Book of Readings. Nursing Practice 2015 .
Key words, concepts from which to
describe the basic process of conception:
-the menstrual cycle, ovulation,
-mitosis, meiosis, gamete, ovum,
-zygote, morula, blastocyst
Refer to images
Prenatal growth
 -germinal stage (fertilisation to 2 weeks)
organism divides….rapid cell
division, increasing complexity,
…..implants in the uterus….forms
the placenta and amniotic fluid.
-embyonic stage (2 to 12 weeks)
major body systems and organs develop.
critical stage of development.
-fetal stage (12 weeks to birth)
increasing development and growth.
The mother’s experience
Signs and symptoms of pregnancy
presumptive signs and symptoms
-may have causes other than pregnancy
-nausea and vomiting
-urinary frequency
-breast tenderness
Probable signs of pregnancy
-may have causes other that pregnancy
-changes in pelvic organs
-enlargement of the abdomen
-Braxton Hicks contractions
-pigmentation of the skin (linea nigra /
-pregnancy test
(hydatiform mole)
Positive signs of pregnancy
-signs observed by the examiner
-can only be caused by
-fetal heart beat heard (piniards or a
-fetal movements palpable by an examiner
-visualisation of the fetus (ultrasound)
Human gestation = 266 days (9 months)
Naegle’s rule
-to find out the
-(EDD) estimated date of delivery
-(EDB) estimated date of birth
Take the first day of the woman’s last
normal menstrual period, add on 7 days
and take off 3 months (or add on 9
LNMP 18 July 2003
18 +7 days=25 July + 9 months =April
EDD or EDB= 25th April 2004
Hormones of pregnancy
Human Chorionic Gonadotropin (hCG) or
-secreted early in pregnancy, stimulates
progesterone & oestrogen production by
the corpus luteum to maintain the the
pregnancy until the placenta is developed to
assume that function.
-the presence of HCG (hCG) in
the urine is the basis for most
commonly used pregnancy tests.
Estrogen (oestrogen)
- growth hormone produced by the ovaries,
corpus luteum and the placenta
-stimulates uterine development (growth of
the decidua and myometrium) to provide a
suitable environment for the fetus.
-stimulates development of the ductal
system of the breast tissue in preparation
for lactation (breastfeeding)
-contributes to water retention
-excreted in urine (oestriol) (when collected
give an indication of the health of the
-secretory hormone secreted by the
corpus luteum and the placenta.
-maintains the pregnancy, maintains the
endometrium and stops spontaneous
uterine contractility.
-relaxes smooth muscle fibres.
(ureters, veins, arteries, uterus,
intestine…) …discomforts of
Maternal nutrition
“A woman’s nutritional status before and
during pregnancy can significantly influence
her health and the health and that of her
Ladewig, P., London, M., Olds, S. (1998) Maternal-Newborn nursing
care . Fourth edition. Addison Wesley.
Maternal nutrition
-important to eat a variety of foods
-quality better than quantity
-iron, folic acid, calcium
-water intake
(review nutrition according to tutorial
Weight gain during pregnancy.
1.0 kg
0.5 kg
-blood volume
3.0 kg
-fat and protein stores
3.0 kg
-average weight at birth
3.5 kg
-amniotic fluid (1L+)
1.0 kg
-placenta (average wgt)
0.5 kg
Overall minimal weight gain = 12.5 kg
Minimum recommended weight gain =
12.5 kg
Referring to the previous chart most of
the weight gained results from new tissue
and fluid volume for the mother and
Weight gain during pregnancy needs to
be assessed
in relation to:
-the woman’ pre-pregnant weight
-ideal weight for height and bone
MOH (2006) Food and Nutrition
Guidelines for Healthy Pregnant and
Breastfeeding Women.
Normal BMI
High BMI
Obese BMI
12.5-18.0 kg
11.5-16.0 kg
7.0-11.0 kg
6.0 kg
The Placenta
The placenta
-respiration: O2 and CO2
-nutrition: water / glucose / electrolytes
-excretion: CO2 / wastes, urea
-secretion of hormones
-develops progressively throughout the
by 37-42 weeks : ovular-circular
1/5 of the baby’s weight
diameter 18-2- cms.
the maternal and fetal circulations do not mix
*simple diffusion (high conc. To lower)
* facilitated diffusion (osmosis / active
The membranes
The membranes (amnion and chorion)
-amnion: thin protective membrane
that entirely surrounds the embryo.
-chorion: outside the amnion and
surrounds the fetus.
Born in a caul
Amniotic fluid
-the fluid surrounding the embryo inside
the amnion.
-clear straw coloured
-approximately 1500 mls.
-protects the fetus from
trauma and temperature changes
-allows room for growth and movement
A pregnant women should contact her LMC
at the routine times or as negotiated and
with any of the following:
-vaginal bleeding
-premature labour
-rupture of the membranes
-decreased fetal movements
-severe headaches,
visual blurring or “ spotting of
vision”, swelling
Fetal movement chart / Kick Chart
non-invasive assessment of fetal well
being carried out by the mother.
Mother notes on the chart the time when
she has felt 10 kicks each day (she starts
counting at the same time each day eg
0700 hours).
-a pattern will emerge over a few days.
If the pattern changes to very few or no
kicks late in the day contact her LMC
-a miscarriage is a pregnancy that ends
spontaneously before 20 weeks
gestation. (about 1 in 4 pregnancies ends
in a miscarriage and 99% before 13
It occurs basically because something
went wrong during or soon after
Reasons for a miscarriage include:
-chromosomal abnormality, poor
implantation of the blastocyst, hormonal
changes, changes in the uterus or
Typically a woman will notice some
bleeding, some pain, other signs of
pregnancy such as breast tenderness
may disappear.
During the miscarriage the cervix
opens, and the conceptus comes away
from the uterine wall and passes out
through the cervix.
A woman needs to be observed for the
amount of blood lost, supported through
any pain, and emotional support is
necessary following the experience.
It is important to ensure that the uterus is
emptied fully to avoid further bleeding and
This may occur naturally or a dilatation and
curratage (D&C) may be performed. Often
an ultrasound is completed.
-abortion is the common medical term for all
pregnancies that end before 20 weeks. (compare
to miscarriage) take care when using these
An abortion (termination of pregnancy) is
purposeful evacuation of the uterus, most
commonly and safest carried out before 12
weeks gestation.
New Zealand laws include (2 consultants, potential
harm for mother or baby, women under 16 can
sign consent forms…..)
-ethical and moral issues for nurses, patients
the community
-follow up care is important.
It is important that pregnant women receive
ongoing antenatal care
Terminology/ definitions
-full term infant:
-premature infant:
born between 37-42 weeks
born before 37 weeks
-postmature infant: born after 42 weeks.
intrauterine growth retardation
any pregnancy, regardless of
-prima gravida:
a woman pregnant for the 1st
a pregnancy proceeding to
after 20 weeks gestation.
(prima para)
a woman who is having her 2nd
or any subsequent pregnancy
time passed since the first day
of the last normal menstrual
period,(LNMP) measured in