Signs of Pregnancy Overview

Presumptive Signs of Pregnancy

• Experienced by the patient, not diagnostic.
• Examples include amenorrhea (missed period), nausea, breast tenderness, fatigue, and quickening (fetal movement felt around 18-20 weeks).

Probable Signs of Pregnancy

• Observed by a healthcare provider, but not definitive.
• Examples include a positive pregnancy test (detecting hCG in urine or blood), Chadwick's sign (bluish discoloration of cervix/vagina), Goodell's sign (softening of the cervix), and Hegar's sign (softening of lower uterus).

Positive Signs of Pregnancy

• Confirm pregnancy with certainty.
• Examples include fetal heart tones (detected by Doppler around 10-12 weeks), ultrasound showing fetal parts or cardiac activity, and fetal movements felt by the examiner.

Supine Hypotensive Syndrome (Vena Caval Syndrome)

• Occurs when the enlarged uterus compresses the inferior vena cava in a pregnant woman lying on her back.
• Symptoms include dizziness, nausea, hypotension, and pallor.
• Interventions include encouraging a side-lying position (preferably left), and using a pillow under the hip to elevate the uterus and relieve pressure.

Hormones in Pregnancy

• hCG (Human Chorionic Gonadotropin): Maintains the corpus luteum until the placenta takes over.
• Progesterone: Relaxes smooth muscles to prevent uterine contractions, supports the endometrium for implantation.
• Estrogen: Promotes uterine growth and blood flow, develops breast tissue for lactation.
• Relaxin: Loosens ligaments and joints for delivery.
• Human Placental Lactogen (hPL): Prepares breasts for lactation and regulates glucose availability for the fetus.

Adolescent Pregnancy

• Increased risk of preterm labor, anemia, and hypertension.
• Psychosocial challenges include interrupted education and lack of support.
• Nursing considerations focus on education, prenatal care compliance, nutrition, emotional health, and birth preparation.

Emotional Responses of Pregnancy

• Maternal: First trimester may include ambivalence, excitement, or fear; Second trimester focuses on the fetus and physical changes; Third trimester includes anxiety about labor and delivery.
• Paternal: May experience "Couvade syndrome" (sympathy symptoms like weight gain, nausea). Stages include announcement, adjustment, and focus.

Prenatal Labs, Physiological Changes, and Vaccination

• Common Labs: Blood type and Rh status, Complete Blood Count (CBC), Rubella titer, Hepatitis B and HIV tests, Glucose tolerance test.
• Vaccination Guidelines: Safe vaccines include Tdap and inactivated influenza; Avoid live vaccines (e.g., MMR, Varicella).
• Physiological Changes: Cardiovascular (increased blood volume, decreased BP in second trimester), Respiratory (increased tidal volume, nasal congestion), and Gastrointestinal (heartburn, constipation).

Gravida and Para (TPAL)

• Gravida (G): Total number of pregnancies, including current.
• Para (P): Number of deliveries beyond 20 weeks (living or not).
• TPAL System: T (term births), P (preterm births), A (abortions), L (living children).

Effects of Alcohol, Obesity, Diabetes, and Smoking on the Fetus

• Alcohol: Causes Fetal Alcohol Spectrum Disorders (FASD).
• Obesity: Increases risk of gestational diabetes, macrosomia.
• Smoking: Causes intrauterine growth restriction (IUGR), low birth weight.
• Diabetes: Risk of congenital anomalies, macrosomia, and neonatal hypoglycemia.

Nagele's Rule

• Used to calculate the Estimated Date of Delivery (EDD).
• Formula: Subtract 3 months from the first day of the last menstrual period (LMP), add 7 days, and add 1 year.

Fundal Height Measurement

• Used to assess fetal growth and amniotic fluid volume.
• Technique involves measuring from the pubic symphysis to the top of the fundus.
• Normal findings: Weeks = Fundal height in cm (after 20 weeks).

Maternal Nutrition

• Caloric Needs: No extra calories in first trimester, +340 calories/day in second trimester, +450 calories/day in third trimester.
• Key Nutrients: Folic acid (400-600 mcg/day), Iron, Calcium (for fetal bone development).

Discomforts and Physical Changes During Pregnancy

Childbirth Preparation

• Topics include breathing techniques, stages of labor, and pain management.

Diabetes in Pregnancy

• Screening: Glucose tolerance test at 24-28 weeks.
• Risks: Pre-eclampsia, macrosomia, polyhydramnios.

Molar Pregnancy

• Abnormal growth of trophoblast tissue.
• Requires D&C and follow-up hCG monitoring.

Cerclage (Nursing Care)

• A surgical procedure to stitch the cervix closed to prevent preterm birth or miscarriage.
• Indications: History of second-trimester losses due to cervical insufficiency, painless cervical dilation.
• Nursing care includes monitoring for infections, preterm labor, educating about activity restrictions (e.g., bed rest, pelvic rest), and post-procedure assessments for bleeding or discharge.

Amniocentesis (Reasons for, Results)

• A diagnostic procedure to withdraw amniotic fluid for testing.
• Indications: Detecting chromosomal abnormalities (e.g., Down syndrome), assessing fetal lung maturity, diagnosing infections or other fetal conditions.
• Nursing care includes ensuring informed consent, monitoring maternal and fetal well-being post-procedure, and education on signs of complications (fluid leakage, bleeding, or fever).

Pregnancy at Risk: Ectopic Pregnancy and Miscarriage

• Ectopic Pregnancy: Fertilized egg implants outside the uterine cavity (often fallopian tube). Symptoms include sharp abdominal pain, spotting, and dizziness. Management includes methotrexate if unruptured or surgery if ruptured.
• Miscarriage (Spontaneous Abortion): Pregnancy loss before 20 weeks. Types include threatened, incomplete, complete, and missed. Management involves monitoring hCG levels, and D&C (if incomplete) . Nursing care includes emotional support and monitoring for infection or hemorrhage.

Psychological Adjustment to Pregnancy

• Maternal: First trimester includes ambivalence, excitement, anxiety; Second trimester focuses on attachment to fetus; Third trimester focuses on labor and delivery fears.
• Paternal: Acceptance of pregnancy, shifts in role expectations, possible Couvade syndrome.
• Nursing interventions: Promote open communication, provide education about pregnancy, childbirth, and parenting, and encourage participation in prenatal visits and classes.