View
6.538
Download
2
Category
Tags:
Preview:
Citation preview
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
1
PRENATAL CARE and
HEALTH TEACHINGS
Basic Concepts in Pregnancy Signs of Pregnancy:
Presumptive Signs
Amenorrhea – absence of menses
Nausea and Vomiting
Increased breast sensitivity and breast changes
Increased pigmentation
Constipation
Frequent urination
Quickening
Abdominal enlargement
Probable Signs
Uterine enlargement
Hegar’s Sign
Goodell’s Sign
Chadwick’s Sign
Ballottement
Braxton Hick’s contraction
Positive Pregnancy Test
Positive Signs
Fetal Heart Tone
X-ray or Ultrasound of fetus
Palpable fetal movements
Discomforts of Pregnancy
Changes Reason Health
Teachings
Nausea and
Vomiting
Increased
HCG Dry crackers
30 min. before
arising
Small,
frequent, low
fat meals
Liquids bet.
meals
Avoid anti-
emetics.
Heartburn
Increased
progesterone
which dec.
gastric
motility
causing
esophageal
reflux.
Pats of butter
before meals
Avoid fried ,
fatty foods
Sips of milk at
frequent
intervals.
Small,
frequent meals
taken slowly.
Bends at the
knees, not at
the waist
Take antacids
Constipation Due to
displacemen
t of the
stomach and
intestines;
iron
supplements
Increased
fluids and
roughage in the
diet.
Regular
elimination
time.
Increase
exercise
Avoid enemas,
harsh laxatives
and mineral oil.
Hemorrhoids Pressure of
growing
fetus,
Increase
venous
pressure
Warm sitz
bathing
High fiber diet
and increase
fluid.
Sit on soft
pillow
Urinary
Frequency
Increase
blood supply
to the
kidney/
Pressure of
enlarged
uterus in the
3rd
Tri
Sleep on the
side at night.
Limit fluid
intake during
evening
Bladder
training
Backache From
exaggerated
lumbo-
sacral
curving
during
pregnancy.
Back exercise
(pelvic rock)
Wear low-
heeled shoes.
Avoid heavy
lifting
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
2
Leg Cramps Increase
pressure of
gravid fetus,
low calcium
Frequent rest
with feet
elevated
Regular
exercise like
walking
Increase milk
intake
Ankle Edema From
venous
stasis
Elevate legs at
least twice a
day.
Sleep on left
side
Varicose
Veins
From faulty
valves or
weakened
vessel walls
Elevate feet
when sitting.
Use support
hose
Apply elastic
bandage
Avoid use of
constricting
garters
Shortness of
breath
From
pressure on
diaphragm
Sleep with feet
elevated or on
regularly.
Nasal
stuffiness and
epistaxis
Elevated
Estrogen
levels
Direct pressure
to the nasal
area
Avoid blowing
of nose.
Fatigue Due to
hormonal
changes
Get regular
exercise
Sleep as much
as needed.
Avoid
stimulants.
Breast
Tenderness
Increase
estrogen and
progesterone
level
Wear well
fitted bra
Warm
compress
Increased
Vaginal
discharges
Due to
hyperplasia
of mucosa
and increase
mucus
production
Consult
physician if
infection is
suspected
Wash carefully
and keep it dry.
Presumptive Signs of Pregnancy
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
3
Formula Used In Providing Estimates In
Pregnancy
A. To estimate the EDC
Given the Use Formula
Last Menstrual
Period (LMP)
Nagele’s Rule First day of
LMP – 3
months + 7
days
Date of
Quickening
Primi:
Q + 4 months
+ 20 days
Multi:
Q + 5 months
+ 4 days
B. To estimate the AOG
Given the Use Formula
Fundic Height McDonald’s
rule
Height in cm
FH x 2/7 =
duration in
months
FH x 8/7 =
Duration in
weeks
Fundus Height at Various week
C. Estimated Fetal Weight
Given the Use Formula
Rump-to-
crown length
in utero cm.
Standard
Formula
Rump-to-crown
length in utero cm.
x 100 = weight in
gm
Johnson’s
Ruler
FH (cm)
- 11 (if unengaged )
- 12 ( if engaged ) x
155
Measuring the Fundic Height
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
4
PRENATAL VISIT Maternal Health Program of the DOH
is tasked to reduced the maternal mortality
ratio by three-quarters by 2015:
MMR of 112/100,000 live births in 2010
MMR of 80/100,000 live births in 2015
Strategic Thrusts for 2005-2010
Launch and implement the Basic Emergency
Obstetric Care or BEMOC. The BEMOC
strategy entails the establishment of facilities
that provide emergency care for every 125,000
population.
Improve the quality of prenatal and postnatal
care
Reduce women’s exposure to health risks
through the institutionalization of responsible
parenthood and provision of appropriate health
care package to all women of reproductive ages.
LGU’s, NGOs and other stakeholders must
advocate for health through resource generation
and allocation of health services for the mother
and the unborn.
Prenatal Clinic Visits
Schedule of first visit is as soon as the woman
missed her menstrual period and pregnancy is
suspected
First 32 weeks : once a month
32-36 weeks : twice a month
36-40 weeks : every week
Length of Pregnancy
267-280 days
38-42 weeks (ave.40 weeks)
9 calendar months
10 lunar months
3 trimester
First Trimester: Period of Organogenesis
Second Trimester: Most comfortable for mother
with continued fetal growth.
Third Trimester: Period of rapid fetal growth
bec. of rapid deposition of fats
iron and calcium.
High Risk Factors During Pregnancy
Life of woman and fetus has significantly
increased risk of disability or death.
Generally, these are:
- abnormal fetal position or presentation
- age 35 years or younger than age 15 years
- bleeding during pregnancy
- drug or alcohol dependent
- hydramnios
- hypertension of pregnancy
- infection of mother
- maternal illness
- past history of difficult delivery
- post cesarean birth
- potential for blood incompatibility
Medical History and current status:
- obstetrical history, current status
- Psychosocial risks, maternal behaviors and
adverse lifestyle.
- smoking
- caffeine: 3 or more cups of coffee
- alcohol: no safe dose
- drugs
- abuse and violence
- Psychological status
- working more than 10 hours, heavy lifting
- standing more than 4 hours.
Socio-demographic risks:
- low income
- lack of prenatal care
- height less than 145 cm ( 4’9”)
- parity more than 5
- marital status
- residence
- ethnicity
Environmental risks:
- infection
- radiation
- chemicals
- physical; extreme heat more than 38.9 c,
noise, vibration and atmospheric pressure,
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
5
Components of a Prenatal Visits
Initial interview Health history
- Menstrual history: menarche, regularity,
frequency and duration of flow and last period.
- Obstetrical history; all pregnancy, outcome,
complication, contraceptives use, sexual history
Danger Signs of Pregnancy
- Vaginal Bleeding
- Swelling of the face or finger
- Severe headache
- Blurring of vision
- Flashes of lights
- Pain in the abdomen
- Persistent vomiting
- Chills and fever
- Sudden escape of fluids from the vagina
- absence of fetal heart tone
Demographic data
Chief concern
Family profile
History of past illnesses
History of family illness
Gynecologic history
Obstetric history
Review of systems
Support person’s role
TPAL T = Full Term Babies
P = Premature
A = Babies Abortion
L = Living Children
Physical Examination
Review of System
Pelvic Examination ( Cardinal Rule: EMPTY BLADDER )
Internal Exam (I.E) to determine:
Hegar’s Sign – softening of the uterus
Goodell’s Sign – softening of the cervix
Chadwick’s Sign – bluish discoloration of
vagina.
Ballotement – fetus will bounce when
lower uterine segment is tapped
sharply
( on the 5th
month )
Fetal Heart Rate Assessment - Doppler Ultrasound ( 10-12 weeks )
- Stethoscope ( 18-20 weeks )
Expected Rate: 120-160 bpm
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
6
Pelvic Measurement are preferably done
after the 6th
lunar month.
Xray Pelvimetry is the most effective
method of diagnosing cephalopelvic
disproportion. But since Xrays are
teratogenic, the procedure can be done
only two weeks before EDC.
Types of Pelvis
Papanicolau ( Pap Smear) –
cytological examination to
diagnose cervical cancer.
Classification of Findings
Class 1 – absence of abnormal cells
Class 2 – abnormal cell but no evidence of
malignancy.
Class 3 – cytology suggestive of malignancy
Class 4 – cytology strongly suggestive of
malignancy
Class 5 – conclusive for malignancy
Clinical Stages of Cervical Cancer
Stage 1 - Cancer confined to the cervix
Stage 2 - CA extends beyond the cervix into
the vagina
Stage 3 - metastasis to the pelvic wall
Stage 4 - metastasis beyond pelvic wall into
the bladder and rectum.
A.
1 : Nulligravida cervix
2 : Cervix after childbirth
3 : “Stellate” cervix seen after mild
cervical tearing.
B
1 : Herpes II
2 : Chancre of syphilis
3 : Erosion or infection
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
7
Leopold, Maneuvers – are a systematic
methods of observation and palpation to
determine fetal position, presentation, lie and
attitude which helps in predicting course of
labor
Preparatory Steps:
1. Palpate with warm hands.
2. Use palms, not fingertips.
3. Woman should lie in supine position with
knees flexed slightly.
4. Done with empty bladder.
Procedure:
1st Maneuver
to determine presenting part
facing the head part of the pregnant woman,
palpate for fetal part found in the fundus to
determine presentation.
( a hard, smooth, ballotable mass at the fundus
means fetus is breech presentation )
2nd
Maneuver
to determine fetal back
still facing the head part of the mother, palpate
side to locate the fetal back.
a feel smooth hard resistant surface is the back
part. ( best place to hear the FHT )
a number of angular nodulation are knees and
elbows.
3rd
Maneuver
to determine engagement and mobility of
presenting part.
still facing the head part of the mother, grasp
the lower portion of the abdomen just above the
symphysis pubis to find out degree of
engagement.
4th
Maneuver
to determine fetal attitude and descent.
Now facing the feet of the mother, press
fingers downward on both sides of the uterus
above the inguinal ligaments to determine
degree of flexion of fetal head.
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
8
Benedict’s Test Test for glycosuria, a sign of possible
gestational diabetes.
Urine should be collected before breakfast
results:
Blue - no sugar
Green - +1 sugar
Yellow - +2 sugar
Orange - +3 sugar
Red - +4 sugar
Vital Signs During Pregnancy
Blood Pressure : limit increase is 10/15
mmHg systolic – diastolic above baseline BP.
Pulse : 60 -90 beats per min.
Respiration : 16 – 24 cycles per min.
Temperature : 36.2 – 37.6 C ( 97-100 F )
PRENATAL
HEALTH TEACHINGS
Nutritional Health During Pregnancy
Nutrition – most important aspect
Weight Gain
11.2 to 15.9 kg. ( 25 – 30 lb ) recommended as an average weight gain in
pregnancy.
2 – 4 lbs during 1st trimester
11 – 14 lbs during 2nd
trimester
8-11 lbs from the 3rd
trimester
Note:
Pattern of weight gain is more important
than amount of weight gain.
Women who need special attention:
Pregnant teenagers
Low pre-pregnant weight and obese
Low income women
Successive pregnancies
Vegetarians
Nutritional Assessment
- Food preferences and eating habits
- Cultural and religious influences
- Education and occupational level
Assessing Maternal Weight Gain
Computation of Caloric Equivalents
Carbohydrates X 4
Proteins X 4
Fats X 9
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
9
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
10
Food Sources
Protein Meat, fish, eggs, milk, poultry,
cheese, beans, mongo
Vit. A Eggs, carrots, squash, all green
leafy vegetables
Vit. D Fish, liver, egg, milk, margarine
Note: excess vit.D may lead to
fetal cardiac problem
Vit. E Green leafy vegetables, fish, corn
Vit. C Tomatoes, guava, papaya, citrus
fruits
Folic Acid Asparagus, organ meat, green
leafy vegetables
Vit. B ( foods rich in protein )
Calcium and
Phosphorus
Milk, cheese, green leafy
vegetables, whole grains,
seafood, tofu
Iron Pork liver, lean meat, kamote
leaves, soybeans, seaweeds,
mongo
Iodine Iodized salt, seafood, milk, egg,
bread
Micronutrient Supplementation
Vitamin A Supplementation
Target Prep. Dose Duration Remarks
Pregnant
Women
10,000
IU
1
cap
2x a
week
Start from
the 4th
month of
pregnancy
until
delivery
Vit. A
should
not be
given to
woman
who
already
taking
vit. that
also
contain
Vit. A
Post
Partum
Women
200,000
IU
1
cap
One dose
only
within 4
weeks
after
delivery
Vit.A
(200K
IU)
should
not be to
pregnant
women.
Pregnat
women
with
night
blindness
10,000
IU
1
cap /
day
For 4
weeks
upon
diagnosis
Vit. A
should
not be
given to
woman
who
already
taking
vit. that
also
contain
Vit. A
Iron Supplementation
Target Prep. Dose /
Duration
Remarks
Pregnant
Women
Coated
Tab.
contains
60 mg
elemental
iron with
400 mg
folic acid
1 tab/day for
6 months or
180 days
during
pregnancy
period
OR
2 tab/day if
prenatal
consultation
are done
during the
2nd
/3rd
trimester
A dose of
800 mcg
folic acid
is still
safe to
pregnant
woman
Lactating
Women
Coated
Tab.
contains
60 mg
elemental
iron with
400 mg
folic acid
1 tab / day for
3 months or
90 days
Iodine Supplementation
Target Prep. Dose / Duration
Women
15-45
yrs.old
Iodized oil
capsule with
200 mg.
iodine
1 capsule for 1
year
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
11
TeTox Routine Immunization of
Pregnant Women
Vaccine Minimum
Interval
Percent
Protected
Duration of
Protection
TeTox 1 As early as
possible
during
pregnancy
TeTox 2
Minimum
required
TeTox for
pregnant
mother
4 weeks
after
TeTox 1
80% infant will
be
protected
by neonatal
tetanus
3 years
protection
for the
mother
TeTox 3 6 months
after
TeTox 2
95 % infant will
be
protected
by neonatal
tetanus
5 years
protection
for the
mother
TeTox 4 1 year
after
TeTox 3
99 % infant will
be
protected
by neonatal
tetanus
10 years
protection
for the
mother
TeTox 5 1 year after
TeTox 4
99 % all infant
born to that
mother will
be
protected
lifetime
protection
for the
mother
Dont’s During Pregnancy
Smoking Causes vasoconstriction,
leading to low birth weight
babies
Drinking Alcohol When excess can cause
respiratory depression in
newborn and fetal
withdrawal syndrome.
Delayed fetal growth and
development
Drugs Drugs are dangerous
especially during 1st Tri.
Thalidomide Causes amelia or
phocomelia (short or no
extremities
Steriods Can cause cleft palate and
abortion
Cough
suppressant
Can cause enlargement of
fetal thyroid gland leading
to tracheal compression and
dyspnea at birth
Vit.K Cause hemolysis and
hyperbilirubinemia
Aspirin Causes bleeding disorder
Streptomycin Cause damage to the 8th
cranial nerve
Tetracycline Causes staining of the tooth
enamel and inhibits growth
of long bones
Cocaine Causes abruption placenta,
preterm labor and fetal
death
Amphetamines Can cause jitteriness and
poor feeding at birth
Marijuana Increase incidence of
respiratory infection
Narcotics Small gestational age,
increase rate of fetal distress,
meconium aspiration,
abnormal fetal liver and lung
tissue
Inhalants Cardiac irregularities,
severe respiratory
depression.
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
12
Sexual Activity
Sexual desires continue throughout
pregnancy, but levels change:
During the First Trimester: there is a decrease
in sexual desire because the woman is more
preoccupied with the changes in her body.
During the Second Trimester: there is an
improvement in sexual desire because the
woman has adapted to the growing fetus.
During the Third Trimester: there is another
decrease in sexual desire because the woman is
afraid of hurting the fetus.
Note:
Sex in moderation is permitted during
pregnancy but not during the last 6 weeks since
there is increased incidence of postpartum
infection in women who engage in sex during the
last 6 weeks.
Recommended Position
- side by side position
- woman on top
- entrance at the back (dog’s style )
- side on the back
Sex is CONTRAINDICATED
Spotting or bleeding
Ruptured BOW
Incompetent cervical OS
Deeply-engage presenting part
Placenta previa
History of spontaneous miscarriage
Employment
As long as the job does not entail handling
toxic substance or lifting heavy objects or
excessive physical and emotional strain, there is
no contraindication to work.
Advise pregnant women to walk about every
few hours of her work day during long periods
of standing or sitting to promote circulation.
Traveling
No travel restriction, but postpone a trip during
the last trimester.
On long rides, 15 – 20 minute rest period every
2-3 hours to walk about or empty the bladder is
advisable.
Exercises
Chief Aim : To strengthen the muscles used in
labor and delivery
Should be done in moderation
Should be individualized: according to age,
physical condition, customary amount of
exercise and stage of pregnancy
Recommended Exercises
Squatting Increase circulation in the
perineum, make pelvic joints
more pliable .
When standing from squatting
position, raise buttocks first
before raising the head to prevent
postural hypotension
Tailor
Sitting
Strengthens the thighs and
stretches perineal muscles to
make them more supple.
Pelvic Rock Maintains good posture
Relieve abdominal pressure
and low back pain
Strengthens abdominal
muscles
Modified
knee-chest
position
Relieve pelvic pressure and
cramps in the thighs and
buttocks
Relieves discomfort from
hemorrhoids.
Shoulder-
circling
Strengthens muscles of the chest
Walking BEST EXERCISE
Kegel Relieve congestion and
discomfort in pelvic region.
Tones up pelvic floor muscles
Recommended