Fetal Development
Embryonic Stage
(Start of 4 weeks though end of 8 weeks)
Week 3
Brain differentiation in 5 areas and
all 12 cranial nerves are present
Week 4
Heart forms and begins beating
Week 5
Lung structure, Liver, Pancreases,
Kidney, Gastrointestinal Tracy and
Sensory organs are developing. Arm and
Leg buds appear with muscle
innervation
Week 6
Hematopoiesis (Formation of blood
begins)
BABY IS SIZE OF A PEA
Week 7
Facial features develop and
Renal System begins to
function.
Week 8
Embryo beginning to resemble human being.
Embryo is size of KIDENY BEAN
During this period any insults can be devastating
to fetus. Teratogen can cause the greatest
damage due to fetal organs developing.
Bone Cells replacing cartilage
Finger and Toes are developing
Week 10 to 12
Can hear the fetus
heartbeat by a Doppler
Week 11 to 12
Able to make breathing and random movements.
Kidneys producing urine
Digestive system shows activity
Week 16 to 20
Quickening: Mom can feel fetal movement
1st time mom: 16 to 20
2nd time mom: 16 to 18
Lanugo: Fine hair completely covers body
Brown Fat is forming
Alveoli of the lungs form
Fetus can respond to sound
Week 24
Fetus is now viable
Has minimal fetal lung maturity,
thermoregulation, respiratory control
Requires NICU care
Grasp and startle reflex evident
VERNIX caseosa present
Week 28
Lashes and eyebrows are present
Eyelids can open and close
Fetus looks like an old man
Nervous system begins regulatory functions
Testes descend into scrotum
WEIGHT 2 to 2 ½ pounds
Week 32
Respirations and thermoregulation
possible if fetus delivered
Forming muscles & beginning to store
fat
Continues to gain weight 4-4 ½ lbs
Skeleton fully developed but not
calcified to ease delivery
Diminishing lanugo
Weight 5 to 6 lbs
Week 36
Having a filled-out appearance
Increase adipose tissue
Still has a lot of vernix
Soft ear shells and lobes
Very few creases on palms/soles
Week 38-40
BABY IS TERM
Weight 6 to 8lbs
Skin pink and smooth
Vernix in skin folds, lanugo on
shoulders and upper back
Firm ear shells and lobes
Antepartum
Gestation: 10 lunar months, 9 calendar months, 40 weeks and 280
days.
Gravida: Any pregnancy, regardless of duration
 Nulligravida-woman who has never been pregnant
 Primigravida-woman pregnant for 1st time
 Multigravida-woman who has been pregnant more than
once
Parity (para): Birth after 20 weeks’ gestation, regardless of
whether the infant is born alive or dead
 Nullipara-woman who has not completed a pregnancy by
the beginning of 20 weeks
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Primipara-woman who has completed one pregnancy by
the beginning of 20 weeks
Multipara-has completed 2 or more pregnancies by the
beginning of 20 weeks
Term: fetus born between 38
weeks and the 41 6/7 weeks
gestation.
Pre-term: fetus born between 20
weeks and 37 6/7 weeks
Abortion: the end of pregnancy
from conception to 19 6/7 weeks.
 May be elective or
spontaneous (miscarriage)
G.T.P.A.L
Code that represents a women’s pregnancy history
G:
Gravida (# of pregnancies) Only time current
pregnancy is included
T:
# of prior Term pregnancies
P:
A:
L:
# of prior Pre-term pregnancies
-# of prior Abortions
-# of current Living children
Example:
Nagele’s Rule
Calculating EDC
Identify 1st day of LMP
Count backward 3 months
Add 7 days
Example:
Pregnancy Presumptive Signs
Subjective, definitive
diagnosis can’t be made in
presence of these.
Amenorrhea--may be caused by strenuous exercise, metabolism changes, endocrine
dysfunction, medications, psych disorders
Nausea--with or without vomiting
 “morning sickness”
 occurs in 50% of pregnancies
 due to hormonal changes
 subsides after 1st trimester
Breast changes--progesterone causes swelling and tenderness, sensitivity
Urinary disturbances common in early pregnancy
 enlarging uterus and increased pelvic blood supply cause urgency and
frequency
 relieved in 2nd trimester
 reoccurs in 3rd trimester
Fatigue
 due to increased metabolic needs
Quickening at 18-20 weeks.
 can help determine EDC in pts. with irregular periods
Pigment changes
 darkening of nipples and areola
 Linea Nigra
 Chloasma
Pregnancy Probable Signs
More objective, can be
observed by medical
personnel
Laboratory tests-- Detects presence of hCG in blood or urine.
 90-98% accurate
Uterine enlargement by end of week 12 the fundus may be felt just
above symphysis pubis. At 20-22 weeks at umbilicus.
Chadwick’s sign--purplish or bluish discoloration of cervix, vagina,
vulva by increased vascular congestion
Goodell’s sign--softening of the cervix
Hegar’s sign--softening of the lower uterine segment just above cervix
Striae on abdomen, breasts, thighs, buttocks--stretch marks
Braxton Hicks contractions--irregular, painless uterine contractions
that occur throughout pregnancy.
Does not dilate cervix.
Fetal outline-able to palpate by week 24
Ballottement--rebounding of fetus by examiner’s fingers at 4-5 months.
Pregnancy positive signs
Diagnostics signs that are
absolute indicators
Fetal heartbeat
 as early as 6 weeks by US
 as early as 10 weeks by Doppler transducer
 18-20 weeks with fetoscope
 FHR 110-160 bpm
Other sounds audible
 uterine souffle--placenta
 funic souffle--umbilical cord
Fetal movements
 palpable by trained examiner in 5th month
 normal intestinal movements feel similar so mother’s
report not as accurate
Ultrasound observation
 gestational sac seen at 4-5 weeks
 embryo visible at 6-8 weeks
Prenatal 1st visit
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Performed commonly 8-12 weeks after missed period
Obtain thorough history:
Medical, Family & OB
Physical exam--look for health deficits
Pelvic exam
Pelvimetry--check condition of organs and birth canal
poor predictor of who will deliver vaginally and is not routinely
performed
False pelvis – flaring wings of the iliac crests of hip bones
True pelvis where the fetus has to rotate and mold to fit
Favorable for delivery
Male type- more common in
Caucasian women
More common in African American
Women-longer labor
Unfavorable for vaginal delivery
1st Visit Lab Test
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Repeat pregnancy test
Urinalysis
Blood type/Rh factor
Rh & ABO incompatibility
o Rh- mother and Rh + father
o Mother: type O & Father: type A, B, or AB
Titers
o Rubella
o Varicella
CBC
o Hgb and Hct--12mg/dl and 35% desirable
Serology for Hep B, Syphilis and HIV
Papanicolaou smear & HPV DNA test
o check cervix for cancer cells
o Human Papilloma Virus
Gonorrhea/Chlamydia culture
o check for STDs
Torch Infection
Maternal infections may cause congenital malformations or
disorders in infant especially if exposed during the first 12 weeks
of gestation
T: Toxoplasmosis
O: Other (gonorrhea, syphilis, varicella, hepatitis B,
HIV)
R: Rubella
C: Cytomegalovirus
H: Herpes simplex virus
Prenatal visits and Assessments
Frequency:
 after initial visit every 4 weeks
 28 weeks every 2 weeks
 37 weeks weekly
Assessments:
 Weight gain
 25-30 pounds average gain
 2-4 lbs. in 1st trimester
 1/2 lb. per week in 2nd trimester
 1 lb. per week in last 4-6 weeks
Vital signs--especially BP.
 Early detection of PIH vital.
Fetal heart tones (FHT)/rate
 Doppler
Fundal height measurement
 Centimeters measure correspond with gestational age
Urinalysis for infection, protein, sugar
Vaginal exams per discretion
Assess for common problems
 N/V
 Edema
 Bleeding/spotting
 Constipation
 Headache
 Urinary tract infections (UTI)
 Yeast or Bacterial Vaginosis infections
Ultrasound
Glucose Challenge Test
H&H
RhoGAM work-up
Group Beta Strep
 Normal vaginal flora
 Woman asymptomatic but can cause serious infection of newborn
 Vaginal and rectal cultures at 36-37wks to detect presence in pregnant woman
 If present will treat with IV antibiotics during labor--usually 2+ doses of Ancef or ampicillin
Vaccination During pregnancy
 Tdap
o Prevents pertussis in newborn.
o All pregnant women between 27 – 36 weeks
 Hepatitis B
o Prevents hepatitis B in newborn.
o Can lead to serious liver disease.
 Influenza
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Inactive form during flu season (October-May)
Influenza exacerbates during pregnancy
Predisposed to PTL and preterm birth
Prenatal Visit Teaching
S/S to report
 fever >38 C (100.4 F)
 pain or burning with urination
 bleeding, fluid leaking from vagina
 decreased fetal movement
 persistent vomiting
 rapid weight gain esp. edema in hands & face
 persistent headache, visual disturbances
Diet
 Increase of 300 kcal/day
 Balanced diet will provide needed vitamins, minerals, proteins.
 Routine supplementation of “prenatal vitamins” prescribed
 Increase fluids, especially water
 Pregnant teens often have poor health habits, high nutritional needs for their
own growing body.
 Need 500-800 kcal/day increase.
Clothing
 need larger clothes by 3rd month
 wide strap support bra
 avoid restrictive clothing, especially in pelvis and legs
 wear comfortable, low-heel shoes
Activity and Rest
 Pre-pregnancy activities usually okay
 Moderate walking, swimming, modified Yoga/Pilates
 Plan for rest periods in daily schedule
 Sit or lie with feet up for 20-30 min.
Other
 Employment--avoid toxic fumes, falls, heavy lifting, prolonged sitting or
standing
 Bathing/Hygiene--increased sweating and oil gland secretion, vaginal
secretions.
 Sexual intercourse--CI in pre-term labor
 Hazards to avoid, abstinence recommended
 smoking
 alcohol
 street drugs
 Causes low birth weight, prematurity, birth defects, increase fetal death
 The nurse functions as a teacher, counselor, resource person, support person.
 Be aware of verbal and nonverbal cues.
 Help interpret and reinforce MD instructions at every visit.
Discomfort of Pregnancy
First Trimester
 Painful breast
 Urinary urgency and frequency
 Fatigue
 Nausea/ Vomiting--low fat, high carb
o Hyperemesis gravidarum may need IV therapy
 Mood swings
 Increased vaginal discharge—yeast/BV?
 Nasal stuffiness
Second
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Trimester
Heartburn
Constipation--increase fluids, fruits/vegetables
Leg cramps
o change position frequently - dorsiflex
o increase calcium intake
o avoid massaging area
 positive Homan’s sign--blood clot
Varicose veins--pooling of blood
support hose
rest frequently with feet elevated
light to moderate walking helpful
Backache
Third Trimester
 Varicosities worsen
o hemorrhoids, vulvar varicosities
 Dyspnea
 Hypermobility of joints
o Relaxin loosens connective tissue
 Edema
o report edema to face/hands
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Backache
Insomnia
DANGER SIGNS
1. Decreased fetal movement or none at all
2. Fever/chills
3. Persistent vomiting after 1st trimester
4. Bleeding or fluid leakage from vagina
5. Increased BP
6. Excessive swelling/weight gain
7. Visual disturbances
8. Dizziness
9. Epigastric pain (RUQ) and Seizures
Considerations
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Need to assess expectant mother’s feelings toward pregnancy
o Planned vs. unplanned
o Impact on career, appearance, relationships, finances
o Expectations for self and infant
Normal for woman to be preoccupied with self in early
pregnancy
Need to assess type of childbirth experience parents are
expecting
o Are classes needed
o Type of delivery facility
o Type of pain relief
o Breastfeeding or bottle-feeding
Emotional Stages
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Early Pregnancy
o normal to internalize
o preoccupation with self and pregnancy
o may be ambivalent about pregnancy
o mood swings common
Second Trimester
o more accepting of pregnancy and fetus
o very focused on body and developing fetus
o exciting period--begin to think of self as “mother”,
fetus as “baby”
Third Trimester
o preparing for baby which is unknown but accepted as
an individual
o introspective about labor and delivery
o begins to separate “pregnant” into “mother and baby”
o feeling tired of pregnancy and body changes