular and other conditions
supervision including examination and advice o Throughout pregnancy, all women
of a woman during pregnancy should have 8 contacts with a health
The supervision should be of a regular and provider which can happen in setting
periodic nature in accordance with the need such as health facilities and
of the individual. community outreach services
Health systems should ensure that all
Goals of Antenatal/Prenatal Care providers are empowered and
 To reduce maternal mortality and morbidity equipped with necessary skills and
rates supplies.
 To improve the physical and mental health of
women and children TERMINOLOGY USED IN MATERNITY NURSING
 To prevent and identify maternal and fetal  Gravida – number of pregnancies
abnormality that can affect pregnancy  Para – number of live births
outcome  Primigravida – a woman is pregnant for the
 To decrease financial recourses for care of first time
mothers  Primipara – a woman who has delivered one
live born child
Objectives  Multigravida – a woman who has been
 To ensure a normal pregnancy with delivery pregnant two or more times
of a healthy baby from a healthy mother  Multipara – a woman who has delivered two
or more live born children
ANTENATAL CARE  Viability – capability of living, usually
 World Health Organization has issued a new accepted as 24 weeks, although survival is
series of recommendations to improve rare, or fetal weight > 500 grams
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  Parity – number of pregnancies in which the  Establish baseline levels that will guide the
fetus has reached viability when they are treatment of the expectant mother and fetus
born throughout pregnancy
 Term – a pregnancy from the beginning of
week 38 of gestation to the end of week 42 History
of gestation Welcome the woman, and ensure a quiet place
 Preterm – pregnancy that has reached 20 where she can express concerns and anxiety without
weeks of gestation but before 37 weeks of being overheard by other people.
gestation  Personal and social history
 Postterm – pregnancy that goes beyond 42  Menstrual history
weeks of gestation  Current problems with pregnancy
 Obstetrical history
SCHEDULE OF ANC (ANTENATAL CHECK UP)  Medical and surgical history
 Check up every four weeks up to 28 weeks of  Family history
gestation
 Every 2 weeks until 36 weeks of gestation Gravidity and Parity
 Visit each week until delivery  Gravida – number of pregnancies
 More frequent visits may be required if there  Para – number of births after 20 weeks
are abnormalities or complications or if  Five-digit system
danger signs arise during pregnancy o G – total number of pregnancies
 o T – full-term pregnancies (37-40
ASSESSMENT weeks)
The provision of prenatal care is the primary factor o P – preterm deliveries (20-36 weeks)
in the improvement of maternal and infant morbidity o A – abortions and miscarriages (before
and mortality statistics. 20 weeks)
To ensure the success of the prenatal care program, o L – living children
it should be remembered that the patients’ Example: G4-T2-P1-A1-L3
understanding of the modalities of care is basic to
cooperative action. Vital Signs
 Temperature
Assessment and Physical Exam  Pulse rate
 The initial assessment interview can establish  Respiratory rate
the trusting relationship between the doctor  Blood pressure
and the pregnant woman
 Getting information about the woman’s Weight
physical and psychological health  Total weight gain: 20-25 lb; average of 24 lb
 Obtaining a basis for anticipatory guidance o 1st trimester: 1 lb/month or 3-4 lb total
for pregnancy o 2nd trimester: 0.9-1 lb/week or 10-12
lb total
Components of prenatal visit done during o 3rd trimester: 0.5-1 lb/week or 8-11 lb
initial visit
total
 Baseline data collection
 Obstetrical history
PRENATAL ASSESSMENT
 Family history
 Verifying pregnancy
During the first visit, assessment and physical
o Signs and symptoms
examination must be completed including:
 Presumptive
 History
 Probable
 Physical examination
 Positive
 Laboratory data
o Pregnancy test
 Health teaching during pregnancy
 LMP
o Estimated date of
Physical Examination
delivery/confinement
Physical examination is important to:
o EDD/EDC/EDB
 Detect previously undiagnosed physical
problems that may affect the pregnancy o Age of gestation
outcome o Measure of fundic height

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  Common term used during pregnancy to o During the nine months of pregnancy,
describe how far along is the pregnancy periods do not occur
 It is measured in weeks, from the first day of o Any type of bleeding that occurred
the woman’s last menstrual cycle to the during the nine months should not be
current date confused with the commonly met
pathological bleeding
Naegele’s Rule o Example: threatened abortion
 A standard way of calculating the due date  Morning sickness
for a pregnancy o Present in about 50% cases, mostly
 To determine the expected date of delivery during first pregnancy
(EDD), take the date of the last menstrual o Nausea and vomiting begin about 6
period, add 7 days to that date, and count weeks after the last menstrual period
back three months and usually disappears by about 14
 Example: weeks
o First day of last period: January 12, o It is due to high level of pregnancy
2002 hormones
o 1/12/02 + 7 days = 1/19/02  Frequency of micturition
o Counting back 3 months to October, o Resting of bulky uterus on the fundus
the EDD is 10/19/02 of the bladder because of anteverted
position of the uterus
Early pregnancy symptoms o Present during week 8-12 of
 Tender, swollen breasts – as early as two pregnancy and subside after 12 weeks
weeks after conception, hormonal changes  Breast discomfort
may make your breasts tender, tingly, or sore o It is present during the 6th week in the
or the breasts may feel fuller and heavier form of feeling of:
 Fatigue and tiredness – in high enough doses,  Tenderness
progesterone can put one to sleep  Tingling
 Slight bleeding or cramping  Fullness
 Nausea with or without vomiting – morning  Increase in size
sickness, which can strike at any time of the  Pigmentation of areola
day or night, is one of the classic symptoms  Pricking sensation
of pregnancy o 2 weeks after implantation of embryo
 Food aversions or cravings – especially in the  Fatigue – it is frequent in early pregnancy and
first trimester, when hormonal changes are subside around 12-14 weeks of pregnancy
the most dramatic with bringing renewed energy
 Headaches – early in pregnancy, increased  Fainting
blood circulation caused by hormonal
changes may trigger frequent, mild Probable – noted by examiner
headaches  Gooddell’s sign – softening of the cervix
 Constipations – an increase in progesterone  Chadwick’s sign – bluish color, cervix, vagina
causes food to pass more slowly through the  Hegar’s sign – softening of the lower uterine
intestines, which can lead to constipation segment
 Mood swings – the flood of hormones in the  Enlarged abdomen
body in early pregnancy can make one  Pigmentation changes
unusually emotional and weeps; mood o Occurs at 24th week
swings are also common especially in the
o Linea nigra
first trimester
o Striae gravidarum
 Faintness and dizziness – as the blood vessels
o Chloasma gravidarum
dilate and blood pressure drops, one may feel
 Stretch marks
lightheaded or dizzy; early in pregnancy,
 Ballottement – method of diagnosing
faintness also may be triggered by low blood
pregnancy in which the uterus is pushed with
sugar
a finger to feel whether a fetus moves away
and returns again
First trimester presumptive signs or
 Positive pregnancy test – can tell whether
subjective symptoms
one is pregnant by checking a particular
 Amenorrhea
hormone in the urine or blood which is the
o Absence of menstruation in woman of
human
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GMT -05:00
reproductive age

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 o HCG – made in the placenta after a  Dental care
fertilized egg implants in the uterus; o The teeth should be brushed carefully
normally made only during pregnancy in the morning and after every meal
 Palpation of fetal outline o Encourage the woman to see her
dentist regularly for routine
Positive signs of pregnancy examination and cleaning
Positive signs of pregnancy are those that signs that o A tooth can be extracted during
are definitely confirmed as pregnancy. pregnancy, but local anesthesia is
 Fetal heart sounds – with the use of recommended
fetoscope doppler  Dressing
 Ultrasound scanning of the fetus o Avoid wearing tight clothes such as
 Perception of fetal movements by the belt or constricting bands on the legs
clinician – movement of the fetus felt by the because these could impede lower
examiner (10-16 weeks) extremity circulation
 X-ray o Suggest wearing shoes with a
 Fetal outline – sonography with the use of moderate to low heel to minimize
ultrasound; fetal image through ultrasound pelvic tilt and possible backache
 Fetal heart tone o Loose and light are the most
o Fetal heart beat – Doppler at 10-12 comfortable
weeks  Travel
o Stethoscope – 18-20 weeks o Early in normal pregnancy, there are
o Right lower quadrant no restrictions
 Quickening – first fetal movement which o Late in pregnancy, travel plans should
occurs naturally at about the middle of be taken into consideration due to the
pregnancy typically at about 18-20 weeks possibility of early labor
Sexual activity

HEALTH EDUCATION/ TEACHING FOR THE o Sexual intercourse is allowed with
PREGNANT WOMAN moderation, it is absolutely safe and
 Diet normal, unless specific problems exist
o Need extra 300kcal/day from 2nd such as: vaginal bleeding or ruptured
trimester onwards membrane
o Protein o If a woman has a history of abortion,
o Salt she should avoid sexual intercourse in
o Iron the early months of pregnancy
o Calcium: 1.5 g daily Exercise

o Vitamin C, folic acid, Vitamin B12 o Regular exercise during pregnancy
o + tablets can improve the posture and decrease
 Hygiene some common discomforts such as
o Daily all over wash is necessary backaches and fatigue
because it is stimulating, refreshing, Sleep

and relaxing o Sleep pattern of pregnant women may
o Hot bath should be avoided because affect the development of the baby
they may cause fatigue and fainting o Pregnant women need at least 6 hours
o Regular washing for genital area, of sleep
axilla, and breast due to increased
discharge and sweating NURSING MANAGEMENT DURING PREGNANCY
o Vaginal douches should be avoided Follow-up visits
except in case of excessive secretion At each subsequent prenatal visit, the following
or infection assessments are completed:
 Breast care  Weight and blood pressure, which are
o Wash breasts with clean tap water compared to the baseline values
o It is not recommended to massage the  Urine testing for protein, glucose, ketones,
breast, this may stimulate oxytocin and nitrites
hormone secretion and may possibly  Fundal height measurement to assess fetal
lead to contraction growth
o Advise the mother to be mentally  Assessment of quickening/fetal movement to
prepared for breast feeding
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At each follow up visit, provide anticipatory guidance  McDonald’s rule – fundal height; measure of
and education, review nutritional guidelines, the size of the uterus used to assess fetal
evaluate the client for compliance with prenatal growth and development during pregnancy
vitamin therapy.
Throughout the pregnancy, encourage the woman’s Fetal movement determination
partner to participate if possible.  Usually perceived by the client between 16-
20 weeks of gestation
Prenatal vitamins Measuring fetal heart rate
These are supplements made for pregnant women  Assist the woman onto the examining table
to give their bodies the vitamins and minerals and have her lie down
needed for a healthy pregnancy.  Cover her with a sheet to ensure privacy, and
The doctor may suggest taking them when one then expose her abdomen
begins to plan for pregnancy, as well as while  Locate the back of the fetus (the ideal
pregnant. position to hear the heart rate)
 Folic acid – can prevent birth defects that  Listen for the sound of the amplified heart
affect the baby’s brain and spinal cord rate, moving the device slightly from side to
Doctors recommend that any woman who side as necessary to obtain the loudest sound
could get pregnant take 400 micrograms  Once the fetal heart rate has been identified,
(mcg) of folic acid daily, starting before count the number of beats in 1 minute and
conception and continuing for the first 12 record the results
weeks of pregnancy.  Fetal heart rate: 110-160 bpm
Sources of folic acid:
o Broccoli Ultrasonography
o Brussels sprouts Real-time scanners can produce a continuous
o Green, leafy vegetables picture of the fetus on a monitor screen. A
o Peas transducer that emits high frequency sound waves is
o Beans placed on the mother’s abdomen and moved to
 Vitamin C visualize the fetus.
o Broccoli  Heartbeat and any malformations in the fetus
o Brussels sprouts can be assessed and measurements can be
o Spinach made accurately from the picture on the
monitor screen
o Tomatoes and tomato juice
 Ultrasound, which is noninvasive, is
 Calcium
considered a safe, accurate, and cost-
o Dairy products
effective tool
o Green, leafy vegetables
 It provides important information about fetal
o Soya drinks with added calcium activity, growth, and gestational age,
 Vitamin A assesses fetal well-being, and determines the
o Liver need for invasive intrauterine tests
o Milk and eggs
 Fiber NURSING MANAGEMENT FOR THE COMMON
o Lentils DISCOMFORTS OF PREGNANCY
o Black beans Most women experience common discomforts during
o Chia seeds pregnancy and ask a nurse’s advice about ways to
 Vitamin B6 minimize them.
o Poultry
o Peanuts First trimester discomforts
o Some fish  Urinary frequency or incontinence – common
o Oats in the first trimester because the growing
uterus compresses the bladder
Fundal height measurement For this same reason, it also is a common
 Distance (in cm) measured with a tape complaint during the third trimester,
measure from the top of the pubic bone to especially when the fetal head settles into
the top of the uterus (fundus) the pelvis.
 The client is lying on her back with knees Health teaching:
slightly flexed o Try Kegel exercises to increase control
over leakage
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 Teach the client to perform Kegel Health teaching:
exercises throughout the day to help o Increase intake of food high in fiber
strengthen perineal muscle tone, and drink at least eight 8-ounce
thereby enhancing urinary control and glasses of fluid daily
decreasing the possibility of o Exercise each day brisk walking to
incontinence. promote movement through the
intestine
o Empty your bladder when you first feel o Reduce the amount of cheese
a full sensation consumed
o Avoid caffeinated drinks, which o Eat a high fiber diet
stimulates voiding o Drink a lot of fluids
o Reduce your fluid intake after dinner to o Exercise routinely
reduce nighttime urination o Over-the-counter remedies – may help
 Fatigue soften bowel movements and reduce
Health teaching: constipation
o Attempt to get a full night’s sleep,  Varicosities – varicose veins are a common,
without interruptions usually harmless part of pregnancy for some
o Eat a healthy balanced diet women
o Schedule a nap in the early afternoon This happens when the uterus applies
daily pressure to the large vein (the inferior vena
 Nausea and Vomiting cava) that carries blood back to the heart
Health teaching: from your feet and legs. Varicose veins can
o Avoid an empty stomach at all times become itchy, uncomfortable, or even
o Munch on dry crackers/toast in bed painful.
before arising Health teaching:
o Eat several small meals throughout the o Walk daily to improve circulation to
day extremities
o Drink fluids between meals o Elevate both legs above heart level
o Avoid greasy, fried food or ones with a while resting
strong odor o Avoid standing in one position for long
 Backache periods of time
Health teaching: o Don’t wear constrictive stockings and
o Avoid standing or sitting in one position socks
for long periods o Don’t cross the legs when sitting for
o Apply heating pad long periods
o Support lower back with pillows when o Wear support stockings to promote
sitting better circulation
o Stand with your shoulders back to  Hemorrhoids – are swollen veins in your
maintain correct posture rectum, the opening in your bottom
 Leg cramps They can cause itching, burning, pain, or
Health teaching: bleeding. It’s common to get them during
o Elevate legs above heart level pregnancy, especially in the third trimester.
frequently throughout the day One should call their doctor if theirs bleed or
o If you get a cramp, straighten both hurt a lot.
legs and flex your feet toward your Causes:
body o More likely to get hemorrhoids if
o Ask your health care provider about constipated, because straining to have
taking additional calcium supplements, a bowel movement swells the veins
which may reduce leg spasm o Growing baby also puts pressure on
 Constipation – thought to occur due to the large veins behind the uterus
hormones that relax the intestinal muscle o Usually go away soon after baby is
and by the pressure of the expanding uterus born
on the intestines Health teaching:
Relaxation of the intestinal muscle causes o Establish a regular time for daily
food and waste to move slower through the bowel elimination
system. Sometimes, iron tablets may o Prevent straining by drinking plenty of
contribute
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 o Use warm sitz baths and cool o If she smokes, encourage her to stop
compresses  Dependent edema – swelling is the result of
 Indigestion – also called heartburn or acid increased capillary permeability caused by
reflux, common in pregnancy elevated hormone levels and increased blood
It can be caused by hormonal changes and volume
the growing baby pressing against your Sodium and water are retained and thirst
stomach. Help ease your indigestion and increases. Edema occurs most often in
heartburn by making changes to your diet dependent areas such as the legs and feet
and lifestyle, and there are treatments that throughout the day due to gravity; it
are safe to take in pregnancy. improves after a night’s sleep.
Health teaching: Health teaching:
o Avoid spicy or greasy foods and eat o Elevate feet and legs above level of
small frequent meals the heart
o Sleep on several pillows so that your o Wear support hose when standing or
head is elevated sitting for long periods
o Stop smoking and avoid caffeinated o Change position frequently
drinks to reduce stimulation throughout the day
o Avoid lying down for at least 2 hours o Lie on the left side to keep the gravid
after meals uterus off the vena cava to return
o Try drinking sips of water to reduce blood to the heart
burning sensation o Avoid food high in sodium, such as
lunch meats, potato chips, and bacon
Second trimester discomforts o Avoid wearing knee-high stockings
A sense of well-being typically characterizes the o Drink six to eight glasses of water
second trimester for most women. By this time, the daily to replace fluids lost from
fatigue, nausea, and vomiting have subsided and perspiration
the uncomfortable changes of the third trimester are
a few months away. NURSING MANAGEMENT TO PROMOTE SELF-
CARE
Third trimester discomforts Nurses can play a major role in providing
As women enter their third trimester, many anticipatory guidance and teaching to foster the
experiences a return of the first trimester woman’s responsibility for self-care, helping to
discomforts of fatigue, urinary frequency, and clarify the misconceptions, and correct any
constipation. misinformation.
These discomforts are secondary to the ever- Educating the client to identify threats to safety
enlarging uterus compressing adjacent structures, posed by her lifestyle or environment.
increasing hormones.  Personal hygiene
 Shortness of breath and dyspnea – the During pregnancy, a woman’s sebaceous
increasing growth of the uterus prevents (sweat) glands become more active under
complete lung expansion late in pregnancy the influence of hormones, and sweating is
As the uterus enlarges upward, the more profuse.
expansion of the diaphragm is limited. Taking showers twice daily helps to keep the
Dyspnea can occur when the woman lies on area dry and promotes better hygiene.
her back and the pressure of the gravid  Perineal care
uterus against the vena cava reduces return Advise pregnant women to shower frequently
to the heart. and wear all-cotton underwear to minimize
Health teaching: the effects of these secretions.
o Instruct her to adjust her body They should also avoid perfumed soaps,
position to allow for maximum perineal sprays, and harsh detergents to help
expansion of the chest prevent irritation and potential infection.
o Avoid large meals, which increase  Breast care
abdominal pressure Wear larger sized bra about halfway through
o Raising of the head of the bed on the pregnancy because of the increasing size
blocks or placing pillows behind the of the breasts.
back is helpful too Advise her to avoid using soap on the nipple
o Advise woman to avoid exercise that area because it can be very drying.
precipitates dyspnea, to rest after Encourage her to rinse the nipple area with
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  Exercise
Exercise is well-tolerated by a healthy woman
during pregnancy. It promotes a feeling of
well-being and improves circulation.
It increases energy level, improves posture,
helps sleep, promotes relaxation and rest,
and relieves the lower back discomfort that
often arises as the pregnancy progresses.
 Employment
For the most part, women can continue
working until delivery if they have no
complications during their pregnancy and the
workplace does not present and special
hazards.
 Immunizations and medications
Ideally, clients should receive all childhood
immunizations before conception to protect
the fetus from any risk of congenital
anomalies.
Immunizations such as measles, mumps, and
rubella (MMR), hepatitis B, and
diphtheria/tetanus (every 10 years) can be
administered if needed.
Two vaccines are routinely recommended
during pregnancy:
o Flu (influenza) shot – recommended
for women who are pregnant during
flu season

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