Nursing Care During the
Antenatal Period
Maria Rubolino, MSN, FNPc
September 6th, 2005
A & P of Pregnancy
Terms to know
 Gravida
 Parity
 Nulliparous
 Multiparous
 Term
 TPAL
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Signs of Pregnancy
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Presumptive Signs/Symptoms
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Probable
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Positive
Uterine Growth
Stimulated by hormones in the 1st
trimester
 Larger as it rises out of the pelvis
 Hegar’s
 Chadwick’s
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Contractility
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Braxton Hicks
Cervical Changes
Goodell’s Sign
 Friability
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Fundal Height Changes
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Changes from week to week
Vaginal Changes
Vaginal mucosa thickens
 Chadwick’s sign
 Vaginal discharge
 Mucous plug
 Varicosities
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Breast Changes
Fullness
 Areolar pigmentation
 Colostrum
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Circulatory Changes
CV- blood volume, cardiac hypertrophy
 Cardiac output increases
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Blood pressure changes
Circulatory changes

Supine hypotension syndrome
Renal Changes
Renal pelvis and ureters dilate
 Urine rate is slowed
 Bladder frequency
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GI Changes
Appetite
 Gastric emptying
 Absorption
 Bowel sounds
 Blood flow to the pelvis
 Morning sickness
 Pyrosis
 Constipation
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Gallbladder and Liver
Gallbladder with decreased tone
 PUPPS
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Skin Changes
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Increased subdermal fat
Hyperpigmentation
Striae
Linea nigra
Chloasma
Angiomas
Pruritis
Palmar erythema
Increased perspiration
Endocrine Changes
Amenorrhea
 Progesterone
 Estrogen
 Ant pituitary suppresses the FSH and LH
causing
to rise
 Post pituitary produces oxytocin

Neurological Changes
Carpal Tunnel Syndrome
 Numbness/Tingling
 HA’s
 Lightheadedness
 Muscle Cramps

Musculoskeletal Changes
Change in posture
 Waddling
 Back Pain

Nutrition Needs
Folic Acid
 Calories increased to 300/day
 Increased protein
 Iron requirements increased
 Increased fluid intake
 Limit caffeine

Exercise
Will produce benefits
 Must consume fluid
 Watching heart rate
 No new activities

Weight Gain in Pregnancy
25-35 pounds total weight gain
With singleton pregnancy
35-45 pound total weight gain with
multiples

Nagele’s Rule
LMP minus 3 calendar days
 Add 7 days and 1 year
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Tests in
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st
1
Trimester
1 hour post glucola if indicated
Blood type
Antibody screen
CBC
UA C/S
Hepatitis
HIV
RPR
TSH
Toxoplasmosis if indicated
CVS if desired
Hyperemesis
N/V
 Small frequent meals
 Avoid spicy foods
 Antiemetics

st
1
Trimester
Hyperemesis
 No menses
 N/V
 Fatigue
 Breast Tenderness

20 Weeks
Quickening
 Pelvic Pressure
 Constipation
 Round ligament pain
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CVS
Screening to detect fetal genetic
abnormalities
 Risks of miscarriage 1 in 100
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Nuchal Fold Thickness
Ultrasound and 9-13 weeks
 Increased with down syndrome
 Screening only!!
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AFP
Triple marker test/screening
 16-20 weeks gestation
 If abnormal refer to specialist

Amniocentesis
Performed between 16-20 weeks
 Done with AMA, FH, +AFP
 Risks of miscarriage 1 in 200-300
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Testing in
rd
3
1 hour post glucola
 CBC
 UA
 Antibody screen
 Rhogam
 TSH
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Trimester
32-36 Weeks
Fetal position
 Descending into pelvis
 Placental location
 GBS
 FKC’s
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36-42 Weeks
Vaginal Exams
 Labor precautions
 PIH precautions
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Childbirth Education
Natural
 Lamaze
 Bradley
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Birth Plan
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Hospital
Birthing Center
Home
Bath
Pain Meds
Epidural
Natural
Lighting
Ambulating
 Doulas
 Hypnosis
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