The course of a pregnancy depends on # of fx, inc. the woman’s prepregnancy health, presence of disease states, emotional status, and past health care.  A thorough Hx is essential.

Nutrition – 300 calories over requirement for age, wt etc.  This can for most part come from Protein. Be able to discuss with client what kinds of foods will help meet requirements for vitamins, minerals, calcium etc.  Pg 220 Table 11-1 Exercise – aerobic and muscle conditioning improves circulation and general health.

Chapter 11, pg.  219: wt. gain: 11lbs – fetus, placenta, amniotic fluid; 2 lbs – uterus; inc blood volume – 4 lbs; breasts – 3 lbs;   maternal stores 5 – 10 lbs

Early Classes – general info about pregnancy, normal changes, sexuality, rest, exercise 

Reproductive: 60 gm uterus ↑ 1100 gms; Braxton Hicks contractions; mucus plug; vaginal pH 3.5 – 6.0, ↓ baterial infections, ↑ yeast infections; breasts enlarge; striae, colostrum last trimester Respiratory: volume of air; diaphragm  ↑ (H&PA); nasal stuffiness & nosebleeds r/t estrogen-induced edema &    ↑ vascular congestion Cardiovascular: Blood volume ↑ 40 – 45% d/t RBCs and plasma; pulse ↑ 10 – 15 bpm; stasis of blood in lower extremeties and varicosity, postural hypotension; enlarging uterus puts pressure on vena cava, R atrium, & aorta. Called supine hypotensive syndrome or venl caval syndrome; physiologic anemia of pregnancy r/t > ↑ in plasma volume than in erythrocyte GI/urinary: N&V, delayed peristalsis increased progesterone leads to smooth muscle relaxatoin; delayed emptying of gallbladder; frequency in 1st trimester when uterus is a pelvic organ.  Rises into abdomen in 2nd trimester. Gylcosuria may be normal or assoc. with diabetes.  Always check Metabolism: Weight gain: 25 – 35 lbs; 3.5 – 5 lbs 1st trimester; 12 – 15 during EACH of the last 2 trimesters Endocrine: Metobolic rate ↑ 25%; hormones during pregnancy: hCG; estrogen for uterine development; progestin for maintaining pregnancy; relaxin for remodeling collagen (waddle)

McDonald’s sign: ease in flexion of the uterus against the cervix; general softening & enlargement : 8th wk Enlargement of abdomen: evidence of pregnancy, esp if continuous, with amenorrhea; Braxton Hicks: palpated after 28th week.  Ballottement – passive fetal movement when examiner pushes against cervix. Pregnancy tests: detect presence of hCG in maternal blood or urine; still not positive sign.  Tests: Pregnosticon R and Gravindex: 1st am urine (concentrated) 10 – 14 days after 1st missed period

Visualization – by ultra sound; gestational sac visible by 4 -5 wks gestation (book is confusing); transvaginal US – 10days after implantation

  r/t trimester  Page 151 table 7-3  1st trimester – inform, feels ambivalent, anxiety r/t labor and responsibility, looks for physical changes as proof of pregnancy, special feelings or renewed interest in mother – help form ID of role  introspective and passive  2nd trimester regressive and introspective, projects others lock of interest on to partner, feels movement and incorporates baby into herself, feeling better, increased desire for sexual activity,  3rd trimester  - anxiety and tension, discomfort and insomnia as size etc makes her more uncomfortable, prepares for birth, dreams about baby, spurt of energy 1st trimester – affected by age, economics etc., link with posterity, aware of own sexual feelings, may be more or less. Deals with spouse interest in her mother.  Increase outside activity – frequently s additional source of income.  2nd trimester gives extra attention to mom,deals with mood ch involvement with pregnancy, may have fears and fantasies about himself being pregnant, may be uneasy with this feminine aspect in himself, may have difficulty accepting he is not most important person at this time 3rd trimester  Adapts to sexual adaptations, financial responsibility, more tender, dreams of child, usually older not newborn. Feels ultimate responsibility in well-being of mom and baby. Couvade – unintentional development of physical symptoms resembling pregnancy Siblings – rivalry, a threat to security of their relationship.  Involve the child in helping to get ready. Provide consistency – people, things etc. Expect regression, soiling it potty trained, wanting to drink from bottle or breast Grandparents:  supportive of the couple, Young grandparents may not show as much interest as anticipated, recognize changes Culture:  each has own ceremonial ritual or rites r/t values.   Understand male and female roles in culture to understand individual behaviors.  Health values and beliefs

Go to page 11 in syllabus.  If you have questions, make sure you bring them up in class or come to me or talk about them in clinical and pre and post conference.

Mc Donald – Fundal height in centimeters correlates with weeks of gestation between 22 to 24 weeks and 34 weeks.  Eg 26 weeks = 26 cm above symphasis    Sudden gush of fluid Dizziness, blurring of vision    Vaginal bldg severe headache    Abdominal pain edema of hands, face, legs and feet

Labs: Hemoglobin, Rh factor, CBC, gonorrhea culture, HIV screen, pap smear, sickle cell screen,, rubella titer, syphilis STS (syhilis tests for syphilis) VDRL (venereal disease research lab) Ongoing labs – hemogolbin, triple screen –16-18 wks – maternal serum alpha-fetoprotein, estriol, and hCG – Elevated AFP r/t neural tube defect, underestimated GA, multiple gestation, Rh disease.  Low AFP r/t trisomy 21, 18.  Elevated hCG combined with low estriol and AFP r/t Down syndrome Group Beta Strep vaginal and rectal culture at 35-37 wk  Antibiotic in Labor.  Must be at least 4 hrs prior to delivery See hand out in back of syllabus: T- Toxoplasmosis, O – other GBS, UTI, candidiasis, chlamydia, syphilis, gonorrhea, R – rubella, anomalies in fetus, C – Cytomegalovirus, microcephaly, hydrocephaly,  retardation, poor growth, or may have no effect, H – herpes simplex virus  problem with fetus if delivered past active lesion.  Develops herpes, 60% die, other have neuro compromise.

WT – r/t body build.  Above 200 or below 100 lb considered abnormal,  sudden gain preeclampsia.  3-5 lb 1st trimester, 12-15 2nd and 3rd trimester. Edema – Small am’t dependent edema esp. toward end of preg.  Note is in hands, face as well as legs, feet

Rubin (1984) identified 4 developmental tasks: safe passage through pregnancy, labor * birth; acceptance of child by others; commitment and acceptance of herself as mother to this infant; and learning to give of herself on child’s behalf Father: must deal with reality of pregnancy, gain recognition as parent; resolve any issues HE may have re: fathering that he received Siblings & grandparents: young child: regression; older child: misconceptions about birth; grandparents: loss of control of couple’s lives; grandparenting classes Cultural: ethnocentrism: believing that one’s own cultural beliefs, values, & practices are best.  Discuss

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