Promoting Fetal and Maternal Health
Promoting Fetal and Maternal Health
 The health of the fetus and mother are directly linked.
 A woman who eats well and takes care of her own health provides a healthy
environment for fetal growth and development.
 Education is a major role in nursing care.
 Providing empathetic and accurate advice.
 Alert for danger signs of pregnancy and current teratogens.
Health Promotion
 The nurse will help the family maintain a state of wellness throughout the
pregnancy and into early parenthood.
 Nursing Process:
 Assessment begins before pregnancy
 Plan- goals and outcomes(realistic).
 Implementation- teaching is one of the major interventions.
 Evaluation- ongoing process aided by regular prenatal health care visits.
Self-Care Needs
 Pregnancy is not an illness so common sense about health care is all that is
required.
 Nurse must be alert to misunderstandings, separate fact from fiction and
prevent unnecessary restrictions.
 Bathing:
 sweating increases
 increased vaginal discharge
 encourage daily bathing, shower is best
 restrict tub bath if cervix dilated ruptured membranes or vaginal bleeding.
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Breast Care:
wear a firm supportive bra with wide straps to spread the weight across the
shoulders.
week 16 colostrum secretions begin; wash daily with clear tap water (no
soap) and dry.
May need gauze squares or breast pads inside bra.
Dental Care:
see dentist regularly
good tooth brushing (gingival tissue tends to hypertrophy during pregnancy).
Perineal Hygiene:
increased vaginal discharge
douching is contraindicated due to risk for infection and lowers pH.
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Dressing:
common sense and comfort.
avoid garters, firm girdles with panty legs, knee-high stockings, anything
extremely restricting.
Wear shoes with a moderate to low heel.
Sexual Activity:
ask if she has any questions
dispel the myths
intercourse is not harmful to the child
if she has a history of miscarriage she may avoid coitus during this time in the
pregnancy when a previous miscarriage occurred.
membranes ruptured or vaginal spotting may lead to infection
caution about male oral-female genital contact
decreased sexual desire due to increased estrogen levels
breast tenderness
increased clitoral sensation
new positions for intercourse
caution about STD’s
Exercise:
prevents circulatory stasis in lower extremities
extreme exercise is associated with lower birth rate.
daily exercise is recommended for 30 minutes; walking is best.
woman can continue any sport she participated in before pregnancy except
contact sports.
Avoid aerobics, jogging, hot tubs or saunas.
Sleep:
needed for building new body cells and increased metabolic demand
may need rest periods during the afternoon
modified Sims’ position is best. This puts the weight of the fetus on the bed
and allows good circulation in the lower extremities
avoid supine position due to supine hypotension syndrome
avoid sitting or lying with knees sharply bent due to increased risk of venous
stasis below the knee.
Employment:
There are few reasons women cannot continue to work throughout pregnancy.
Some reasons involve exposure to toxic substances, lifting heavy objects,
excessive physical strain, long periods of standing, or having to maintain body
balance.
Public Law 95-555 in 1978
Family Leave Act passed in 1993
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Travel:
early in normal pregnancy - no restrictions
late in pregnancy; possibility of early labor
know the nearest health care facility
if extended period of time, medical records need to be copied and prenatal
visits continued and adequate prescriptions.
frequent rests q 1-2 hours.
wear seat belt under abdominal bulge
check air travel restrictions and immunizations needed for destination.
Discomforts of Early Pregnancy
 These symptoms may not seem minor to the pregnant woman.
 They may lead to more serious problems if not monitored adequately.
 Listening, observing and developing a nursing diagnosis based on assessment
data.
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Breast Tenderness:
one of the first symptoms noticed
wear proper bra
avoid cold drafts
Palmar Erythema:
constant redness or itching of the palms
caused by increased estrogen levels, will disappear once her body adjusts.
Calamine lotion may help
Constipation:
weight of the growing fetus presses against the bowel and slows peristalsis.
encourage regular BM’s
increase roughage and water
Avoid OTC drugs (Colace or glycerin suppositories may be prescribed).
Nausea, Vomiting and Pyrosis:
Fatigue:
common in early pregnancy
due to increased metabolic requirements
increase rest and sleep
short rest period during the day
Muscle Cramps:
decreased serum calcium levels, increased serum phosphorus levels and
circulatory interference cause cramps to legs.
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relieved by woman lying on back, and extending involved leg while keeping
knee straight dorsiflex foot until pain is gone
may need Rx. for aluminum hydroxide gel (Amphojel) which binds to
phosphorus in intestinal tract and lowers levels
lower milk intake to 1 pint /day and add
calcium lactate will reduce phosphorus levels
elevate legs frequently
Hypotension:
supine hypotension
blood pooling in the pelvic area or lower extremities
raise slowly and avoid standing for long periods of time.
Varicosities:
due to pressure from the fetus on the veins returning blood from the lower
extremities.
causes pooling of blood in the vessels
veins become engorged, inflamed and painful
can extend to the vulva
rest in Sims’ position or on back with legs raised against the wall or on foot
stool for 15 to 20 minutes twice a day.
avoid crossing legs or knees bent
avoid knee high hose or garters
may need medical support hose (apply before arising).
exercise and walk 2 times a day
increase vitamin C with fresh fruit
Hemorrhoids:
due to pressure on veins from the uterus
daily BM’s
Sims’ position or knee chest position for 10 to 15 minutes
stool softeners, witch hazel or cold compresses
Heart Palpitations:
with sudden movements
due to circulatory adjustments for increased blood supply during pregnancy
encourage slow gradual movements
Frequency of Urination:
due to pressure of uterus on anterior bladder
lasts for 3 months then returns again in late pregnancy
check for symptoms of UTI
decrease caffeine
Kegel exercises
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Abdominal Discomfort:
feeling pressure may be relieved by putting gentle pressure on the fundus
pulling pain in lower abdomen from tension on round ligaments (can be sharp)
rise slowly
Leukorrhea:
whitish viscous vaginal discharge due to high estrogen levels and increased
blood supply to vaginal epithelium and cervix
daily bath or shower
no douching, tampons, tight underpants, pantyhose
wear cotton underwear and sleep without underwear at night
Discomforts of Middle to Late Pregnancy
 20th to 24th week a woman is ready for further health teaching.
 Inform her of signs and symptoms of beginning labor.
 Backache:
 lumbar lordosis and postural changes
 encourage her to wear shoes with low heals and walk with pelvis tilted
forward.
 Local heat, squat instead of bending over, firm mattress, monitor for bladder
or kidney infections, avoid herbs ask MD about Tx.
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Headache:
from expanding blood volume, which puts pressure on cerebral arteries.
avoid eye strain or tension
rest with cold towels on forehead
Tylenol
intense or continuous notify the doctor.
Dyspnea:
SOB due to uterus pressing on diaphragm
noticed at night or with exercise
Discomforts of Middle to Late Pregnancy
 may need 2 pillows to sleep on at night
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Ankle Edema:
more noticeable by the end of the day
due to reduced blood circulation to the lower extremities due to uterine
pressure and general fluid retention.
encourage left side lying position which increases the kidney’s glomerular
filtration and allows good venous return.
elevate legs and avoid constricting clothing
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Braxton Hicks Contractions:
can begin at week 8 to 12
become stronger later in pregnancy
a rhythmic pattern can be a beginning sign of labor
Danger Signs of Pregnancy:
Review with woman and have her report any of the symptoms to her health
care provider.
Vaginal Bleeding:
report to MD no matter how slight
check for hemorrhoids
Persistent Vomiting:
1 to2 times daily for first trimester is common
persistent vomiting past week 12 is not normal
this depletes nutritional supply available to the fetus
Chills and Fever:
may indicate intrauterine infection or gastroenteritis
Sudden Escape of Clear Fluid From The Vagina:
membranes may have ruptured so uterine cavity is no longer sealed against
infection
umbilical cord may prolapse
cord could be compressed
Abdominal or Chest Pain:
report immediately may be ectopic pregnancy, separation of placenta, pre
term labor, appendicitis, ulcer or pancreatitis
chest pain may indicate pulmonary embolus or thrombophebitis.
Pregnancy-Induced Hypertension (PIH)
refers to potentially severe or fatal elevation of blood pressure
Symptoms
 rapid weight gain(over 2 lbs/ wk in 2nd trimester and 1 lb/wk in 3rd
trimester
 swelling of face or fingers
 flashes of light or dots before the eyes
 dimness or blurring of vision
 severe, continuous headache
 decreased urine output
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Increase or Decrease in Fetal Movement:
fetus normally moves the same amount every day
change can be the fetus responding to a need for oxygen
Teratogens
 Any factor, chemical or physical, that adversely affects the fertilized ovum,
embryo or fetus.
 Effects of Teratogens on the Fetus:
 Factors:
 strength of teratogen (radiation)
 timing of the teratogen; before implantation, when the main body systems
are being formed (2 to 8 weeks)
 effects caused by organisms of syphilis and toxoplasmosis
 affinity for specific tissue (lead, thalidomide, tetracycline, rubella virus)
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Teratogenic Maternal Infections:
sexually transmitted of systemic infections
TORCH
T-toxoplasmosis-a protozoan infection, spread through contact with uncooked
meat, cat stool
 almost no symptoms - malaise and posterior cervical lymphadenopathy
CNS damage, hydrocephalus, microcephaly, intracerebral calcification and
retinal deformities
O-other infections (syphilis, HBV, HIV)
 rubeola, coxsackievirus, mumps, varicella, poliomyelitis, influenza, viral
hepatitis and parvovirus B19 (5th disease) are all teratogenic.
 Syphilis - congenital syphilis, extremely damaging to fetus at week 16 to 18
 deafness, cognitive challenge, osteochondritis, and fetal death.
test for VDRL or RPR at first prenatal visit
Lyme Disease:
multisystem disease
avoid tick repellent with diethyltoluamide
monitor for migratory rash and joint pain
Tx. Penicillin
Illness at birth
gonorrhea, candidiasis, chlamydia, strep B, hepatitis B
R-rubella
 mild rash and mild systemic illness in mother
 deafness, mental and motor challenges, cataracts, cardiac defects, retarded
intrauterine growth, thrombocytopenia, purpura, dental and facial clefts
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a titer > 1:8 suggests immunity to rubella
can not be be immunized during pregnancy because the vaccine uses a live
virus which will effect the same as a case of rubella
advise women to not become pregnant for 3 months after immunization
avoid children with rashes
infants born to mothers who had rubella can transmit the disease for 8
months after birth
isolate the newborn
nurses should be immunized against rubella
C-cytomegalovirus:
member of herpes virus family
severe neurological damage, hydrocephalus, microcephaly, spasiticity, optic
atrophy, chorioretinitis, deafness, chronic liver disease, blueberry-muffin
lesions
no Tx.
H-herpes simplex virus:
1st trimester > severe congenital anomalies or spontaneous miscarriage
2nd and 3rd trimester > premature birth, intrauterine growth retardation,
continuing infection of newborn at birth
Hx of herpes and lesions needs a C section
recurrence; antibodies prevent systemic transfer
IV or oral Zovirax during pregnancy
All are known to cross the placenta and affect the fetus during pregnancy
TORCH screen provides a quick way to assess the potential risk of teratogenic
infection in pregnant women and newborns
infections can be viral, bacterial or protozoan
most cause flu-like symptoms in the woman and much more serious effects on
the fetus.
Vaccines:
Live virus vaccines are contraindicated.
Wait 3 months before becoming pregnant.
Drugs:
women should not take any drug or supplement not prescribed by a physician.
accutane - acne
recreational drugs effects fetus 2 ways-direct effect and exposure to HIV HepB
Cocaine causes vasoconstriction in the mother causing decreased placental
blood supply > decreased nutrients.
 Miscarriage, preterm labor, meconium staining, growth retardation, learning
disorders or poor attention span.
Alcohol > congenital deformaties and cognitive impairment, vitamin B
deficiency
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fetal alcohol syndrome-small for gestational age craniofacial deformity,
short palpebral fissures, thin upper lip upturned nose.
Cigarettes:
associated with infertility
growth retardation of fetus, SIDS, low birth weight due to limited blood supply
to fetus,
inhaled carbon monoxide, second hand smoke
nicotine patches are harmful to fetus
Environmental:
can be lethal to the fetus
Metal and Chemical Hazards
 pesticides, carbon monoxide, arsenic,
 formaldehyde, mercury, lead.
Radiation
 rapid growing cell destruction depending on the stage of development and
length of exposure
 most damaging from implantation to 6 weeks (lead apron)
 nervous system, brain and retinal innervation, Ca, genetic mutation
 Sonogram and MRI replaced X Ray
Hyperthermia and hypothermia;
interferes with cell metabolism (growth)
saunas, hot tubs, tanning beds (limit 10 min), work environment
abnormal brain development, seizure disorder, hypotonia and skeletal
deformaties
hypothermia - mothers temperature lowered significantly before fetal changes
result
Stress:
myths exist
teach common sense
effects on sympathetic division of autonomic nervous system(fight or flight)
prolonged - constriction of uterine vessels > interfere with blood supply and
nutrients
Preparation For Labor
 Midpoint of pregnancy is time to review the events that signal the beginning of
labor.
 Lightening - settling of the fetal head into the inlet of the true pelvis (2 weeks
before labor in primiparas)
 not SOB, increased urination, abdominal contour changed, sciatic pain
 Show - release of cervical plug and beginning of cervical dilatation
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Rupture of the Membranes:
a sudden gush of fluid
danger of cord prolapse and uterine infection
Excess Energy:
clean house, finish paperwork and exhaust herself before labor begins
Uterine Contractions:
start in the back and sweep froward across the abdomen like the tightening of
a band
Gradually increase in frequency and intensity; notify health care provider
5 minutes apart and regular