Maternal and Child Health Nursing
Psychological Changes of Pregnancy
u Pregnancy is a huge changes in a woman’s life that it brings about more psychological changes
than any other life events besides puberty. (Rojas, Wood and Blakemore,2007)
Common psychosocial changes that occur during pregnancy
First Trimester: Accepting the pregnancy
> Women and partner spend time recovering from shock and learning they are pregnant and
concentrate on what it feels to be pregnant.
> “Ambivalence” is a common reaction.
Second Trimester: Accepting the baby
> Woman and partner move through emotions such as narcissism and introversion as they
concentrate on what it will feel like to be a parent
> “Roleplaying and Dreaming” are common.
Third Trimester Task
> Woman and partner prepare clothing and sleeping arrangements for the baby but also grow
impatient with pregnancy as they ready themselves for birth
> “nest-building”
> Couvade Syndrome
Many men experience physical symptoms such as nausea, vomiting, and backache to the same
degree or even more intensely than their partners during a pregnancy. These symptoms apparently
result from stress, anxiety and empathy for the pregnant woman.
> Emotional Lability
Due to increased estrogen and progesterone, moods swings may be so common that they make a
woman’s reaction to her family and health care routines unpredictable.
Physiological changes of pregnancy
> Reproductive System Changes
Affecting their entire body
Uterine changes- most obvious alteration in a woman’s during pregnancy is increase in the size of the
uterus to accommodate the growing fetus.
> Uterus Changes
Length increases from approximately 6.5-32cm
Depth increases from 2.5 to 22cm
Width expands from 4-24cm
Weight increases 50 to 1000g
Nursing Care Plan
> Nursing Diagnosis : Risk for deficient fluid volume related to vomiting secondary to hyperemesis
gravidarum
> Imbalanced nutrition less than body requirements, related to prolonged vomiting
THEORIES OF LABOR ONSET
> Uterine muscle stretching, which results in releases of prostaglandins
> Pressure on the cervix, which stimulates the release of oxytocin from the posterior pituitary gland
> Oxytocin stimulation, which works together with prostaglandins to initiate contractions
> Change in the ration of estrogen to progesterone (increasing estrogen in relation to progesterone,
which is interpreted as progesterone withdrawal)
> Placental age,which trigger contractions at a set point
> Rising fetal cortisol levels, which reduces progesterone formation and increases prostaglandin
formation.
> Fetal membrane production of prostaglandin, which stimulates contractions
PRELIMINARY SIGNS OF LABOR
> Lightening, or descent of the fetal presenting part into the pelvis. It occurs 10-14 days before the
labor begins
> Fetal descent- it changes the woman’s abdominal contour because it positions the uterus lower
and more anterior in the abdomen
> Shooting leg pain- due to increase pressure in the sciatic nerve
> Increased amounts of vaginal discharge and urinary frequency
> Increase level of activity- due to increase of epinephrine release and by a decrease in progesterone
produced by the placenta
> Slight loss of weight- body fluid is more easily excreted from the body. This increase in urine
production can lead to weight loss between 1-3pounds
> Braxton Hicks Contraction – false contractions
> Ripening of the cervix- is an internal sign similar seen only on pelvic examination.
SIGNS OF TRUE LABOR
> Uterine contractions
> Show- as the cervix softens and ripens, the mucus plug that filled the cervical canal during
pregnancy (operculum) is expelled.
> Bloody show- blood mixed with mucus, takes on a pink tinge
> Rupture of Membranes
> Labor may begin with rupture of membranes, experienced either as sudden gushed or as scanty ,
slow seeping of clear liquid from vagina.
> Amniotic fluid continues to be produced until delivery. So, no labor is ever dy.
> Early rupture of memebranes can be advantageous as it can cause the fetal head to settle snugly
into the pelvis, actually shortening labor.
Two risks associated with ROM:
> Intrauterine infection
> Prolapse of the umbilical cord
Question 1. Krisha did not recognized for over an hour that she was in labor. A sign of true labor is?
1.
2.
3.
4.
Sudden increased of energy from epinephrine release
“Nagging” but constant pain in the lower back
Urinary urgency from increased bladder pressure
“Show” or release of the cervical mucus plug
COMPONENTS OF LABOR
> Passage- is of adequate size and contour
> Passenger- (the fetus) is of appropriate and in advantageous position and presentation
> Powers of labor- uterine factors are adequate.
> Psychological outlook- is preserved, so that afterward labor can be viewed as positive experience.
MECHANISMS (CARDINAL MOVEMENTS) OF LABOR
> Engagement
> Descent
> Flexion
> Internal Rotation
> Extension
> External Rotation
> Expulsion
Cervical Changes
> Effacement- is shortening and thinning of the cervical canal.
STAGES OF LABOR
DILATATION (1st stage of labor)
> Dilatation- refers to the enlargement or widening of the cervical canal from an opening a few
millimetres wide to one large (approximately 10cm) to permit passage of foetus.
SECOND STAGE OF LABOR
> Expulsion Stage- is the period of from full dilation and cervical effacement to birth of the infant.
THIRD STAGE OF LABOR
> Placental Stage- begins with the birth of the infant and ends with the delivery of the placenta.
> Two separate phases are involved
> Placental separation
> Placental expulsion
> Placental Separation
> Lengthening of the umbilical cord
> Sudden gush of vaginal blood
> Change on the shape of the uterus
> Firm contraction of the uterus
Appearance of the placenta at the vaginal opening
Two types of separation
>Schultze presentation
>Duncan presentation
> Placental Expulsion
> The placenta is delivered either by the natural bearing-down effort of the mother or by gentle
pressure on the contracted fundus by a physician or nurse midwife (Crede’s Manuever)
FOURTH STAGE OF LABOR
> Several hours after the birth
MATERNAL AND FETAL RESPONSES TO LABOR
Cardiovascular System
> Labor involves strenuous work and effort and requires a response from cardiovascular system.
> Cardiac Output
> Average blood loss (300-500ml) NSD, (800-1000ml) CS
> Blood Pressure- systolic bp increases by 15mmHg
> Hematopoeitic System- development of leukocytosis, WBC above 5,000-10,000 cells/mm3
> Temperature Regulation-increase muscular activity with labor associated to slight elevation of
(1degree farenheit)
Fluid Balance- due increase RR, w/c causes moisture to be lost with each breath, diaphoresis and
insensible water loss increases during labor.
> Urinary System- increase level, 1.020- 1.030
> Musculoskeletal System
> Gastrointestinal System- fairly inactive
> Neurological System
Question 2. Suppose Krisha is having long hard and uterine contractions. What length of contraction
would you report as abnormal?
1.
2.
3.
4.
Any length over 30 seconds
A contraction over 70 seconds in length
A contraction that peaks at 20 seconds
A contraction shorter than 60 seconds
Ectopic Pregnancy
> Is one in which implantation occurs outside the uterine cavity
> Due to chronic salphingitis or pelvic inflammatory disease.
> Intrauterine devices
Medications:
> Methotrexate- a folic acid antagonist chemotherapeutic agent attacks and destroys fast-growing
cells.
> Mifepristone- an abortificacent, is also effective at causing sloughing of the tubal implantation site.
GESTATIONAL TROPHOBLASTIC DISEASE/ HYDATIDIFORM MOLE
> Is abnormal proliferation and the degeneration of the trophoblastic villi
> A partial mole has 69 chromosomes (a triploid formation in which there are three chromosomes
instead of two every pair, one set supplied by ovum fertilized by one sperm in which meiosis or
reduction division did not occur)
Question 3. Suppose Krista was discovered to have an ectopic pregnancy. What advice would you
give to her?
1.
Most ectopic pregnancies go to completion, although the newborn is small.
2. If she must have a fallopian tube removed, she will be sterile afterward
3. She will have a continuous nagging pain through the rest of pregnancy
4. Ectopic pregnancy can be either medically or surgically treated
PREMATURE CERVICAL DILATATION
> Previously termed an incompetent cervix
> Refers to a cervix that dilates prematurely and therefore cannot hold a fetus until term.
Treatment:
> Cervical Cerclage
> Mcdonald procedure
> Shirodkar technique
PLACENTA PREVIA
> Is a condition of pregnancy in which the placenta is implanted abnormally in the uterus.
> Painless bleeding
It occurs in four degrees:
> low-lying placenta
> Marginal implantation
> Partial placenta previa
> Total placenta previa
betamethasone (Celestone)
Action: Betamethasone is a corticosteroid that acts as a anti-inflammatory and
immunosuppressive agent. It is given to pregnant women 12-24 hours before birth to hasten fetal
lung maturity if a fetus is less than 34 week gestation and help prevent respiratory distress syndrome
in the newborn
Dosage: 12-12.5mg Intramuscular
PRETERM LABOR
u Is a labor that occurs before the end of week 37 of gestation
4. Krista is in preterm labor. When you see her in the ER, what should be your first action?
1.
2.
3.
4.
Keep her walking so her fetal head puts harder pressure on the cervix
Ask her to lie down in a side-lying position and assess her contractions
Obtain blood for human chorionic gonadotropin hormone assessment
Caution her not to allow anyone to start IV fluid; dehydration starts contraction
Pregnancy Induced-Hypertension or PIH
> Is a condition in which vasospasm occurs during pregnancy in both small and large arteries.
> Also known as Toxemia, Eclampsia.
ISOIMMUNIZATION (RH INCOMPATIBILITY)
> Also known as haemolytic disease if the newborn or eythroblastosis fetalis.
> People who have Rh-positive blood protein (the D antigen) that Rh-negative people have not ,
when Rh-positive fetus begins to grow inside an Rh-negative mother who is sentisized, it is though
her body is being invaded by foreign agent.
PSEUDOCYESIS
> False pregnancy, nausea and vomiting, amenorrhea, and enlargement of the abdomen occur in
either a non-pregnant woman or a man.
FETAL DEATH
> One of the most severe complications of pregnancy is fetal death. The most likely include
chromosomal abnormalities, congenital malformations, infections such as Hepa B, immunologic
causes and complication of maternal disease.
ABRUPTIO PLACENTA – dark red, painful bleeding that occurs during pregnancy
**nothing follows**
Prepared by:
Kristine Glory DR. Mendillo, BSN, RN.
St. Augustine Foundation Colleges
Academic Instructor
References
Maternal and Child Health, 6th Edition
Adele Pilliteri