Antepartum – The time between conception and the onset of labor
Intrapartum – The time between the onset of labor to the birth of the infant and placenta
Postpartum – The time from the delivery of the placenta until the woman’s body returns to
normal (about 6 weeks)
Gestation – number of weeks of pregnancy since the first day of the last menstrual period
Gravida – woman who is or has been pregnant, regardless of the duration (includes current
pregnancy) (Gravida = positive pregnancy test)
Primigravida – woman who is pregnant for the first time
Multigravida – woman who has been pregnant more than once
Nägele’s rule: Take the first day of the woman’s last menstrual cycle, subtract 3 months, and
then add 7 days and 1 year, adjusting for the year as necessary.
Parity: number of pregnancies in which the fetus or fetuses reach 20 weeks of pregnancy, not
the number of fetuses. Parity is not effected whether the fetus is born still born or alive.
Primipara: has completed one pregnancy to stage of viability
Multipara: has completed two or more pregnancies to stage of viability
GTPAL acronym
Gravidity
Term births (38 weeks or more)
Preterm births (from viability up to 37 weeks)
Abortions/miscarriages (prior to viability)
Living children
Early Term- 37-386/7 weeks.
Full Term- 39-406/7 weeks.
Late Term- 41-416/7 weeks.
Post Term- 42- weeks and beyond.
Trimester – division of pregnancy into 3 equal parts of 13 weeks each.
Abortion – termination of pregnancy before 20 weeks gestation. Can be spontaneous or
induced (miscarriage).
Viability: the point in time when an infant has the capacity to survive outside the uterus. There
is not a specific weeks of gestation; however, infants born between 22 to 25 weeks are
considered on the threshold of viability.
Hegar’s sign: softening and compressibility of lower uterus
Chadwick’s sign: deepened violet-bluish color of cervix and vaginal mucosa
Goodell’s sign: softening of cervical tip
Cardiovascular: Cardiac output increases (30% to 50%) and blood volume increases (30% to
45% at term) to meet the greater metabolic needs. Heart rate increases during pregnancy
beginning around week 5 and reaches a peak (10 to 15/min above pre-pregnancy rate) around
32 weeks of pregnancy.
Blood Pressure:
-
Blood pressure measurements are within the pre‑pregnancy range during the first
trimester. (Decrease in peripheral vas resistence(5/10mmhg). Never elevate!!) Systolic:
-
slight or no increase from pre‑pregnancy levels. Diastolic: slight decreases around 24 to
32 weeks; will gradually return to pre-pregnancy level by the end of the pregnancy.
The position of the pregnant woman also might affect blood pressure. In the supine
position, blood pressure might appear to be lower due to the weight and pressure of the
gravid uterus on the vena cava, which decreases venous blood flow to the heart.
Maternal hypotension and fetal hypoxia might occur, which is referred to as Supine
Hypotensive Syndrome or supine vena cava syndrome. Signs and symptoms include
dizziness, lightheadedness, and pale, clammy skin. Encourage the client to engage in
maternal positioning on the left lateral side, semi‑Fowler’s position, or, if supine, with a
wedge placed under one hip to alleviate pressure to the vena cava.
Cardiovascular System
Hypercoagulable state- due to fibrin and plasma fibrinogen level increase. This can cause what?
Actions to prevent complications?
Weight gain Pregnancy
p. 83
Normal weight- 25-35 lbs. overweight less, under more.
First trimester-1.1-4.0 lbs.
1 lb per week last two trimesters. ACOG recommends BMI and go from there.
Average 300- 400 more calories. (How can she get this?)
Endocrine System
Thyroid gland= Basal metabolic rate increase. Gland enlarges. Incr in gland secretion 1st trimester.
BMR incr. Hr and CO incr. Low levels affect fetal neruologic
Pancreas=insulin- first half low glucose levels.
Second- maternal sensitivity to insulin decrease, thus gestational diabetes can occur. GTT at 24-28
weeks above 140mg/dl.abnormal.
Adrenals=cortisol, aldosterone-Increase.
Endocrine System
Super Important!!
Pituitary gland-Hypothalamic stimulation of AP!!
Anterior-produces FSH stimulates ovum growth!
Also produces LH which brings about ovulation and maintains the endometrium for pregnancy!
Oxytocin- released by pituitary, contractions before and after delivery. Muscle layers of the
myometrium become more sensitive to oxytocin near term.
Prolactin- from anterior pituitary creates initial lactation!! Levels rise during pregnancy.
Oxytocin is responsible for milk ejection during breast-feeding
Endocrine System
Questions to know/understand
Why are the mother’s glucose levels low during the first half of pregnancy? Thus a type 1 diabetic
will have low glucose levels and thus will need less insulin during this time, adjustment is needed in
her daily or pump dose of insulin. What could happen if the type 1 diabetic does not adjust her
insulin during this time?
The need for insulin rises during pregnancy. Then at labor it does what? During labor a woman
needs more or less insulin?
Why do some women acquire gestational diabetes during pregnancy?
Hormones During Pregnancy
Hormones the placenta secretes.
HPL- Facilitates fetal growth by altering maternal metabolism. Insulin antagonist or (insulin
resistance). Thus pregnancy is a state of insulin resistance. P.67
Estrogen
Progesterone
Relaxin
HCG
Changing nutritional needs of Pregnancy
Positive birth outcomes with no complications starts with optimal nutritional intake during
pregnancy.
Nutritional intake during pregnancy has a direct effect on fetal well-being and birth outcome.
Starts with the myplate.gov website.
Inadequate intake/excessive intake.
Iron and folic acid supplements needed because of diet.
30mg fe and 600mcg folic acid
Increase in calories during pregnancy is 300- 400. Healthy non-pregnant is 1,800-2,200cal per day.
Protein 80g/day, iron 27g/day, and folic acid 800mcg/day.
Fish and shellfish important- high quality protein with low saturated fat and omega-3 fatty acids. /
Mercury levels concern.
Safety advice for diet when pregnant
Nutrient dense foods
Weight gain- 25-35 pounds / average weight prior
Vitamins/Minerals
Folic Acid
Deficiency in 1st trimester linked to neural tube defects
Sources: green leafy vegetables, organ meats, peanuts, fortified OJ, foods are fortified also
Calcium
Needed for cell growth
Fetus needs are greatest in the last 2 trimesters
Recommended 1200 mg/day = 4 cups of milk
Caffeine increases the urinary excretion of Ca+
Sources- milk, cheese, yogurt, fish with bones
Vitamins/Minerals
Iron
Increased requirements during pregnancy
Fetus rarely is iron deficient at birth
Sources: lean meats, eggs, whole grains, dried fruits, sunflower seeds, shell fish, dark green
leafy vegetables, molasses
Teach
Increased absorption with Vitamin C
Increased absorption with an empty stomach
Supplements are often necessary
Stools may by black
Vitamins/Minerals
Vitamin C
Increased need during pregnancy
Sources: citrus products, strawberries, cantaloupe, potatoes, broccoli, tomatoes
Fluids
8-10 glasses per day
Dehydration can lead to preterm labor
Nutritional supplements
Sweeteners
Factors that can influence Nutrition during Pregnancy
Anemia – iron rich foods
Nausea and vomiting
Cravings
PICA – persistent eating of substances such as dirt, clay, starch, freezer frost, burnt
matches, etc
Good nursing assessment
Be non-judgmental
Re-education important!
Calculation of the due date: p. 75
Length of pregnancy is approx. 280 days or 40 weeks from fist day of LMP.
Nagel’s rule – begin with the first day of the last menstrual period, subtract 3
months, add 7 days
Example
Patient’s last period = July 10th
Subtract 3 months = April 10th
Add 7 days
= April 17th
Maternal Psychosocial
Ch 5
First trimester=uncertainty, ambivalence, self as primary focus
Second trimester=physical, fetus primary focus, narcissism and introversion, body image, changes in
sexuality
Third trimester=vulnerability, dependency, preparation for birth
Maternal Role Tasks
Reva Rubin
Maternal tasks that a woman must accomplish to incorporate the maternal role into her personality:
Ensuring safe passage throughout pregnancy and birth
Seeking acceptance of infant by others
Seeking acceptance of self in maternal role \to infant
Learning to give of oneself
Conflict
Healthy prior to pregnancy
Folic acid 400mcg/day.
Immunizations
Chronic diseases
Risk Factors for adverse pregnancy outcomes.
Nursing Management
Antepartal Tests
Screening- Offered to all pregnant women, some.
Designed to identify those who are not affected by a disease or abnormality. Alpha-fetoprotein,
Triple Marker screening, US.
Diagnostic- Identify structural or functional anomalies or birth defects in the fetus.
Ongoing fetal Assessment-p.142 Basic Information only. (ATI)
Kick Counts CST
NST
AFI
BPP
VAS