week 3-4

• Preconception planning

  • Limit smoking an etoh use
  • Some medications are teratogens
  • Cessation of birth control in order to conceive
• Education

  • Healthy diet: prenatal vitamins

  Folic acid- prevents neural tube defects

  • Only a 25-40 pound weight gain
  • Exercise: walking, weight bearing, swimming
  • Safe food handling
  • Do not pick up cat feces
• ABC’s of conception

  1. Ovum released into fallopian tube- viable for 24 hours
  2. Sperm deposited into vagina- viable for 48-72 hours
• • Chromosome pairs split up to produce diploid zygote
  • 23+23=46
  • Zygote contains new combination of genetic material
  • Sex of zygote determined at moment of fertilization
• Nageles rule

  • 1st day of LMP subtract 3 months and add seven days
  • Can be difficult as periods are irregular and can affect ovulation
• Prenatal considerations

  Adaptations- weight gain, additional hormones, changes in personal relationship

  Prenatal classes and education resources

  Creation of birth plan- communication between healthcare providers. Keep in mind labor does not always go according to plan
• Follow up visits- every 4 weeks for first 28 weeks gestation, every 2 weeks from 28 weeks until 36 weeks gestation, after 36 week- every week until childbirth

  • Gestational hypertension+diabetes= extra screening/care
• 1st Trimester ultrasound- important for:

  • Premature babies and knowing exact dates
  • Adjust dates(miscarage then get pregnant right away
• Prenatal assessments- vitals and weight, uterine size and fetal heartbeat, Tests: urinalysis, blood tests, group b strep test, re-evaluation/prenatal history-questions will change
• Gravida + TPAL

  G- any pregnancy, regardless of duration, including present pregnancy

  T- number of term infants born(37/0 and after)

  P- number of preterm infant born(20/0, 36/6)

  A-number of pregnancies ending in either spontaneous or therapeutic abortion

  L- number of living children
• Abortion- a birth that occurs before the end of 20 weeks gestation

  • Spontaneous: naturally occurring from a multitude of causes, cause not always known
  • Therapeutic: medically induced
  • Stillbirth: a birth of an infant whom is dead< occurring after 20 weeks gestation
• Umbilical cord: develops from amnion
• Contains two arteries and one vein; surrounded by Wharton's jelly to protect vessels

  • Wharton's jelly: specialized connective tissue that protect blood vessels, less wharton's jelly puts baby at risk
• Placenta: developed at site where embryo attaches to uterine wall at 3rd week after conception
• Metabolic and nutrient exchange between embryonic and maternal circulation
• Maternal portion- surface appears red and flesh-like

  Fetal portion- appears shiny and gray
• 4 weeks: the fetal heart begins to beat
• 8 weeks: all body organs are formed(if something happens to mom during this stage, it can effect babies organ development)
• 8-12 weeks: fetal heart rate can be detected
• 16 weeks: the sex of the baby can be detected, looks like a baby on an ultrasound image
• 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 present
• 24 weeks: weighs 780g, increasingly active, respiratory movements begin, sucking movements
• 28 weeks: eyes open/close, baby can breath, surfactant is developed
• 32 weeks: fingernails and toenails from, subcutaneous fat is developing less red and wrinkled
• 38+ weeks: baby fills entire uterus, reciving antibiotics from mother
• Multiple gestation

  Therapeutic management: serial ultrasounds, close monitoring during labor, operative delivery

  Nurse assess- uterus larger than expected for EDB
• Monochorionic-monoamniotic is most dangerous- cords can wrap around each other and twins can fuse together

  A)
• Dichorionic-Diamniotic

  A)

  
• Monochromic-monoamniotic

  
• Monochorinic-diamniotic

  A)

  
• Dichorionic-diamniotic

  A)

  
• Presumptive

  • Subjective changes experienced by a women
  • Cannot be used to diagnose pregnancy
  • Amenorrhea, nausea and vomiting, excessive fatigue, urinary frequency, breast changes, quickening, weight changes
• Probable

  • Objective changes can be observed by the women or an examiner
  • These changes alone cannot confirm pregnancies
  • Pelvic organ changes, enlargement of the abdomen with amenorrhea, braxton hicks contractions, changes in skin pigmentation, fetal outline, pregnancy tests
• Positive

  • Objective changes that cannot be confused with a pathologic state and can be measured conclusively
  • Fetal heartbeat, fetal movement, visualization of the fetus via ultrasound
• First

  Week 1-12

  Extreme fatigue, tender swollen breasts, nausea and vomiting, taste changes, mood swings, constipation, urinary frequency, headache, heartburn, weight changes
• Second

  Week 13-28

  Body aches, stretch marks, darkening of the skin around the nipples, linea nigra, darker patches on the face, carpal tunnel syndrome, insomnia, itchiness, swelling of ankles, fingers and face
• Linea nigra-darkening of line of stomach

  Itching- palms of feet can indicate colestitus
• Third

  Week 29-40+

  Shortness of breath, heartburn, swelling, hemorrhoids, tender breasts with/out colostrum, leakage, umbilical protrusion, difficulty sleeping, lightening, braxton hicks
• Exercise

  • Recommended throughout pregnancy 5x per week for 30 minutes a day
  • Avoid contact sports
  • Pelvic physiotherapy and kegel exercises are recommended
  • For first 4-6 weeks postpartum women should avoid exercise until their follow-up appointment
  • Women having c-section should avoid lifting more than 10 pounds
• Nutritional needs

  • Caffeine should be limited to 1-2 cups a day
  • Avoid- unpasteurized dairy products, raw fish and eggs, deli meats
  • 2nd trimester +340 kcal, 3rd +452
  • Women who are breast feeding require +330kcal per day in first six months; +400kcal per day in next six months