Pregnancy

1. Reproductive Health NursingNUR 324Lecture 2 Part 1+2 Pregnancy

2. The Whole Period of Pregnancy Can Be Divided Into Three Stages (Trimesters ):

3. The Whole Period of Pregnancy Can Be Divided Into Three Stages (Trimesters ):

4. Regular visits during pregnancy Prenatal visits • Q 4 weeks for 1st 28 weeks • Q 2 weeks until 36 weeks, then • Q 1 week until childbirth

5. Important Estimates of Pregnancy • These are tools used in calculating the gestational age of the growing fetus and its Expected Date of Birth (EDB) • Nagele’s Rule: Computation of expected date of birth. Formula: Last Menstrual Period in Day / Month / Year (+7) (-3) (+1) = Expected Date of Birth • Johnson’s Rule: estimates the weight of the fetus in grams.

6. The Diagnosis of the First Trimester 1. History and symptoms A. Cessation of menstruation This is the first frequent symptom of pregnancy, although a few women may have slight bleeding after conception. But amenorrhea is not only due to pregnancy but also other reasons. Women of breast feeding may be pregnant before the recovery of menses.

7. 1.The history and symptoms • B. Nausea and vomiting Also called morning sickness because they occur upon arising. These symptoms appear one or two weeks after the period is missed and last until 10th to 12th week, its severity varies from mild nausea to persistent vomiting (e.g. Hyperemesis gravidarum).

8. 1.The history and symptoms • C. Urinary symptoms Increased frequency of urination is due to increased circulation associated with the effect of estrogen and progesterone on the bladder, combined with pressure by the gradually enlarged uterus on the bladder.

10. 2. Signs Breast changes Breast enlargement and vascular engorgement. Nipple and areola become blacker. Enlargement of the accumulated sebaceous glands of the areolas may be noted.

11. Changes of the reproductive organs • Vagina: The vaginal wall become discoloration as the pelvic blood vessel becomes congested. • Cervix: Cyanosis and a gradual softening due to congestion.

12. Changes of the reproductive organs • Uterus: enlargement and softening. The isthmus of the uterus is also soft and can be compressed between the fingers palpating vagina and abdomen (Hegar’s sign). After the 12th week, the fundus of the uterus is usually palpable above the symphysis pubis.

14. C. Supplementary examination Pregnancy test The laboratory test for pregnancy are based on the identification of human chorionic gonadotrophin (hCG), which can be detected as early as 7-9 days after fertilization by high sensitive technique. The samples may be blood or urine.

15. Basal body temperature (BBT) A persistent elevation of BBT for longer than 18 days may be presumptive evidence of pregnancy.

17. Ultrasonography • There are trans-vaginal and abdominal Ultrasonagraphys. • A gestational sac can usually be identified at 5-6 weeks after the beginning of the last period.

18. Ultrasonography • Fetal heart beating can be detected by about 7th week and the fetus itself can be seen by about the 8th week. • Doppler is also an ultrasound technique, which diagnoses the pregnancy by revealing the heart beating.

19. The diagnosis of the second and the third trimester pregnancy Symptoms • Abdominal enlargement and fetal movement generally occurs after the 18th to 20th week of gestation.

20. Signs • The uterus continues to enlarge • Fetal movement (quickening) can usually be seen or heard after 18th week of gestation

21. Height of the uterine top xiphoid

22. Signs • Fetal heart sound can be heard at rate varies from 120 to 140 beats per minute. • The fetal body can usually be palpated by the 18th to 20th week of gestation unless the patient is too fat, the abdomen is tender or there is an excessive amount of amniotic fluid.

23. Fetal heart

24. Other Examinations • X-ray. It is rarely used recently because the harmfulness to the fetus. • Fetal electrocardiogram. A fetal electrocardiogram can first be recorded at about the 12th week of pregnancy.

25. Different methods of pregnancy diagnosis

26. Fetal lie & fetal Presentation • Fetal lie: the relationship between the long axis of the mother and the long axis of the fetus. (longitudinal lie and transverse lie) • Fetal presentation: the portion of the fetus that descends into pelvis first.

29. Nutrition During Pregnancy

30. Recommended Weight Gain 1 pound = about 0.45 kilograms

31. Normal Pregnancy Weight Gain

32. Risks of Low Weight Gain • Low weight gain in second or third trimester increases risk of intrauterine growth retardation • Low weight gain in third trimester increases risk of preterm delivery • Higher weight gains and greater postpartum weight retention is common if mother is still growing (teenager)

33. Special Interest Nutrients

34. Vitamin B12 • Generally adequate amounts are obtained through animal products • Fish, eggs, milk, meats, etc. • Vegans that do not have any animal products in their diet need supplementation • Works with folic acid in cell growth and is essential to the normal development of the infant

35. Folic Acid • A supplement taken 1-3 months prior to conception and during first 6 weeks gestation reduces the risk of neural tube defects, cleft palate/lip • 400 micrograms per day of synthetic folic acid needed per day (pregnant women and those of childbearing age) • Needed for rapidly dividing cells, protein metabolism, and formation of red blood cells

36. Iron • Needed for the formation of red blood cells • 15 milligrams a day for woman during childbearing years recommended • Iron supplement (30 mg/day) recommended for pregnant women

37. Calcium • Is used in the formation of fetal bones • Will be absorbed from maternal bones if not enough calcium in diet • Calcium absorption increases with Vitamin D • Recommended amounts of calcium during Pregnancy 1200-1500 mg per day