Embryonic and fetal structures
1.Decidua- The endometrium is now
termed the decidua
(Latin word for “falling off”),
because it will be discarded
after the birth of the child.
The embryo continues to
grow, it pushes the decidua
capsulate before it like a
blanket.
Embryo enlarges so much that
this action brings the decidua
capsularis into contact with
the opposite uterine wall
(the decidua vera)
2.Chronic Villi - Once implantation is
complete, the
trophoblast layer of the
cells of the blastocyst
begins to mature
rapidly
Cytotrophoblast or
Langhan’s layer, is
present as early as 12 days
gestation.
It appears of function early
in pregnancy to protect the
growing embryo and fetus
form certain infectious
organisms such as the
spirochete of syphilis.
Placenta
• Developed by the first month of pregnancy
• Provides fetal oxygenation, nutrition and
elimination
• Produce progesterone; estrogen; HCG; and
human placental lactogen (hPL); human
chorionic somatomammotropin (HCS) –
both similar to growth hormone; affects
maternal insulin production; prepares
breast for lactation.
• Transport mechanism between the
embryo and the mother.
• Braxton Hicks contractions, the barely
noticeable uterine contractions that are
present form about the 12th week of
pregnancy, aid in maintaining pressure
• placental circulation, is most efficient
when the woman lies on her left side, in
which this position lifts the uterus away
from the inferior vena cava, preventing
blood for being trapped in the woman’s
lower extremities.
Umbilical cord
• Develops at same time as placenta
• Connects fetal circulation to placenta
• Consists of 2 arteries and 1 vein supported
by mucoid material (Wharton’s jelly) to
prevent kinking and knotting
• 55 cm long and 2 cm in diameter.
Amniotic fluid
• Surrounds the fetus and fetal side of
placenta made up of 2 membranes, chorion
and amnion which is also called
bag of water (BOW)
• Protects the embryo against injury; allows
fetal movement; provides a constant
temperature.
• swallowed by fetus; promotes normal
prenatal development
• primarily water but contains small amount
of protein, glucose, fetal hair, fetal urine
and vernix caseosa.
• Oligohydramnios- less than 400 ml of
amniotic fluid is associated with poor fetal
lung development and malformations that
result from compression of fetal parts. This
may occur because the kidneys fail to
develop, urine excretion is blocked, or
placental blood flow is inadequate.
• Polyhydramnios or Hydramnios- more
than 200 ml or amniotic fluid index greater
than 97.5 percentile for the corresponding
gestational age); may occur when the fetus
has severe malformation of the CNS or
gastrointestinal tract that prevents normal
ingestion of amniotic fluid.
Origin and development of organ
systems
1.Stem Cells - zygote cells are termed
totipotent stem cells, or cells
that are so undifferentiated
they have the potential to
form a complete human being
2. Zygote Growth - From the beginning of
fetal growth,
development proceeds
in a Cephalocaudal
(head-to-tail) direction;
that is head
development occurs first
and is followed by
development of the
middle and finally the
lower body parts.
As a fetus grows, body
organ systems develop
form specific tissue
layers called germ
layers.
Embryonic period
•Occurs 3rd to 8th week AOG
•Most critical time of development
• Germ layers:
- Ectoderm
- Mesoderm
- Entoderm
• Fetal membranes develop and surround the
embryo/fetus
• Amnion: inner membrane
• Chorion: outer membrane
• organogenesis (organ formation), the
growing structure is most
vulnerable to invasion by
teratogens
(any factor that affects the fertilized ovum,
embryo, or fetus adversely, such as alcohol)
Naegele's Rule
• To calculate the date of birth by this rule,
count backward 3 calendar months from the
first day of the last menstrual period and
add 7 days
Assessment of fetal growth and
development;
1. Health history - Asks specifically about
nutritional intake,
because, if a woman is
not eating a well
balanced diet, she may
not be taking in
sufficient nutrients for
fetal growth.
2. Estimating fetal growth
- McDonald’s rule, a symphysis-fundal
height measurement, although not
recommended to be thoroughly reliable,
is an easy method of determining during
midpregnancy
- Fundal height is measured to
evaluate the fetus’ gestational age
3. Assessing fetal well-being
- Fetal movement can be felt by the mother
begins at approximately 18-20 weeks and
peaks at 28-38 weeks. Fetus moves at
least 10 times a day
- Fetal heart rate = 120- 160 bpm
- Sandovsky : the mother is asked to lie in
a left recumbent position
after a meal and record how
many fetal movements she
feels over the next 10
minutes or an average of
10-12 times an hour.
 - Cardiff method: count to ten, the
mother records the time interval it takes
for her to feel 10 fetal movements.
Fetal Heart Rate
• Fetal hearts beat at 120 to 160 beats per
minute throughout pregnancy.
• Fetal heart sounds can be heard and
counted as early as the 10th to 11th week of
pregnancy by the use of an ultrasonic
Doppler technique highlights appropriate in
relation to assessing fetal heart rates.
Ultrasonography
• measures the response of sound waves
against solid objects, is a much-used tool in
modern obstetrics
• to diagnose pregnancy as early as 6 weeks'
gestation. To confirm the presence, size,
and location of the placenta and amniotic
fluid
• To establish that a fetus is growing and has
no gross anomalies, such as hydrocephalus,
anencephaly, or spinal cord, heart, kidney,
and bladder defects
• To establish sex if a penis is revealed
• To establish the presentation and position of
the fetus
• To predict maturity by measurement of the
biparietal diameter of the head
Amniocentesis
• from the Greek amnion for sac and kentesis
for puncture) is the aspiration of amniotic
fluid from the pregnant uterus for
examination
• technique can be used again near term to
test for fetal maturity
PSYCHOLOGICAL AND PHYSIOLOGIC
CHANGES OF PREGNANCY
• Melasma: excessive body pigment on the
face that occur during pregnancy
• Multipara: a woman who has given birth to
more than one child past the age of viability
• Primigravida: a woman during her first
pregnancy
• Quickening: the first movement of the
fetus perceived by the mother
• Striae gravidarum: reddish steaks
appearing on the abdominal wall during
pregnancy
• Ballottement = the sensation of an object
rebounding after being pushed by an
examining hands; used for pregnancy
diagnosis
• Braxton Hicks contractions = painless,
erratic uterine contractions that occur
toward the end of pregnancy. They ready
the cervix for labor.
• Chadwick’s sign = discoloration of vaginal
walls from pink to violet.
• Goodell’s sign = softening of the cervix;
probable sign of pregnancy
• Hegar’s sign = softening of the lower
uterine segment; a probable sign of
pregnancy
• Lightening = descent of the fetus into the
pelvis at about 2 weeks prior to birth; also
called engagement
• Linia nigra = a narrow brown line running
from the umbilicus to the symphysis pubis,
separating the abdomen into right and left
hemisphere.
Emotional Responses to Pregnancy
Ambivalence
• it refers to the interwoven feelings of
wanting and not wanting that can
exist at high levels. It is important to
emphasize that this ambivalence is
normal
 hormonal changes, particularly the sustained

increase in estrogen and progesterone.

Grief
• could be associated with such a positive
process as childbirth seems at first out • Mood swings may be so common that they
of place. make a woman's reaction to her family and to
• She must incorporate her new role as a health care routines unpredictable.
mother into her other roles as a
daughter, wife, or friend. Changes in Sexual Desire
• Her partner must incorporate a new role • First trimester: most women report a
as a father into his other roles of son, decrease in libido because
husband, or friend.
of the nausea, fatigue, and
Narcissism
• Self-centeredness (narcissism) is generally breast tenderness that
an early reaction to pregnancy accompany early
• A woman who previously was barely pregnancy.
conscious of her body, who dressed in the
• Second trimester: as blood flow to the
morning with little thought about what to
pelvic area increases to
wear, who was unconcerned about her
posture or her weight, suddenly begins to
supply the placenta,
concentrate on these aspects of her life.
libido and sexual
enjoyment rise
Body Image and Boundary
markedly.
• change during pregnancy as the woman
begins to envision herself as a mother in • Third trimester: sexual desire may
addition to being a daughter or wife and remain high, or it may
begins to see herself becoming “bigger” in decrease because of
many different ways. difficulty finding a
comfortable position
and increasing
Couvade Syndrome abdominal size.
• Many men experience physical symptoms such as
nausea, vomiting, and backache to the same The Diagnosis of Pregnancy
degree or even more intensely than their partners • Pregnancy- is officially diagnosed on the
do during a pregnancy. These symptoms basis of the symptoms
apparently result from stress, anxiety, and reported by the woman and
empathy for the pregnant woman. the signs elicited by a health
• woman's abdomen begins to grow, the father care provider.
may perceive himself as growing larger, too, he These signs and symptoms are
were the one who was pregnant or has changing
traditionally divided into three
boundaries the same as his part.
classifications: presumptive,
probable, and positive
Emotional Lability
• Mood changes occur frequently in a PRESUMPTIVE SIGNS AND
pregnant woman, partly as a manifestation
SYMPTOMS (SUBJECTIVE)
of narcissism and partly because of
▪ Amenorrhea- cessation of menstruation
▪ Quickening- maternal perception of fetal
movement occurring bet. 16-
20 weeks of gestation.
▪ Chadwick sign- blue-purple discoloration of
the vagina. (8 –12 weeks)
PROBABLE SIGNS AND SYMPTOMS
(OBJECTIVE)
▪ GOODELL sign- softening of the cervix.
▪ HEGAR sign- softening of the lower
uterine segment.
▪ PISKACEK sign- enlargement and
softening of the uterus
Laboratory Tests
• commonly used laboratory tests for
pregnancy are based on detecting the
presence of human chorionic gonadotropin
(hCG), a hormone created by the chorionic
villi of the placenta, in the urine or blood
serum of the pregnant woman
Home Pregnancy Tests
• Several brand-name kits for pregnancy
testing based on immunologic reactions are
available over the counter
• These tests have a high degree of accuracy
(about 97%) if the instructions are followed
exactly
• the woman dips a reagent strip into her
stream of urine.
• A color change on the strip denotes
pregnancy.
(3) Positive Signs of Pregnancy
- Demonstration of a fetal heart separate
from the mother's
- Fetal movements felt by the examiner
- Visualization of the fetus by ultrasound
(3)POSITIVE SIGNS AND SYMPTOMS
- Fetal heartbeat
- Palpation of fetal outline
- Fetal movements
Physiologic signs of Pregnancy:
Reproductive changes
Uterine Changes
• the most obvious alteration in the woman's
body during pregnancy is the increase in the
size of the uterus to accommodate the
growing fetus. Over the 10 lunar months of
pregnancy, the uterus increases in length,
depth, width, weight, wall thickness, and
volume.
Amenorrhea
• Absence of menstruation occurs with
pregnancy because of the suppression of
follicle stimulating hormone (FSH) by rising
estrogen levels. In a healthy woman who
has menstruated previously, the absence of
menstruation strongly suggests that
impregnation has occurred.
Vaginal changes
• Chadwick’s sign, a probable sign of
pregnancy changes of vaginal color from the
normal light pink to deep violet.
• Candida infection in the newborn is termed
thrush or oral monilia
Body Mass/Metabolism
• Expected weight gain in pregnancy
1st trimester: 2–4 lbs;
2nd trimester: 12–14;
3rd trimester: 8–12
ASSESSING FETAL AND MATERNAL
HEALTH: PRENATAL CARE
(Health Promotion During
Pregnancy) G: Gravida

T: Term infants (38 to 42 weeks)

Preconceptual Visit
• women schedule appointments with a
P: Preterm (20 – 38 weeks)
physician or nurse-midwife before becoming A: Abortions (less than 20 weeks)
pregnant to obtain accurate reproductive life
planning information, receive reassurance L: Living children
about fertility (as much as can be given based
on a health history and a routine physical 4 CLASSIFICATIONS OF PREGNANCY
examination), and detect any problems that PARA - number of pregnancies that
may need correction through a health history, lasted more than 20 weeks,
pelvic examination, and Papanicolaou (Pap) regardless of outcome.
test

Prenatal Care
NULLIPARA - a woman who has not
• important because lack of it is associated
given birth to a baby
with the birth of preterm infants and various
beyond 20 weeks
gestation.
complications for the woman
• The first visit includes an extensive health PRIMIPARA - a woman who has
history, a complete physical examination, given birth to one baby
including a pelvic examination, and blood more than 20 weeks
and urine specimens for laboratory work. gestation.

ANTEPARTUM CARE MULTIPARA - a woman who has had

• Refers to the medical and nursing care two or more births at
given to the pregnant woman between more than 20 weeks
conception and the onset of labor. gestation.
• Consideration is given to the physical, Note: Twins or triplets
emotional, and social needs of the woman, counted as 1 para.
the unborn child, her partner, and other
family members TPAL - Para subdivided to reflect births that
went to Term, Premature births,
5 Terminologies: GTPAL Abortions, and Living children.

PRETERM - newborn born before 37 weeks

of gestation.

TERM - newborn born after 37 weeks to 40

weeks of gestation.

POST-TERM - newborn born after 40 weeks

of gestation.
 maneuver), measurement of fundal height,
determine fetal length, calculation of fetal
ESTIMATED DATE OF CONFINEMENT weight in grams and age of gestation (AOG),
(EDC) and expected date of confinement EDC by
Neagel’s rule.
NAEGELE’S RULE – count back 3 months
from the first day of 1. Baseline height/weight and vital
LMP and add seven signs measurements
and one year • Measure a woman’s weight and height at a
(-3+7+1). first prenatal visit to establish a baseline for
future comparison
ULTRASONOGRAPHY- estimates fetal age
from head 2. Assessment of systems
measurements • General appearance: the manner she dress,
the way she speak, and the body posture may
assume all suggest how they feel about
themselves. Inspect for signs such as careless
hygiene, unwashed hair, inappropriate or soiled
FUNDAL HEIGHT - measurement of fundal clothing and sad facial expression that may
suggest fatigue or depression about their
height from the top of diagnosis.
symphysis pubis to the
top of the fundus with a • Head and scalp: examine for symmetry.
Look for chloasma (extra pigment on the
flexible, non- face)
stretchable tape
• Eye: edema of eyelids combined with
measure; used as a
swollen optic disk suggest edema form
gross estimate of dates.
pregnancy induced hypertension

Antepartal visits • Nose: the nasal stuffiness that accompanies

• Initial visit for pregnancy test as early as
inn pregnancy as possible in 1st trimester
• Monthly visits for the first 7 months if
pregnancy without problems
• during 8th month, visits usually every 2
weeks, and then weekly during last month
until delivery
SCHEDULE OF VISITS
Every 4 weeks, up to 32 weeks
Every 2 weeks from 32-36 weeks
(more frequently if problems exist)
Every week from 36-40 weeks
Physical Examination
• including internal gynecologic exam,
bimanual exam, weight, vital signs,
auscultation of fetal heart rate(FHR),
palpation of fetal outline (Leopold’s
pregnancy may lead to blocked Eustachian
tubes and therefore a feeling of “fullness” in
the ears or dampening of sound during early
pregnancy.
• Sinuses: should feel nontender
• Mouth, teeth and throat: gingival hypertrophy
may result from estrogen stimulation during
pregnancy.
• Neck: light thyroid hypertrophy may occur with
pregnancy because the overall metabolic rate is
increased.
• Lymph nodes: no palpable lymph nodes
• Breasts: areola darken; overall breast
increases; blue streaking of veins becomes
prominent; colostrums may be expelled as early as
the 16th week of pregnancy
• Rectum: assess the rectum for haemorrhoidal
tissue which commonly occur form uterine
pressure on pelvic vein.
Extremities and skin: may develop palmar
erythema or itching early in pregnancy due to
increase in estrogen level
3. Measurement of fundal height and
fetal heart sound
• 12-14 weeks of pregnancy, the uterus becomes
palpable as a firm globular sphere over the
symphysis pubis
• Auscultate for fetal heart sounds (120-160 bpm)
these can be heard at 10-12 weeks if a Doppler
technique is used but not until 18-20 weeks if a
regular stethoscope is used.
Computing the gestational age
Example: LMP= July 15, 2005
July (16 days) (31-15)
Aug 31
Sept 30
Oct 31
Nov 15 (date today)
123 days divided by 7
Gestational Age= 17 weeks and 3/7 days
METHODS OF CALCULATING EDB
Naegele’s Rule- Is used to establish EDC
EDC – is based on the first day of the last
menstrual cycle
Conception occurs approximately 2 weeks
after beginning of menstruation.
The average duration of pregnancy from the
1st day of the last normal menstrual period is
40 weeks or 280 days.
Subtract 3 months and add 7 days to the LMP
and correct the year
Example:
LMP: June 12, 2008
6 / 12 / 2008
Naegele’s rule: -3 / + 7 / +1
3 / 19 / 2009
EDC: March 19, 2009
4. Pelvic examination and estimating
pelvic size
•It is to know whether the fetus an pass
through or whether the pelvic ring will be
adequate for a fetus to pass through its
center.
5. Blood studies
• CBC including hemoglobin or hematocrit : to
determine the presence of anemia; white
blood cell count to determine infection and a
platelet count to estimate clotting ability
• Blood typing (including Rh factor) blood
type is documented because blood may have
to be made available if a woman has bleeding
during pregnancy and to detect the possibility
of Rh isoimmunisation
• Coomb’s test (determination if Rh
antibodies are present in an Rh negative
woman)
6. Urinalysis
• Performed to test for proteinuria, glycosuria
and pyuria.
• All three of these can be done by means of
test strips or microscopic examination of the
urine.
7. Tuberculosis screening
• Physician or nurse-midwife may order a
purified protein derivative (PPD) tuberculin
test for a woman to screen for tuberculosis.
Any woman who has a positive reaction would
then require a chest radiograph for further
diagnosis.
• Screening for tuberculosis early inn
pregnancy is important because it is a chronic
and debilitating disease than increases the
risk of miscarriage. The change in the shape
of the lung tissue as the growing fetus
presses on the ling may reactivate old lesions.
8. Ultrasonography
• If the date of the last menstrual pressure is
unknown, a woman will be scheduled for an
ultrasound to confirm the pregnancy length
and document healthy fetal growth.
• Be certain that women know an ultrasound
done this early in pregnancy will show only
the presence of a gestational sac, not moving,
kicking fetus so their expectations of what
they will see are realistic.
Leopold’s Maneuver
First maneuver
• Are performed in pregnancy after the uterus
becomes large enough to allow differentiation
of fetal parts by palpations
• Answer the questions: what is in the
fundus? Head or breech?
• Finding: presentation; this maneuver
identifies the part of the fetus that lies over
the inlet into the pelvis. The commonest
presentations are cephalic (head first) and
breech (pelvis first)
Second maneuver
• Answers the question: where is the
back?
• Finding: position; this maneuver identifies
the relationship of the fetal body part to the
front, back or sides of the maternal pelvis.
There are many possible fetal positions.
Third maneuver
• Answers the questions: where is
the presenting part?
• Finding: presenting part; this maneuver
identifies the most dependent part of the
fetus- that is, the part that lies nearest
the cervix. It is the part of the fetus that
first contracts the finger in the vaginal
examination, most commonly the head or
breech
Fourth maneuver
• Answer the questions: where is the
cephalic prominence?
• Finding: cephalic prominence; this
maneuver identifies the greatest
prominence of the fetal head palpated
over the brim of the pelvis. When the
head is flexed, the forehead forms the
cephalic prominence. When the head is
extended (extension attitude), the occiput
becomes the cephalic prominence)
(7) Danger sign of pregnancy
- Vaginal Bleeding
▪ A woman should report vaginal bleeding,
no matter how slight, because some of the
serious bleeding complications of pregnancy
begin with only slight spotting.
- Persistent Vomiting
▪ Once- or twice-daily vomiting is not
uncommon during the first trimester of
pregnancy.
▪ that continues past the 12th week of
pregnancy is also extended vomiting
- Chills and fever
▪ indicate an intrauterine infection, a serious
complication for both a woman and a fetus.
▪ symptoms of a relatively benign
gastroenteritis.
- Sudden escape of clear fluid from
the vagina
▪ discharged suddenly from the vagina, it
means the membranes have ruptured and
mother and fetus are now both threatened,
because the uterine cavity is no longer
sealed against infection.
- Abdominal or chest pain
▪ is a signal that something is
abnormal, so the woman should
report it immediately.
▪ Abdominal pain is a sign of some
other problem, such as a tubal
(ectopic) pregnancy, separation of the
placenta, preterm labor, or something
unrelated to the pregnancy but
perhaps equally as serious, such as
appendicitis, ulcer, or pancreatitis.
▪ Chest pain may indicate a pulmonary
embolus, a complication that can follow
Thrombophlebitis.
- Pregnancy induced hypertension
▪ refers to a potentially severe and even
fatal elevation of blood pressure that
occurs during pregnancy. A number of
symptoms signal that PIH is developing:
• Rapid weight gain (over 2 lb per week
in the second trimester, 1 lb per week
in the third trimester)
• Swelling of the face or fingers
• Flashes of light or dots before the eyes
• Dimness or blurring of vision
• Severe, continuous headache
• Decreased urine output
- Increase or decrease in fetal
movement
▪ Because a fetus normally moves more or
less the same amount every day, an
unusual increase or decrease in movement
suggests that a fetus is responding to the
need for oxygen
Preventing Fetal Exposure to
Teratogens
▪ A teratogens is any factor, chemical or
physical, that adversely affects the
fertilized ovum, embryo, or fetus.
▪ To reach maturity in optimal health, a
fetus needs sound genes and a healthy
intrauterine environment that protects it
from the influence of teratogens.
Teratogenic Maternal Infections
▪ Teratogenic maternal infections can involve
either sexually transmitted or systemic
infections.
▪ Most cause relatively mild, flulike symptoms
in a woman but can have much more serious
effects on a fetus or newborn
PROMOTING NUTRITIONAL HEALTH
DURING PREGNANCY
Calories: usual addition is 300 kcal/day, but
where will be specific guidelines for those
beginning pregnancy either over or
underweight
Protein: additional 30gms.//day to ensure
intake 74-76 gms/day
Carbohydrates: intake must be sufficient for
energy needs, using fresh fruits and
vegetables as much as possible to derive
additional fiber benefit.
Fats: high energy foods, which are needed to
carry the fat soluble vitamins
Iron: needed by mother as well as the fetus;
reserves usually sufficient for first trimester,
should be taken with vit. C to promote
absorption
Calcium: 1200 mg/day needed; dairy
products most frequent source
Sodium: contained in most foods; needed in
pregnancy; should not be restricted without
serious indication
Vitamins: both fat and water soluble are
needed in pregnancy; essential for tissue
growth and development, as well as
regulation of metabolism
Folate (folic acid): folate is a B vitamin
which is essential for the formation of red
blood cells and must be taken before and
during pregnancy. The requirement for
women for folate increases by 50% during
pregnancy because this is a time of additional
blood formation and rapid tissue growth for
the baby. Additional folate intake during early
stages of conception helps prevent neural
tube defects (e.g., cleft lip & cleft palate)
size. If she plans on breast-feeding her
newborn, she might choose to buy bras
suitable for breast-feeding so she can
continue to use them after the baby's birth.
• At about the 16th week of pregnancy,
colostrum secretion begins in the breasts.
Instruct her to wash her breasts with clear
tap water (no soap, because that could be
drying) daily to remove the colostrum and
reduce the risk of infection.
• If colostrums secretion is profuse, a woman
may need to place gauze squares or breast
pads inside her bra, changing them frequently
to maintain dryness. Otherwise, constant
moisture next to the breast nipple can cause
nipple excoriation, pain, and fissuring.

Self care needs

• Because pregnancy is not an illness, few
Dental Care
• Gingival tissue tends to hypertrophy during
special care measures other than common
pregnancy. Unless a pregnant woman brushes
sense about self-care are required.
well, pockets of plaque form readily between
the enlarged gumline and teeth. In addition,
Bathing
encourage pregnant women to see their
• is important because of the increased dentists regularly for routine examination and
perspiration and mucoid vaginal discharge
cleaning
• woman may have difficulty maintaining her
balance when getting in and out of a bathtub.
If so, she should change to showering or
Perineal Hygiene
• Although women have increased vaginal
sponge bathing for her own safety. If
discharge during pregnancy, douching is
membranes rupture or vaginal bleeding is
contraindicated because the force of the
present, tub baths are contraindicated
irrigating fluid could cause it to enter the
because then there might be a danger of
cervix and lead to infection.
contamination of uterine contents. During the
• douching alters the pH of the vagina,
last month of pregnancy, when the cervix
leading to an increased risk of bacterial
may begin to dilate, some health care
growth.
providers restrict tub bathing for the same
reason.
Dressing
• The days when a woman had to purchase a
Breast Care
completely new maternity wardrobe have
• A general rule is for a woman to wear a
disappeared
firm, supportive bra with wide straps to
• A woman should avoid garters, extremely
spread weight across the shoulders. A woman
firm girdles with panty legs, and knee-high
may need to buy a larger bra halfway through
stockings because these may impede lower-
pregnancy to accommodate increased breast
extremity circulation.
• Suggest wearing shoes with a moderate to
low heel to minimize pelvic tilt and possible
backache. Otherwise, the rules are common
sense and comfort.
Sexual Activity
• Many need information to refute some of
the myths about sexual relations in pregnancy
that still exist, such as:
- Coitus on the expected date of her period
will initiate labor.
- Orgasm will initiate labor, but participating
in sexual relations without orgasm will not.
- Coitus during the fertile days of a cycle will
cause a second pregnancy or twins.
- Coitus might cause rupture of the
membranes.
Discomforts of Early Pregnancy:
The First Trimester
Breast Tenderness
• is often one of the first symptoms noticed in
early pregnancy; it may be most noticeable
on exposure to cold air.
• the tenderness is minimal and transient,
something they are aware of but not
something that overly concerns them.
Palmar Erythema
▪ Palmar erythema, or palmar pruritus, occurs
in early pregnancy and is probably caused by
increased estrogen levels
▪ Constant redness or itching of the palms
may make a woman believe she has
developed an allergy.
▪ Explain that this type of itching in early
pregnancy is normal before she spends time
and effort trying different soaps or detergents
or attempting to implicate certain foods she
has eaten.
▪ For some women, calamine lotion is
soothing.
▪ As soon as her body adjusts to the increased
level of estrogen, the erythema and pruritus
disappear
Constipation
▪ As the weight of the growing uterus presses
against the bowel and peristalsis slows,
constipation may occur
▪ Encourage her to evacuate her bowels
regularly (many women neglect this first
simple rule); to increase the amount of
roughage in her diet by eating raw fruits,
bran, and vegetables; and to drink at least
eight 8-oz glasses of water daily.
▪ Enemas also should be avoided because
their action might initiate labor.
▪ Over-the-counter laxatives are
contraindicated, as are all nonessential drugs
during pregnancy unless specifically
prescribed or sanctioned by a woman's
physician .
Nausea, Vomiting, and Pyrosis
▪ At least half of pregnant women experience
other gastrointestinal symptoms such as
nausea, vomiting, and pyrosis. Because these
symptoms also interfere with nutrition
▪ Morning sickness due to elevated HCG levels
and changes in carbohydrate metabolism
Teach to take small frequent meals with dry
crackers
Drink liquids between meals
Instruct to avoid greasy, highly seasoned food
Suggest intake of complex carbohydrates with
the onset of nausea
Nausea is aggravated by fatigue and may be
aggravated by emotional disturbance.
Fatigue
▪ Fatigue is extremely common in early
pregnancy, probably due to increased
metabolic requirements.
▪ Much of it can be relieved by increasing the
amount of rest and sleep.
▪ Some women are reluctant to take time out
of their day for rest.
▪ They know that pregnancy is not an illness,
and so they proceed as if nothing
Muscle Cramps
▪ Decreased serum calcium levels, increased
serum phosphorus levels, and, possibly,
interference with circulation commonly cause
muscle cramps of the lower extremities
during pregnancy.
▪ These problems are best relieved if a woman
lies on her back momentarily and extends her
involved leg while keeping her knee straight
and dorsiflexing the foot until the pain
disappears
Hypotension
▪ Supine hypotension is a symptom that
occurs when a woman lies on her back and
the uterus presses on the vena cava,
impairing blood return to her heart.
Varicosities
▪ Varicosities, or the development of tortuous
leg veins, are common in pregnancy because
the weight of the distended uterus puts
pressure on the veins returning blood from
the lower extremities.
▪ This causes pooling of blood and distention
of the vessels. The veins become engorged,
inflamed, and painful. Although usually
confined to the lower extremities, varicosities
can extend up to and include the vulva.
▪ Resting in a Sims' position or on the back
with the legs raised against the wall or
elevated on a footstool for 15 to 20 minutes
twice a day is a good precaution.
Hemorrhoids
▪ Hemorrhoids (varicosities of the rectal
veins) occur commonly in pregnancy
because of pressure on these veins from
the bulk of the growing uterus.
▪ Daily bowel evacuation to relieve
constipation and resting in a modified
Sims' position daily are both helpful. At
day's end, assuming a knee–chest
position for 10 to 15 minutes is an
excellent way to reduce the pressure on
rectal veins.
Heart Palpitations
▪ On sudden movement, such as turning over
in bed, a pregnant woman may experience a
bounding palpitation of the heart. This is
probably due to the circulatory adjustments
necessary to accommodate her increased
blood supply during pregnancy.
▪ Although only momentary, the sensation can
be frightening because the heart seems to
have skipped a beat.
▪ It is reassuring for women to know that
palpitations are normal and to be expected on
occasion.
▪ Only if they occur very frequently or
continuously or are accompanied by pain are
they a concern.
Frequent Urination
▪ Frequent urination occurs in early pregnancy
due to the pressure of the growing uterus on
the anterior bladder.
▪ The sensation may last for about 3 months,
sometimes beginning as early as the first or
second missed menstrual period, disappear in
midpregnancy when the uterus rises above
the bladder, and return again in late
pregnancy as the fetal head presses against
the bladder
Cravings
▪ Cravings for food or aversions to certain
foods during pregnancy are so common that
they are considered a normal part of
adaptation to pregnancy.
Cravings are actually more likely a result of a
physiologic need for more carbohydrates or
particular vitamins and minerals such as iron.
Some woman during pregnancy report an
abnormal craving for non-food substances
(termed pica form the Latin word of “magpie”
a bird that is an indiscriminate eater)
The most common form of pica in the past
was a craving for laundry starch, dirt,
cornstarch, or ice cubes.
Encouraging a woman to stop eating the non-
food substance may not be effective because
the habit may be deeply ingrained.
c.fatigue
Get plenty of rest
d.urinary urgency and frequency
Because of pressure of fundus on bladder
e. breast tenderness
From increase levels of estrogen and
progesterone
f.increased vaginal discharge
From hyperplasia of mucosa and
increased mucus production
Take shower daily; do not use vaginal
cleansing products
g.nasal stuffiness and epistaxis from
elevated estrogen level causing
edema of nasal mucosa
Encourage the use of cool moist
humidifier
Suggest the use of normal nose drops or
nasal spray
Advise patient to apply cool compresses
to the nasal nares
h.palmar erythema (palmar pruritus)
Probably caused by increased estrogen
level
Tell the woman that this is normal
Advise her to apply calamine lotion on the
affected side.
i.hypotension
Symptoms that occur when a woman lies
on her back and the uterus presses on
the vena cava impairing blood return to
the heart
Turn the woman to her side to remove
pressure from the vena cava, blood flow
will be restored
Second trimester
▪Heartburn (pyrosis) from
esophageal reflux
▪ Pyrosis is a burning sensation along the
esophagus caused by regurgitation of
gastric contents into the lower
esophagus.
▪ Pyrosis is probably caused by decreased
gastric motility, which slows gastric
emptying, and pressure of the expanding
uterus pushing up against the stomach.
▪ Ankle edema
▪ varicose veins
▪ Hemorrhoids
▪ Constipation
▪ Backache
▪ Leg cramps
▪ Faintness