CHAPTER 4

NURSING CARE DURING PREGNANCY

ANTEPARTAL VISITS
Initial visit for pregnancy test as early in pregnancy as possible, in 1 st trimester
Monthly visit for the first 7 months if pregnancy without problems
During 8th month, visits usually every 2 weeks, and then weekly during last month until delivery
COMPONENTS OF PRENATAL VISITS
GUIDE SUMMARY:
1. ASSESSMENT
2. DIAGNOSTIC TEST DURING PREGNANCY
1.ASSESSMENT
A. DATA COLLECTION of clients health history in all pertinent areas in order to form basis of comparison
with data collected on subsequent visits ant to screen for any high risk factors . ask patients name , age , religion ,
economic status ,and any educational attainment ant the ff.
1. Menstrual history : menarche , regularity , frequency and duration of flow , last period .
2. Obstetrical history : all pregnancies , complications , outcomes , contraceptive use , sexual history .
Summarizing pregnancy information : GTPAL/GTPALM:GPab
A. GTPAL/GTPLM: (PILLETERI , ADELLE 2007)
Gravida = the number of pregnancy including the present one
Term = the total number of infants born at term 37 or more up to 42 weeks
Preterm = the total number of infants born before 37 weeks
Abortion = the total number of spontaneous or induced abortions
Living = the total number children currently living
Multiple pregbnancies = the total of multiple pregnancies
*Example : a woman who has had two previous pregnancies , has given birth to two term children , and
is again pregnant would be 32002 or GRAVIDA 3 , Para 2002 (GTPAL).
A pregnant woman with a boy born at 39 weeks gestation now alive; a girl born at 40 weeks gestation,
now alive; a girl born at 33 weeks gestation, now alive would be 421030or Gravida 4, Para 21030
(GTPALM)
Note : a multigestation pregnancy like twins is considered one para.
*Examples : a woman who had term twins, then one preterm infant, and is now pregnant again would be
321031 or Gravida 3, Para 21031 (GTPALM)
B. GPAb
Gravida = the number of items the woman has been pregnant, including the current pregnancies.
Para = the number of pregnancies that reaches the age of vialibity-in 24 weeks deliveries after 24 weeks
gestation, and has had one aboetion ; the sbrevation would be G3, P2, Ab1.
3. Medical history : include past illness, surgeries, current uyse of medications any drug and & food
sensitivity , use of oral contraceptives , use of alcohol and tobacco , blood transfusions , endocrine disorders ,
infections , diabetes and heart desease.
4. Family history / Psychosocial data: Ask for congenital disorders , hereditary diseases , multiple
pregnancies , diabetes , heart disease , hypertension , mental retardation , others.
B. PHYSICAL EXAMINATION including internal gynaecologic exam , bimanual exam , weight , vital signs ,
auscultation of fetal heart rate(FHR), palpation of fetal outline (Leopolds Maneuver), measurement of fundal
height as correlation for appropriate progress of pregnancy, determine fetal length , calculation of fetal weight
in grams and age of gestation (AOG), and expected date of confinement EDC by (Neagles Rule).

SEE THE FF:

1. LEOPOLDS MANEUVER
Leopolds Maneuver are performed in pregnancy after the uterus becomes large enough to allow
differentiation of fetal parts by palpation.

 FIRST MANEUVER
Answers the question: What is in the fundus?Head or breech?
Finding: Presentation. This maneuver identifies the part of the fetus thet lies over the inlet into the
pelvis. The commonest presentations are cephalic (head first) and breech (pelvis first).
Performing first Maneuver
Facing the patients head, use the tips of the fingers of both hands to palpate the uterine fundus.
When the fetalk head is in thefundus, it will fell shard, smooth, globular, mobile and ballotable .
When the breech is in the fundus, it will fell soft, irregular, round and less mobile.
The lie of the fetus the relationship between the long axis of the fetus and the long axis of the
mother can also be determined during the first maneuver.
The lie is commonly longitudinal or transverse but occasionally be oblique.
SECOND MANEUVER
Answers the question: where is the back ?
Finding: Position. This maneuver identifies the relationship of the fetal body part to the front, back or side of the
maternal pelvis. There are many possible fetal positions.
Performing Second Maneuver
Remain facing the patient head. Place your hands on either side of the abdomen.
Steady the uterus with your hand on one side, and palpate the opposite side to determine the location of
the fetal back.
The back will feel firm, smooth, convex, resistant.
The small parts (arms and legs) will feel small, irregularly placed, and knobby may be actively or
possibly mobile.
Third maneuver
Answers the question: where is the presenting part?
Finding: Presenting part. This maneuver identifies the most dependent part of the fetus that is, the part that lies
nearest the cervix.
It is the part of fetus that first contracts the finger in the vaginal examination, most commonly the head or breech.
Performing the third maneuver
Turn and face the patients feet.
Place the tips of the first three fingers of each of hand on either side of the patients abdomen just above
the symphysis, and ask the patient to take a deep breath and let it out.
As she exhales, sink your fingers down slowly and deeply around the presenting part. Note the contour,
size and consistency of the part.
The head will feel haed, smooth, and, mobile if not engaged. Immobile if engaged.
The breech will feel soft and irregular.
Fourth Maneuver
Answers the question: where is the cephalic prominence. This maneuver identifies the greatest prominence of the
fetal head palpated over the brim of the pelvis. When the head is flexed (flexion attitude), the forehead forms the
cephalic prominence. Whem the head is extended (extension attitude), the occiput becomes the cephalic

prominence.
Performing the fourth maneuver.
Face the patients feet
Gently move your fingers down the sides of the abdomen toward the pelvis until the fingers of one hand
encounter a bony prominence. This is the cephalic prominence.
If the prominence is on the opposite side from the back, it is the babys brow, and the head is flexed.
If the head is extended, the cephalic prominence will be located on the same side as the back and will be
the occiput.
2. McDONALDs METHOD & RULE (measuring fundic height using tape measure)
Uterine growth and estimated fetal growth

a.
b.
c.
d.
e.
f.
g.
h.
i.

Fundus at symphysis pubis = 12 week gestation

Fundus between symphysis pubis and umbilicus = 16 weeks
Fundus at umbilicis = 20-22 weeks gestation
2 fingerbreadths above umbilicus = 24 weeks
Fundus 28 cm . from top of symphysis pubis = 28 weeks gestation
Midway between umbilicus and xiphoid process = 30 weeks
Just below xiphoid process = 34 weeks
Fundus at lower border rib cage or at the level of xiphoid process = 36 weeks gestation
Uterus becomes globular and drops = 40 weeks gestation
McDONALDs Rule : in months : Fundic Height (cm) multiplied (x)2/7
Example: 25 cm x2 = 50 =7 months
7
7
In weeks : Fundic height (cm) multiplied (X)8/7
EXAMPLES: 25 cm X 8 = 200 = 28-29 weeks
7 7

`
3. Another method of calculating AGE OF GESTATION (AOG) by weeks
Ask the clients first day of Last Menstrual Period (LMP) e.g February 19, 2009
Subtract the date of (LMP) from the total no. of that same month
EXAMPLE: February has
28 days
Less(-)
February.
19 (LMP)
8 Days (Difference)
Add the difference to the present date of the month when the client had consulted/visited the clinic
( present prenatal visit )
Example:
DIFFERENCE 9
add(+)
March
22 (present prenatal visit)
31 total no. of days
Then the total no. of days will be devided by 7
Examples:
31
Divided by
7 = Answer: 4.42 weeks or 4 weeks and 3 days
4. NEAGLES RULE
Formula in finding expected/esdtimated date of confinement (EDC) or estimated due date (EDD):
Add 7 days to the first day of the last menstrual period. (LMP)
Substract 3 months
Add 1 year
Example:
First day of (LMP) september 16, 1998
Add 7 days September 23,
Subtract 3 month - June 23
Add 1 year June 23 , 1999 will be the estimated due date (EDD)
5. HAASEs Rule: it is used to determine the length of the fetus in cm.
A. During the first half (1 to 5 months )of pregnancy , square the number of the months.
EXAMPLE: (3 months) 2=9 cm
B. During the second half (6 to 10 months) of pregnancy , multiply the number of the months by 5
Example: (7 months )X 5 = 35cm.
6. Johnsons Rule: Use to calculate the fetal weight in grams.
Fundic height in (cm) N multiplied (X) K = weight of the fetus
K= 155 (constant) ; n is 12 (engaged), 11 (not engaed)
Example: 30 cm. 12 X 155 = 18 X 155 = 2790grams
Fetal Movements: quickening (first fetal movements) felt by mother at 18 -20 weeek, and peaks at 28-38 in 10
movements/day; if mother is in left recumbent position after meal, 2X every minute and 10-12 X/hour. Decreased

Movement: Placental insufficiency, instruct woman to seek consultation and tell her that fetal movements vary in
relation to motherss activity (Pillitteri, 2007).
7. FETAL HEART RATE: 5-3th week, heartbeat seen in ultrasound; 10th -11 weeks heard with ultrasonic
Doppler; 16 weeks heard at fetoscope (Pilliteri, 2007).
C. LABORATORY WORKS including CBC & blood typing, urinalysis, urine and blood glucose, urine ketone and
urine protein; Paps Smear test; Rubella titer; testing for STD; HbsAg & Hepatitis; toxoplasmosis; ECG; TB test; other
test as indicated.
2. DIAGNOSTIC TESTS DURING PREGNANCY
1. Pregnancy test measures HCG in urine; accurate early in pregnancy.
2. Ultrasonography identifies fetal amd maternal structures; measures the response of sound waves against solid
objects; used to discover complications of pregnancy.
Purposes of ultrasound:
diagnose pregnancy as early as 6 weeks gestation.
To confirm the presence, size, and location of the placenta/amniotic fluid
To see fetal abnormalities (congenital anomaly screening) e.g hydrocephalus, anencephaly, or spinal cord, heart,
kidney, and bladder defects.
To establish sex, presentation and positionof fetus. Sex is seen as early as 15 weeks through 4 dimension
ultrasound (4D)
Preparation of client/ nurse responsibilities
Explain test to client.
Have client drink 6-8 glassess of water, without voiding before the test, so that fetal parts are more visible.
3. Amniocentesis determines genetic disorders, sex and fetal lung maturity ( LECITHIN: spingomyelin L:S ratio of 2:1
isDURING AND accepted normal). It is a done through the aspiration of 15 ml amniotic fluid from the uterus between
14th and 16th weeks of pregnancy. During and 30 minutes after the procedure, observe the FHR to be certain that the rate
remains normal and theat uterine contractions are not occurring.
Preparation of Clmient/Nurse Resaponsibilities:
Ask the woman to void, to prevent bladder puncturing.
Since the procedure involves penetration to the amniotic sac, such is frightening to the woman, explain the
procedure and alleviate her fear.
Place in supine position and provide privacy but exposing only her abdomen.
Place folded towel under her right buttock to tip her body slightly to the left and move the uterus off the vena
cava, to prevent supine hypotension.
Take the maternal blood pressure and FHR for baseline, then attach to electronic fetal monitoring.
Caution the woman that she may feel a sensation of pressure as the gauge 20-22 spinal needle, a 3-4 inches is
introduced for aspiration.
Caution the woman not to take a deep breath and hold it because the diagram lowers uterus and shifts intrauterine
contents.
Amniocentesis can provide information in some of these areas:
Color: Normal color of the amniotic fluid is color water; late in pregnancy is slightly yellow tinge; blood
incompatibility is strong yellow result from bilirubin release with hemolysis of RBC; meconium staining is green
color suggest fetal distress.
Lecithin/Sphingomyelin Ratio: lecithin and sphingomyelin are the protein components of the lung enzyme
surfactant that the alveoli begin to form at about 22 nd to 24th weeks of pregnancy. After amniocentesis, the L/S
ratio maybe determined quikly by shake the test ( if bubbles appear in the amniotic fluid after shaking the ratio is
mature) or sent to laboratory for laboratory analysis.
Phosphadyl Glycerol and Desatured Phosphatidylcholine: these are compounds substances found in surfactant
which are present only with mature lung function at 35 to 36 weeks. This means that fetus has no respiratory
distress syndrome.
Bilirubin Determination: the blood specimen must be free from the presence of bilirubin (yellowish pigment
found in bile, a fluid produced by the liver or a yellow breakdown product of red blood cells.

Fetal Fibronectin: fibronectin is a glycoprotein that plays a part in helping the placenta attach to the uterine
deciduas, found in amniotic fluid until after 20 weeks of pregnancy and is assessed through cervical , mucus. As
labor approaches, it can be found in vaginal or cervical fluid, but higher amount of these substances in the
amniotic fluid would mean a preterm labor may begin.
detected by amniocentesis.
Alpha-Fetoprotein: an increased level of alophafetoprotein in the amniotic fluid signifies anencephaly,
myeloningocele, or omphalocele. But if level is found to be decreased, the result is Down syndrome.

4. Percutaneous Umbilical Blood Sampling (PUBS) = also called cordocentesis or funicentesis is the aspiration of blood
from the umbilical vein for analysis.
After the umbilical cord is located by sonography, a thin needle is inserted by amniocentesis technique into the
uterus until it pierces the umbilical vein.
A sample of blood is removed for blood studies, such as complete blood count, direct Coombs test, blood gaes,
and karyotyping.
To ensure that the blood sample is from fetus, it is submitted to a kleihauer-Betke btest.
If a fetus is found to be anemic, blood maybe transfused using the same technique.
The fetus is monitored by a nonstress test before and after the procedure to be certain that there are no uterine
contraction and no vaginal bleeding.
5. Contraction Sress Test (CST)- based on principles that healthy fetus can withstand decreased oxygen, but compromised
TYPES:
A. Nipple Stimulated (CST):massaghe or rol;ling of one or both nipples to stimulate uterine activity and
check effect on FHR.
B. Oxytocin Challenge /test (OCT): to maintain ?IV line:controlled by infusion ppump, amount infused
increased every 15-20 minutes until 3 good uterine contracdiction are observed within 10 minute period.
Patient Preparation:
Explain the procedure to the client that intervenous infusion of oxytocin were initiated.
Then ask the woman to roll her nipples between her fingers and thumb until uterine contractrion begin, which are
recorded by a monitor.
Results
3 contraindication with a duration of 40 second or longer must be present in a 10 minute window. If the test is
negative, it means normal because there is no fetal heart decelaration (fetal heart rate deviations seen though
monitor.
If the test is positive. It is abnormal, meaning 50% or more of contractions cause late declaration (there is
uteroplacental insufficiency resulting to the fetal hypoxia.
6. Non Sterss Test (NST) evaluates fetal heart rate in response to fetal movement, done in 10 to 20 minutes. The uterine
contraction monitors are attached to the rhythm strip and the woman pushes the button attached to the monitor whenever
she feels the fetus moves. This can be done also at home as part of home monitoring program.
RESULT:
When the fetus moves, the fetal heart rate should increase vabout 15 beats per minute and remain elevated for 15
seconds.
If no increase in beats per minute on fetal movements, there is poor fetal oxygen.
If a 20 minute period passes without any fetal movement, the fetus is only sleeping the mother should be given an
ortal carbohydrates snack, cause fetal movement; also may be stimulated with a loud sound.
7. Chorionic Villus Sampling. (CVS)s aspiration of small sample of chorionic villus tissue at 8-12 weeks of gestation to
detect abnormalities, chromosomal or DNA analysis.
The chorion cells are located by ultrasound. A thin catheter is inserted vaginally or abdominally and number of
chorionic cells are removed for analysis.

Side effects of CVS:

Excessive bleeding, pregnancy loss, baby born with missing limbs, threatened abortion.

8. Maternal serum alpha-fetoprotein: assesses quantity of fetal serum proteins (substance produced by the fetal liver),
done at 15 weeks of pregnancy. If elevated are associated with neural tube defects. If the level is low, fetus has
chromosomal defect, e.g Down Syndrome (see the previous explanation)
9. Biophysical Profile: looks at fetal hypoxia and fetal compromised by measuring 5 parameter of fetal activity fetal
heart rate, fetal tone and amniotic fluid volume. It can be done daily during a high risk pregnancy.
A score of 6 is suspicious; 4 denotes fetal compromised; but score of 10 (highest score), means good fetal well
being.
NUTRITION
A. WEIGHT GAIN
Total WEIGHT GAIN of 25 to 35 lbs. (11-16 kg) for the whole pregnancy.
1st RIMESTER, 3.5-5 lbs. (1.6- 2.3kg) or 1.16-1.66 lbs/month or .29-.42 lb/week or less than 1
lb/week
Each of 2nd & 3rd TRIMESTER, 12-15 lbs. (5.5 to 6.8 kg) or 4-5 lbs/month or 1-1.25 lbs/week or
0.45-0.56 kg/week which consist of
Fetus - 7 -7.5 lbs (3.4 kg)
Amniotic fluid 2lbs (0.9 kg)
Placenta and membrane 1.5 lbs (0.6 kg)
Breast 1.5-3 lbs (0.6-1.3kg)
Uterus 2.5 lbs. (1.1kg)
Increased blood volume 2-4 lbs. (0.90-1.8 kg)
Body fat 7 lbs (3.8 kg)
Extravascular fluid and fat 5-10 lbs (2.3-4.5kg)
B. SPECIFIC NUTRIENTS needs are:
1. CALORIES: usual addition is 300 kcal/day, but there will be specific guidelines for those
beginning pregnancy either over or underweight.
2. PROTEIN: additional 30grms. /day to insure intake of 74-76 gms/day
3. CARBOHYDRATES: intake must be sufficient for energy needs, using fresh fruit and vegetables
as much as possible to derive additional fiber benefit.
4. FATS: high energy foods, which are needed to carry the fat soluble vitamins.
5. IRON: needed by mother as well as fetus; reserves usually sufficient for first trimester should
be taken Vit. C to promote absorption.
6. CALCIUM: 1200 mg/day needed; dairy products most frequent source.
7. SODIUM: contained in most foods; needed in pregnancy should not be restricted without
serious indication.
8. VITAMINS: both fat and water soluble are needed in pregnancy; essential for tissue growth and
development, as well as regulation of metabolism.
9. FOLATE (Folic Acid): Folate is a B vitamin which is essential foe the formation of red blood cells
and must be taken before and during pregnancy because. The requirement for women folate
increase by 50% during pregnancy because this is the time of additional blood formation and
rapid tissue growth for the baby. Studies have shown that additional folate intake during early
stages of conception helps prevent neural tube defects e.g cleft flip & cleft palate. ( Guide to a
healthy pregnancy, anmum book.
C. TETRATOGENIC FOODS, ADDITIVES, DRUGS according to US Food and Drug.
Teratogen: an agent that can cause defect in a developing fetus/baby
Teach the woman to be aware of the potential hazards, because ingesting large
quantities of these substance may be harmful to her fetus.
1. Nitosamines (N-nitroso Compound)

These compounds are patent carcinogens in all tested species, including amphibians,
birds, fish, and mammals e.g sodium nitrate and sodium nirtrite are added to most smoke
and cured meat and fish to act as an antioxidant to ensure preserving the foodstuff.
2. Alatoxins
These substances are related to mycotoxins and are produced by fungal growths on a wide
range of food stuffs. For instace, the mycotoxin ergotism of rye can induce abortion as
well as gangrene and other ills of vascular system.
3. US Certified Food Colorings
This are the azo dyes, which include red #2 (amaranth), red #4 ,yellow #6,
(tartrazine),green (ferrous gluconate), and some others.
4. Artificial Sweeteners
Researchers have found that mothers who hasd taken cyclamates during pregnancy had
children who suffered
from hyperactivity and learning disability.
5. Caffeine
The substance is of concern because oof its chemical structure, purine, one of the
constituent groups of DNA. Moreover, it crosses placenta and is known to penetrate the
preimplantation blastocytes in mammals.
6. Trace Elements and Metallic and Chemical Contaminants
Such trace elements and metallic contaminants as lead, selenium, arsenic, cadmium,
mercury and metyhylmercury occur in the ground; in fish and crustaceans, especially
when they came from contaminated waters.
7. Oral analgesics (NSAID):
Oral hypoglycemic: Orinase; Antithyroid: Methimazol: Anticoagulant: Coumarine;
Antibiotics: sulfanamides, Tetracycline; ACE inhibitors: Capotene, Vasotic; Tranquilizers:
Diazepam; Vitamin A derivatives: Isotretinoim, Etretinate; Nicotine; Alcohol: Whisky, wine.

SEXUAL ACTIVITY DURING PREGNANCY

1. The result of physiologic, anatomic, and emotional changes of pregnancy makes the
couples usually ask questions and concerns about sexual activity during pregnancy.
2. Due to the possible injury to the baby, the couples are often warned to avoid sexual
intercourse during the last 6-8 weeks of pregnancy.
3. In healthy pregnancy, there is no medical reason to limit sexual activity.
4. The expectant mother may experience changes in sexual desire is decreased due to
various discomfort that occur throughout pregnancy.
5. Dyring the first trimester, sexual desire is decreased due to the various discomforts
brought about by fatigue, nausea and vomiting, and breast tenderness.
6. During second trimester, woman may experience greater sexual desires and satisfactions
due to lessend discomforts.
7. During the third trimester, interest in coitus may again decrease due to fatigue, shortness
of breath, pain in the pelvis and other discomforts.
8. Solitary and mutual masturbation and oral genital intercourse maybe used by couples as
alternatives to penile-vaginal intercourse.
9. The side by side position is often preferred, especially during third trimester because it
requires less energy and places less pressure on the pregnant abdomen.
10.
Intercourse is conducted medical reasons such as
Multiple pregnancy
Threatened abortion
Incompetent cervix
Partners with sexually transmitted disease
Maternal history of miscarriage
Membranes are ruptured

 History of preterm labor

Abdominal pain
Vaginal bleeding
Uterine contractions
11. Sexual activity styles are:
Spoon-both bodies fit close together in this position, making it very intimate,
relaxing and optimal for slow and sensual love-making. Spooning is a great
introduction to rear-energy sex, and also is very comfortable during late pregnancy
because there is very little pressure on the womans stomach.
(http://www.ehow.com/how_2026525_sex-spoon.html)
Scissors- the woman is laying side by side so that the man is facing the womans
back, then sliding his body so that his body is perpendicular to the womans body.
The end result is a little like the doggy-style position laid on its side.
(http://www.ehow.com/how_2026351_perform-scissors-position.html)
Penguin-a sexual [position where the male is lying down, while the pregnant woman
partner is sitting on top of him, enough to secure the abdomen or the fetus against
harm (author). Note: other positions see internet and other books.

IMMUNIZATION
Immunity is the resistance that an individual has against diseases. As a general rule,
immunizations are best avoided during pregnancy.
1. Immunizations with attenuated live viruses (including mumps and rubella vaccines)
shouldnt be given during pregnancy because of their teratogenic effect on the developing
embryo.
2. Vaccinization with killed viruses (including varicella, hepatitis, influenza, tetanus, and
diphtheria vaccines) may be given during pregnancy.
Schedule of tetanus toxoid immunization for Women as per DOH(Phils.)
TT1 - as early as possible during pregnancy; TT2 at least 4 weeks later
TT3 at least 6 months later; TT4 at 1 year later; TT5 at least 1 year later
Benefits of tetanus toxoid
1. Infants : protection from neonatal tetanus.
2. Mother : protection from tetanus 3,4,10 years and lifetime .

COMMON DISCOMPORT IN PREGNANCY

1. FIRST TRIMESTER
A. Nausea and vomiting (morning sickness) due to elevated HCG levels and changes in carbohydrate metabolism.
Teach client to take small frequent meals with dry crackers; drink liquids between meals; instruct patient
to greasy, highly seasoned food.
Suggest intake of complex carbohydrates with the onset of nausea.
B. Fatigue
Get plenty of rest.
C. Urinary urgency and frequency because of pressure of fundus on bladder.
Do not limit fluid intake; decreases in 2nd trimester.
D. Breast tenderness from increase level of estrogen and progesterone.
E. Increase vaginal discharge from hyperplasia of mucosa and increase mucus production.
Take shower daily; do not use commercial vaginal cleansing products.
F. Nasal stuffiness and epistaxis from elevated estrogen level causing edema of nasal mucosa.
Encourage the use of cool-moist humidifier
Suggest the use of normal saline nose drops or nasal spray.
Advise patient to apply cool compresses to the nasal area.

G. Palmar erythema (palmar pruritis); probably caused by increased estrogen level. The woman may believe that she
has developed an allergy.
Tell the woman that this is normal.
Advise her to apply calamine lotion on the affected part.
H. Hypotension: symptoms that occur when a woman lies on her back and the uterus presses on the vena cava
impairing blood return to the heart. (philliteri, adele 2007)
Turn woma on her side to removed the pressure from the vena cava, blood flow will be restored.
2. SECOND AND THIRD TRIMESTER
A. Heartburn: from esophageal reflux
avoid caffeine and spicy food; sit up after meal.
B. Ankle edema : from venous statis; normal because of the pressure of the enlarging uterus
Elevate legs when sitting and do not cross legs.
Avoid prolonged standing and wear support stockings.
Recommend the woman to avoid wearing tight, constrictive clothing.
Suggest her to get up and move about every 1-2 hours when sitting for long filtration
C. Varicose veins: from weakening walls or faulty veins. (pilliteri, A.1 st trimester 2007) same mgt. with ankle edema.
D. Hemorrhoids:from increased pressure or constipation. (pilliteri, A.1 st trimester 2007)
increase bulk and fluid in diet .
caution the woman against prolonged standing and wearing constrictive clothing.
Suggest use of topical ointment or anesthetic if allowed.
Encourage the use of witch hazel compresses.
Teach the woman how to perform sitz bath or apply warm soaks.
Encourage woman to lie on her left side with her feet slightly elevated.
E. Constipation : from sluggish bowl from progesterone and steroid metabolism, displaced intestines, and iron
supplements (pilliteri, A.1st trimester 2007)
Increase fluid and bulk in the diet. Maintain regular exercise regimen.
Caution the woman to avoid the use of mineral oil, which deplete her level of fat soluble vitamins.
F. Backache from exaggerated lumbosacral nerve from enlarge uterus.
Maintain good body mechanics and postures; wear low heeled shoes; sit in chair with proper back
support.
Advice woman to apply local heat to the back if necessary.
Suggest sleeping in firmer mattress or using board under the current mattress to add firmness.
Teah the woman to do pelvic rocking or tilting exercise.
G. Leg cramps; from pressure on nerves.
Stretch and exercise legs; maintain good posture and bodu mechanics.
Encourage frequent rest period with the legs slightly elevated.
Encourage her to wear warm clothing.
H. Faintness: a result of orthostatic changes.
Change position slowly; sit up for several minute before rising.
I. Shortness of breath: from pressurte on diaphragm
Rest with head elevated; sleep in reclining position
J. Braxton hicks: contraction beginning as early as the 8th to 12th weeks of pregnancy. The uterus periodically
contracts and then relaxes again. A rhythmic pattern of very light contractions can be a beginning sign o0f labor.
Advice woman to telephone or e-mail their primary caregiver.
DANGER SIGNS IN PREGNANCY
Teach woman to report immediately these danger signs: recall FRESH A/C PADS
F-ever: indicates infection
R-ush of water from vagina: indicates premature rupture of membrane (PROM)
E-pisgastric pain ( pain in the abdomen ): indicates preeclampsia, ischemia in the pancreas

S-welling of the face, hands, and feet; spots before eyes: hypertension, preeclampsia
H-ard fall
A-absesnce for babys movement: indicates fetal death
C-ontinuous headache; convulsions: indicates hypertension, preeclampsia, eclampsia
P-ersistent vomiting: indicates hyperemesis gravidarum.
A-ny vaginal bleeding; abdominal pain: abruption placenta, placenta previa, premature labor
D-imness/blurring of vision; D-ecrease uterine output (oliguria): indicates hypertension, preeclampsia,
renal impairment.
S-eizures or muscular irritability: indicates preeclampsia, eclampsia
ENVIRONMENTAL RISK FACTORS IN PREGNANCY
1. GERMAN MEASLES
A. Can cause major defects in fetus between 2nd and 6th weeks after conception
B. Measles titer should be given before pregnancy to determine risks.
2. SEXUALLY TRANSMITTED DISEASE
A. Chlamydial infection
1. Most common sexually transmitted disease, especially in teenager.
2. Transmission to neonates of infected mother during passage through birth canal
3. Must be careful with timing of treatment because doxycycline or tetracycline used can interfere with tooth
enamel formation.
B. Syphilis
1. Passed to fetus; usually leads to spontaneous abortions
2. Treatment with penicillin up to last trimester; important to prevent congenital syphilis; increased
incidence of mental sub normality and physical deformities.
C. Herpes
1. Contamination of fetus after membranes rupture or with vaginal delivery
2. Generalized herpes results in 100% mortality; caesarean section indicated if labor occurs during an
episode.
D. Gonorhea
1. Fetus contaminated during vaginal delivery
2. Risk to neonate; ophtalmia neonatorum, pneumonia and sepsis
3. Problems avoided if treatment given before delivery
E. Human immunodeficiency virus.
1. Risk of transmission to fetus estimated from 30% to as high as 75%
2. Newborn maybe asymptomatic as birth, but signs and symptoms usually develop during first year of life.
3. No effective treatment if mother HIV positive.
F. Group B streptococcus infection
1. Most common cause of neonatal sepsis in the United States; can lead to post-partal infection in mother.
2. Treatneb in last semester with ampicillin can prevent transmission to neonate during labor.
3. DRUGS, ALCOHOL, TOBACCO
Drugs cross placenta (teratogen)
1. No drugs unless prescribe by physician.
2. No over the counter medications e.g. aspirin, herbal remedies.
3. No illegal drugs.
4. Category D drugs are those that have clear health risk for the fetus, include alcohol, lithium, and
phenytoin (dilantin)
5. Category X drugs are those that have been shown to cause birth defects and should never be taken
during pregnancy.
Alcohol during pregnancies may lead to fetal alcohol syndrome, physical abnormalities, congenital
abnormalities, growth deficits or jitteriness.
Cigarette smoking
a. Leads to low birth weights and higher incidence of birth defects and stillbirth
b. Research indicates that even second hand smoke is harmful
c. Nicotine cigarettes causes vasoconstriction; alters maternal and fetal heart rate.

4. RADIATION EXPOSURE
A. Women should always be asked about possibility of pregnancy before radiographs are taken
B. Increased risk of abortion and physical deformities.
5. OTHER RISK FACTOR
a. Stress causes increased activity in fetus in response to increased epinephrine.
b. Women over age 35 years have great risk of genetic abnormalities
c. Girls under 15 years have greater risk of stillbirths, spontaneous abortion, and premature birth.

ADOLESCENT PREGNANCY AND PRENTHOOD

A. General information
1. Pregnancy in a female under 17 years of of age. Pregnancy is a condition of both physical and psychologic
risk. Adolescent pregnancy is considered high-risk because of frequency of serious complication, particularly
toxemia, iron deficiency anemia, preterm birth and low birth weight infants
2. Incidence: one million teenage per year worldwide (World Health Organizations)
a. Earlier onset of menarche
b. Changing sexual behaviour
c. Poor family relationship
d. Poverty
3. Prognosis
a. For pregnant girls under 15 years, a high risk of stillbirths, low birth weight infants, neonatal, mortality,
and cephalopelvic disproportion (CPD)
b. Increased maternal risk of pregnancy induced hypertension, prolonged labor, iron deficiency anemia and
urinary tract infection
B. Nursing process
a. Assessment/analysis
1. Nutrition status
2. Knowledge of physiology of pregnancy
3. Emotional status
4. Support system
b. Plan, implementation, and Evaluation
Goal: the pregnant teen will maintain good health; will eat a balance diet with adequate protein; will prepare
for birth and care for newborn; will achieve developmental task of adolescence and pregnancy; fetus will
develop appropriately for gestastion
Plan/Implementation
1. Assist pregnant teen to achieve developmental task of adolescence in addition to the role of pregnancy
- Develop sense of identity
- Accept changing body image
- Develop close, mature relation with peers
- Socialize into appropriate gender role
- Establish an independent and satisfying lifestyle
2. Provide dietary counselling regarding importance of well balance meal, and increase protein, calcium,
and iron intake. Adolescent is frequently undernourished and not yet completely matured physically or
psychosocially.
3. Encourage adequate care. Prepare for child birth: arrange foe coaching assistance
4. Refer social service for career and educational counselling; options regarding child care/ adoption;
preparing classes; and supplemental food programs
EVALUATION
Client is free from preventable complications; has positive birth experience; delivers a healthy newborn;
cares safely for newborn or arranges for alternate placement; achieves appropriate developmenatal task.

PRACTICE TEST NO. 3

1. Diagnostic test during pregnancy that evaluates fetal heart rate in response to fetal movement.
a. Maternal estriol levels
b. Biophysical profile
c. Non stress test
d. Contraction stress test
Ans: c
2. During her pre natal visit, Jing Santos, 19 years old primigravida is on her first trimester. Her first day of LMP is
January 12, 2009. Her expected due date (EDD) thru
Neagles rule is
a. Oct. 19, 2009
b. July 17, 2009
c. Sept. 19, 2009
d. Aug. 17, 2009
Ans: a
3. The diagnostic test during pregnancy through assessing quantity of fetal protein serum, that if elevated are
associated with neural tube defect.
a. Amniocentesis
b. Maternal serum alpha-fetoprotein
c. Biophysical profile
d. Chorionic Villus Sampling
Ans: b
4. Danger sign in pregnancy that indicates premature rupture of membranes (PROM)
a. Presence of protein in uterine
b. Dimness or blurring of vision
c. Rush of water from the vagina
d. Continuous headache
Ans:b
5. Which of the following is not considered teratogenetic food and additive
a. Caffeine
b. Cyclamates
c. Monosodium glutamate
d. Collard green
Ans: d
6. Pregnant adolescent (teenager) are more seriously to have complication of
a. Toxemia (PIH)
b. Hyperemesis gravidarum
c. Spontaneous abortion
d. Gestational diabetes
Ans: a.
7. Common discomports in pregnancy resulting from the elevated estrogen level causing edema of nasal mucos.
a. Faintness
b. Sanal Stuffiness (epistaxis)
c. Nausea and vomiting
d. Decreased sense of smell
ans: b
8. An important nursing management for pregnant woman complaining of backache.
a. Wear low-heeled shoes
b. Elevate legs when sitting
c. Wear support stocking
d. Do not cross legs
Ans: a.
9. An important nursing management for pregnant woman complaining of ankle edema.
a. Sit in chairs with proper back support
b. Food rich in iron

10.

11.

12.

13.

14.

15.

c. Maintaining good body mechanics

d. Foods rich in protein
An: d
An important B vitamin which is essential for the formation of red blood cells and must be taken before and
during pregnancy to prevent fetal neural tube defects
a. Foods rich in folate
b. Foods rich in iron
c. Foods rich in potassium
d. Foods rich in protein
Ans: a
A kind of environmental risk factor that leads to low birth weights, higher incidence of birth defects and still birth
a. Radiation exposure
b. Group B streptococcus infection
c. Stress reaction
d. Cigarette smoking
Ans: d
A kind of infection which is the most common cause of neonatal sepsis
a. Human immunodeficiency syndrome
b. Clammydial infection
c. Group B streptococcus infection
d. Herpes
Ans: c
Which is a common discomfort of the second and third trimester
a. Breast tenderness
b. Backache
c. Nasal stuffiness
d. Nausea and vomiting
Ans: b
During pregnancy, sexual intercourse is advised and sexual desire is greater in what trimester
a. First trimester
b. Second trimester
c. Third trimester
d. The last 6-8 weeks of pregnancy
Ans:b
The ff. are contraindications of sexual intercourse during pregnancy. Select that all apply:
a. Multiple pregnancy
b. Single pregnancy
c. Partner with no sexually transmitted disease
d. Maternal history of miscarriage
e. Threatened abortion
Ans: a,d,e