Chapter 12: Nursing Management During Pregnancy

Goals of Preconception Care

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Promote the health and well-being of a woman
and her partner before pregnancy
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Identify and modify biomedical, behavioral, and
social risks to a woman’s health or pregnancy
outcome through prevention and management
intervention
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CDC guidelines

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Risk Factors for Adverse Pregnancy Outcomes #1

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Isotretinoins
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Alcohol misuse
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Antiepileptic drugs
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Diabetes (preconception)
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Folic acid deficiency
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HIV/AIDS

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Risk Factors for Adverse Pregnancy Outcomes #2

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Hypothyroidism
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Maternal phenylketonuria
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Rubella seronegativity
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Obesity
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Oral anticoagulant
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STI
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Smoking

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Period of Greatest Environmental Sensitivity

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Greatest consequent risk developing embryo
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17 to 56 days after conception

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Preconception Care

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Immunization status
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Underlying medical conditions
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Reproductive health care practices
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Sexuality and sexual practices
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Nutrition
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Lifestyle practices
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Psychosocial issues
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Medication and drug use
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Support system
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First Prenatal Visit

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Establishment of trusting relationship
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Focus on education for overall wellness
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Detection and prevention of potential
problems
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Comprehensive health history, physical
examination, and laboratory tests

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Comprehensive Health History

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Reason for seeking care
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Suspicion of pregnancy
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Date of last menstrual period
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Signs and symptoms of pregnancy
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Urine or blood test for hCG
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Past medical, surgical, and personal history
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Woman’s reproductive history: menstrual, obstetric,
and gynecologic history

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Menstrual History #1

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Menstrual cycle
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Age at menarche
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Days in cycle
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Flow characteristics
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Discomforts
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Use of contraception

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Menstrual History #2

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Date of last menstrual period (LMP)
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Calculation of estimated or expected date of birth (EDB) or
delivery (EDD)
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Nagele rule
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Use first day of LNMP 11/21/07
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Subtract 3 months 8/21/07
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Add 7 days 8/28/07
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Add 1 year 8/28/08 = EDB
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Gestational or birth calculator or wheel (see Figure 12.3)
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Ultrasound is best method of dating a pregnancy
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Obstetric History #1

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Gravida: a pregnant woman
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Gravida I (primigravida): first pregnancy
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Gravida II (secundigravida): second pregnancy, etc.
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Para: a woman who has produced one or more viable
offspring carrying a pregnancy 20 weeks or more
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Primipara: one birth after a pregnancy of at least 20
weeks (“primip”)
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Multipara: two or more pregnancies resulting in viable
offspring (“multip”)
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Nullipara: no viable offspring;
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Obstetric History #2

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Terminology
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G (gravida): the current pregnancy
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T (term births): the number of pregnancies ending
>37 weeks’ gestation, at term
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P (preterm births): the number of preterm
pregnancies ending >20 weeks or viability but before
completion of 37 weeks
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A (abortions): the number of pregnancies ending
before 20 weeks or viability
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L (living children): number of children currently living

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Question #1

Is the following statement True or False?

A multipara refers to a woman who is pregnant
for the first time.
a. True
b. False

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Answer to Question #1

b. False
A multipara refers to a woman who has had two
or more pregnancies resulting in viable offspring.

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Physical Examination #1

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Vital signs
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Head-to-toe assessment
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Head and neck
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Chest
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Abdomen, including fundal height if
appropriate
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Extremities

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Physical Examination #2

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Pelvic examination
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Examination of external and internal genitalia
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Bimanual examination
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Pelvic shape: gynecoid, android, anthropoid,
platypelloid
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Pelvic measurements: diagonal conjugate, true
(obstetric) conjugate, and ischial tuberosity

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Laboratory Tests

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Urinalysis
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Complete blood count
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Blood typing
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Rh factor
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Rubella titer
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Hepatitis B surface antigen
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HIV, VDRL, and RPR testing
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Cervical smears
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Ultrasound

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Risk Profile

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The goal of preconception care is to identify any areas
such as health problems, lifestyle habits, or social
concerns that might unfavorably affect pregnancy.
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A thorough history and physical examination are
performed on the initial prenatal visit.
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Encourage folic acid 400 to 800 mcg per day depending
on risk profile, as well as proper diet and exercise.
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Elevated levels of maternal serum AFP or amniotic fluid
AFP were first linked to the occurrence of fetal neural
tube defects. This biomarker screening test is now
recommended for all pregnant women along with other
prenatal screening test depending on risk profile.

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Follow-up Visits #1

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Visit schedule:
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Every 4 weeks up to 28 weeks
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Every 2 weeks from 29 to 36 weeks
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Every week from 37 weeks to birth

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Follow-up Visits #2

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Assessments
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Weight and BP compared to baseline values
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Urine testing for protein, glucose, ketones, and
nitrites
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Fundal height
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Quickening/fetal movement
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Fetal heart rate
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Teaching: danger signs

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Question #2

Is the following statement True or False?

A woman who is 24 weeks’ pregnant would
arrange for a follow-up visit every 2 weeks.
a. True
b. False

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Answer to Question #2

b. False
A woman who is 24 weeks’ pregnant would have
follow-up visits scheduled every 4 weeks until she
reaches 29 weeks’ gestation.

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Assessment of Fetal Well-Being #1

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Ultrasonography
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Doppler flow studies
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Alpha-fetoprotein analysis
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Marker screening tests
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Nuchal translucency screening
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Amniocentesis

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Assessment of Fetal Well-Being #2

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Chorionic villus sampling (CVS)
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Percutaneous umbilical blood sampling (PUBS)
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Nonstress test
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Contraction stress test
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Biophysical profile

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First-Trimester Discomforts

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Urinary frequency or incontinence
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Fatigue
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Nausea and vomiting
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Breast tenderness
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Constipation
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Nasal stuffiness, bleeding gums, epistaxis
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Cravings
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Leukorrhea

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Second-Trimester Discomforts

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Backache
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Varicosities of the vulva and legs
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Hemorrhoids
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Flatulence with bloating

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Third-Trimester Discomforts

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Return of first-trimester discomforts
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Shortness of breath and dyspnea
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Heartburn and indigestion
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Dependent edema
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Braxton Hicks contractions

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Question #3

While assessing a woman at 18 weeks’ gestation,

which of the following would the nurse report as
unusual?
a. Urinary frequency
b. Backache
c. Leukorrhea
d. Flatulence with bloating

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Answer to Question #3

a. Urinary frequency
During the second trimester, urinary frequency
typically improves when the uterus becomes an
abdominal organ and moves away from the bladder
region. Backache and flatulence with bloating are
common during the second trimester. Leukorrhea
begins in the first trimester and continues
throughout pregnancy.

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Nursing Management to Promote Self-Care #1

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Personal hygiene
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Avoidance of saunas and hot tubs
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Perineal care
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Dental care
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Breast care
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Clothing
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Exercise

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Nursing Management to Promote Self-Care #2

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Sleep and rest
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Sexual activity and sexuality
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Employment
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Travel
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Immunizations and medications

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Preparation for Labor, Birth, and Parenthood #1

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Perinatal education
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Childbirth education
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Lamaze (psychoprophylactic) method: focus on
breathing and relaxation techniques
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Bradley (partner-coached childbirth) method:
focus on exercises and slow, controlled
abdominal breathing
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Dick-Read (natural childbirth) method: focus on
fear reduction via knowledge and abdominal
breathing techniques
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Preparation for Labor, Birth, and Parenthood #2

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Options for birth setting
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Hospitals: delivery room, birthing suite
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Birth centers
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Home birth
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Options for care providers
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Obstetrician
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Midwife
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Doula
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Preparation for Labor, Birth, and Parenthood #3

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Feeding choices
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Breast-feeding: advantages and
disadvantages
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Bottle-feeding: advantages and
disadvantages
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Teaching
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Final preparation for labor and birth
•

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Images adapted from: Elliot, L. (2020).

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