Chapter 9

Nursing Care During Normal

Pregnancy and Care of the
Developing Fetus
Fetal Growth and Development #1

Stages of development
o Fertilization (also referred to as conception and
impregnation): union of ovum and spermatozoon
o Implantation: contact between growing structure and
uterine endometrium, approximately 8 to 10 days after
fertilization

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Ovulation, Fertilization, and Implantation

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Fertilization (also referred to as conception and
impregnation) is the union of an ovum and a
spermatozoon.
This usually occurs in the outer third of a fallopian
tube, termed the ampullar portion.
 only one of a woman’s ova reaches maturity each
month.
ovum is capable of fertilization for only about 24
hours (48 hours at the most)
functional life of a spermatozoon is also about 48
hours, possibly as long as 72 hours
 the total critical time span during which sexual
relations must occur for fertilization to be successful
is about 72 hours (48 hours before ovulation plus 24
hours afterward
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Stages of Fetal Development

Pre-embryonic (first 2 weeks, beginning with

fertilization)
• Embryonic (weeks 3 through 8)
• Fetal (from week 8 through birth)

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Fetal Growth and Development #2

End of fourth gestational week

End of eighth gestational week
End of 12th gestational week (first trimester)
End of 16th gestational week
End of 20th gestational week
End of 24th gestational week (second trimester

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Fetal Growth and Development #3

End of 28th gestational week

End of 32nd gestational week
End of 36th gestational week
End of 40th gestational week (third trimester)

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Name Time Period
Ovum From ovulation to fertilization
Zygote From fertilization to implantation
Embryo From implantation to 5–8 weeks
Fetus From 5–8 weeks until term
Conceptus Developing embryo and placental
structures throughout pregnancy
Age of viability
The earliest age at which fetuses survive if they are
born is generally accepted as 24 weeks or at the
point a fetus weighs more than 500–600

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Fetal Growth and Development #4

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Critical Periods of Fetal Growth

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2020 National Health Goals Related to
Fetal Growth

Reduce the fetal death rate (death between 20 and

40 weeks of gestation) to no more than 5.6 per
1,000 live births from a baseline of 6.2 per 1,000.
Reduce low birth weight to an incidence of 7.8% of
live births and very low birth weight to 1.4% of live
births from baselines of 8.2% and 1.5%.
Increase the proportion of women of childbearing
potential with an intake of at least 400 mg of folic
acid from fortified foods or dietary supplements from
a baseline of 23.8% to 26.2%.

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Assessing Fetal Growth and Development
#1

Reasons for testing

o Predict outcome of pregnancy
o Manage remaining weeks of pregnancy
o Plan for possible complications at birth
o Plan for problems that may occur in newborn
o Decide whether to continue pregnancy
o Find conditions that may affect future pregnancies

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Assessing Fetal Growth and Development
#2

Health history
Physical examination
Estimating fetal health
o Fetal growth
 McDonald’s rule

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Assessing Fetal Growth and Development
#3

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Measuring Fundal Height

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Assessing Fetal Growth and Development
#4

Fetal well-being
o Fetal movement (kick counts)
o Fetal heart rate
o Ultrasonography
o Biophysical profile
o MRI

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Measuring Fetal Heart Rate

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Assessing Fetal Growth and Development
#5

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Assessing Fetal Growth and Development
#6

Maternal serum analysis

o Maternal serum α-fetoprotein
o Maternal serum for pregnancy-associated plasma protein
A
o Quadruple screening
o Fetal gender

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Assessing Fetal Growth and Development
#7

Invasive fetal testing

o Chorionic villi sampling
o Amniocentesis
o Percutaneous umbilical blood sampling
o Fetoscopy

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Amniocentesis

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Nursing Diagnoses: Fetal Growth and
Development

Focus on mother, family, and fetus

o Readiness for enhanced knowledge related to usual fetal
development
o Anxiety related to lack of fetal movement
o Deficient knowledge related to need for good prenatal care
for healthy fetal well-being

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Nursing Outcomes: Fetal Growth and
Development

Outcome identification and planning

o Parental education
 Be realistic
 Based on parents’ previous knowledge and desire for
information
 Explain additional assessment measures needed

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Quality & Safety Education for Nurses
(QSEN)

Patient-Centered Care
Teamwork & Collaboration
Evidence-Based Practice
Quality Improvement
Safety
Informatics

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Implementing Nursing Care

Teaching about fetus at various points in pregnancy

to help parents visual coming newborn
Teaching about healthy behaviors
Showing sonogram to help initiate bonding
Individualize care

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Evaluating Nursing Care

Outcomes evaluation
o Were healthy lifestyle changes made?
o Do the parents have confidence that baby is healthy and
growing?

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Question #1

A fetus is able to maintain blood circulation in utero by

the presence of circulatory shunts. The nurse
understands this is because the ductus arteriosus in
utero shunts blood in which direction?
A. Left to right heart atria
B. Aorta to the pulmonary veins
C. Right ventricle to the aorta
D. Pulmonary artery to the aorta

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Answer #1

D. Pulmonary artery to the aorta

Rationale: Because the fetal lungs are not inflated, blood
must be diverted past them. The ductus arteriosus helps to
do this by shunting blood from the pulmonary artery to the
aorta.

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Question #2

Mrs. Smith asks the nurse to compute her expected

due date. Based on the fact that her last menstrual
flow began on July 20, which due date would the
nurse estimate?
A. April 27
B. March 13
C. April 13
D. May 20

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Answer #2

A. April 27
Rationale: Naegele’s rule is to count backward 3 months and
add 7 days from the first day of the last menstrual period to
determine an expected due date.

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Question #3

Which of the following nursing interventions is

appropriate when preparing a woman for an
amniocentesis?
A. Inform her that a narcotic premedication will be given to
prevent pain during needle insertion.
B. Be certain she knows that there is a slight risk of
complication, such as premature labor, from amniocentesis.
C. Instruct her not to empty her bladder prior to the procedure.
D. Suggest that she take a deep breath and hold it during
needle insertion.

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Answer #3

B. Be certain she knows that there is a slight risk of

complication, such as premature labor, from
amniocentesis.
Rationale: Amniocentesis carries a slight risk of beginning
labor. The woman should not hold her breath because that
depresses the diaphragm, shifts the contour of the uterus,
and may shift the location of the placenta to the chosen
needle insertion site. The bladder should be emptied to
avoid accidental puncture.

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