Signs and Nutrition in Pregnancy

Presumptive Signs of Pregnancy

• Amenorrhea (absence of menstruation) is a primary early indicator.
• Symptoms often include nausea, vomiting, fatigue, and increased urinary frequency.
• Notable physical changes: breast alterations (darkened areolae, enlarged Montgomery’s glands) and Chadwick’s sign (cervical color change to bluish-purple).
• Quickening refers to fetal movement typically felt between 16 to 20 weeks.

Foods to Avoid in Pregnancy

• High-risk foods include soft and moldy cheeses, deli meats, hot dogs, raw dairy, and raw produce to reduce listeria infections.
• Raw or lightly cooked sprouts (e.g. alfalfa, clover) should be avoided.
• Reheat luncheon meats and hot dogs until steaming to mitigate risk.
• Soft cheeses must be made from pasteurized milk; avoid refrigerated pâté and unpasteurized products.

Leading Cause of Neonatal Mortality

• Primary contributors are congenital malformations, premature birth, and maternal pregnancy complications.
• Neonatal morbidity and mortality correlate with gestational age and birth weight, with preterm labor being a significant factor.

Expected Changes in Pregnancy

• The uterus enlarges, alters shape, and changes position.
• Cardiac output can increase by 30% to 50%; blood volume rises by 30% to 45% at term to support metabolic needs.
• Heart rate increases, peaking by 32 weeks; common heart sound changes include splitting and systolic murmurs.
• Oxygen demands rise, leading to alterations in respiratory rate and lung capacity by the third trimester.
• Relaxation of pelvic joints and increased renal filtration rates occur.

HIV Patient Precautions

• Early treatment reduces perinatal transmission risks.
• Procedures like amniocentesis should be avoided to prevent blood exposure.
• Refrain from using internal fetal monitors and instruments that risk maternal blood contact.
• Delayed newborn treatments (injections, blood tests) until after the first bath.
• Vaginal delivery may be possible with a viral load under 1,000 copies/mL; Cesarean birth is advised for higher loads.
• Breastfeeding is contraindicated for HIV-positive mothers.

Safe Exercises in Pregnancy

• Regular moderate exercise (30 minutes) such as walking or swimming is beneficial if no contraindications exist.

Reasons for Spontaneous Abortion

• Factors include chromosomal abnormalities, maternal illnesses (e.g., type 1 diabetes), age, and trauma.
• Other contributors include malnutrition, substance abuse, and conditions like antiphospholipid syndrome.

Warning Signs in Pregnancy

• Immediate medical contact is advised for abnormal bleeding, fluid leakage, or contractions.
• Other concerning symptoms include high blood pressure and signs of preeclampsia (swelling, headaches).

Ethical Principles

• Ensure ethical practice through patient autonomy, beneficence, non-maleficence, and justice in care.

Teen Pregnancy Education

• Vital to provide comprehensive education regarding risks, prenatal care, and developmental support for teen mothers.

Priority Interventions for Abruptio Placentae

• IV line initiation and constant monitoring of maternal cardiovascular status and fetal condition are crucial.
• Prepare for immediate birth and administer fluids and oxygen as necessary.

Rhogam Administration

• Given to Rh-negative women exposed to Rh-positive blood during pregnancy or delivery.
• Administer a standard dose at 28 weeks and after the birth of an Rh-positive infant.

Glucose Challenge Test (GCT)

• Conducted between 24 to 28 weeks; no fasting required.
• The test involves consuming 50g of glucose and drawing blood one hour later to assess blood sugar levels.

Sources of Folate

• Rich in leafy greens, legumes, seeds, and fortified cereals; necessary for fetal development.

Fetal Lung Development

• Completion typically occurs around 37 weeks gestation.

RN Responsibilities After Amniocentesis

• Prepare by explaining the procedure and ensuring informed consent; assess vital signs and FHR before starting.
• Maintain maternal positioning for safety and facilitate ultrasound.

Infection Prevention in Pregnancy

• Promote good hygiene, regular immunizations, and avoidance of sick individuals to prevent infections.

Safety for Moms with Herpes

• Active genital lesions necessitate a C-section; antiviral treatment like Acyclovir may reduce risks.
• Safe breastfeeding is possible if no lesions are present, with infant monitoring for signs of infection.

Weight Gain Guidelines

• Discuss appropriate weight gain for women based on Body Mass Index (BMI) categories.

Fetal Development Milestones

• Heartbeat detectable via ultrasound at 8 weeks; Doppler may detect it by 10-12 weeks.
• Fetal gender can be identified around week 12.

Non-Stress Test (NST)

• A non-invasive test performed in the third trimester to monitor fetal well-being, measuring FHR in response to fetal movements.