Expectant Family

1
Expectant Family
2
(No Transcript)
3
Menstrual cycle

• Feedback system of three cycles endometrial,
  hypothalamic-pituitary, and ovarian
• Hypothalamic-pituitary cycle toward end of
  normal menstrual cycle, levels of estrogen and
  progesterone fall, stimulate hypothalamus to
  produce GNR which stimulates the anterior
  pituitary to secrete FSH (follicular phase)
• Ovarian cycle FSH estrogen stimulate follicle
  to mature. Surge of LH affects a follicle and
  causes ovulation. Corpus luteum produces
  progesterone and some estrogen to maintain
  endometrium (luteal phase)
• Endometrial cycle if fertilization occurs,
  endometrium is maintained due to production of
  HCG which maintains the corpus leteum. If no
  fertilization, corpus luteum regresses
  progesterone estrogen levels drop, endometrium
  is shed

4
Menstrual cycle conception

• Ovulation occurs 14 days prior to menses
• Ovum viable approx. 24 hrs
• Sperm viable approx. 72hrs
• Fertilization occurs usually in outer third
  portion of fallopian tube
• Resulting structure Zygote, produces HCG
• Implantation occurs around 8-10 days

5
Embryo

• Once implanted called embryo, after 8 weeks
  becomes fetus
• Embryonic stage rapid tissue differentiation
  (teratogens)
• End of 8th week every organ system and external
  structure is present, remainder of gestation is
  refinement of systems

6
Embryonic membranes

• Chorion outermost, fingerlike projections
  called chorionic villi (only those under embryo
  remain)
• Amnion thin protective membrane contains the
  embryo and amniotic fluid

7
Structures

• Placenta
• Provides for metabolic nutrient exchange
• Functioning by about third week
• Acts as endocrine gland produces estrogen,
  progesterone, HCG and Human Placental lactogen

8
Structures cont.

• Umbilical cord
• Connects embryo fetus to placenta
• Contains 1 large vein (oxygenated blood) and 2
  small arteries

9
(No Transcript)
10
Structures cont.

• Amniotic fluid
• Constantly formed and reabsorbed
• At term amount is 800-1200cc
• Polyhydramnios 2000
• Oligohydramnios
• Functions
• Shields against pressure
• Protects against temp. changes
• Musculoskeletal developments
• Protects against cord compression

11
Fetal maturation

• Fetal circulation
• Foreman ovale
• Ductus arteriosus
• Milestones in development
• 12 weeks FHR with doppler
• 20 weeks quickening
• 22 weeks earliest point of viability
• 28 weeks more developed resp system
• 36 weeks survival with little support

12
Physiologic Changes

• Uterus
• 12-14 weeks above symphisis
• Hegars sign
• McDonalds
• Braxton hicks
• Lightening
• Quickening
• ballotment

13
(No Transcript)
14
(No Transcript)
15
Physiologic changes

• Cervix
• Chadwicks sign
• Goodells sign
• Mucus plug
• Increased friability

16
(No Transcript)
17
Physiologic changes cont.

• Vagina
• Increased vascularity, increased sensitivity
• Leukorrhea
• Ph changes
• Breasts
• Increased vascularity, sensitivity
• Increased glandular tissue
• Precolostrum, colostrum by 16 weeks

18
Physiologic changes cont.

• Integument
• Striae
• Chloasma
• Linea nigra
• Palmar erythema
• Gum hypertrophy
• Respiratory
• Increased tidal volume
• Increased congestion vascularity in upper
• Resp. rate little change
• Increased basal metabolic rate

19
Physiologic changes cont.

• Cardiovascular
• Increased blood volume (more audible splitting
  S1, S3?, murmur?)
• Blood pressure decreases 2nd trimester, no
  elevations, supine hypotension
• Physiologic anemia (pseudoanemia), Hgb 12-16, Hct
  37-47
• Elevated clotting factors
• Elevated WBCs

20
Physiologic changes

• Gastrointestinal nausea vomiting,
  constipation, pyrosis, hemorrhoids
• Renal stasis, increased glomerular filtration
  rate, frequency, glucosuria?, no proteinuria
• Skeletal relaxin, balance, diastis recti
• Endocrine increased producation of insulin
• Metabolic increased rate, increased need for
  protein, carbohydrates and water

21
Presumptive signs least indicative

• Amenorrhea
• Nausea vomiting
• Breast tenderness
• Urinary frequency
• Weight gain
• Fatigue
• quickening

22
Probable signs

• Uterine changes
• Cervical softening
• Ballotment
• Lab tests
• Enlargin abdomen

23
Positive signs

• Fetal outline on sonography or x-ray
• Fetal heart tones
• Fetal movement palpated by examiner

24
Psychological response - pregnancy

• Accepting the pregnancy
• Identifying with mother role
• Re-ordering relationships
• Establishing relationship with infant
• Preparing for childbirth

25
Other responses

• Role playing
• Fantasy
• Ambivalence
• Couvade
• Narcissism

• Introversion
• Change in body image
• Mood swings
• boredom

26
Prenatal Care

• Monitoring physical psychological changes
• Providing anticipatory guidance and health
  teaching
• Preparing for labor postpregnancy events

27
First Prenatal visit

• Estimating date of birth
• Nageles rule first day of last menstrual
  period (LNMP) 3 months 7 days and 1 year

28
History

• Menstrual history
• Presumptive signs
• Risk assessment
• Younger than 17yrs
• History of abortions
• 5 or more pregnancies
• Previous stillborns or losses
• Substance use or abuse
• History or preterm births or anomalies
• Physical abuse

29
History cont.

• OB/Gyn
• Previous pregnancies outcomes
• Sexual history
• Sexually transmitted infections
• Contraceptive history
• Nutrition
• Family history

30
Physical exam

• Baseline vitals signs
• Head to toe exam
• Pelvic
• Adequacy for vaginal birth
• Cervical uterine changes
• Cervical smear
• Pap
• Chlamydia gonorrhea if at risk

31
Periodic visits

• Monthly until 28 weeks
• Bi-weekly 28-36 weeks
• Weekly from 36 weeks

32
Periodic visits

• BP and weight
• Urinalysis
• Anticipatory guidance and teaching
• Assessment of fetal well-being

33
Fetal Well being

• Fetal growth measurement at the umbilicus at
  20 weeks
• Fetal movement pattern,
• FHR detected by doppler at 12 weeks
• Leopolds maneuver
• Ultrasound
• Non-stress tests, stress tests
• Biophysical profile

34
Lab tests

• Urinalysis protein, glucose, nitrites,
  leukocytes
• Hemoglobin and Hematocrit initially, and again
  at 26-28 weeks
• Rh type and irregular antibodies
• Rubella titer 110 or greater
• RPR or VDRL
• Triple screen 15-18 weeks (alpha-fetoprotien,
  estriol level HCG)
• Glucose challenge 24-28 weeks

35
Teaching Self-care

• Comfort measures handout
• Exercise
• Sexual activity
• Danger signals
• Vaginal bleeding
• Fever
• Absence of fetal movement
• Abdominal pain, cramping, pressure
• PPROM
• Persistent vomiting
• Headache
• Visual disturbance
• Burning or painful urination

36
Teaching self-care

• Childbirth preparation
• Preparation for breastfeeding
• Signs of labor
• Contractions that increase in frequency,
  intensity and duration
• Braxton hicks
• Lightening
• Mucus plug
• Nesting
• ROM
• Bloody show

37
Nutrition

• Pattern
• 2 to 5 lb first trimester
• ½ to 1 lb per weeks 2nd and 3rd trimester
• Breakdown
• 11 lb fetus
• 2 lb uterus
• 4 lb increased blood volume
• 3 lb breast tissue
• 5-10 maternal stores

38
Nutrition

• Recommended weight gain depends on prepregnant
  weight
• Normal BMI 11.5-16kg (25-35lbs)
• Underweight 12.5-18kg (27-40lbs)
• Overweight 7-11.5kg (15-25lbs)

39
Nutrition needs

• Energy additional 300kcal
• Protein nutritional element basic to growth
• Fluids 6-8 glasses (1500-2000ml)
• Iron recommended 30mg, supplement
• Fat soluble vitamins only as prescribed
• Water soluble folic acid

40
Nutrition related

• No alcohol
• Avoid smoking
• Caffeine no more than 300mg (1 cup of coffee)
• Aspartame- okay unless PKU

41
Nutrition

• Nausea vomiting
• Constipation
• Heartburn
• Pica