Preconception Care
Promotion of health before pregnancy
Identify areas that might unfavorably
affect pregnancy.
Risk Factors
for adverse pregnancy outcomes
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Smoking
Alcohol
Folic Acid
Obesity
Drugs
Medical conditions
Nursing Management
• Assessment History
• Health promotion activities and education
Prenatal Care
Essential for ensuring the overall health of newborns
and their mothers.
Ideally, begins during the mother’s childhood.
Includes balanced nutrition, adequate
immunizations, positive attitudes and education.
• Choosing a health care provider
– clinic
– HMO
– nurse midwife
– obstetrician
– family practitioner
Preconceptual Visit
• Before becoming pregnant to obtain
accurate reproductive life planning.
First Prenatal Visit
• Establish a baseline
• Treat any health problems
First Prenatal Visit
Interview
• provide privacy
• when scheduling the appointment caution
the woman that it may be a long session
• establish your role
• provide face to face interview
Components of Health History:
• Establish rapport
• Gain data on physical and psychosocial
health
First Prenatal Visit
• Obtain basis for anticipatory guidance for
the pregnancy
• Demographic data
• Chief concerns
• Family profile
• History of past illnesses
• History of family illnesses
• Day history/social profile
• Gynecologic history
• Review of systems
Obstetric History
Terms
• Viability:
– 24 weeks: earliest age fetal survival
• Abortion:
– Pregnancy terminated before viability (spontaneous or
elective)
• Term:
– Infants born > 37 weeks
• Preterm
– Infants born 24-36 weeks
• Living
First Prenatal Visit
Support Person’s Role:
• Partners, children, best friends come to
prenatal visits.
• Also allow time for privacy at each visit.
Physical Examination:
• woman should undress, put on a patient
gown, and empty her bladder.
• Obtain urine specimen (clean catch)
– bacteriuria, protein, glucose, ketones
• VS, height, weight baseline
Physical Examination
Assessment of systems:
• general appearance and mental status
• head and scalp
• eyes
• nose
• ears
• sinuses
• mouth, teeth and throat
• neck
• lymph nodes
• breasts
• heart
• lungs
• back
• rectum
• extremities and skin
Measurement of Fundal Height/FH
Palpate the fundus at 12 weeks
• measure the fundal height
• plot on graph
• auscultate fetal heart with doppler at 10 to
12 weeks
• palpate fetal outline at 28th week
Pelvic Examination:
• Reveals health information on internal and
external reproductive organs.
• Equipment - speculum, brush/broom for
cervical scrapings, slide/medium for PAP,
culture tube, gloves, lubricant, 2-3 cotton
tipped applicators, light and stool.
• Support is needed during this exam
Pelvic Examination
External Genitalia
• Check for signs of infection, inflammation,
irritation, redness, ulceration, discharge or
herpes.
• Check Skene and Bartholin glands for
infection.
• Check for rectocele or cystocele.
Pelvic Examination
Internal Genitalia
• Cervix - purple if pregnant, check for
lesions, ulcerations, or discharge.
• Nulligravida - a woman who is not or
never has been pregnant. Cervical os is
round and small.
• In a woman with previous pregnancy the os
will be more slitlike.
Pap Smear
• Sample from cervical os or vaginal pool.
Pelvic Examination
Vaginal Inspection
• Culture for gonorrhea, chlamydia or group B strep
• Dark blue to purple color.
Examination of Pelvic Organs
• Bimanual exam to assess position, contour,
consistency and tenderness of pelvic organs.
• Palpate uterus, ovaries and check Hegar’s sign.
Rectovaginal Examination
• Assess strength and irregularity of posterior
vaginal wall.
Pelvic Examination
• Types of pelvis
– Android - male pelvis, the pubic arch forms an
acute angle, making the lower dimensions of
the pelvis extremely narrow.
– Anthropoid - ape like pelvis, the transverse
diameter is narrow and the anteroposterior
diameter of the inlet is larger than normal.
– Gynecoid - normal female pelvis, inlet is well
rounded forward and backward, the pubic arch
is wide. Ideal for childbirth.
– Platypelloid - flattened pelvis, inlet is an oval,
smoothly curved, but the anteroposterior
diameter is shallow. A fetal head might not be
able to rotate to match the curves of the cavity.
Pelvic Examination
Diagonal conjugate - distance between
anterior surface of sacral prominence and
anterior surface of inferior margin of
symphysis pubis.
• Most useful measurement for estimation of
pelvic size.
• Anteroposterior diameter of the pelvic inlet.
• Sacral prominence to symphysis pubis.
• Pelvimeter
• If measurement is more than 12.5 cm it is
adequate (average is 11cm in diameter).
Pelvic Examination
Ischial tuberosity - measures is the distance
between the ischial tuberosities, or the
transverse diameter of the outlet.
• The narrowest diameter at that level.
• Medial and lowermost aspect of the ischial
tuberosities at the level of the anus.
• Pelvimeter or ruler is used.
• 11 cm is adequate because it will allow the
widest part of the fetal head, or 9 cm, pass
freely through the outlet.
Laboratory Assessment
Blood studies
• CBC, H&H and red cell index (anemia),
platelet count, sickle cell trait.
• VDRL or RPR
• Blood typing (include Rh factor)
• AFP at 16 to 18 weeks
• Indirect Coombs’ test (Rh antibodies) repeat
at 28 weeks.
• Antibody titers for rubella and hepatitis
Blood Studies
• Antibodies for varicella
• Obtain consent for HIV screening (ELISA)
Western blot (Can start AZT).
• 50-g oral 1-hour glucose loading or
tolerance test to R/O diabetes if she has a
previous history or symptoms of diabetes.
Urinalysis
• test for albuminuria, glycosuria and pyuria.
Laboratory Assessment
Tuberculosis Screening
• PPD (purified protein derivative) tuberculin
test to screen for tuberculosis.
• Positive requires a chest X-ray
Ultrasonography
• Confirms pregnancy length or document
healthy fetal growth.
Risk Assessment
Previous surgery, health history, meds, etc
Signs Indicating Complications
of Pregnancy
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Vaginal Bleeding
Persistent Vomiting
Chills and Fever
Sudden escape of clear fluid from vagina
Abdominal or chest pain
PIH signs
Increase or decrease fetal movement