Contraception and fetal development and parental Care L&D

• Preconception planning for health history includes

  • Limit smoking and alcohol use
  • Evaluation of existing conditions and medications (Teratogens)
  • Cessation of birth control in order to conceive
• Preconception planning education includes

  • Diet and prenatal vitamins with folic acid
  • Weight, physical fitness/activity
  • Smoking, drug, and alcohol cessation offer resources available
  • Safe food handling and environmental risks
  • Healthy relationship and parenting support
• Conception key principles

  • Ovum released into fallopian tube viable for 24 hours
  • Sperm in vagina viable for 48 –72 hours
  • Chromosomes pair up to make diploid zygote (23 + 23= 46)
  • Sex of zygote determined at moment of fertilization
• Can predict baby's delivery date by using first day of last menstrual period. 1st day of LMP - 3 months + 7 days
• Prenatal nursing considerations

  • Adaptation and changes (weight gain, relationships with family)
  • Acceptance: normal to initially have feelings of ambivalence
  • Prenatal classes and education resources
  • Concerns with birth, hospitalization, after care
  • Creation of a birth plan
• A visit schedule: Every 4 weeks for the first 28 weeks' gestation. Then every 2 weeks from 28 weeks until 36 weeks' gestation. After week 36, every week until childbirth.
• Prenatal assessments include

  • Vital signs and weight
  • Uterine size and fetal heartbeat
  • Testing: Urinalysis, blood test, group B strep
  • Expected psychological state of pregnancy
  • Re-evaluation/ prenatal history-questions will change
• GTPL stands for: G= any pregnancy T= number of term infants born

  P= number of preterm infants born (20–37 weeks) A= number of spontaneous or therapeutic abortions L= number of currently living children
• Abortion: A birth that occurs before the end of 20 weeks gestation

  -Abortions are classified as spontaneous or theraputic
• Spontaneous: Naturally occurring abortion, from a multitude of causes, cause not always known
• Therapeutic abortion: Medically induced, a variety of methods are used depending on the gestational age of the fetus
• Stillbirth: A birth of an infant whom is dead, occurring after 20 weeks gestation
• Umbilical cord: develops from amnion and contains 2 arteries and 1 vein surrounded by wharton's jelly (specialized connective tissue & protects blood vessels). Function is it provides circulatory pathway to embryo.
• Placenta: Develops at site where embryo attaches to uterine wall 3 weeks after conception. Function is it provides metabolic and nutrient exchange between embryonic and maternal circulation

  • Maternal portion: surface appears red and flesh like
  • Fetal portion: appears shiny and gray
• Label the maternal and fetal side

  A) Maternal

  B) Fetal

  
• Fetal development

  • 4 weeks the fetus heart begins to beat
• Fetal development

  • 8 weeks all body organs are formed (injury to mom can impact organs being developed)
• Fetal development

  • 8 - 12 weeks fetal heart rate can be detected
• Fetal development

  • 16 weeks the sex of the baby can be detected, looks like a baby on an ultrasound image
• Fetal development

  • 20 weeks heart beat can be detected, mother experiences quickening, baby develops a regular schedule, vernix and lanugo is present, head hair, eyebrows, and eyelashes are present
• Fetal development

  • 24 weeks weighs 780 g, increasingly active, respiratory movements begin, sucking movements
• Fetal development

  • 28 weeks eyes open/close, baby can breathe, surfactant is developed, baby is 2/3 final length
• Fetal development

  • 32 weeks fingernails and toes form, subcutaneous fat is developing, less red and wrinkled
• Fetal development

  38 + weeks baby fills entire uterus, receiving antibodies from mother
• Multiple gestation (Therapeutic management): serial ultrasound, close monitoring during labor, operative delivery (common)
• Multiple gestation (nursing assessment): Uterus larger than expected for EDB (estimated delivery birth), ultrasound confirmation
• Multiple gestation (nursing management): education and support antepartally (labour management with perinatal team on standby), postpartum assessment for possible hemorrhage
• Dichorionic= 2 separate placentas

  Diamniotic= 2 separate amniotic sacs

  Can be monozygotic (identical) or Dizygotic (fraternal)

  In the picture is an example of twins having separate placentas

  
• Dichorionic= 2 separate placentas

  Diamniotic= 2 separate amniotic sacs

  Monozygotic (identical) or Dizygotic (Fraternal)

  In the picture is an example of twins having fused placenta

  
• Monochorionic= 1 shared placenta

  Diamniotic= 2 separate amniotic sacs

  Monozygotic (identical) only

  In the picture is an example of twins having 1 placenta and 2 separate amniotic sacs

  
• Monochorionic= 1 shared placenta

  Monoamniotic= 1 shared amniotic sacs

  Monozygotic (identical) only

  In the picture is an example of twins having 1 placenta and 1 amniotic sac *Most dangerous**cord accidents*

  
• Presumptive changes (signs of pregnancy)

  • Subjective changes experienced by a woman
  • Cannot be used to diagnose pregnancy
  • Examples: Amenorrhea (no periods), nausea, vomiting, excessive fatigue, urination frequency, breast changes, quickening, weight changes
• Probable changes (signs of pregnancy)

  • Objective changes that can be observed by woman or examiner
  • These changes alone cannot confirm pregnancy
  • Example: Pelvic organ changes, enlarged abdomen with amenorrhea, Braxton hicks contractions, changes in skin pigmentation, fetal outline, pregnancy test
• Positive changes (signs of pregnancy)

  • Objective changes cannot be confused with a pathologic state and can be measured conclusively
  • Example: Fetal heart beat, fetal movement, visualization of fetus via ultrasound
• First trimester are between weeks 1 - 12
• First trimester S/S are: nausea, vomiting, fatigue, swollen and tender breast, headache, taste changes, mood swings, constipation, urinary frequency, heart burn and weight changes
• Second trimester are between weeks 13 - 28
• Second trimester S/S are: Body aches, stretch marks, darkening of the skin around nipples, linea nigra, darker patches on the face, carpal tunnel syndrome, insomnia, itchiness, swelling of ankles, face, and fingers
• Third trimester are betweek weeks 29 - 40 +
• Third trimester S/S are: SOB, heartburn, swelling, hemorrhoids, tender breast without colostrum leakage, umbilical protrusion, difficulty sleeping, lightening, and Braxton Hicks contractions