MICHAEL BRIAN M.
GALVAN Pregnancy Concepts
BSN 2-1
11/3/21
1:30 P.M
MATERNAL AND CHILD HEALTH NURSING
ANTEPARTUM
Conception: Understanding the Process
• Step 1
• During the first half of the
menstrual cycle, hormones
stimulate the growth and
development of a single follicle
within one of the ovaries. At
the same time, another
hormone stimulates growth of
the uterus lining in preparation
for the fertilized egg.
• Step 2
• When the egg cell matures,
hormone levels surge and
trigger the egg’s release. The
egg follicle bursts, releasing a
fertile egg, which migrates to
the fallopian tube. What’s left
of the spent follicle helps
produce a hormone, which
prepares the endometrium for
the implantation of the
fertilized egg.
• Step 3
• En route from the fallopian
tube to the uterus, the egg may
be fertilized. During
fertilization, the couple’s genes
combine to create an embryo.
• Step 4
• As the first few cells divide,
the embryo continues its course
toward the uterus. Just
before implantation, it hatches
from the egg’s protective
membrane.
• Step 5
• Six days after fertilization,
the embryo embeds itself into
the nutrient-rich lining of
the uterus. A placenta forms to
exchange nutrients and gases
between mother and embryo,
and essential hormones are
released to maintain
pregnancy.  1. Decidua > the endometrium
a) Fertilization
> union of mature egg cell & a sperm
cell
Site:
fallopian tube
ampullary portion or outer third
Time:
occurs as early as 12-24 hrs or 24-36 hrs after
ovulation
 Capacitation
 > final process that a sperm must
undergo to be ready for fertilization.
> consists of changes in the plasma
membrane of the sperm head which reveal the
sperm binding receptor sites
• Hyaluronidase > enzyme that facilitates
the spread of fluids thru tissues,
dissolving the layer of cells protecting
the ovum
• Zona pellucida> ring of
mucopolysaccharide fluid
Corona radiata > circle of cells
 Zygote > fertilized ovum
3 Factors that affect fertilization
1. Equal maturation of both sperm and
ovum
2. Ability of the sperm to reach the ovum
3. Ability of the sperm to penetrate the
zona pellucida and cell membrane and
achieve fertilization
Implantation
 Contact between the growing structure
& the uterine endometrium
Site: uterus
upper third of the uterus
Time: 8-10 days after fertilization
Embryonic Germ Layers
1. Ectoderm > develops into nervous
system, hair, skin, nails, sebaceous
glands, salivary glands
2. Mesoderm > develops into
cardiovascular, reproductive,
musculoskeletal, & urogenital
3. Endoderm > develops into bladder,
thyroid, thymus, respiratory tract,
linings of the GIT, liver, pancreas
Cephalocaudal
Embryonic & Fetal Structures
during
pregnancy
3 Separate Areas
1. Decidua Basalis > part of the
endometrium that lies directly under
the embryo
2. Decidua Capsularis > portion of the
endometrium that stretches or
encapsulates the surface of the
trophoblast
3. Decidua Vera/parietalis > the remaining
portion of the uterine lining
4. 2. Chorionic Villi > the cellular,
outermost extraembryonic membrane,
composed of trophoblast line with
mesoderm
5. > it develops villi that forms the
fetal part of the placenta
6. > appears on the 11th or 12th day
7. > disappears between the 20th
th
& 24 week
3. Placenta
>arises out of the trophoblast tissue
 Weighs 400-600g at term, 15-20cm in
dm, & 2-3 cm in depth at term
 Matures at 10-12 weeks
 Functions most effectively thru 40-41
wks
Parts:
a. Fetal side > bluish, shiny, smooth, clean
with vessels & amnion
b. Maternal side > reddish, rough, dirty
with cotyledons & chorions nearest to it
Functions:
1. Nutritive
2. Respiratory
3. Excretory
4. Protective
5. Endocrine
Placental Delivery
1. Schultze Presentation > fetal side out
first
2. Duncan Presentation > maternal side
out first
Endocrine Function
a) hCG ( human chorionic gonadotropin)
> found in maternal blood and urine as
early as the first missed menstrual period
> purpose of hCG is to act as a fail-safe
measure to ensure that the corpus luteum of
the ovary continues to produce progesterone &
estrogen
b)Progesterone > sex hormone secreted by the
corpus luteum to prepare the endometrium for
implantation
> level rises progressively during the remainder
of the pregnancy
c) Estrogen > stimulate the development of
female secondary sex characteristics
> contributes to the mother’s mammary
gland development & stimulates uterine growth
d) Human placental lactogen (hPL) or human
chorionic somatomammotropin
> hormone with both growth promoting
& lactogenic or milk-producing properties
> produced by the placenta beginning as early
as the 6th wk of pregnancy
> serves the impt role of regulating
maternal glucose, protein, & fat levels so that
adequate amount will always be available to the
fetus
4. Umbilical Cord
> formed from the fetal membranes &
provides a circulatory pathway that connects
the embryo to the chorionic villi of the placenta.
> transport oxygen & nutrients to the fetus
from the placenta & to return waste products
from the fetus to the placenta.
> about 53-55 cm at term & about 2cm
thick
> contains 1 umbilical vein & 2 umbilical
arteries
> contains Wharton’s jelly
5. Amniotic Fluid
> clear, straw colored fluid
> pH of 7-7.25
> 500-1,000ml at term
Functions:
1. Protective cushion 7. specimen
2. Excretory 8. equalize uterine
3. Thermal
pressure in labor
4. Promotes symmetrical growth
5. Movement
6. Fetal drink
Contents:
Albumin
lecithin
urea
sphingomyelin
 uric acid
bilirubin
creatinine fat
fructose
leukocyte
CHON epithelial cells
lanugo
Abnormal Variations in amniotic fluid volume
a) Oligohydramnios > less than 400ml
b) Hydramnios/polyhydramnios
> above 2,000ml

Assessment:

1. Estimation of EDC

Naegele’s Rule > counting back 3

months & adding 7 days to the first day of LMP.

2. Age of Gestation (AOG)

> length of time of pregnancy

Mc Donald’s Rule

 Used in the 2nd & 3rd trimester to

estimate AOG

Formula: FH (in cm) x 2/7 = AOG in mos

Bartholomew’s Rule of Fours

 Measures age of gestation by

determining the position of the fundus
in the abdominal cavity

 Fundic height is determined by

palpation & by relating to different
landmarks in abdomen

12 wks – level of symphisis pubis

16 wks – halfway bet umbilicus &

symphisis pubis

20 wks – level of umbilicus

24 wks – 2 fingers above umbilicus

28-30 wks – halfway bet. Umbilicus &

xiphoid process

32-34 wks – just below the xiphoid

process

36 wks – level of xiphoid process

40 wks – at 34 wks level

 0.5 – 1 lb/wk in the 3rd trimester

OB Classification/Components of an Obstetrical
History

a) Preceding pregnancies & prenatal

outcomes

T – number of fullterm births

P – number of premature births

A – number of abortions

L – number of currently living

Greater Fundic Height may indicate: children

1. Multiple pregnancy b) Gravida > number of pregnancies regardless

of duration & outcomes
2. Miscalculated due date
 Gravida 1 > pregnant for the first time
3. Polyhydramnios
 Primigravida > had one pregnancy
4. Hydatidiform mole
 Nulligravida > woman who is not &
Lesser Fundic Height may indicate never
1. Fetal growth rate retardation has been pregnant
2. Fetal death c) Parity > number of pregnancies carried to
period of viability
3. Error in estimating AOG
• Primipara > a woman who has delivered
4. oligohydramnios
once a fetus or fetuses who reached the
stage of viability

3. Fetal Length • Multipara > a woman who has

completed 2 or more pregnancies to
Haase’s Rule
the stage of viability
 Formula: 1-5mos: square the month or
Signs of Pregnancy
multiply the month by itself
1. Presumptive
6-10mos: multiply month by 5
a) Morning sickness
4. FHR Assessment
b) Amenorrhea
a) Doppler ultrasound
c) Changes in the breast
b) Fetoscope
d) Fatigue
5. Leopold’s Maneuver
e) Lassitude
> Systemic palpation of the abdomen to
determine fetal descent, uterine contour
f) Urinary frequency
6. Weight
g) Quickening
Total > 20-25 lbs
h) Linea nigra
Patterns of Wt. Gain >
i) Melasma
1 lb/mo in the first trimester
j) Striae Gravidarum
0.9 – 1 lb/wk in the second
trimester 2. Probable Signs
 a) Chadwick’s sign Alcohol

b) Hegar’s sign  Small to moderate amount can lead to

fetal alcohol effect which can cause
c) Uterine enlargement
developmental delay, and hyperactivity
d) Positive PT in the child

e) Ballotement  Heavy use can lead to fetal alcohol

syndrome which can cause small head
f) Outlining of fetal body size, facial abnormalities, heart defects,
g) Goodell’s sign learning difficulties, behavioral
problems, and mental retardation
h) Souffle & Braxton Hick’s contraction
Cigarette Smoking

 The more a woman smokes, the higher

3. Positive Signs the risk of miscarriage, stillbirth, low
a) FHR birth weight, premature birth, SIDS,
possible increase in developmental
b) Fetal outline delays, a 1% risk for cleft palate, and
failure to thrive.
c) Fetal skeleton
Medications
d) Fetal parts/movement on palpation
 Antibiotics

Aminoglycosides have a 2% increased risk for

Length of Pregnancy
Days – 267 – 280
Weeks – 40
Lunar months – 10
Calendar months – 9
Trimester - 3
 First trimester
organogenesis
hearing ipairment.
Tetracycline and doxycycline if used in the 3 rd
trimester may cause decreased fetal bone
growth.
 Accutane
 Can cause hydrocephalus, brain defects,
mental retardation, ear/face
abnormalities, heart and limb defects,
chronic skin lesions
> period of
 Antidepressants

 Second trimester > most comfortable
for the mother with continued fetal
growth
 Third trimester > period of most rapid
growth
There can be a less than 1% increased risk for
learning difficulties, and possibly mild to
moderate but temporary withdrawal symptoms
at birth.

Schedule of Clinic Visits  Chickenpox

first 32 wks > once a month  Skin scarring, small head, blindness,
seizures, low birth weight, and mental
32-36 wks > twice a month retardation
36-40 wks > 4 times a month  HIV

 Fetus can contract the virus themselves

Teratogens • Rubella
 Any exposure that can cause harm to an
unborn or breastfeeding baby.
> Can cause vision and hearing problems, heart
abnormalities, mental retardation, even death
of the fetus, and stillbirth.

 Syphilis

 Fetus can become infected with the

bacteria.

 Can cause stillbirth or death shortly

after birth.

 Those who live are at risk for

developmental delay, having seizures,
or even dying.

Radiation

 Can cause spontaneous abortion, low

birth weight, premature delivery,
developing skin tags, undescended
testicles

Psychologic/Emotional Adaptation to Pregnancy

1. Acceptance of Pregnancy (First

Trimester)

“I am pregnant.”

> The unborn child is incorporated as part of a

woman’s body image or as part of herself.

2. Acceptance of the Fetus as a Separate

Individual (Second Trimester)

“I am going to have a baby.”

> The woman begins to fantasize about the

child’s sex and appearance

3. The woman prepares for the birth of the

baby and her role as a mother (Third Trimester)

“I am going to be a mother.”

> Woman begins to plan about the birth of the

baby