ANTENATAL (MCHN) Importance of Antenatal Care
Learning Objectives:
At the end of the topics the students can:
1. Assess mother and child's health status with the
use of specific methods and tools to address
existing health needs.
2. Assess fetal growth and development through
maternal and pregnancy landmarks.
3. Perform safe, appropriate and holistic care to the
individuals, families, population groups and
community utilizing nursing process.
4. Practice nursing in accordance with existing
laws, legal ethical and moral principles.
5. Report/ document client care accurately and
comprehensively.
6.Descibe common psychological and physiological
changes that occur with pregnancy and in
relationship of the changes to pregnancy diagnosis.
7.Describe the growth and development of a fetus
by gestational age in weeks.
8. Formulate nursing diagnoses related to the
needs of the mother and fetus.
9. Implement nursing care to help ensure both safe
fetal environment and a safe pregnancy outcome.
10. Evaluate expected outcomes for achievement
and effectiveness of care.
Antenatal care
 comprehensive health supervision of a
pregnant woman before delivery
 Or it is planned examination, observation
and guidance given to the pregnant woman
from conception till the time of labor.
Goals
 To reduce maternal and perinatal mortality
and morbidity rates
 To improve the physical and mental health
of women and children
 To ensure that the pregnant woman and her
fetus are in the best possible health.
 To detect early and treat properly
complications
 Offering education for parenthood
 To prepare the woman for labor,
lactation and care of her infant
Terminology Used in Maternity Nursing
 Gestation - pregnancy or maternal
condition of having a developing fetus in the
body.
 Embryo - human conceptus up to the 10th
week of gestation (8th week post
conception).
 Fetus - human conceptus from 10th week
of gestation (8th week post conception) until
delivery.
 Viability - capability of living, usually
accepted as 24 weeks, although survival is
rare, or fetal weight >500 grams.
 Gravida- a woman who is or has been
pregnant, regardless of pregnancy outcome.
 Terminology Used In Maternity Nursing
 Multigravida- a woman who has had 2 or
more pregnancies
 Multipara- a woman who has completed 2
or more pregnancies to the stage of fetal
viability.
 Nulligravida- a woman who has never
been pregnant
 Nullipara- a woman who has not completed
a pregnancy with a fetus who has reached
the stage of fetal viability.
 Terminology Used In Maternity Nursing
 Parity- the number of pregnancies in which
the fetus has reached viability when they
are born, not the number of fetuses (i.e.:
Twins) born. Whether the fetus is born alive
or is stillborn after viability is reached does
not affect parity.
 Postdate or Postterm- a pregnancy that
goes beyond 42 weeks of gestation
 Preterm- a pregnancy that has reached 20
weeks of gestation but before 37 weeks of
gestation
  Primigravida- a woman who is pregnant for
the first time. 1.Baseline Data Collection
 Primipara- a woman who has completed 2.Obstetrical History
one pregnancy with a fetus who have 3.Family History
reached the stage of fetal viability. 4.Current Problem
 Term- a pregnancy from the beginning of
week 38 of gestation to the end of week 42 INITIAL AND SUBSEQUENT VISITS
of gestation.
a. Vital signs
NORMAL DURATION/LENGTH OF PREGNANCY b. Weight

Total weight gain: 20 -25 lb; average of 24 lb;

MONTHS :10 lunar month and upper limit of 25 -35 lb
: 9 calendar month
 1st Tri: 1 lb /mo or 3 – 4 lb total
WEEKS : 38 – 42 Wks. (aver of 40 weeks)  2nd Tri: 0.9 - 1 lb/wk or 10 -12 lb total
DAYS : 280 days - singleton  3rd Tri: 0.5 – 1 lb/wk or 8 – 11 lb total
: 260 days - twins
: 247 days - triplets The pattern of weight gain is more important than
the amount of weight gain

Assessme c. Urine testing for albumin and sugar

nt  Sugar – ideally not more than 1 +
glucose
 Albumin – negative
Examinat Investiga o non pregnant3.5-4.8 g/dL
History
ion tion o pregnant1 g/dL decrease

Protein in the urine could also mean that the body

ASSESSMENT
The provision of prenatal care is the primary factor
in the improvement of maternal and infant morbidity
and mortality statistics. To ensure the success of
the prenatal care program, it should be
remembered that the patients’ understanding of the
modalities of care is basic to cooperative action.
Schedule for Antenatal Visits:
The first visit or initial visit should be made as early
is pregnancy as possible.
Return Visits:
 Once every month till 28 weeks.
 Once every 2 weeks till the 36 w
 Once every week, till labor.
is fighting a minor infection. if in the second half of
pregnancy, as it may be a sign that the mother is
developing pre- eclampsia.
d. Fetal Growth and Development Assessment
 Fundal height (Mc Donald’s Rule)
 Fundus at symphysis pubis indicates 12
weeks' gestation.
 Fundus at umbilicus indicates 20 weeks'
gestation.
 Fundal height corresponds with gestational
age between 22 and 34 weeks.
 Fundus at lower border of rib cage indicates
36 weeks' gestation.
 Uterus becomes globular, and drop
indicates 40 weeks' gestation.

Components of prenatal visit, done during

A greater fundal height suggests:
initial visit:
 Multiple pregnancy.
  Miscalculated due date.
 Polyhydramnios (excessive amniotic fluid).
 Hydatidiform mole (degeneration of villi into
grapelike clusters; fetus does not usually
develop).
 Uterine fibroids.
A lesser fundal height suggests:
 Intrauterine fetal growth restriction.
 Error in estimating gestation.
 Fetal or amniotic fluid abnormalities.
 Intrauterine fetal death.
 SGA.
Fetal heart tones/fetal heart rate
 FHT - palpate abdomen for fetal position.
 Normal - 110 to 160 beats per minute
(bpm).
 Abdominal palpation (Leopold’s maneuver)
 Quickening
 First fetal movement and subsequent
mobility
 Allow client to express concerns, problems,
discomforts and learning needs
Obstetrical History
 Present Obstetric History
 Gravidity, parity.
a. Four-point system [TPAL]
 T - Represents full-term deliveries, 37
completed weeks or more.
 P - Represents preterm deliveries, 20 to
less than 37 completed weeks.
 A - Represents abortions, elective or
spontaneous loss (miscarriage) of a
pregnancy before the period of viability.
 L - Represents the number of children
living. If a child has died, further explanation
is needed for clarification.
 If, for example, a particular woman's history
is summarized as 5-0-2-5, then she has
been pregnant seven times, had five term
deliveries, zero preterm deliveries, two
abortions, and five living children.
b. Five-point system [GTPAL]
 G - Represents gravida.
 T - Represents full-term deliveries, 37
completed weeks or more.
 P - Represents preterm deliveries, 20 to
less than 37 completed weeks.
 A - Represents abortions, elective or
spontaneous loss of a pregnancy before the
period of viability.
 L - Represents the number of children
living. If a child has died, further explanation
is needed for clarification
c. Six-point system [GTPALM]
 G - Represents gravida.
 T - Represents full-term deliveries, 37
completed weeks or more.
 P - Represents preterm deliveries, 20 to
less than 37 completed weeks.
 A - Represents abortions, elective or
spontaneous loss of a pregnancy before the
period of viability.
 L - Represents the number of children
living. If a child has died, further explanation
is needed for clarification.
 M - Represents the number of multiple
gestations and births (not the number of
neonates delivered).
 Ex . G 5, P 5
PRENATAL ASSESSMENT
A. VERIFYING PREGNANCY  Primigravida: 20 weeks
 Signs and Symptoms  Multigravida: 16 weeks
o Presumptive  presence of gas in intestine may also
o Probable stimulate same sensation
o Positive
 Pregnancy Test 6. Pigmentations
 @ 24th week
B. LMP  LINEA NEGRA
o Estimated Date of Delivery/  Striae gravidarum
Confinement
o EDD/ EDC/EDB 7. Breast changes
o Age of gestation  usually noticeable during 1st pregnancy
o Measure Fundic Height  2 weeks after implantation of embryo

Frequency of antenatal appointments B. Probable Signs

 Nulliparous with an uncomplicated - objective signs (signs that can be

pregnancy, a schedule of 10 appointments. documented by the examiner)
 Parous with an uncomplicated pregnancy, a
schedule of 7 appointments. 1. Abdominal enlargement

CONFIRMATION OF PREGNANCY 2. Hegar’s sign

 softening of the lower uterine segment
A. Presumptive signs
- subjective sign 3. Chadwick’s sign
- least indicative of pregnancy  bluish discoloration of the vagina
 at 6th week but easily noted at 8th week
1. Amenorrhea
 impregnation has occurred 4. Ballottement
 stress  a sinking and rebounding of the fetus in
 anemia its surrounding amniotic fluid
 strenuous exercise
5. Goodell’s sign
2. Nausea & vomiting  softening of the cervix
 GI disorder
6. Braxton Hicks’s contraction
 emotional stress
 painless, palpable contractions
3. Frequent Urination
7. Positive pregnancy test
 @ 3 weeks
- measures the HCG secreted by the
 UTI
chorionic villi of implanted ovum
4. Fatigue
 illness HCG - peaks at 60- 70th day
 overexertion

5. Quickening Tests:
a. Enzyme Link Immunosorbent Assay test:
- done as early as 7-10 days
b. Radio Immunosorbent Assay test:
- can detect beta subunit of HCG as early
as 8 days
8. Ladin’s sign
9. Braun von Fernwald’s sign
 irregular enlargement @ the site of
implantation
10. Piskacek’s sign
 tumor like enlargement of the uterus
CGURO…Preggy B U?
Chadwick’s sign
 bluish purplish discoloration of the vagina
Goodell’s sign
 softening of the cervix
Uterine softening (Hegar’s sign)
 lower part of the uterus.
Rising and rebound of fetus when tapped
 (Ballottement).
Outline of the fetus felt through palpitation.

C. Positive signs Braxton hick’s contraction

 painless and irregular.
1. Auscultation of fetal heart sounds
(fetoscope and doppler) Ultrasound
2. Fetal movements felt by the examiner  shows gestational sack.
 24th weeks
3. Visualization of embryo or fetus (ultrasound)
POSITIVE SIGNS
U my gosh! Buntis Me!
PRESUMPTIVE SIGNS
NASALO Q B and sperm?
Ultrasound
 reveals fetal outline (sonogram).
Nausea and vomiting

Amenorrhea Beating of the fetal heart audible

 fetal heart tone
Skin discoloration
 Fetal heart beat – Doppler at 10 – 12
 Chloasma or melasma
weeks; Stethoscope (18 – 20weeks).
 right lower quadrant.
Abdominal changes
 There is uterine enlargement
Movement of the fetus felt by the examiner
 Linea nigra – below the xyphoid process
 fetal movement)
to symphysis pubis.
 Fetal image through ultrasound scanning
 Striae Gravidarum – Lines of Pregnancy

Laging pagod (fatigue)

Overactive bladder (frequent urination)

Quickening

Breast changes – darkening of areola; nipple is

more erectile.

PROBABLE SIGNS ESTIMATE OF EDC/ EDB/ EDD

 EDC/ EDD/ EDB Fetal length

HAASE’S RULE
- 1 to 5 months
(multiply the age of pregnancy by itself)
ex: 4 months x 4 = 16 cm
- 6 to 9 months
(multiply the age of pregnancy by 5)
ex: 6 months x 5 = 30 cm

MC DONALD’S RULE
Example: - Lunar months
Fundal height(cm) x 2/7
LMP: January 1, 2010 ex: 14 cm x 2/7 = 4 months
Date of consult: August 31, 2010 - Weeks:
Fundal height (cm) x 8/7
AOG: Total # of days from LMP up to ex: 14 cm x 8/7 = 16 weeks
date of consult
7
January 30 days
February 28 Total = 242 days  Symphysis–fundal height should be
March 31 AOG = 242 measured and recorded at each antenatal
April 30 7 appointment from 24 weeks.
May 31 34 to 35 weeks  Fetal presentation should be assessed by
June 30 abdominal palpation at 36 weeks
July 31
August 31

Other computations

JOHNSON’S RULE
- Estimation of weight in grams
Formula:
Fundic height in cm – N x K
“K” is constant, it is always 155
“N” is minus 11 if part is not yet engaged
minus 12 if part is already engaged
Example: 21 cm, not engaged
21 – 11 = 10 x 155 = 1,550 gms
Antepartum Assessment & Care
BARTHOLOMEW’S RULE
Physical Examinations:
- The approximate weight gain during
pregnancy is 12 kg.; 2kg in the first 20
weeks and 10 kg in the remaining 20 weeks
(1.5 kg per week until term).
- Fetal heart sound is heard by sonicaid as
early as 10thweek of pregnancy.
 - Fetal heart sound is heard by Pinard's fetal  fantasies about motherhood & about
stethoscope after the 20thweek of having a “dreamchild”
pregnancy.  possible decrease in sex drive

TASK:
Accepting the pregnancy, “I am pregnant”

2. Second Trimester
 alternate feelings of emotional well-
being & lability
 acceptance of pregnancy
 possible increase in sex drive
 adjustment to change in body image

TASK:
Accepting the baby, “A baby is growing inside me”

3. Third Trimester
 feelings of awkwardness & clumsiness
 renewed fears & tension about labor
 spurt of energy during the last month
“nesting instincts”

TASK:
Preparing for parenthood, “I am a mother”

COUVADE SYNDROME
- Group of physiological & behavioral
manifestation experienced by the husband

PSEUDOCYESIS
- Mother or father experience the
presumptive and probable signs of
pregnancy however there is no fetal heart
tone

PSYCHOLOGIC CHANGES OF PREGNANCY

PREGNANCY: maturational crisis

Emotional Responses to Pregnancy
1. First Trimester  Ambivalence
 ambivalence  Grief
 fear  Narcissism
 Introversion vs extroversion
  Body image and boundary
 Stress
 Couvade syndrome – men experience
physical symptoms
 Emotional lability
 Changes in sexual desire
 Changes in the expectant family
 Pregnancy
PHYSIOLOGICAL CHANGES OF PREGNANCY
Reproductive System Changes
1. Uterus
 Enlargement during pregnancy involves
stretching and marked hypertrophy of
existing muscle cells secondary to
increased estrogen and progesterone
levels.
 Increased vascularity in the pelvic
region results:
o Softening of the lower uterine
segment called isthmus - Hegar’s
sign
 The size and number of blood vessels
and lymphatics increase.
o Weight from 60 g to 1000 g;
o length from 7.5 cm to 32 cm;
o width from 4 cm to 24 cm
o depth from 2.5 cm to 22 cm
Fundic height changes
 12th week: level of symphysis pubis
 20th week: the fundus has reached the level
of the umbilicus.
 36th week: the fundus has reached the
xiphoid process.
 Height of over 150 cm indication of an
average-sized pelvis
 Symphysis–fundal height should be
measured and recorded at each antenatal
appointment from 24 weeks.
 Fetal presentation should be assessed by
abdominal palpation at 36 weeks.
at the end of the 5th month, the walls of the uterus
become thinner, allowing palpation of the fetus
• Ballottement - rebounding of fetal head
against examining fingers.
• Braxton Hicks contractions - Painless,
intermittent, irregular, contractions felt by
the mother.
Consists of three layers:
 Parietal peritoneum - serous coat; covers
most of uterus except cervix and anterior
portion of body.
 Myometrium - three layers:
o Outer layer - provides power to
expel the fetus.
o Middle layer - provides contractions
after childbirth to control blood loss.
o Inner layer - provides sphincter
action to help keep cervix closed
during pregnancy.
 Endometrium - highly vascular mucous
membrane; responds to hormonal
stimulation with hypertrophy and secretion;
sloughs if pregnancy does not occur.
Structure of the Uterus
 Located behind the symphysis pubis
between the bladder and the rectum.
 Uterine size increases after childbirth.
 Consists of four parts:
o Fundus
o Body (corpus)
o Isthmus (neck) - lower uterine segment.
o Cervix divided into two sections:
 Supravaginal
 Vaginal
2. Cervix
 Pronounced softening and cyanosis due
to increased vascularity, edema,
hypertrophy, and hyperplasia of the
cervical glands.
 Endocervical glands secrete thick
mucus that forms a cervical plug and
obstructs the cervical canal. This plug
prevents bacteria and other substances
from entering and ascending into the
uterus; mucus plug appears at week 7
Goodell’s sign
 softening of the cervix.
  due to the increased vascularity and
hyperemia caused by increased estrogen
levels.
o Non pregnant – consistency of the tip
of the nose
o Pregnant - consistency of the ear lobe
o Ripe for labor – consistency of whipped
butter
 Evidence of Goodell’s sign, softening of
the cervix. This sign is due to the increased
vascularity and hyperemia caused by
increased estrogen levels.
3. Vagina
 Increased vascularity, hyperemia, and
softening of connective tissue in skin
and muscles of the perineum and vulva.
 Increased vascularity resulst to bluish or
purplish dsicoloration of the vaginal
mucosa – Chadwick’s sign
 Vaginal secretions increases
o Leukorrhea – a whitish, mucoid,
non-foul, non-pruritic vaginal
secretion added protection from
bacterial invasion
4. Ovaries
 Ovulation ceases during pregnancy;
maturation of new follicles is suspended.
 One corpus luteum functions during
early pregnancy (first 10 to 12 weeks),
producing mainly progesterone.
However, small levels of estrogen and
relaxin are also produced by the
corpus luteum.
Steroid Hormones
Estrogen:
- The three classic estrogens during
pregnancy are ;
 estrone
 estradiol
 estriol (90%)
Progesterone:
- Is initially secreted by the corpus luteum
and later by the placenta.
- Plays a critical role in the maintenance of
the pregnancy by suppressing the maternal
immunologic response to the fetus and the
rejection of the trophoblasts.
- Progesterone also helps to maintain the
endometrium, inhibits uterine contractility,
helps in the development of breast lobules
for lactation, stimulates the maternal
respiratory center, and relaxes smooth
muscle.
Relaxin:
- Secreted primarily by the corpus luteum.
Can be secreted in small amounts by the
decidua and the placenta.
- Inhibits uterine activity, decreases the
strength of uterine contractions, softens the
cervix, and remodels collagen.
- Placenta major endocrine organ in
pregnancy
5. Breasts
 Tenderness and tingling occur in early
weeks of pregnancy.
 Increase in size by second month,
hypertrophy of mammary alveoli. Veins
become more prominent, and striae may
develop as the breasts enlarge.
 Nipples become larger, more deeply
pigmented, and more erectile early in
pregnancy.
 Colostrum -a yellow secretion rich in
antibodies, may be expressed by
second trimester.
 Areolae become broader and more
deeply pigmented. The depth of
pigmentation varies with the person's
complexion.
 Scattered through the areola are a
number of small elevations (glands of
Montgomery), which are hypertrophic
sebaceous glands.
 6. Pelvis
Bones of the Pelvis
The pelvis is composed of four bones:
A. Two innominate bones (hip bones)
form the sides and front.
B. Sacrum and coccyx form the back.
Pelvic bones are held together by
fibrocartilage of the symphysis pubis
and several ligaments.
Divisions of the Pelvis
 False pelvis
o lies above an imaginary line called
the linea terminalis or pelvic brim.
o Function of the false pelvis is to
support the enlarged uterus.
 True pelvis
o lies below the pelvic brim or linea
terminalis; it is the bony canal
through which the fetus must pass.
o It is divided into three planes: the
inlet, the midpelvis, the outlet.
Inlet:
 Transverse - Largest diameter of inlet
 anteroposterior -Smallest diameter of
inlet most important diameter of inlet
 measured clinically by diagonal
conjugate
Obstetric (true) conjugate - distance between
inner surface of symphysis and sacral promontory.
This is the shortest anteroposterior diameter
through which the fetus must pass.
Midpelvis:
 Bounded by inlet above and outlet below -
true bony cavity. Contains the narrowest
portion of the pelvis.
Outlet:
 Lowest boundary of the true pelvis.
• Bounded by lower margin of symphysis
in front, ischial tuberosities on sides, tip
of sacrum posteriorly.
• Most important diameter clinically is
distance between the tuberosities.
Endocrine System Changes
PLACENTA
This is a fetomaternal organ.
It has two components:
• Fetal part – develops from the chorionic
sac
• Maternal part – derived from the
endometrium
• The placenta and the umbilical cord are a
transport system for substances between
the mother and the fetus.
Function Of The Placenta:
1. Protection.
2. Nutrition.
3. Respiration.
4. Excretion.
5. Hormone production,
(progesterone,estrogen,Gonadotrop
hins
 DECIDUA
Definition:
1. It is the functional layer of endometrium of
the gravid (pregnant) uterus.
2. It includes the endometrium of fundus &
body of uterus
3. The endometrium of the cervix does not
form a part of decidua.
Cause of formation:
1. Trophoblast secretes chorionic
gonadotrophins which prolong the life of
corpus luteum
2. The corpus luteum of pregnancy continues
to secrete progesterone till the 20th week
3. The increasing level of progesterone in
maternal blood induces changes in the
endometrial into decidua
Steps of formation (decidual reaction):
1. The endometrium becomes thicker & more
vascular
2. The endometrial glands become full of
secretion
3. The connective tissue cells enlarge due to
accumulation of lipid & glycogen.
4. They are called “decidual cells”
1. Decidua basalis
- It lies at the site of implantation, it
forms the maternal part of the
placenta
2. Decidua capsularis
- it covers the conceptus
3. Decidua parietalis
- the rest of the endometrium that
lines the body & the fundus.
DEVELOPMENT OF PLACENTA
Until the beginning of the 8th week, the entire
chorionic sac is covered with villi, (C).
As the chorionic sac grows, only the part that is
associated with Decidua basalis retain its villi, (D).
Villi of Decidua capsularis compressed by the
developing sac.
Thus, two types of chorion are formed: Chorion
frondosum (villous chorion) Chorion laeve – bare
(smooth) chorion
 PRIMARY CHORIONIC VILLI

At the end of 2nd week, finger-like

processes formed of outer syncytiotrophoblast &
inner cytotrophoblast appear

SECONDARY CHORIONIC VILLI

The villous chorion will form the fetal part of the Early in 3rd week, extraembryonic
placenta. mesoderm extends inside the villi

The decidua basalis will form the maternal part of

the placenta.

The placenta will grow rapidly.

By the end of the 4th month, the decidua basalis is

almost entirely replaced by the cotyledons.

1. Fetal Part: Villous Chorion

2. Maternal Part: Decidua Basalis
TERTIARY CHORIONIC VILLI
During 3rd week, arterioles, venules &
capillaries develop in the mesenchyme of villi & join
umbilical vessels
By the end of 3rd week, embryonic blood begins to
flow slowly through capillaries in chorionic villi
PLACENTA
A) MATERNAL SURFACE
Irregular, divided into convex areas (cotyledons)
B) FETAL SURFACE: smooth, transparent,
covered by amnion with umbilical cord
attached near its center & umbilical vessels
radiating from it

FULL-TERM PLACENTA

Cotyledons –about 15 to 20 slightly bulging villous

areas. Their surface is covered by shreds of
decidua basalis from the uterine wall.
After birth, the placenta is always carefully
inspected for missing cotyledons.
Cotyledons remaining attached to the uterine wall
after birth may cause severe bleeding.
(500 -600 gm- Diameter 15-20 cm)
Fetal surface: It separates fetal from maternal blood.
This side is smooth and shiny. It is covered by It prevents mixing of them.
amnion. It is an incomplete barrier as it only prevents large
The umbilical cord is attached close to the center molecules to pass (heparin & bacteria)
of the placenta. But cannot prevents passage of viruses (e.g.
rubella), micro-organisms (toxoplama, treponema
The umbilical vessels radiate from the umbilical pallidum) drugs and hormones.
cord. BIRTHING PLAN
They branch on the fetal surface to form chorionic
vessels. BIRTHING PLAN
They enter the chorionic villi to form
arteriocapillary-venous system. NURSING CARE PLANNING BASED ON 2020
NATIONAL HEALTH GOALS:
PLACENTAL MEMBRANE • Increase the proportion of pregnant woman
who attend a series of prepare childbirth
classes.
• Increase the proportion of pregnant woman
who receive early and adequate prenatal
care from a baseline
• Increase the proportion who delivering a
livebirth who received preconception health
behaviors

Three important decisions families need to

make before labor includes:
 Choice of birth attendant
 Choice of setting
 How much and what type of analgesic they
want to use in labor.

For Child birth and Parenting Education

 Assessment- couples readines for decision
making about child birth as well as
providingfoundation information early in the
process can help woman or couples make
plans for child birth.
This is a composite structure that separating the
 Nursing diagnosis - tend to cluster around
fetal blood from the maternal blood.
whether the woman or couple is sure about
their decision about the childbirth setting
It has four layers:
and childbirth preparation.
• Syncytiotrophoblast
Ex. Health seeking behavior re/ted to
• Cytotrophoblast
learning more about childbirth and newborn
• Connective tissue of villus
care.,
• Endothelium of fetal capillaries
 Outcome identification and planning
 Implementation
After the 20th week, the cytotrophoblastic cells
 Outcome evaluation
disappear and the placental membrane consists
only of three layers.
Common Discomfort of Pregnancy
1.Nausea and vomiting
• due to altered hormone levels usually
occurring on 1st trimester
• sedatives or antiemetics as necessary or as
ordered
• advise expectant mother to eat dry crackers
before arising in the morning to prevent N/V
• modify diet to small and frequent feedings
• ice chips
• avoid, greasy, highly seasoned food, take
adequate fluids in between meals, eat high
protein snacks at bedtime
2.Heartburn
• Caused by regurgitation of gastric
secretions to esophagus due to decreased
gastric motility
• Maalox or Gelusil as prescribed, avoid
taking sodium bicarbonate
• Educate expectant mother to eat small and
frequent meals and avoid lying down after
meals
• Avoid overeating, ingesting fatty or fried
foods
3.Constipation
• Due to the pressure of growing uterus on
bowel and decreased peristalsis
• Educate women regarding good bowel
habits, take a high fiber diet
• Encourage increased fluid intake and
regular exercise
4. Hemorrhoids
• Prevent occurrence by encouraging good
bowel habits
• Teach patient to rest in modified Sims
position / knee-chest position
• Apply warm compress, avoid constipation
and take hot sitz bath
5.Backache
• Due to increased spinal curvature
secondary to altered posture
• Instruct mother proper posture and
exercises such as pelvic rock and tailor
sitting
• Teach importance of proper shoes, firm
mattress, and sufficient rest
6.Leg cramps
• Caused by pressure on nerves of lower
extremities and also due to decreased
calcium absorption due to increased
circulating phosphorus
• Medications such as Amphojel as ordered
to decrease circulating phosphorus
• Instruct woman to dorsiflex foot to involve
leg to relieve discomfort
7.Edema of lower extremities
• Due to impeded venous return because of
pressure on lower extremities of enlarging
uterus
• Instruct woman to take frequent rest periods
with legs elevated to facilitate venous return
• Instruct against wearing of constricting
garters and undergarments to prevent
pooling of blood
8.Varicose veins
• Pooling of blood in lower extremities
• Teach woman to raise legs against wall for
15-20 minutes daily
• Encourage 2 short walks daily
• Encourage increased intake of vitamin C
• Avoid tight or constricting hosiery or garters
9.Increased vaginal discharge
• Due to increased estrogen levels and
increased blood supply to vagina
• Instruct woman to bathe daily, no douching
unless prescribed.
• Wear cotton crotch underwear
• Report any burning, redness, or change in
vaginal discharges
10.Flatulence
• Due to progesterone effect the GI tract
relaxes
• Eat small frequent meals
• Avoid gas-forming foods

11.Frequency of urination
• Due to uterine pressure on the bladder
• Increase fluids but restrict in the late
afternoon
• Do Kegel exercises
• Practice regular voiding
• Practice frequent flushing ‘front to back’
• Report any burning sensation, dysuria,
cloudy urine or tea-colored urine

12.Fatigue
• Have adequate rest and sleep
• Avoid prolonged standing
• Practice good body mechanics
• Report increasing fatigue with regular
activities – danger in of heart problem

13.Faintness/supine hypotensive syndrome/

vena caval syndrome
• Avoid sudden change in position
• Avoid in supine position in 2nd and 3rd
trimester
• Arise from a bed from a lateral position and
gradually
• Avoid staying in one position for long period
• Assume frequent left lateral position in bed

14.Shortness of breath
• Maintain good posture
• Avoid fatigue
• Elevate head with pillows
• Avoid constricting bra and other tight
clothes
• Report increasing dyspnea with minimal
activity or prior to 36 weeks.