Antepartal Period PDF

ANTEPARTAL PERIOD EDWIN B. DEL ROSARIO, CCRN, ACNP, AGNP PHYSIOLOGY OF CONCEPTION LESSON 1  EMBRYONIC & FETAL STRUCTURES Corpus luteum Resembles probing develops finger into Grows from Trophoblast secretes trophoblast cell to...

ANTEPARTAL PERIOD EDWIN B. DEL ROSARIO, CCRN, ACNP, AGNP PHYSIOLOGY OF CONCEPTION LESSON 1  EMBRYONIC & FETAL STRUCTURES Corpus luteum Resembles probing develops finger into Grows from Trophoblast secretes trophoblast cell to trophoblastic cells Human Chorionic form placenta Serves to transport Gonadotrophin Endometrium grows in Produce placental blood and hormones (HCG, HPL, thickness and nutrients from vascularity estrogen, progesterone mother to fetus Endometrium now called decidua CHORIONIC VILLI PLACENTA DECIDUA  EMBRYONIC & FETAL STRUCTURES Formed from fetal membranes Dual-walled sac Function; shield fetus Provide circulatory pathway that with chorion and against pressure connect embryo to chorionic villi amnion Absorbed from the of placenta Fused together to fetal intestine --- fetal Function: transport oxygen and circulation nutrients to fetus from placenta form a single sac Removes waste product from Approximately 800- fetus to placenta 1200 ml Contains 1 vein and 2 arteries AMNIOTIC AMNIOTIC UMBILICAL MEMBRANE FLUID CORD  PLACENTAL HORMONES OF PREGNANCY Human Chorionic Human Placental Gonadotrophin (HCG) Estrogen Progesterone Lactogen First placental “hormone of “maintains Promotes hormone women” pregnancy” fetal growth produced Ensure the Contribute to Maintains the and milk corpus luteum developmen endometrial production continue to t of lining Stimulates produce mammary mammary estrogen and Prevents progesterone gland for premature gland Maintain lactation labor, growth and endometrium Stimulate reduces uterine Suppressing uterine contractility growth maternal growth of uterus immunologic response  FETAL GROWTH AND DEVELOPMENT 16th day of life – network of blood vessels and single heart tube 24th day of life – fetal heartbeat is evident Cardiovas 10-12th week of pregnancy – FHT by doppler cular after 28th week AOG – heart rate stabilizes 110-160 bpm 3rd week of intrauterine life = forms single-tube respiratory and digestive tracts End of 4th week = a septum begins to divide the esophagus from the trachea. Respirato 3 months gestation = spontaneous respiratory practice movements begins ry 24th week AOG: production of SURFACTANT 3rd week – neural plate differentiates into neural tube ---- CNS (brain and spinal cord - neural crest form PNS - brain forms in utero, brain growth continues until 5-6 years of age Nervous 24th week – ears respond to sound, eyes exhibit a pupillary reactions  FETAL GROWTH AND DEVELOPMENT - fetal pancreas produces insulin - the thyroid and parathyroid glands- roles in fetal metabolic function and Calcium balance. ENDOCRINE - The fetal adrenal glands supply a precursor necessary for estrogen synthesis by the placenta. 4th week - the digestive tract separates from respiratory tract, begins to grow rapidly. 16TH WEEKS – fetus produces MECONIUM 32 weeks – sucking and swallowing reflex present 36 weeks - secretes enzymes essential for CHO and CHON digestion DIGESTIVE 3 months after birth – amylase is present in saliva, but not LIPASE First 2 weeks of life, cartilage prototypes provide position and support to the fetus. 12th week - Ossification of this cartilage into bone begins at about the and continues all through fetal life and into adulthood. MUSCULO SKELETAL  FETAL GROWTH AND DEVELOPMENT 8 weeks of life - A child’s sex is determined REPRO The testes first form in the abdominal cavity and do not descend into the scrotal sac until DUCTIV 34th to 38th week of intrauterine life. E end of the 4th week of intrauterine life - Kidneys are present 12th week- Urine is formed, excreted in the amniotic fluid by the 16th week of URINARY gestation. INTEGUM 36 weeks - subcutaneous fat begins to be deposited underneath ENTARY 20th – 24th weeks - Immunoglobulin (Ig) G maternal antibodies cross the IMMUNE placenta into the fetus Fetal Circulation before Birth FETAL CIRCULATION  https://youtu.be/HVBu9HhTkD4  https://youtu.be/HVBu9HhTkD4  https://youtu.be/iciwEwNXEWI?si=oBakg4Xity-_X7ZK  STRUCTURES INTRAUTERINE EXTRAUTERINE (AT BIRTH) FETAL CIRCULATION Carries mixed blood except the Right side: deoxygenated blood umbilical vessels Left side: oxygenated blood FORAMEN OVALE Opening between the right and left Closes due to increase pressure in the atria left atrium Blood goes to left atrium by passing the lungs DUCTUS VENOSUS Connection between umbilical vein Obliterated and ascending vena cava Becomes ligamentum venosum bypassing the liver  STRUCTURES INTRAUTERINE EXTRAUTERINE (AT BIRTH) DUCTUS ARTERIOSUS Connection between pulmonary Obliterated trunk and aorta bypassing the lungs UMBILICAL ARTERIES Present Obliterated Becomes Vesical ligament UMBILICAL VEIN Present Obliterated Becomes round ligament Fetal Circulation before Birth Maternal Adaptations to Pregnancy LESSON 2  PREGNANCY 9 calendar 10 lunar 280 days 40 weeks months months  PHYSIOLOGICAL CHANGES OF PREGNANCY REPRODUCTIVE ENDOCRINE Uterine changes Length : 6.5- 32, width: 4-24 cm Placenta : produces estrogen and Depth: 2.5-22 cm Weight 60-1000 g progesterone, HPL. hCG Breast Pituitary gland: increase prolactin and oxytocin Fullness, tingling, tenderness Thyroids: increase BMR by 20% Increase in size and vascularity Adrenal glands: increase Areola darkens – secondary areola corticosteroids Montgomery tubercles Pancreas : increase insulin production  PHYSIOLOGICAL CHANGES OF PREGNANCY CARDIOVASCULAR/ INTEGUMENTARY RESPIRATORY HEMTOLOGIC GASTROINTESTINAL Striae Congestion or Increased RBC Morning sickness Gravidarum stuffiness of production (20- Constipation Umbilicus : 30% Pyrosis stretched, the Increased blood nasopharynx Flatulence obliterated, volume (30-50% hypersalivation protruding Displaced Increased fetal Linea nigra diaphragm demand (Iron) Diastasis recti Iron-Deficiency Melasma or anemia chloasma  PHYSIOLOGICAL CHANGES OF PREGNANCY GENITOURINARY MUSCULOSKELETAL IMMUNOLOGIC Compression of the Increased Calcium Increased bladder and phosphorus corticosteroid Increase blood needs production volume to the Releases relaxin Decreased kidneys and progesterone - immunologic Increase urine -- softens pelvic response production bones/ligaments Decreased IgG production CLINICAL MANIFESTATIONS OF PREGNANCY PRESUMPTIVE SYMPTOMS OF PREGNANCY  AMENORRHEA  MELASMA  QUICKENING  LINEA NIGRA  STRIAE GRAVIDARUM  BREAST TENDERNESS  MORNING SIKNESS  FREQUENT URINATION  FATIGUE CLINICAL MANIFESTATIONS OF PREGNANCY PROBABLE SYMPTOMS OF PREGNANCY  CHADWICK SIGN  GOODELL SIGN  HEGAR SIGN  BALLOTEMENT  BRAXTON HICKS CONTRACTION  FETAL OUTLINE BY EXAMINER Positive Pregnancy test CLINICAL MANIFESTATIONS OF PREGNANCY POSITIVE SYMPTOMS OF PREGNANCY  PRESENCE OF FETAL HEART BEAT  FETAL MOVEMENT FELT BY EXAMINER  VISUALIZATION OF THE FETUS BY UTZ Prenatal Care LESSON 3 PRENATAL VISIT TO AN OBSTETRICIAN  PRENATAL VISIT FREQUENCY First 7 Lunar 8TH AND 9TH Lunar 10TH Lunar month month month EVERY WEEK UNTIL EVERY MONTH EVERY OTHER WEEK LABOR PAINS ASSESSING MATERNAL WEIGHT GAIN  Occurs from both fetal growth and accumulation of maternal stores  Weight increase 1.5 lb. per month = 4.5 lbs. for 1st trimester 1 lb. per week during the last 2 trimesters = 12 lbs. for 2nd/3rd trimester  Assure the pregnant woman Assessment Prenatal  Vital signs  Assessment  Pelvic examination :vaginal/bimanual  Rectovaginal examination  Routine laboratory  Leopold’s maneuver  https://youtu.be/5K-ERuVrvj4  PELVIC EXaMINATION VAGINAL/BIMANUAL EXAMIINATION https://youtu.be/baLYJEqxrhs RECTOVAGINAL EXAMINATION https://youtu.be/KWKwpTKYtao AGE OF GESTATION (AOG) DETERMINATION BY FUNDIC HEIGHT (FH) Bartholomew rule At 20 week AOG = FH 20 cm at level of umbilicus McDonald’s rule FH /4 = AOG in months Expected Date of Confinement (EDC) LMP + 7 days – 3 Months + 1 year OBSTERIC HISTORY TERMS  Important to obtain maternal history during the first prenatal visit  Gravida – total number of pregnancies  Parity – number of pregnancy reaching the age of viability GRAVIDITY AND PARITY Gravidity - # pregnancy Gravida Nulligravida Primigravida Multigravida Parity = # pregnancy that reach age of viability (20 weeks AOG) Nullipara Primipara Multipara Abortion Preterm Post term  SAMPLE  You are admitting a client to the maternity unit. Two hours ago, she delivered a baby boy on her due date. She gives her OB history as follows: she has a 3 –year old daughter who was delivered a week past her due date, and late year she had a miscarriage 8 weeks, How would you note her OB score.  Mrs. Smith was admitted due to active labor pains at 40 week AOG. Her OB history is stated as follows: she delivered a twin in 2010 at 38 weeks AOG, both alive, she had another pregnancy in 2012, baby boy, delivered at 28 weeks, alive, she had delivered stillborn baby at 16 weeks AOG, What is her current OB score HIGH-RISK PREGNANCY 35 y/o Unwed mother Pre-existing diseases- asthma, heart disease, thyroid disease Substance/drug abuse Negative attitude towards pregnancy Developmental Tasks of the Mother Accepting the pregnancy Identifying with the role of mother Re-ordering her relationship between herself and her own mother, herself and the partner establishing a relationship with her unborn child Preparing for the birth experience Developmental task of the father-to-be Adjustment to the reality of pregnancy Acceptance of the pregnancy Establishing a relationship with the child  Determine Discomforts Nausea Consti Varico Edem Urinary Hemorr Leg Leukorr and Backache Dyspnea Vomiting Frequency pation hoids sities Cramps a hea Health Teachings in Prenatal Care Regular pre natal checkups Nutrition Clothing and shoes Rest and exercise Dental checkup Preparation for Delivery Breastfeeding Avoidance of Tetatogens Personal hygiene Sexual Intercourse Fetal Movement counting SELF CARE DURING PREGNANCY Bathing Breast care Dental care Perineal care Clothing Sexual activity Exercise Sleep Employment Travel vaccines EXERCISES DURING PREGNANCY  https://youtu.be/Eq4uMHzdaI8?si=JBtrDeW_2WDxw35f  Health Teachings in Prenatal Care Tetanus immunization (DOH protocol) DOSE TIMING PROTECTION TT1 1st contact after 20wks none TT2 1mo after TT1 3 yrs TT3 6mos after TT2 5 yrs TT4 1yr after TT3 10yrs TT5 1yr after TT4 lifetime Preparing for Childbirth : Parenting LESSON 5 BABY’S LAYETTE Baby’s blanket with hood Jumpers (one-piece)/ Bodysuit (one piece) One piece pull on Pajama pants Chest covers/tops/ Unisex Undershirts with side snaps 2 Small dresses for girls / suitable gown for the boys 1 or 2 Cardigan Sweaters 3 Socks or booties 2 bonnets and 2-3 mittens/cloth gloves Papers to accomplish Valid ID Phil health Form Diagnostic/Laboratory Results Preparation for Labor and Delivery GRANTLY DICK READ Fear Tension Pain METHOD  LAMAZE METHOD  Termed as psychoprophylactic method based on stimulus response and conditioning  “breathing techniques”  Classes on or after the 26th week up to end Six major Concepts about LAMAZE Natural birth Mother- child Mobility bonding Position Support No routine interventi on  BRADLEY ( PARTNER-COACHED) METHOD  Emphasis : manage pain thru deep breathing  Support of a partner or labor coach LEBOYER METHOD  Lights are dimmed, room is warm with minimum of noise  Skin-to-skin contact is initiated immediately after delivery  BONDING  Signs indicating possible complications of Pregnancy LESSON 6 DANGER SIGNS OF PREGNANCY  Danger signs of pregnancy Sudden Spotting Vomiting: 3- fever escape Abdominal Increased/ 4x a day – decreased or vaginal lost in weight and of clear pian/chest PIH fetal bleeding of 1o lbs. chills vaginal pain movements fluid Pregnancy- Induced Hypertension Rapid weight gain Swelling of face or fingers Flashes of lights or dots Severe headache Dimness or blurring of vision Decreased urine output Edema: ankles, face, eyelids Visual disturbance Myths / Birth Practices LESSON 7  MYTHS Mom’s belly reveals baby gender Pregnant mother should avoids cats Mom can give colds to fetus Pregnant women should not wear high heels Exercise can strangle the baby Skipping breakfast starves the baby Pregnant women should not dye hair Sex hurts the baby Pregnant women shouldn’t fly  FILIPINO MYTHS ABOUT PREGNANCY Wearing Using Heart rate Eating twin You need to necklace or Paglilihi abdominal Usog determines banana eat for two wrap towel binder gender around neck