Antepartum period

RAQUEL PONELAS, MAN RN

Menstrual cycle

 The periodically recurring changes in the

hormonal status that prepare the body
for pregnancy

 LMP
 In a 28-day cycle, ovulation is 14 days after
the beginning of the menstrual flow
Menstrual cycle

 PMS
 Headache
 Bloating
 Heaviness in lower abdomen and legs
 Tenderness of breasts
 Food cravings
 Depression and irritability
Conception*
 Fertilization of the ovum by the sperm cell
 Ovum – 12-72H
 Sperm – 24-72H
 Cellular multiplication
 Morula – 12-16 cells
 Implantation – 1 week after
 Pregnancy – 280 days (40 weeks)
Fetal development
 Pre-embryonic (fertilization to 2 weeks)
 Embryonic (2 weeks to 8th week)
 Most critical
 Blastocyts
 Ectoderm – skin, NS
 Mesoderm – muscles/bones, CS, repro, connective
 Endoderm – alimentary and respi, liver, bladder and
pancreas
 Fetal (8th week to 40th week or birth)
 Fetal circulation
Amniocentesis
Contraction stress test/non-stress
test
 Non-stress test (NST)
 Fetal body movements
causes a corresponding
increase in HR
 Reactive NST is desirable
 10-15 beats for 15 secs
lasts 10 mins.
 Non-reactivity may mean:
 Fetal sleep, medications,
fetal immaturity
 Calls for CST or biophysical
profile
 Contraction stress test (CST)
 Uterine contractions cause
changes in FHR
 To assess if fetus can
tolerate labor
 (-) CST is desirable with no
late decelerations
 Contraction is induced by
oxytocin (15 mins) or nipple
stimulation until 3
contractions is (+) in 10
mins
Indications for NST/CST
 PIH  Management:
 DM  L side-lying
 Stimulate fetal activity
 Placenta previa
 Orange juice
 Abruptio placenta  Transvaginal light
 Post maturity  Abdominal
manipulation
 Decreased fetal  Monitor maternal and
activity fetal response
 Biophysical profile
Score 2 Score 0
Fetal breathing 1 or more episodes lasting 30 Not present or not
secsx30 mins lasting 30 secs
Fetal movement 3 or more body/limb movements 2 or fewerbody/limb
x 30 mins movements x 30 mins
Fetal tone 1 or more episodes of active Slow extension with
flexion/extension return to partial flexion,
or movement absent

Fluid assessment 1 or more pocket of amniotic No pocket, or no

fluid 1 cm in 2 perpendicular pocket 1cm in 2
planes perpendicular planes
Fetal reaction Reactive NST Nonreactive NST
Normal physiological changes
 HCG
 Progesterone
 Estrogen
 HPL
 Relaxin
 Nagele’s rule
 GPTPAL
Normal physiological changes
 Presumptive signs
 Amenorrhea
 Nausea and vomiting
 Breast changes
 Urinary frequency
 Easy fatigability
 Abdominal changes
 Quickening
Normal physiological changes
 Probable signs
 Pelvic changes
 Chadwick’s sign
 Hegar’s sign
 Goodels’s sign
 Braxton-Hick’s contractions
 Increased pigmentation
 Linea nigra
 Striae gavidarum
 Chloasma
 Ballotement
 Pregnancy test
Normal physiological changes

 Positive signs
 Fetal movement
 Fetal heart sound
 Fetal visualization
Management
 Pharmacological
 Analgesics (reduce pain perception)
 Morphine, demerol, sublimaze, nubain
 Barbiturates (sedatives)
 Seconal, nembutal, luminal
 Ataractics (tranquilizers)
 Sparine, phenergan, vistaril
 Regional anesthesia
 EpidurAl, spinal, caudal
Management
 Non-pharmacological
 Herbal medications
 Black cohosh for PMS
 Gastric irritation
 Feverfew
 Increased bleeding
 Evening primrose
 Diarrhea, headache, nausea, skin rash

 ALL PAIN MEDICATIONS CROSS THE PLACENTA

Normal physiological changes

 MacDonald method
 Measurement varies as much as 4 weeks
 12-14 weeks uterus is above the
symphysis pubis
 22 weeks equals fundal height in cm
Nutrition
 Add 300 calories/day to diet
 Folic acid to prevent neural tube defect
 Iron (30mg/day)
 Weight gain
 25-35 lbs.
 3.5 lbs. x first 3 months
 1 lb./week thereafter
Nutrition

 Postpartum
 2200-2300 kcal diet is optimum
 2700-2800 kcal for lactating women
 2L of fluid/day
 3L/day for lactating women
Prenatal danger signs
 Vaginal bleeding
 Rupture of membranes
 Severe persistent headache
 Visual disturbances
 Edema of hands and face
 Abdominal pain
 Dysuria
 Persistent vomiting (>1 day)
 Change in, or absence of, fetal movement