Promoting Fetal and Maternal Health

Promoting Fetal and Maternal Health

The health of the fetus and mother are directly linked.

A woman who eats well and takes care of her own health
provides a healthy environment for fetal growth and development.

Education is a major role in nursing care.

Providing empathetic and accurate advice.

Alert for danger signs of pregnancy and current teratogens.

Health Promotion

The nurse will help the family maintain a state of wellness

throughout the pregnancy and into early parenthood.

Nursing Process:

Assessment begins before pregnancy

Plan- goals and outcomes(realistic).

Implementation- teaching is one of the major interventions.

Evaluation- ongoing process aided by regular prenatal health

care visits.
Self-Care Needs

Pregnancy is not an illness so common sense about health care is

all that is required.

Nurse must be alert to misunderstandings, separate fact from

fiction and prevent unnecessary restrictions.

Bathing:

sweating increases

increased vaginal discharge

encourage daily bathing, shower is best

restrict tub bath if cervix dilated ruptured membranes or vaginal

bleeding.
Breast Care:
wear a firm supportive bra with wide straps to spread the weight
across the shoulders.

week 16 colostrum secretions begin; wash daily with clear tap

water (no soap) and dry.

May need gauze squares or breast pads inside bra.

Dental Care:

see dentist regularly

good tooth brushing (gingival tissue tends to hypertrophy during

pregnancy).

Perineal Hygiene:
increased vaginal discharge

douching is contraindicated due to risk for infection and lowers

pH.
Dressing:

common sense and comfort.

avoid garters, firm girdles with panty legs, knee-high stockings,

anything extremely restricting.

Wear shoes with a moderate to low heel.

Sexual Activity:

ask if she has any questions

dispel the myths

intercourse is not harmful to the child

if she has a history of miscarriage she may avoid coitus during

this time in the pregnancy when a previous miscarriage occurred.

membranes ruptured or vaginal spotting may lead to infection

caution about male oral-female genital contact

decreased sexual desire due to increased estrogen levels

breast tenderness

increased clitoral sensation

new positions for intercourse

caution about STDs

Exercise:

prevents circulatory stasis in lower extremities

extreme exercise is associated with lower birth rate.

daily exercise is recommended for 30 minutes; walking is best.

woman can continue any sport she participated in before

pregnancy except contact sports.

Avoid aerobics, jogging, hot tubs or saunas.

Sleep:

needed for building new body cells and increased metabolic

demand

may need rest periods during the afternoon

modified Sims position is best. This puts the weight of the fetus
on the bed and allows good circulation in the lower extremities

avoid supine position due to supine hypotension syndrome

avoid sitting or lying with knees sharply bent due to increased

risk of venous stasis below the knee.

Employment:

There are few reasons women cannot continue to work

throughout pregnancy.

Some reasons involve exposure to toxic substances, lifting heavy

objects, excessive physical strain, long periods of standing, or having
to maintain body balance.

Public Law 95-555 in 1978

Family Leave Act passed in 1993

Travel:
early in normal pregnancy - no restrictions

late in pregnancy; possibility of early labor

know the nearest health care facility

if extended period of time, medical records need to be copied

and prenatal visits continued and adequate prescriptions.

frequent rests q 1-2 hours.

wear seat belt under abdominal bulge

check air travel restrictions and immunizations needed for

destination.

Discomforts of Early Pregnancy

These symptoms may not seem minor to the pregnant woman.

They may lead to more serious problems if not monitored

adequately.

Listening, observing and developing a nursing diagnosis based

on assessment data.

Breast Tenderness:
one of the first symptoms noticed
wear proper bra
avoid cold drafts

Palmar Erythema:

constant redness or itching of the palms

caused by increased estrogen levels, will disappear once her

body adjusts.

Calamine lotion may help

Constipation:

weight of the growing fetus presses against the bowel and slows
peristalsis.

encourage regular BMs

increase roughage and water

Avoid OTC drugs (Colace or glycerin suppositories may be

prescribed).

Nausea, Vomiting and Pyrosis:

Fatigue:
common in early pregnancy
due to increased metabolic requirements
increase rest and sleep

short rest period during the day

Muscle Cramps:

decreased serum calcium levels, increased serum phosphorus

levels and circulatory interference cause cramps to legs.

relieved by woman lying on back, and extending involved leg

while keeping knee straight dorsiflex foot until pain is gone

may need Rx. for aluminum hydroxide gel (Amphojel) which

binds to phosphorus in intestinal tract and lowers levels

lower milk intake to 1 pint /day and add

calcium lactate will reduce phosphorus levels

elevate legs frequently

Hypotension:
supine hypotension
blood pooling in the pelvic area or lower extremities
raise slowly and avoid standing for long periods of time.

Varicosities:

due to pressure from the fetus on the veins returning blood from
the lower extremities.

causes pooling of blood in the vessels

veins become engorged, inflamed and painful

can extend to the vulva

rest in Sims position or on back with legs raised against the wall
or on foot stool for 15 to 20 minutes twice a day.

avoid crossing legs or knees bent

avoid knee high hose or garters

may need medical support hose (apply before arising).

exercise and walk 2 times a day

increase vitamin C with fresh fruit

Hemorrhoids:
due to pressure on veins from the uterus
daily BMs
Sims position or knee chest position for 10 to 15 minutes
stool softeners, witch hazel or cold compresses

Heart Palpitations:

with sudden movements

due to circulatory adjustments for increased blood supply during

pregnancy

encourage slow gradual movements

Frequency of Urination:

due to pressure of uterus on anterior bladder

lasts for 3 months then returns again in late pregnancy

check for symptoms of UTI

decrease caffeine
Kegel exercises

Abdominal Discomfort:

feeling pressure may be relieved by putting gentle pressure on

the fundus

pulling pain in lower abdomen from tension on round ligaments

(can be sharp)

rise slowly

Leukorrhea:
whitish viscous vaginal discharge due to high estrogen levels and
increased blood supply to vaginal epithelium and cervix

daily bath or shower

no douching, tampons, tight underpants, pantyhose

wear cotton underwear and sleep without underwear at night

Discomforts of Middle to Late Pregnancy

20th to 24th week a woman is ready for further health teaching.

Inform her of signs and symptoms of beginning labor.

Backache:

lumbar lordosis and postural changes

encourage her to wear shoes with low heals and walk with pelvis
tilted forward.

Local heat, squat instead of bending over, firm mattress, monitor

for bladder or kidney infections, avoid herbs ask MD about Tx.
Headache:

from expanding blood volume, which puts pressure on cerebral

arteries.

avoid eye strain or tension

rest with cold towels on forehead

Tylenol

intense or continuous notify the doctor.

Dyspnea:
SOB due to uterus pressing on diaphragm
noticed at night or with exercise

Discomforts of Middle to Late Pregnancy

may need 2 pillows to sleep on at night

Ankle Edema:
more noticeable by the end of the day

due to reduced blood circulation to the lower extremities due to

uterine pressure and general fluid retention.

encourage left side lying position which increases the kidneys

glomerular filtration and allows good venous return.

elevate legs and avoid constricting clothing

Braxton Hicks Contractions:

can begin at week 8 to 12
become stronger later in pregnancy
a rhythmic pattern can be a beginning sign of labor

Danger Signs of Pregnancy:

Review with woman and have her report any of the symptoms to
her health care provider.

Vaginal Bleeding:
report to MD no matter how slight
check for hemorrhoids
Persistent Vomiting:
1 to2 times daily for first trimester is common
persistent vomiting past week 12 is not normal
this depletes nutritional supply available to the fetus
Chills and Fever:
may indicate intrauterine infection or gastroenteritis

Sudden Escape of Clear Fluid From The Vagina:

membranes may have ruptured so uterine cavity is no longer

sealed against infection

umbilical cord may prolapse

cord could be compressed

Abdominal or Chest Pain:

report immediately may be ectopic pregnancy, separation of
placenta, pre term labor, appendicitis, ulcer or pancreatitis

chest pain may indicate pulmonary embolus or thrombophebitis.

Pregnancy-Induced Hypertension (PIH)

refers to potentially severe or fatal elevation of blood pressure

Symptoms

rapid weight gain(over 2 lbs/ wk in 2nd trimester and 1 lb/wk in

3rd trimester

swelling of face or fingers

flashes of light or dots before the eyes

dimness or blurring of vision

severe, continuous headache
decreased urine output

Increase or Decrease in Fetal Movement:

fetus normally moves the same amount every day
change can be the fetus responding to a need for oxygen

Teratogens

Any factor, chemical or physical, that adversely affects the

fertilized ovum, embryo or fetus.

Effects of Teratogens on the Fetus:

Factors:

strength of teratogen (radiation)

timing of the teratogen; before implantation, when the main

body systems are being formed (2 to 8 weeks)

effects caused by organisms of syphilis and toxoplasmosis

affinity for specific tissue (lead, thalidomide, tetracycline, rubella

virus)
Teratogenic Maternal Infections:

sexually transmitted of systemic infections

TORCH

T-toxoplasmosis-a protozoan infection, spread through contact

with uncooked meat, cat stool

almost no symptoms - malaise and posterior cervical

lymphadenopathy

CNS damage, hydrocephalus, microcephaly, intracerebral

calcification and retinal deformities

O-other infections (syphilis, HBV, HIV)

rubeola, coxsackievirus, mumps, varicella, poliomyelitis,

influenza, viral hepatitis and parvovirus B19 (5th disease) are all
teratogenic.

Syphilis - congenital syphilis, extremely damaging to fetus at

week 16 to 18

deafness, cognitive challenge, osteochondritis, and fetal death.

test for VDRL or RPR at first prenatal visit

Lyme Disease:
multisystem disease
avoid tick repellent with diethyltoluamide
monitor for migratory rash and joint pain
Tx. Penicillin

Illness at birth
gonorrhea, candidiasis, chlamydia, strep B, hepatitis B

R-rubella
mild rash and mild systemic illness in mother

deafness, mental and motor challenges, cataracts, cardiac

defects, retarded intrauterine growth, thrombocytopenia, purpura,
dental and facial clefts

a titer > 1:8 suggests immunity to rubella

can not be be immunized during pregnancy because the vaccine

uses a live virus which will effect the same as a case of rubella

advise women to not become pregnant for 3 months after

immunization

avoid children with rashes

infants born to mothers who had rubella can transmit the disease
for 8 months after birth

isolate the newborn

nurses should be immunized against rubella

C-cytomegalovirus:
member of herpes virus family

severe neurological damage, hydrocephalus, microcephaly,

spasiticity, optic atrophy, chorioretinitis, deafness, chronic liver
disease, blueberry-muffin lesions

no Tx.

H-herpes simplex virus:

1st trimester > severe congenital anomalies or spontaneous

miscarriage

2nd and 3rd trimester > premature birth, intrauterine growth

retardation, continuing infection of newborn at birth

Hx of herpes and lesions needs a C section

recurrence; antibodies prevent systemic transfer

IV or oral Zovirax during pregnancy

All are known to cross the placenta and affect the fetus during
pregnancy

TORCH screen provides a quick way to assess the potential risk

of teratogenic infection in pregnant women and newborns

infections can be viral, bacterial or protozoan

most cause flu-like symptoms in the woman and much more

serious effects on the fetus.

Vaccines:
Live virus vaccines are contraindicated.
Wait 3 months before becoming pregnant.

Drugs:

women should not take any drug or supplement not prescribed

by a physician.

accutane - acne

recreational drugs effects fetus 2 ways-direct effect and exposure

to HIV HepB

Cocaine causes vasoconstriction in the mother causing

decreased placental blood supply > decreased nutrients.

Miscarriage, preterm labor, meconium staining, growth

retardation, learning disorders or poor attention span.

Alcohol > congenital deformaties and cognitive impairment,

vitamin B deficiency

fetal alcohol syndrome-small for gestational age craniofacial

deformity, short palpebral fissures, thin upper lip upturned nose.

Cigarettes:

associated with infertility

growth retardation of fetus, SIDS, low birth weight due to limited

blood supply to fetus,

inhaled carbon monoxide, second hand smoke

nicotine patches are harmful to fetus

Environmental:
can be lethal to the fetus
Metal and Chemical Hazards
pesticides, carbon monoxide, arsenic,
formaldehyde, mercury, lead.

Radiation
rapid growing cell destruction depending on the stage of
development and length of exposure

most damaging from implantation to 6 weeks (lead apron)

nervous system, brain and retinal innervation, Ca, genetic

mutation

Sonogram and MRI replaced X Ray

Hyperthermia and hypothermia;

interferes with cell metabolism (growth)

saunas, hot tubs, tanning beds (limit 10 min), work environment

abnormal brain development, seizure disorder, hypotonia and

skeletal deformaties

hypothermia - mothers temperature lowered significantly before

fetal changes result

Stress:
myths exist
teach common sense

effects on sympathetic division of autonomic nervous

system(fight or flight)

prolonged - constriction of uterine vessels > interfere with blood

supply and nutrients

Preparation For Labor

Midpoint of pregnancy is time to review the events that signal

the beginning of labor.

Lightening - settling of the fetal head into the inlet of the true
pelvis (2 weeks before labor in primiparas)

not SOB, increased urination, abdominal contour changed, sciatic

pain

Show - release of cervical plug and beginning of cervical

dilatation

Rupture of the Membranes:

a sudden gush of fluid

danger of cord prolapse and uterine infection

Excess Energy:

clean house, finish paperwork and exhaust herself before labor

begins

Uterine Contractions:

start in the back and sweep froward across the abdomen like the
tightening of a band

Gradually increase in frequency and intensity; notify health care

provider

5 minutes apart and regular