Maternal Adaptation to Pregnancy PDF

Lesson 1: Maternal Adaptation to Pregnancy Reproductive System Changes Psychological Changes / Tasks - By 12 weeks of pregnancy, the enlarging - Psy...

Lesson 1: Maternal Adaptation to Pregnancy Reproductive System Changes Psychological Changes / Tasks - By 12 weeks of pregnancy, the enlarging - Psychological changes during pregnancy: uterus may cause a woman's abdomen to Pregnancy is always associated with protrude slightly. The uterus continues to changes in psychological functioning of enlarge throughout pregnancy. The enlarging pregnant women. It is usually associated uterus extends to the level of the navel by 20 with ambivalence, frequent mood changes, weeks and to the lower edge of the rib cage varying from anxiety, fatigue, exhaustion, by 36 weeks. sleepiness, depressive reactions to excitement. Systemic Changes - The cardiovascular system of a pregnant Diagnosis of Pregnancy individual will undergo significant physiologic - is usually based on measurement of human changes, including an increased heart rate, chorionic gonadotropin (hCG) in urine or stroke volume, cardiac output, and a blood, but ultrasonography is also an decrease in vascular resistance. Increased accurate diagnostic technique. History and ventricular wall mass, myocardial physical examination are not highly sensitive contractility, and cardiac compliance are also methods for early diagnosis. seen. 1. Presumptive Signs - are things such as amenorrhea, The Normal Prenatal Period nausea/vomiting, larger and fuller breasts, urinary frequency, pronounced nipples, skin changes, fatigue, Prenatal Care & Health Assessment Quickening, changes in the color of vaginal mucosa, - Prenatal tests are tests done during and a positive home pregnancy test. pregnancy to check a woman's health and her baby's. They can detect conditions that 2. Probable Signs can put a baby at risk for problems like preterm birth if they're not treated. Tests also Classic signs and symptoms of pregnancy can help health care providers find things ○ Missed period. If you're in your childbearing like a birth defect or a chromosomal years and a week or more has passed abnormality. without the start of an expected menstrual cycle, you might be pregnant.... Gravida Gravida or gravidity describes the total ○ Tender, swollen breasts.... number of confirmed pregnancies that a ○ Nausea with or without vomiting.... female has had, regardless of the outcome. ○ Increased urination.... ○ Fatigue. Para Para or parity is defined as the number of births that a female has had after 20 weeks gestation. 3. Positive Signs - Active fetal movement felt by practitioner, visual confirmation of fetus on ultrasound, Primigravida A woman pregnant for the first time. fetal heartbeat heard on ultrasound (6-8 weeks) or by a doppler at around 12 weeks Primipara Primipara describes a woman who has had a.Quickening: Maternal feeling of the fetus one viable pregnancy. move, the earliest usually around 16 weeks Multigravida A pregnant woman who has been pregnant b.Ballottement: examiner inserts finger into two or more times. the vagina, pushes on uterus and feels the Multipara Multipara refers to a woman who has had two return of the fetus to the finger or more viable pregnancies. This term is used regardless of whether the infant is born alive. c.Chadwick’s sign is a purple/blue/violet The pregnancy must last at least 20 weeks discoloration of the cervix, labia and vagina for it to be considered a viable pregnancy due to increased vascularity and blood flow Nulligravida a female who has never been pregnant. d.Hegar’s sign is a softening at the bottom of the uterus, usually around 4-6 weeks E. Goodell’s sign is at approximately 4 weeks gestation, the vaginal portion of the cervix gets softer due to increased vascularization GTPALM increases the risk of pre-eclampsia, depression, and of needing a Caesarean section. Gravida total number of confirmed pregnancies – regardless of outcome 5. Bleeding - while common in pregnancy, may also be a sign of placental complications, a vaginal or cervical Term Complete 36-40 weeks infection, or preterm labor. Para number of pregnancies a woman has carried past 6. Placenta Previa - is when the placenta attaches 20 weeks of gestation – regardless of outcome inside the uterus but in a position near or over the cervical opening. Symptoms include vaginal bleeding Abortion in the second half of pregnancy. The bleeding is bright red and tends not to be associated with pain. Living children 7. Placenta Abruption - is when the placenta separates Multi Birth Twins, triplets, quadruplets – counted as one early from the uterus, in other words separates before pregnancy but 2,3,4 living children childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low Review of Systems blood pressure. Pelvic Examination & Pelvic Size Blood Studies / Laboratory 8. Anemia - is a blood disorder in which the blood has a - Second trimester prenatal screening may reduced ability to carry oxygen. This can be due to a include several blood tests. These are called lower than normal number of red blood cells, a multiple markers. They give information reduction in the amount of hemoglobin available for about a woman's risk of having a baby with oxygen transport, or abnormalities in hemoglobin that certain genetic conditions or birth defects. impair its function. Screening is often done by taking a sample of your blood between the 15th and 20th The body produces around 20–30% extra weeks of pregnancy. blood during pregnancy. This means the body needs extra iron to make hemoglobin - All pregnancy tests work by detecting a special hormone in the urine or blood that is 9. Ectopic Pregnancy - is a complication of pregnancy only there when a woman is pregnant. It is in which the embryo attaches outside the uterus. called human chorionic gonadotropin or Signs and symptoms classically include abdominal hCG. hCG is made when a fertilized egg pain and vaginal bleeding, but fewer than 50 percent implants in the uterus of affected women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Complications of Pregnancy During pregnancy, some common infections 1. Preeclampsia - is a multi-system disorder specific to that may occur are the flu, vaginal yeast pregnancy, characterised by the new onset of high infections, uterine infections, group B blood pressure and often a significant amount of streptococcus, bacterial vaginosis, and protein in the urine or by the new onset of high blood listeria. Changes in immune function may pressure along with significant end-organ damage, cause this increased risk of infection, and if with or without the proteinuria. left untreated, may lead to serious complications. 2. Preterm labor - happens when people go into labor before 37 weeksTrusted Source of pregnancy. Preterm labor can increase the chance of health problems 3. Miscarriage - also known in medical terms as a spontaneous abortion, is an end to pregnancy resulting in the loss and expulsion of an embryo or fetus from the womb before it can survive independently. Miscarriage before 6 weeks of gestation is defined as biochemical loss by ESHRE. 4. Gestational Diabetes - is a condition in which a woman without diabetes develops high blood sugar levels during pregnancy. Gestational diabetes generally results in few symptoms; however, it Lesson 2: Promoting Fetal and Maternal Health most people because the fetus is heaviest. Following a healthy, safe diet; getting regular exercise The added weight places pressure on your as advised by a healthcare provider; and avoiding joints, bladder and gut. exposure to potentially harmful substances such as lead and radiation can help reduce the risk for 3. Preventing Fetal Exposure to Teratogens problems during pregnancy and promote fetal health and development. How can you avoid teratogens during pregnancy? Talk with your healthcare provider about any How can you promote maternal and fetal health? medications you're taking. The WHO recommends four or more antenatal care Avoid cigarettes, alcohol and recreational drugs. visits during pregnancy to ensure the wellbeing of Don't take any supplements, medications or mothers and newborns. During these visits, women prescription drugs without checking with your should be given nutritional advice, alerted to warning healthcare provider. signs indicating possible problems during their term, Avoid cleaning litter boxes. and given support when planning a safe delivery. Nutrition Regular prenatal care, women can reduce the risk of Maternal Diet and Infant Health pregnancy complications. This is done in part through following a healthy diet, getting regular exercise as 1. Calorie Needs - For most normal-weight pregnant advised by a healthcare provider, maintaining a women, the right amount of calories is: healthy weight, and avoiding potentially harmful About 1,800 calories per day during the first substances, such as lead and radiation. trimester. About 2,200 calories per day during the Health Promotion During Pregnancy second trimester. Discomforts of Early Pregnancy About 2,400 calories per day during the third trimester. Common Discomforts During Pregnancy Nausea and vomiting. About half of all pregnant 2. Protein Needs - recommend 75 to 100 grams of people have nausea and sometimes vomiting in the protein per day. Protein positively affects the growth of first trimester. fetal tissue, including the brain. It also helps your Fatigue. breast and uterine tissue to grow during pregnancy, Hemorrhoids. and it plays a role in your increasing blood supply. Varicose veins. Heartburn and indigestion. 3. Fat Needs - needs more fat. Roughly 25%to 35%of Bleeding gums. your daily calories should come from fat, depending Pica. on your carbohydrate goals. Eating monounsaturated Swelling or fluid retention (edema) fat is preferred over saturated varieties. Women normally accumulate fat during 1. First Trimester pregnancy. It is estimated that pregnant Soon after you become pregnant, hormonal women who gain 12.5 kg (27.5 lb) without changes might make your breasts sensitive edema acquire about 3.5 kg (7.5 lb) of fat. or sore. You'll likely have less discomfort after a few weeks as your body adjusts to 4. Vitamin Needs - During pregnancy you need folic hormone changes. Upset stomach with or acid, iron, calcium, vitamin D, choline, omega-3 without vomiting. Feeling like vomiting during fatty acids, B vitamins, and vitamin C. pregnancy is known as morning sickness. Why are minerals important to an expectant mother? 2. Middle to Late Pregnancy - You and your baby need iron to Achiness in your lower abdomen.In your make the haemoglobin in red blood second trimester, you may notice some cells. While your baby's developing cramps or aches in your lower belly. Cramps they get the iron they need from happen because as your uterus expands you. This means your iron levels during pregnancy, it puts pressure on nearby can fall, making you anaemic. Your muscles and ligaments. During your second body needs time to build up iron trimester, your round ligament muscle often throughout pregnancy, so it's cramps as it stretches. important to make sure you're regularly getting enough. You may notice swelling and stretch marks. 5. Fluid Needs - you should drink 8 to 12 cups (64 to Third trimester (weeks 27 to week 40): The 96 ounces) of water every day. Water has many third trimester is the most uncomfortable for benefits. It aids digestion and helps form the amniotic  fluid around the foetus. Water also helps nutrients 1. Leboyer Method - With the Leboyer method, the circulate in the body and helps waste leave the body. birthing room is darkened so there is no sudden 6. Fiber Needs - The dietary reference intakes indicate contrast in light; it is kept pleasantly warm, not chilled. that 28 g of total dietary fiber per day (14 g/1,000 Soft music is played, or at least harsh noises are kept kcal/day) is adequate for pregnant women to a minimum. The infant is handled gently; the cord is cut late; and the infant is placed immediately after Preparation for Childbirth and Parenting birth into a warm-water bath. Childbirth Education 1. Tailor Sitting - encourages good posture, which, in turn, may ease back pain and improve circulation along the midline of your body. Good posture also helps move the uterus forward. Why is this important? Well, extra wiggle room may help your baby move themselves into a more favorable position for birth. 2. Squatting - are an excellent resistance exercise during pregnancy to maintain strength and range of motion in the hips, glutes, core, and pelvic floor muscles. When performed correctly, squats can help improve posture and have the potential to assist with the birthing process. 3. Kegel Exercises - exercise is like pretending you have to urinate and then holding it. You relax and 2. Hydrotherapy and Water Birth - Reclining or sitting tighten the muscles that control urine flow. It is in warm water during labor can be soothing; the important to find the right muscles to tighten. feeling of weightlessness that occurs under water as well as the relaxation from the warm water both can 4. Abdominal Muscle - All pregnant women experience contribute to reducing discomfort in labor. diastasis recti, a separation in the abdomen that occurs when the tissue between the rectus abdominis muscles—the two sides of your “six pack”—stretches or tears at the central vertical line. Lesson 3: Alternative Methods of Birth The Intrapartal Period Theories of Labor Onset Labor normally begins when a fetus is sufficiently mature to cope with extrauterine life yet not too large to cause mechanical difficulty with birth. In some instances, labor begins before a fetus is mature (preterm birth). In others, labor is delayed until the fetus and the placenta have both passed beyond the optimal point for birth (postterm birth). Premonitory Signs of Labor  1. Lightening - Lightning In primiparas, lightening, or descent of the fetal presenting part into the pelvis, occurs approximately 10 to 14 days before labor begins. This fetal descent changes a woman’s abdominal contour, because it positions the uterus lower and more anterior in the abdomen. Lightning gives a woman relief from the diaphragmatic pressure and shortness of breath that she has been experiencing and in this way “lightens” her load. 2. Increase in Level of Activity - A woman may awaken on the morning of labor full of energy, in contrast to the feeling of chronic fatigue she felt during the previous month. This increase in activity is related to an increase in epinephrine release initiated by a decrease in progesterone produced by the placenta 3. Slight Loss of Weight - As progesterone level falls, 2. Passenger - The passenger is the fetus. The body body fluid is more easily excreted from the body. This part of the fetus that has the widest diameter is the increase in urine production can lead to a weight loss head, so this is the part least likely to be able to pass between 1 and 3 pounds through the pelvic ring 4. Braxton Hicks Contractions - In the last week or days before labor begins, a woman usually notices extremely strong Braxton Hicks contractions. Women having their first child may have great difficulty distinguishing between these and true contractions. 5. Ripening of the Cervix - Ripening of the cervix is an internal sign seen only on pelvic examination. Throughout pregnancy, the cervix feels softer than normal to palpation, similar to the consistency of an earlobe 3. Molding - Molding is a change in the shape of the (Goodell’s sign). fetal skull produced by the force of uterine contractions pressing the vertex of the head against the not-yet-dilated cervix. Because the bones of the fetal skull are not yet completely ossified and therefore do not form a rigid structure, pressure causes them to overlap and molds the head into a narrower and longer shape, a shape that facilitates passage through the rigid pelvis. Components of labor 1. Passage - The passage refers to the route a fetus must travel from the uterus through the cervix and vagina to the external perineum. Mechanisms / Cardinal Movements of Labor Passage of a fetus through the birth canal involves several different position changes to keep the smallest diameter of the fetal head (in cephalic presentations) always presenting to the smallest  diameter of the pelvis. These position changes are termed the cardinal movements of labor: descent, As the fetal head pushes against the perineum, the flexion, internal rotation, extension, external rotation, vaginal introitus opens and the fetal scalp appears at and expulsion the opening to the vagina. At first, the opening is slitlike, then becomes oval, and then circular. The circle enlarges from the size of a dime, then a quarter, then a half-dollar. This is called crowning. Third Stage Placental separation - As the uterus contracts down on an almost empty interior, there is such a disproportion between the placenta and the Stages of Labor contracting wall of the uterus that folding and separation of the placenta occurs. Active bleeding on First stage the maternal surface of the placenta begins with separation; this bleeding helps to separate the Latent Phase - The latent or preparatory phase placenta still farther by pushing it away from its begins at the onset of regularly perceived uterine attachment site. contractions and ends when rapid cervical dilatation begins. Contractions during this phase are mild and Placental expulsion - If the placenta does not deliver short, lasting 20 to 40 seconds spontaneously, it can be removed manually. With delivery of the placenta, the third stage of labor is Active Phase - During the active phase of labor, complete. cervical dilatation occurs more rapidly, increasing from 4 to 7 cm. Contractions grow stronger, lasting 40 to 60 seconds, and occur approximately every 3 to 5 minutes. This phase lasts approximately 3 hours in a nullipara and 2 hours in a multipara. Transition Phase - During the transition phase, contractions reach their peak of intensity, occurring every 2 to 3 minutes with a duration of 60 to 90 seconds and causing maximum cervical dilatation of 8 to 10 cm. If the membranes have not previously ruptured or been ruptured by amniotomy, they will rupture as a rule at full dilatation (10 cm). Physiologic Effects of Labor on a Woman Second phase Cardiovascular System Hemopoietic System The second stage of labor is the period from full Respiratory System dilatation and cervical effacement to birth of the infant; Temperature Regulation with uncomplicated birth, this stage takes about 1 Fluid Balance hour  Urinary System Musculoskeletal System Gastrointestinal System Neurologic and Sensory Responses Psychological Responses of a Woman to Labor Fatigue Fear Cultural Influences Physiologic Effects of Labor to a Fetus Neurologic System Cardiovascular System Periodic Changes Integumentary System Musculoskeletal System Respiratory System Danger Signs of Labor 1. Maternal Danger Signs High or Low Blood Pressure Inadequate or Prolonged Contractions Pathologic Retraction Ring Abnormal Lower Abdominal Contour Increasing Apprehension 2. Fetal danger signs Care of Woman During – 1 st Stage of Labor High or Low Fetal Heart Rate (FHR) Respect Contraction Time Meconium Staining Promote Change of Positions Fetal Hyperactivity Promote Voiding and Provide Bladder Care Oxygen Saturation Offer Support Respect and Promote the Support Person Fetal Heart Rate Comfort Needs During Labor and Delivery Normal Fetal Heart Rate (FHR): 120-160 bpm Moderate Bradycardia: 100-119 bpm Etiology of Pain During Labor and Birth Marked Bradycardia: Less than 100 bpm Moderate Tachycardia: 161-180 bpm - Normally, contractions of involuntary muscles, such as Marked Tachycardia: Greater than 180 bpm the heart, stomach, and intestine, do not cause pain. This concept makes uterine contractions unique Variability because they do cause pain FHR variability is one of the most reliable indicators of Physiology of Pain During Labor and Birth fetal well-being. Baseline variability is the variation or differing rhythmicity in the heart rate over time and is - Pain is a basic protective mechanism that alerts a reflected on the FHR tracing as a slight irregularity or person that something threatening is happening “jitter” to the wave. somewhere in the body. The sensation of pain begins in nociceptors, the end points of afferent nerves, when they are activated by mechanical, chemical, or thermal stimuli. Nociceptors are located predominantly in the skin, bone periosteum, joint surfaces, and arterial walls Complementary and Alternative Therapies for Pain Relief Anesthesia Relaxation 1. Regional anesthesia - Regional anesthesia is the Focusing and Imagery injection of a local anesthetic such as tetracaine Prayer (Pontacaine) or bupivacaine (Marcaine) to block Breathing Techniques specific nerve pathways (Cho & Penning, 2007). This Herbal Preparations achieves pain relief by blocking sodium and Aromatherapy and Essential Oils potassium transport in the nerve membrane, thereby Heat or Cold Application stabilizing the nerve in a polarized resting state, so Bathing or Hydrotherapy that it is unable to conduct sensations. Therapeutic Touch and Massage Yoga and Meditation Reflexology Crystal or Gemstone Therapy Biofeedback Transcutaneous Electrical Nerve Stimulation (TENS) Acupressure and Acupuncture Intracutaneous Nerve Stimulation (INS) Narcotic Analgesics - Narcotics may be given during labor because of their potent analgesic effect, but all drugs in this 2. Local Anesthetics - Local anesthesia reduces the category cause fetal CNS depression to ability of local nerve fibers to conduct pain some extent so are used cautiously (McDonald & Yarnell, 2007). Intrathecal Narcotics -Intrathecal administration refers to injection into the spinal cord. With intrathecal narcotic injection, a catheter is introduced into the spinal canal (the subarachnoid space), and a narcotic such as morphine or fentanyl citrate is injected into the canal by way of the catheter. 1.1 Pudendal Nerve Block - A pudendal nerve block is the injection of a local anesthetic such as bupivacaine (Marcaine) near the right and left pudendal nerves at the level of the ischial spine. 1.2 General Anesthesia - General anesthesia is never 1. Paternal Reactions – may parallel those of mother; preferred for childbirth, because it carries the dangers of some may experience physical symptoms of hypoxia and possible inhalation of vomitus during pregnancy (couvades syndrome) administration. 2. Adaptation of Siblings – age and experience related Nursing Care To Promote The Comfort Of A Woman During Labor Emotional Response to Pregnancy Reduce Anxiety With Explanations of the Labor Emotional Responses Process Ambivalence Help the Woman Identify Coping Strategies Grief Provide Comfort Measures Narcissism Encourage Comfortable Positioning Introversion vs extroversion Assist the Woman With Prepared Childbirth Method Body image and boundary Provide Pharmacologic Pain Relief Stress Couvade syndrome – men experience physical symptoms Emotional lability Lesson 4: Psychological and Physiological changes of Changes in sexual desire pregnancy Changes in the expectant family Psychological Changes Of Pregnancy 1. Social Influences view pregnancy as a time of health relate to experiences 2. Cultural Influences Supporting these beliefs EBP caused complications of pregnancy 3. Family Influences positive attitude toward her pregnancy difficulty loving and accepting the fetus 4. Individual Influences resolve conflict and adapt to the new life coping with change and stress Psychological Tasks Of Pregnancy 1. Psychological First Trimester – Accepting The Pregnancy ○ maternal ambivalence ○ anticipation and concern related to fears and fantasies about the pregnancy Second Trimester – Accepting The Baby ○ increased maternal feelings of physical and emotional well-being; mother is often described as self-absorbed and introverted Third Trimester – Preparing For Parenthood ○ possible new fears related to labor and delivery and fantasies about the appearance of the baby; feelings of awkwardness, clumsiness, and decreased femininity related to changes in body image Diagnosis of Pregnancy 3. Positive signs of pregnancy 1. Presumptive Signs of Pregnancy Fetal heart separate from the mother’s (Doppler, auscultation) (subjective) – experienced by the woman; Fetal movements felt by examiner (+) suspicion of pregnancy, Visualization of fetus: fetal outline can be not proof, seen and measured by sonogram could easily indicate other conditions Maternal Adaptations In Pregnancy Amenorrhea Nausea/ vomiting Reproductive System Changes Breast sensitivity/fullness Fatigue Quickening Abdominal (uterine) enlargement Skin pigmentation changes (melasma or chloasma, linea nigra, striae gravidarum) Frequent urination 2. Probable signs of pregnancy objective, can be documented by examiner; increased suspicion of pregnancy but still not the true diagnostic proof Serum Laboratory tests (hCG) - a hormone created Uterine Changes by the chorionic villi of the placenta, in the urine or the uterus increases in length, depth, width, weight, blood serum of the pregnant woman wall thickness, and volume uterine growth is due to formation of a few new Home pregnancy tests - Several kits for pregnancy muscle fibers in the uterine myometrium testing 97% accuracy Bimanual Examination: Chadwick’s sign - Color change of the vagina from Hegar’s sign - Hegar’s sign is a softening of the pink to violet lower uterine segment, which occurs early in pregnancy (around 6-12 weeks of gestation). This Goodell’s sign - Softening of the cervix sign is detected by a healthcare provider during a bimanual examination. Hegar’s sign - Softening of the lower uterine segment Ballottement - physical exam in mid-pregnancy Ballottement - When lower uterine segment is tapped (around 16-20 weeks). The healthcare provider taps on a bimanual exam, the fetus can be felt to rise or pushes on the lower part of the uterus through the against abdominal wall abdomen or the vagina, causing the fetus to move up and then return to its original position. This creates a Fetal outline palpation - Fetal outline or contour bouncing sensation when the fetus is pushed away palpated by examiner and returns. Braxton hicks- periodic uterine tightening/ contractions occurs Sonographic evidence - evidence of gestational sac Uterine souffle - muffed swishing sound over the abdomen in union with the mother’s heartbeat Pregnancy test  uterine contractions begin early in pregnancy related nasal felt by a woman as waves of hardness or tightening congestion across her -/ false labor function of the corpus luteum True labor Cervical changes Cardiovascular 1. Blood Volume cervix of the uterus becomes more vascular and System total circulatory blood volume of edematous a woman’s body increases by at least 30% Operculum Blood loss Goodell’s sign ○ NSD=300-400 mL ○ CS= 800-000 mL Vaginal Changes increase in the activity of the epithelial cells results in 2. Iron, Folic Acid, and Vitamin Needs a white vaginal discharge iron supplementation during Chadwick’s sign pregnancy = decreased gastric acidity Decrease of pH level = Candida Albicans folic acid increases = NT medications disorder foods high in folic acid prenatal vitamins Ovarian Changes Ovulation stops with pregnancy 3. Heart 16th week of pregnancy- corpus luteum HR increases by 10 beats per minute chief provider of progesterone and estrogen difficulty handling her normal corpus luteum, no longer essential circulating load heart is shifted to a more Changes in the Breasts transverse position in the chest feeling of fullness, tingling, or tenderness cavity breast size increases Palpitations of the heart areola of the nipple darkens 4. Blood Pressure vascularity of the breasts increases BP does not normally rise sebaceous glands of the areola enlarge and become BP decreases slightly - 2nd protuberant trimester colostrum BP rises again – 3rd trimester 5. Peripheral Blood Flow blood flow to the lower Systemic changes extremities is impaired Integumentary striae gravidarum 6. Supine Hypotension Syndrome System diastasis pregnant woman lies supine= umbilicus is stretched by the hypotension 28th week - lightheadedness, linea nigra - faintness, melasma (chloasma), or the - palpitations “mask of pregnancy” fetal hypoxia. Vascular spiders or telangiectases 7. Blood Constitution Palmar erythema fibrinogen and platelet count increases WBC increase Protein decrease = ankle and foot edema Respiratory pressure is put on the diaphragm lipids increase and cholesterol System / lungs serum level increases woman’s vital capacity = not decrease residual volume = decreased Gastrointestinal nausea and vomiting / Morning tidal volume = increased System sickness total oxygen consumption = - early in the morning increases - smoke cigarettes heartburn / constipation / flatulence - slow intestinal peristalsis Temperature body temperature increases - relaxin slightly Progesterone associated with pregnancy gradual slowing of the GIT  Haemorrhoids Immune system Immunologic competency hypertrophy at their gum lines decreases and bleeding of gingival tissue Immunoglobulin G (IgG) hyperptyalism increase in the white blood cell count Urinary System fluid retention and renal, ureter, and bladder function Effects of high oestrogen and progesterone levels Compression of the bladder and Lesson 5: GTPAL (Ma’am Nava) ureters by the growing uterus Increased blood volume Postural influences GRAVIDA The number of pregnancies 1. Fluid Retention total body water increases TERM Number of pregnancies carried (beyond 38 influence of progesterone weeks) water is retained during pregnancy PRE-TERM Number born 20-37 weeks (alive or stillborn) 2. Renal Function ABORTION Pregnancy loses before 20 weeks (if kidneys excrete waste products miscarriage happen at 20 weeks counted) kidneys may increase in size GFR and renal plasma flow begin to increase LIVING Number of current living minimal spilling of glucose Creatinine clearance Para - Number of pregnancies that have reached increase in urinary frequency viability, regardless of whether the infants were born Lightening ureters increase in diameter and alive the bladder capacity increases Primigravida - Woman who is pregnant for the first pressure on the right ureter time pressure on the urethra Primipara - Woman who has given birth to one child past age of viability Skeletal System calcium and phosphorus needs Multigravida - Woman who has been pregnant change her center of gravity and previously make ambulation easier Multipara - Woman who has carried two or more Endocrine System 1. Placenta pregnancies to viability - estrogen, Nulligravida - Woman who has never been and is not - progesterone, currently pregnant - hCG, - human placental lactogen(hPL), A. Pelvic examination - reveals information on the - relaxin, health of both internal and external reproductive - prostaglandins. organs. 2. Pituitary Gland - increased growth hormone and Insertion of a vaginal speculum. melanocyte-stimulating hormone - posterior pituitary produce oxytocin 3. Thyroid and Parathyroid Glands - thyroid changes - parathyroid glands increase 4. Adrenal Glands - increased levels of corticosteroids and aldosterone - regulate glucose metabolism (A) Blades held obliquely on entering the vagina. - helps to safeguard the blood volume (B) Blades rotated to horizontal positionas they pass the - provide adequate perfusion introitus. pressure across the placenta (C) Blades separated by depressing thumbpiece and elevating handle. The position of the 5. Pancreas blades is maintained by adjusting a thumbscrew - increases production of insulin - effect of diminishing the action of insulin Speculum - Equipment required (a metal or plastic instrument 1. External genitalia - A pelvic examination begins with with movable flat blades, a spatula for cervical scraping, a inspection of the external genitalia. Any signs of clean examining glove, lubricant, a glass slide or liquid inflammation, irritation, or infection, such as redness, collection device for the Pap smear, a culture tube, two or three ulcerations, or vaginal discharge, are noted. sterile cotton-tipped applicators or cytobrushes for obtaining cervical cultures, a good examining light, and a stool at correct 2. Internal genitalia - To view the cervix, the vagina sitting height. must be opened with a speculum. 3. Pap smear - A Pap smear is taken for early detection and diagnosis of precancerous and cancerous conditions of the uterine cervix, vulva, or vagina; the test also reveals inflammatory and infectious diseases 4. Vaginal inspection - Before the vaginal speculum is removed, a culture for gonorrhoea, human papillomavirus (HPV), chlamydia, trichomoniasis, or group B streptococci may be taken Allow a woman the opportunity to talk with the person performing the examination while sitting up, before being 5. Examination of pelvic organs - Following the placed in a lithotomy position speculum examination, a bimanual (two-handed) examination is performed to assess the position, contour, consistency, and tenderness of pelvic organs 6. Rectovaginal examination - After a bimanual pelvic examination, the hand is withdrawn from the vagina. The index finger is reinserted into the vagina and the middle finger into the rectum. Internal pelvic measurements give the actual diameters of the inlet and outlet through which the fetus must pass. The following measurements are made most commonly: Diagonal conjugate (solid line) True conjugate or conjugate vera (dotted line) Ischial tuberosity Blood Studies The following blood studies are usually Relieving a leg cramp in pregnancy obtained at a first prenatal visit: complete blood count A genetic screen serologic test for syphili Blood typing (including Rh factor) Maternal serum for alpha-fetoprotein (AFP) indirect Coombs’ test Antibody titers for rubella and hepatitis B HIV screening glucose loading or tolerance test Signs Indicating Complications In Pregnancy 2. Discomforts of Middle to Late Pregnancy 1.Vaginal Bleeding Backache 2.Persistent Vomiting Headache 3.Chills and Fever Headache 4.Sudden Escape of Clear Fluid From the Vagina Ankle Edema 5.Abdominal or Chest Pain Braxton Hicks Contractions 6.Pregnancy-Induced Hypertension 7.Increase or Decrease in Fetal Movement Preventing fetal exposure to teratogen: Lesson 6: Promoting Fetal and Maternal Health Effects of teratogens on a fetus Radiation Health promotion during pregnancy Medications Recreational Drugs Alcohol Viruses Bacteria Environmental Factors Maternal Diet and Infant Health Self-care needs: bathing, breast care, dental care, 1. Calorie - The DRI of calories for women of perineal hygiene, and clothing childbearing age is 2200. An additional 300 calories, Sexual activity or a total caloric intake of 2500 calories, is Exercise recommended to meet the increased needs of Sleep pregnancy Employment Travel 2. Protein - The DRI for protein in women is 46 g/d. During pregnancy, the need for protein increases to 1. Discomforts of Early Pregnancy: The First 71 g daily Trimester Breast tenderness 3. Fat - Only linoleic acid, an essential fatty acid Palmar Erythema necessary for new cell growth, cannot be Constipation manufactured in the body from other sources. Nausea, Vomiting, and Pyrosis Because linoleic acid must be obtained from food, Fatigue women must be sure to consume a source of this Muscle Cramps nutrient during pregnancy. Hypotension Varicosities 4. Vitamins - The intake of vitamins as a daily dietary Haemorrhoids supplement has become so common that their Heart Palpitations importance may be underestimated by some women. Frequent Urination Requirements for both fat-soluble and water-soluble Abdominal Discomfort vitamins increase during pregnancy to support the Leukorrhea growth of new fetal cells 5. Mineral - Minerals are necessary for new cell building in a fetus. Because they are found in so many foods and because mineral absorption improves during  pregnancy, mineral deficiency, with the exceptions of 3. The Childbirth Plan calcium, iodine, and iron, is rare. - Most classes for expectant parents urge couples to make a written childbirth plan or 6. Fluid -Extra amounts of water are needed during spell out their choice of setting, birth pregnancy to promote kidney function because a attendant, special needs such as the extent woman must excrete waste products for two. Two or of family participation they wish during labor, three glasses of fluid daily over and above the three birthing positions, medication options, plans servings of milk recommended by the food pyramid is for the immediate postpartum period and a common recommendation during pregnancy (a total baby care, and family visitation (Simkin, of six to eight glasses daily) 2007). Urge couples to make decisions about these issues before the day of birth to 7. Fiber - Constipation can occur during pregnancy from avoid feeling stressed by last minute slowed peristalsis because of the pressure of the decisions. uterus on the intestine. Eating fiber-rich foods, foods consisting of parts of the plant cell wall resistant to 4. Preconception classes normal digestive enzymes such as broccoli and - Preconception classes are held for couples asparagus, are a natural way of preventing who are planning to get pregnant within a constipation, because the bulk of the fiber left in the short time and want to know more about intestine aids evacuation. what they can expect a pregnancy to be like and what are birth setting/procedure choices 5. Expectant parenting classes - Expectant parenting classes are designed for couples who are already pregnant. They focus on family health during a pregnancy, covering such topics as the psychological and physical changes of pregnancy, pregnancy nutrition, routine health care such as dental checkups, and newborn care In addition to teaching about normal labor, they include several exercises to ready the body for labor, as well as methods of pain prevention or pain relief in labor. Prenatal Yoga Preparation for Childbirth and Parenting (Childbirth Perineal and Abdominal Exercises education) ○ Tailor Sitting ○ Squatting 1. Childbirth Educators and Methods of Teaching ○ Kegel Exercises - Childbirth educators are health care ○ Abdominal Muscle providers who usually have a professional degree in the helping professions as well as 1. Tailor sitting - stretches perineal muscles to make a certificate from a course specifically about them more supple. Notice that the legs are parallel so childbirth education. They teach expectant that one does not compress the other. A woman could parents about the physical and emotional use this position for television watching, telephone aspects of pregnancy, childbirth, and early conversations, or playing with an older child. parenthood and present coping skills and labor support techniques. 2. Efficacy of Childbirth Education Courses - Many studies have been done to determine just how effective childbirth courses are in reducing the pain of childbirth, shortening the length of labor, decreasing the amount of medication used, and increasing overall enjoyment of the experience  2. Squatting - helps to stretch the muscles of the pelvic floor. Notice that the feet are flat on the floor for optimal perineal stretching. 3. Pelvic Floor Contractions (Kegel Exercises) Abdominal muscle contractions help strengthen abdominal muscles during pregnancy and therefore may help prevent constipation as well as help restore abdominal tone after pregnancy. Strong abdominal muscles can also contribute to effective second-stage pushing during labor.