Maternal: Risk and Diseases in Pregnancy

• ■ Ovum expelled from graafian follicle (ovulation); then sperm unites with ovum (fertilization) in fallopian tube within 24hr

  ■ Fertilized ovum attaches to uterine endometrium (implantation)

  ■ Conceptus called embryo (first 8wk), then fetus

  ■ Trimesters: 1st (0–15wk); 2nd (16–27wk); 3rd (28–37/40wk)
• Fetal heart audible with Doptone after 12wk

  ■ Fetal lungs produce pulmonary surfactants at 24 to 28wk

  ■ Deposits of brown fat begin at 28wk; most ↑wt in 3rd trimeste
• ENDOCRINE CHANGES

  ■ Placenta secretes human chorionic gonadotropin (hCG); used for pregnancy screening; has role in AM nausea

  ■ Progesterone and estrogen from corpus luteum in 1st trimester; from placenta in 2nd and 3rd trimesters

  ■ Thyroid, parathyroids, and pancreas ↑secretions; need for ↑insulin

  ■ Estro levels ↑; excess in maternal saliva may indicate preterm labor
• ■ Ovum expelled from graafian follicle (ovulation); then sperm unites with ovum (fertilization) in fallopian tube within 24hr

  ■ Fertilized ovum attaches to uterine endometrium (implantation)

  ■ Conceptus called embryo (first 8wk), then fetus

  ■ Trimesters: 1st (0–15wk); 2nd (16–27wk); 3rd (28–37/40wk)
• Amenorrhea and leukorrhea are common signs of reproductive changes during pregnancy related to the menstrual cycle.
• An increase in vaginal acidity contributes to protecting against bacterial invasion during pregnancy.
• Goodell’s sign, Chadwick’s sign, and Hegar’s sign are three cervical/uterine changes associated with pregnancy, and their corresponding signs include cervical softening, bluish discoloration of the cervix, and softening of the isthmus.
• The uterus is in the pelvic cavity at 12–14 weeks, moves to the abdominal cavity at 22–24 weeks, and reaches the umbilicus at term, extending almost to the xiphoid process.
• Some of the breast changes during pregnancy include fullness, tingling, soreness, darkening of areolae and nipples, nipples becoming more erect, veins becoming more prominent, reddish stretch marks, and enlargement of Montgomery’s follicles.
• Question: During pregnancy, what should a nurse regularly assess to monitor the progress of gestation?

  Fundal height
• Question: What contributes to an increase in salivation during pregnancy?

  Hormonal changes.
• Question: Define pica in the context of pregnancy-related changes.

  Answersubstances not normally edible.
• 1. Question: Identify two gastrointestinal symptoms during pregnancy caused by delayed stomach emptying and pressure from the uterus.Answer: Heartburn and gastric reflux.
  2. Question: What is the primary cause of flatulence during pregnancy?Answer: Decreased GI motility and air swallowing
• 1. Question: Why does constipation commonly occur during pregnancy?Answer: It is primarily due to decreased peristalsis, pressure from the uterus, and the presence of hemorrhoids.
  2. Question: List three nursing interventions to help alleviate gastrointestinal discomfort during pregnancy.Answer:

  • Teaching to avoid gastric irritants, gas-forming foods, and antacids containing sodium.
  • Advising to remain upright for one hour after meals.
  • Recommending small, frequent meals and having dry crackers before getting up.
• Question: What lifestyle changes and interventions are recommended for managing hemorrhoids during pregnancy?

  Answer: Avoiding straining at stool and prolonged sitting, using warm sitz baths or ice packs, and applying anesthetic ointments.
• HUMAN CHORIONIC GONADOTROPIN (HCG)

  ■ Tests for pregnancy

  ■ hCG is produced by cells covering the chorionic villi of placenta

  ■ Detectable 8 days after conception

  ■ ↓Or slowly elevating levels:Threatened abortion, ectopic pregnancy ■ ↑Levels: May indicate ectopic pregnancy, hydatidiform mole, Down syndrome
• Question: What is the primary purpose of Maternal Serum Alpha-Fetoprotein (MS-AFP) screening during pregnancy?

  Answer: To screen for neural tube defects in the fetus.
• Question: At what point in gestation do peak concentrations of MS-AFP occur?

  Answer: At the end of the first trimester.
• Question: What is the optimum time for performing MS-AFP screening?

  The 16-18th week of gestation.
• Question: What does an increase in MS-AFP levels indicate in terms of fetal risk?

  Answer: risk for open neural tube defect.
• Question: In the context of MS-AFP screening, what does a decrease in levels suggest regarding fetal risk?

  Answer: A decrease in levels suggests a risk of Down syndrome.
• Question: When persistently decreased MS-AFP levels are observed, what additional diagnostic procedures are typically recommended?

  Answer: Ultrasonography for structural anomalies and amniocentesis for chromosomal analysis are done.
• Gestational diabetes occurs in pregnancy, usually in the second or third trimester, in clients not previously diagnosed as diabetic.
• Gestational diabetes happens when the pancreas cannot respond adequately to the increased demand for insulin.
• Screening for gestational diabetes should be done between 24 and 28 weeks of gestation.
• A 3-hour oral glucose tolerance test is conducted to confirm gestational diabetes mellitus.
• Gestational diabetes can often be treated by diet, but some clients may need insulin.
• Most women return to a euglycemic state after birth, but they have an increased risk of developing diabetes mellitus in their lifetimes.
• Older than 35 years, obesity, multiple gestation are factors that predispose a woman to gestational diabetes.
• Family history of diabetes mellitus and a large for gestational age fetus are additional factors that contribute to the predisposition to gestational diabetes.
• Excessive thirst, hunger, weight loss are signs of hyperglycemia that may be observed during the assessment of gestational diabetes.
• Maternal complications related to gestational diabetes can include signs of gestational hypertension, polyhydramnios, recurrent urinary tract infections, and vaginal yeast infections.
• Glycosuria and ketonuria are potential indicators of gestational diabetes.
• The primary interventions for managing gestational diabetes include diet, medications, exercise, and blood glucose determinations to maintain levels between 65 mg/dL and 130 mg/dL, as prescribed.
• Monitoring for signs of hyperglycemia, glycosuria, and ketonuria, as well as hypoglycemia, is crucial during interventions for gestational diabetes.
• During labor, fetal status should be continuously monitored for signs of distress in a mother with gestational diabetes.
• Labor depletes glycogen, and maintaining glucose levels is crucial for women with gestational diabetes.
• In the postpartum period, hypoglycemic reaction should be monitored closely in a mother with gestational diabetes, as a precipitous decline in insulin requirements occurs.
• Insulin needs should be re-regulated after childbirth according to blood glucose testing.
• Dietary needs in the postpartum period for a woman with gestational diabetes should be assessed based on blood glucose testing and insulin requirements.