Assessment of the Pregnant Woman
Positive pregnancy test- presence of hCG in the
Pregnancy
- occurs when an egg is fertilized by a sperm, grows
inside a woman’s uterus and develops into a fetus
- In humas, this process takes about 264 days from
thje date of fertilization of the egg, but he
obstetrician will fate the pregnancy from the first
day of the last menstrual period (280 days to 40
weeks)
Intra- uterine pregnancy
- a normal pregnancy occurs when a fertilized egg is
implanted in the uterus (womb) and an embryo
grows.
Embryo
- the term used for the developing fertilized egg
during the first 9 weeks of pregnancy.
Human Chorionic Gonadotropin (hCG)
- This hormone is secreted by the placenta and can
be measured to determine the presence and
progression of the pregnancy.
- The presence hCG to rule out the pregnancy can be
done through urine or blood tests.
Trimester
- the duration of an individual pregnancy is divided
into three periods called trimester (approximately
three months in duration)
- Each trimester is characterized by specific events
and developmental markers
- For instance, the first trimester includes the
differentiation of the different organ systems.
Estimated date of Delivery (EDD)
- the delivery date is estimated by counting forward
280 days from the first day of the woman’s last
period.
- Also called the estimated date of confinement (EDC)
or Expected date of birth (EDB).
SIGNS AND SYMPTOMS OF PREGNANCY
Presumptive signs- the changes are felt by women
o Morning sickness
o Amenorrhea – absence of menstrual bleeding
o Changes in breast- milk formation starts
o Fatigue
o Lassitude (lack of energy
o Urinary frequency
o Quickening (18th-20th weeks)- baby starts to
move
Probable signs- changes that are observed by the
examiner
1. Chadwick’s sign- bluish discoloration of the vaginal
wall
2. Hegar’s sign- softening of the lower uterine
segment
3. Uterine enlargement- at 12 weeks gestation, the
growth is felt just above the symphysis pubis.
4.
urine.
5. Ballottment
- a palpatory technique for detecting or
examining a floating object in the body, as a.
- The use of a finger to push sharply against the
uterus and detect the presence or position of a
fetus by its return impact.
6. Outlining of the fetal body
7. Goodell’s sign- softening of the cervix
8. Souffle- a low murmuring or blowing sound heard
through a stethoscope.
9. Braxton Hicks Contraction- an intermittent weak
and painless contractions of the uterus occurring
during pregnancy.
For easy to remember
- To arrange Hegar, Chadwick and Goodell signs,
arrange them anatomically from external to internal
organ, then match them with alphabetical
sequence.
- Where Chadwick is to the vagina.
- Goodell is to the cervix while
- Hegar is to the uterus
POSITIVE SIGNS: are definitive signs of pregnancy
FETAL
o Heart beat
✓ 10 weeks- doppler
✓ 16 weeks fetoscope
✓ 18-20- auscultation
o Movement: felt after 20 weeks
o Skeleton- by ultrasonography or X-ra
Maternal Physiology During Pregnancy:
REPRODUCTIVE SYSTEM CHANGES
Uterus
- enlargement and thickening of the uterus; marked
in the fundus.
- At the end of umbilicus by the 20th weeks AOG,
xiphoid process by the 36th weeks;
- Descends slight during the last 3 weeks due to the
fetal descent into the pelvis
Cervix
- Pronounced softening and cyanosis (due to
increased vascularity, edema, hypertrophy and
hyperplasia of cervical glands) Goodell sign
- Cervical plug formed by the thick mucus
(operculum) that stops bacteria from entering the
uterus.
Ovaries- ovulation ceases throughout pregnancy
Vagina
- vascularity, hyperemia, and softening of the
perineum and vulva.
- Chadwick sign noted. Vaginal mucosa in thickness,
connective tissue loosens and small muscles cells
hypertrophy. Vaginal secretions; pH is 3.5-6 due to
production of lactic acid (Doderlein bacillus)
Breasts Pituitary
- Tender and tingle in the early part of pregnancy - Elevated estrogen and progesterone; suppressed
- In size, Larger nipple. More pigmented. LH, FSH, Oxytocin
- Areola darker in color
- Colostrum present by the 2nd trimester. Elevated CARDIOVASCULAR CHANGES
glands of Montgomery (Hypertrophic sebaceous
gland) Heart
- Colostrum first milk that contains all the nutrients - Heart is deplaced upwards by elevated diaphgram
- There maybe splitting of the first heart sound with
INTEGUMENTARY CHANGES common systolic murmurs.
- Displaced upward to the left and forward
Striae Gravidarum
- reddish slightly depressed streaks in the abdominal Blood Volume
wall, breast and thighs. - Increases by 30-50g/ml
Linea Nigra - RBC volume increases by 20-305
- line of dark pigment extending from the umbilicus - Hematocrit decreases by 7& causing physiologic
down the midline to the symphysis. anemia
Chloasma Pulse Rate- increases by 10-15 bpm
- “Masks of pregnancy” are brownish patches on the Supine Hypotensive Syndrome- occurs during the 2nd
face. trimester.
Pigmentation
- pigmentation changes due to melanocyte Circulation
- stimulating hormone elevated from the 2 nd month - Cardiac volume increases by 40-50% causing slight
of pregnancy cardiac hypertrophy and increase in Cardiac Output.
- ex. Chloasma CO increases when the woman turns from her back
to her left side.
METABOLIC CHANGES - (+) Physiologic anemia
- PR increases 10-15 bpm during pregnancy
Weight gain - Slight decreases in bp (30%) during the 2 nd and 3rd
- weight gain averages is 11-13 kgs (24-28 lbs.) trimester
- Fetus (3,400gm); Placenta (450 gm); Amniotic Fluid
(900 gm); Uterus (1gm); Breast tissue (1400 gm); Hematologic
Blood Volume (1800 gm); Maternal Stores (1800- - Total circulating blood cells increases
3600 gm) - Leukocyte count is elevated during labor
- Fibrinogen levels increases by 50% along with other
Water Metabolism clothing factors
- Average woman retains 6.5 liters of extra water
during pregnancy Cardiac Classification in Pregnancy

Protein Metabolism Class I

- Fetus, Uterus and Maternal blood are rich in - Asymptomatic in all activity
protein. - No limitation of activity

Carbohydrate metabolism Class II

- Human placental lactogen, estrogen, progesterone - Asymptomatic at rest
and insulin produced by the placenta during - Symptomatic with heavy physical activity
pregnancy prevent the action of insulin during - Slight limitation of activity
pregnancy.
- Pregnancy can initiate diabetes and Class III
- DM can be aggravated by pregnancy - Asymptomatic at rest
- Symptomatic with ordinary activity
Fat Metabolism - Able to handle physiologic demands of pregnancy
- fats are more completely absorbed during - Considerable limitation of activity
pregnancy; plasma lipid levels increase during
the2nd half of pregnancy Class IV
- Symptomatic with all activity and at rest
Iron Metabolism - High risk for pregnancy
- iron requirement increases to 20-40 mg daily.
- During the first half of pregnancy, iron is transferred GASTROINTESTINAL CHANGES
to the fetus and stored in fetal liver.
Nausea and Vomiting- common during the 1st trimester
ENDOCRINE SYSTEM CHANGES due to increased Hcg
Placenta
- Produces estrogen, progesterone, human chorionic Ptyalism- excessive saliva in pregnancy due to changing
gonadotropin (hCG) and Human Placental Lactogen hormones
(hPL), Relaxin
Heartburn and Flatulence- often occur dur to reduction Psychological Adaptation of Pregnancy Based on Reva
in gastric acidity. Growing uterus and smooth muscle Rubin’s Theory
relaxation
- Distinct emotional responses of the mother to
Heartburn- the hormone progesterone causes the valve pregnancy
to relax, which causes
First Trimester
Flatulence--excessive gas during pregnancy is caused by - Accepting the pregnancy
hormone progesterone - Ambivalence: having mixed feeling or
- contradictory ideas about something or someone.
RESPIRATORY SYSTEM CHANGES
Second Trimester
Ventilation - Accepting the baby
- Hyperventilation occurs increasing respiratory rate, - Fantasizes about the baby
tidal volume by 45%
- PCO2 lowers. There is a substantial reduction in the Third Trimester
partial pressure of carbon dioxide (pCO2) in - Preparing for parenthood
pregnancy. - Identification of baby’s appearance

Diaphragm Emotional Aspects of Pregnancy

- enlarging uterus elevates the diaphragm
- displacement of the diaphragm causes shortness
of breath
- nasal stuffiness and epistaxis are common due to
edema and vascular congestion induced by
increased estrogent
Thoracic cage
- expands by means of flaring of the ribs hence
increasing the mobility of rib attachments
SKELETAL SYSTEM CHANGES
Hormone Relaxin- relaxation of pubic joints during
pregnancy
Lumbodorsal curve- increase in the 3rf trimester
Reva Rubin Maternal Role Attainment Theory
a) Anticipatory stage: begins ion the pregnancy and
includes the initial social and psychological
adjustments to pregnancy. The mother learns the
expectations of the role, fantasizes about the role,
related to the fetus in the uterus, and begins to role
play
b) Formal stage: begins with the birth of the infant and
includes learning and taking of the role of the
mother. Role behaviors are guided by formal,
consensual expectations and others in the mother’s
social system
c) Informal stage: begins as the mother develops
unique way of dealing with the role not conveyed by
the social system. The woman makes her ne role fit
within her existing lifestyle based on past
experiences and future goals
d) Personal stage: role identity stage occurs as the
woman internalizes her role. The mother
experiences harmony, confidence and competence
in the way she performs the role and the maternal
role is achieved
First Trimester
- is denoted by ambivalence having mixed feeling or
contradictory ideas about something or someone
- Focus: bodily changes
- Developmental Tasks: to accept the biological facts
of pregnancy
Second Trimester
- The mother feels well and happy and fantasies
about the baby.
- Focus: self-growth and development of the fetus
- Developmental task: accepts the growing fetus as
part of her own
Third Trimester
- Personal indication of the appearance of the baby.
- Focus:
o the baby,
o mother’s delivery process,
o responsible parenthood.
- Developmental Task: Preparation for Childbirth
Fetal Development
- Cephalocaudal in progression
- 1st trimester period of organogenesis
- 2nd trimester period of rapid increase in length
- 3rd trimester period of continuous growth and
development
- Cephalocaudal- refers to growth and development
that occurs from the head down to the lower
extremities
- Organogensis- the three germ layers of the embryo
form into the major organs of the body system
Development at 1-4 Weeks (1 month)
- Length 0.75 to 1 cm
- Weight 400 gm
- Spinal cord fused at midpoint
- Rudimentary heart appears as a bulge on the
anterior surface
- Extremities appear as buds
- Recognizable eyes, ears and nose
Development at 5-8 Weeks (2 months)
- Length 2.5 cm; weight 20 g,
- Completed organogenesis
- Heart with septum beats rhythmically
- Facial features identifieable
- Extremities developed
- External genitals present but not clear
Development at 9-12 Weeks (3 months)
- Length 7-8cm; weight 45 g
- Nailbeds formed formation of bone ossification
centers
- Tooth buds present
- Heat beat audible by doppler
- Kidney secretion starts
Development at 35-37 Weeks (9 months)
- Length 42- 48 cm; Weight 1800-2700g
- Body shares glycogen, iron and carbohydrates
- Calcium deposition
- Deposition of subcutaneous fats
- Decrease in lanugo
Development at 38-40 Weeks (10 months)
- Length 48-52 cm; Weight: 3000 g
- Fetus kick actively
- Start of conversion of fetal hemoglobin to adult
- Vernix caseosa fully formed
- Sole creases cover 2/3 of feet
- Lightening
- Maybe present

Development at 13-16 Weeks (4 months) Birth!

- Length 10-17 cm, 55-120g - A mother’s due date marks the end of her 40th week
- Fetal heart beat audible by stethoscope - The delivery date is calculated using the frist day of
- Lanugo well-formed her last period.
- Functional liver and pancreas - Based on this, pregnancy can last between 38 and
- Fetus swallow’s amniotic fluid 42 weeks with a full-term delivery happening
- Urine present in amniotic fluid around 40 weeks
- Sex determined by ultrasound - Some post-term pregnancies those lasting more
than 42 weeks- the due date may just not be
Development at 17-20 Weeks (5 months) accurate
- Length 25cm; 223g. - For safety reasons, most babies are delivered by 42
- Quickening present weeks.
- Hair and eyebrows formed - Sometimes the doctor may need to induce labor.
- Meconium present in upper intestine
- Vernix caseosa forms FETAL CIRCULATION
- Definite sleeping patterns develop
Structure Location Function
Time for an Ultrasound Placenta Attached to the Gas exchange
- An ultrasound is usually done for all pregnant uterus during fetal life
women at 20 weeks.
Umbilical Two arteries in Carry oxygenated
- Sex can be determined whether it’s a boy or a girl at
arteries the cord blood from the
20 weeks
fetus (descending
Development at 21-25 Weeks (6 months) aorta) to the
- Length 28-36cm; 550g. placenta
- Passive antibody transfer Umbilical vein One vein in the Carry oxygenated
- Meconium present in the rectum cord blood to the fetus
- Start of surfactant production Forman ovale Opening in the To shunt blood
- Eyelids open interatrial from the R atrium
- Pupils reactive to light septum (between to the L atrium so
- Well-defined eyebrows and eyelids
R&L atrium) that blood can be
- Capable of hearing sounds
supplied to the
Development at 26-29 Weeks (7months) brain, heart, and
- Length 35-38cm; 1200g kidney
- Alveoli matures Ductus Accessory vein To supply blood to
- Surfactant present in amniotic fluid venosus connecting the the liver. A bypass
- Tastes begin tom descend umbilical vein to the fetal liver
- Thin retinal blood vessels which are extremely into fetal liver
susceptible to damage. and inferior vena
cava
Development at 30-34 Weeks (8 months)
Ductus Connection Shunting of the
- Length 38-43 cm; weight 1800-2700g
arteriosus between fetal larger portion of
- Deposition of brown fat
- Fetus responds to external voice lungs and the blood away from
- Active presence of Moro reflex aorta the lungs and
- Fetus assumes birth position directly into the
aorta
 Embryonic and Fetal Support Structures
Corpus Luteum
- Supplies most of the estrogen and progesterone in
the 1st two gestational months before the placenta
is fully developed
- Estrogen and progesterone essential for sustaining
the uterine endometrium and preventing
menstruation
Decidua
- The endometrium (the lining of the inside of the
uterus) becomes the decidua following fertilization
and implantation
- The portion under the blastocyst where the
chorionic villi intersect with the maternal blood
vessels is the decidua basalis
- The portion covering the blastocyst is called the
decidua capsularis
- The portion lining the rest of the uterus is the
decidua vera
- It will protect and nourish the developing embryo
Placenta
- The placenta begins to function by the 4th week of
gestation
- By the 14th week it is a complete independently
functioning organ
- It transmits nutrients and oxygen to the fetus and
removes wastes and carbon dioxide by diffusion
Hormones Produced by Placenta
o Placenta
o Estrogen
o Progesterone
o Human chronic gonadotropin
o Human placental lactogen
Hormones of Pregnancy
Estrogen
o It stimulates the growth of uterine muscle
(myometrium) and glandular epithelium
(endometrium) and induces the synthesis of
receptors for progesterone
o Stimulates uterine growth and uteroplacental
blood flow
o Enhances growth of all organs and ensures
nourishment of developing tissue
o It indicates placental function, fetal maturity and
fetal well-being (levels of maternal serum estriol)
Progesterone
o Promotes thickening and increased viscosity of
cervical mucus (the mucus plug) to protect the
fetus against invading bacteria
o Decreases motility of oviducts and uterus
o Stimulates growth of gland breast tissue (acini
cells) in preparation for lactation
o Maintains uterine lining for implantation
o Relaxes smooth uterine muscle
Human Chorionic Gonadotropin (HCG)
o Secreted by trophoblast cells of the blastocyst
(early product of conception) and the placenta
(after the 2nd gestational month). It is partly
responsible for maintaining the corpus luteum
o First indicator of a positive pregnancy detected in
the uterine and plasma (by day 8)
o HCG levels are also monitored later in the
pregnancy to determine fetal well-being
Human Placental Lactogen (HPL)
o Human chorionic somatomammotropin levels
increased after 20 weeks AOG
o It is a growth like substance that stimulates
maternal metabolism
o It facilitates glucose transport acroos the
placenta
o It also stimulates breast development to
prepare for lactation
Embryonic and Fetal Support Structures
Membraned and Amniotic Fluid
- Two membranes form to protect and support the
embryo
1. Amnion (inner membrane) encloses the
amniotic cavity, containing the amniotic
fluid and the fetus
2. Chorion (outer membrane) contains the
amnion and is part of the placenta
Amniotic Fluid
- is a clear, yellow fluid which is found within the first
23 days following conception within the amniotic
sac. It surrounds the growing baby in the uterus
- Fluid volume normally ranges from 500-1,000 ml
- The functions of the amniotic fluids are the
following
o Protects the embryo and fetus
o Controls temperature
o Supports symmetrical growth
o Prevents adherence to amnion
o Allows the embryo or fetus to move within
the amniotic cavity
Umbilical term
- at term, it is 30 to 90 cm long and 2 cm in diameter
- it contains two arteries and one vein
- two arteries carry blood from the fetus to the
placenta
- one vein returns blood and nutrients to the fetus
- the umbilical cord is normally inserted at the
center of the placenta
- the cord also contains a clear jelly0like substance
called Wharton Jelly, which is a connective tissue
that prevents compression of the blood vessels
Methods of Assessing Pregnancy and Methods of
Estimating EDC
1. Indirect/ Non-invasive
a. Nagele’s rule
- is a standard way of calculating the due date for a
pregnancy. The rule estimate the expected date
of delivery (EDD) by adding one year, subtracting
three months, and adding seven days to the first
day of a woman’s last menstrual period (LMP)
 b. Fundal height gross estimate of expected of
confinement
- if above the symphysis pubis- between 12-14 weeks
of AOG
- if at the level of the umbilicus – 20 weeks AOG
- Fundal height is generally defined as the distance
from the pubic bone to the top of the uterus
measured in centimeters. After 20 weeks of
pregnancy, the fundal height measurement often
matches the number of weeks the woman has been
pregnant
2. McDonald’s rule
- is a measure of size of the uterus used to assess fetal
growth and development during pregnancy
- it is measured from the top of the mother’s uterus to
the top of the mother’s symphysis pubis
3. Haase’s rule
- a full-term newborn’s length ranges from 18-22
inches, 9-21 inches or 48-52 cm
- average length – 50 cm
Formula:
a. From 1-5 lunar months, square the month of
pregnancy (to square a number is to multiply it
by itself)
b. (months of pregnancy) x (months of
pregnancy)= fetal length
Sample Problem A: how long is a 4-month-old fetus?
Sol’n: 4 x 4 = 16 cm
Sample Problem B: What is the estimated length of a 3-
month-old fetus?
Sol’n: 3x3= 9 cm
Direct/ Invasive
- Ultrasonography
- Laboratory findings/ deviations
- Urine tests
- Blood tests
4. Bartholomew’s Rule
c. Bartholome’s rule of 4s- measures AOG by
determining the position of the uterus in the
abdominal cavity
d. This method estimates the age of gestation relative
to the height of the fundus of the uterus above the
symphysis pubis
Antenatal Care
Prenatal visits
o 1st trimester- every 4 weeks (monthly)
o 2nd trimester- every two weeks (twice monthly)
o 3rd trimester every week (4 x a month)
o Philippine DOH Guideline: 80% of pregnant
women should have at least 5 prenatal visits
Assessment of Risk Factors
o Age
o Gynecologic history
o Underlying medical conditions
o Sexually transmitted infections
o Teratogenic drugs substance abuse
Diagnostic Tests and Procedures (DOH) Standards
- Urine tests
- Blood tests
✓ Complete blood count evaluates
hemoglobin/hematocrit and RBC to detect
anemia;
✓ WBC to detect infection
✓ Platelet Count to assess clotting ability
- Blood typing- determines blood type and Rh status to
rule out blood incompatibility
- Rubella Titer- detects antibodies for the virus that
causes German measles; titer should be higher than 1:8
- Hepatitis B- determines if mother has hepatitis B by
detecting the presence of hepatic antibody surface
antigen (HBsAg)
- HIV testing- detects HIV antibodies
- Syphilis Screening- VDRL or RPR serologic tests
- Cervical Smears- detects cervical cancer or infections
Pharmacologic Treatment Antenatal Care
- Iron supplementation- 60 mg OD
- Folic acid- 2 tabs daily
- Tetanus toxoid- 0.5 ml IM
o 1st dose- 1st prenatal check-up
o 2nd dose- 1 months after
o 3rd dose- 6 months after 2nd dose
o 4th dose- 1 year after 3rd dose
o 5th dose- 1 year after 4th dose
In endemic areas give any of the following:
- Iodized capsule (endemic goiter)
- Chloroquine Phosphate (as malaria prophylaxis)
Obstetric History Terms
- Gravida- state of being pregnant; total number of
pregnancies including present pregnancy
- Para- number of pregnancies reaching the age of
viability whether born alive or not
- G- gravida; the current pregnancy
- T- the number of full-term children born (children born
37 weeks and beyond)
- P- number of preterm children (born before 37 weeks
AOG)
- A- abortions; the number of pregnancies ending before
20 weeks AOG
- L- number of living children
- M- multiple pregnancies
Vaccine Administration During Pregnancy
- Vaccines to be considered unless otherwise
contraindicated
o Hepatitis B
o Influenza (inactivated)
o Tetanus
o Meningococcal
o Rabies
- Vaccines absolutely contraindicated during pregnancy
o Influenza (live attenuated)
o Measles
o Mumps
o Rubella
o Varicella
Diagnostic Tests to Evaluate Fetal growth and Well-
being
Daily fetal movement count (DFMC)
- Assess fetal activity
- Noninvasive test done by woman who is pregnant
- Five to 10 movements per hour; normal activity
- Five movements or less per hour may indicate fetal
threat or sudden change in movement pattern
- Assess for fetal sleep patterns
Nonstress Test (NST)
- Correlates fetal movement with FHR. Requires
electronic monitoring
- Reactive test- three accelerations of FHR to 15
beats/min above baseline FHR, lasting for 15 seconds
or more, over 20-minute time period
- Nonreactive test- no accelerations or acceleration
less than 15 beats/min above baseline FHR. May
indicate fetal danger
Vibroacoustic stimulator (VAS) to
differentiate hypoxia from fetal sleep
- Unsatisfactory test- data that cannot be interpreted
or inadequate fetal activity; repeat
- Contraindication stress test (CST); oxytocin challenge
test (OCT)
- Correlates fetal heart rate response to spontaneous
or induced uterine contractions
- Requires electronic monitoring
- Indicator of uteroplacental sufficiency
- Identifies pregnancies at risk for fetal compromise
from uteroplacental insufficiency
- Increasing doses of oxytocin are administered to
stimulate uterine contractions until three in 10-
minute period
- Interpretation: negative results indicate absence of
late decelerations with all contractions
- Positive results indicate FHR decelerations with
contractions
- Nipple stimulations (breast self-stimulation test) may
also release enough systemic oxytocin to contract
uterus to obtains CST. Instruct not to do at home
Biophysical profile (BPP)
- Observation by ultrasound for four variables for 30
minutes and results of nonstress testing:
- fetal body movements
- fetal tone
- amniotic fluid volume
- fetal breathing movements
- Variables are scored at 2 for each variable if
present, score of 0 if not present; score of less than
6 is associated with perinatal mortality
- Ultrasound
o Noninvasive procedure involving passage of
high-frequency sound waves through
uterus to obtain data regarding fetal
growth, placental positioning, and the
uterine cavity
- Purpose may include:
o Pregnancy confirmation
o Fetal viability
o Estimation of fetal age
Amniocentesis
- Invasive procedure for amniotic fluid analysis to
assess fetal lung maturity or disease; done after 14
weeks of gestation
- Needle placed through abdominal-uterine wall;
designated amount of fluid is withdrawn for
examination
- Empty bladder if gestation greater than 20 weeks
- Possible complications: onset of contractions;
infections (probably amnionitis); placental
punctures; cored puncture; bladder of fetal puncture
- Advise women to observe and report the following to
physician: fetal hypoactivity or hyperactivity, vaginal
bleeding, vaginal discharge (clear or colored), signs of
labor, signs of infection
Analysis of Amniotic Fluid
- Chromosomal studies to detect genetic abberations
- Biochemical analysis of fetal cells to detect inborn
errors of metabolism
- Determination of fetal lung maturity by assessing
lecithin/sphingomyelin ration
- Evaluation of phospholipids; aids in determining lung
maturity
- Determination of creatinine levels; aids in
determining fetal age. (greater than1.8 mg/dL
indicates fetal maturity and the fetal age.)
- Assesses isoimmune disease
- Presence of meconium may indicate fetal hypoxia
Chorionic villus sampling (CVS)
- Cervically invasive procedure
- Advantage- results can be obtained after 10 weeks of
gestation due to fast-growing fetal cells
- Procedure- removal of small piece tissue (chorionic
villus) from fetal portion of placenta. Tissue reflects
genetic makeup of fetus
Health Promotion During Pregnancy
- Bathing- daily bath or shower is recommended
because of increased sweating and vaginal discharge.
Leukorrhea is thick, whitish or yellowish vaginal
discharge due to estrogen imbalance
- Breast Care- wear firm supportive brassiere to prevent
breast discomfort; wash breast with clear tap water to
remove colostrum secretion if present
- Dental care- continue good brushing habits throughout
pregnancy especially because gingival tissue
hypertrophy usually occurs
- Sexual activity- although there is a decrease in the
desire for coitus in the woman, there are no restrictions
unless there is a history of preterm labor or history of
spontaneous abortion
- Exercise- exercise should be maintained at 70-85% of
their maximum heart rate. This is important to prevent
circulatory stasis in the lower extremities
- Sleep- may need rest periods during the afternoon in
modified Sim’s position
- Employment- no contraindications during pregnancy
unless there is exposure to toxic substances, lifting of
heavy objects, excessive physical strain, long periods
of standing or having to maintain body balance
- Travel- in early pregnancy, there are no restrictions; in
the late pregnancy, advise the pregnant woman to
take frequent rest or stretch during long trips

Expected Weight Gain During Pregnancy

- First trimester- 1lb. a month

- Second trimester- 1 lb. a week
- Third trimester- 1 lb. a week

Nutritional Requirements During Pregnancy

Nutrient Daily Requirement for

pregnant women
calories Additional 300, in
second and third
trimesters
Calcium 1200 milligrams
folate 600-800 micrograms
iron 27 milligrams