MATERNAL AND CHILD HEALTH NURSING

PRENATAL PERIOD

Lecturer: Mark Fredderick R. Abejo RN,MAN

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I. Assessment of Risk Factors in the Prenatal Period

Age of Pregnant Women -17 below: Have a higher incidence of

1. Prematurity
2. Pregnancy Induced Hypertension
3. Cephalopelvic Disproportion

Women over 35 years old are at Risk for:

1. Chromosomal Disorders in infants
2. PIH
3. Cesarean Delivery

Infections: Use TORCH

T - Toxoplasmosis
O - Other infections
R - Rubella
C - Cytomegalovirus
H - Herpes

A. Toxoplasmosis (protozoa)
 Produces symptoms of acute, flu-like infection in mother
 Transmitted through raw meat or handling cat litter of infected cats
 Spontaneous abortion likely to occur early in pregnancy

B. Rubella
 Extremely teratogenic in first trimester
 Causes congenital defects of eyes, heart, ears, and brain
 Women with low rubellatiters should be vaccinated at least 3 months before becoming pregnant or following a
delivery
NOTE: Any woman in the first trimester of pregnancy is at risk if exposed to rubella. Congenital Fetal defects often
results from such an infection.

C. Cytomegalovirus (CMV)
 .Produces flu-like or mononucleosis-like symptoms in the mother
 Transmitted through the respiratory or sexual route
 May cause fetal death, retardation, heart defects, deafness
 No effective treatment available

D. Herpes Simples
 Affects the external genitalia, vagina, and cervix
 Causes draining, painful vesicles
 Delivery of the fetus is usually by cesarean section active lesions are present in the vagina; delivery may be
performed vaginally if the lesions are in the anal, perineal, or inner thigh area (strict precautions are necessary
to protect the fetus during delivery)
 No vaginal examinations are done in the presence of active vaginal herpetic lesions
 Maintain CONTACT isolation procedures during hospitalization if the disease is active
 Neonate and mother may be separated during the active period, or other special precautionary measures
may be used to avoid transmission to neonate
Teratogenic Drugs: BASA-O(code)
B - Barbiturates
A - Anti-malarial
S - Salicylates
A - Anesthetic
O - Oral hypoglycemics

Substance Abuse:

Alcohol:causes learning disabilities, Mongolism, fetal alcohol syndrome

Nicotine: increases vasoconstriction, retardation, SGA (small gestational age), low birth weight
Heroin addict: babies are born with an EXAGGERATED/ HYPERACTIVE CNS / REFLEXES or CNS IRRITABILITY.
Coccaine:The effect of cocaine in a labor and the fetus is preterm labor thus increased uterine contractions,
intrauterine growth retardation and the potential for a sick, addicted infant

Physiological Changes in Pregnancy

Increases during pregnancy
 Increase Heart Rate for 10-15 beats/minute
 Increase Cardiac Output for 20% - 30% during 1st – 2nd trimester to meet increase tissue demand
 Increase secretion of sugar (Glycosuria)
 INCREASE PLASMA VOLUME
 Increase Urinary Frequency due to pressure to bladder.
 Increase normal dependent Edema (bilateral or ankle edema) normal for 36 weeks gestation.

Decreases during pregnancy

 Decrease (slightly of blood pressure) in the 2 nd trimester due to decrease peripheral resistance
 Decrease Hemoglobin & Hematocrit because of Iron Deficiency (Pseudo- ANEMIA)
 Decrease gastrointestinal motility & peristalsis due to displacement of the intestine & compression of the
stomach. ---leading to CONSTIPATION.
 Decrease Urine Specific gravity: a result of increase Urinary Output.

Others:
Chloasma : Mask of pregnancy
Leukorrhea: whitish vaginal discharge without signs of inflammation & itching.
Operculum: formation of mucus plug in CERVIX to seal out bacteria.
Lordosis: the Pride of Pregnancy
Relaxin: responsible hormone for the softening of the pelvic cartilages. Produce by the corpus luteum,
contributes to the waddling gait typically noted in pregnancy.
 Normal delivery blood loss: 300 – 400 ml of blood
Cesarean Section: 800 – 1000 ml

Prenatal Health Promotion

Prenatal Visit
Schedule of visit if with no complications:
a. Every 4 weeks, up to 32 weeks
b. Every 2 weeks, from 32-36 weeks (more frequently if problems exist)
c. Every week from 36-40 weeks

Classifications of Pregnancy

GRAVIDA – number of times pregnant, regardless of duration, including present pregnancy.

PRIMIGRAVIDA – pregnant for the first time.

It's important for the nurse to distinguish between a client who's having her first baby and one who has already had a
baby. For the client who's pregnant for the first time, quickening occurs around 20 to 22 weeks. Women who have had
children will feel quickening earlier, usually around 18 to 20 weeks, because they recognize the sensations.
 MULTIGRAVIDA – pregnant for second or subsequent time.
PARA – number of pregnancies that lasted more than 20 weeks.
NULLIPARA – a woman who has not given birth to a baby beyond 20 weeks gestation.
PRIMIPARA – a woman who has given birth to one baby more than 20 weeks gestation.
MULTIPARA – a woman who has had two or more births at more than 20 weeks gestation.
Note: Twins or triplets counted as 1 para.
PRETERM – newborn born before 37 weeks of gestation.
TERM – newborn born after 37 weeks to 40 weeks of gestation.
POST-TERM – newborn born after 40 weeks of gestation.

Parity (TPAL)
T - Number of terms births,
P - Number of premature births,
A - Number of Abortions,
L - Number of living children

NUTRITION

1st Trimester: 2 –4 lbs gain / 30-35 calories/kg/day

2nd trimester: 1 lb per week / 200 calories/kg/day
3rd trimester: 1 lb per week/ 200 calories/kg/day
Pregnant Women needs 300 extra calories PER DAY for adequate nutrition.
A diet of 2500 calories per day
An increase of about 500 calories per day is needed during LACTATION.
Iron Deficiency Anemia is a result of PICA.

DifferentTypes of Exercises

Pelvic Floor Contractions (Kegel’s Exercise): Promotes perineal healing, increase sexual responsiveness, press
stress incontinence. Done 50-100 times. Examples: Tightening & strengthening the muscles of the
Vagina, rectum, perineum & then relax after. Efficient for Urinary Frequency & Hemorrhoids. Increase
elasticity of the Pubococcygeus muscle.
Abdominal muscle Contractions: prevent constipation in pregnancy, done in standing or lying position,
strengthening the abdominal muscles.
Pelvic Rocking: Relieves backache during pregnancy, done by tightening the buttocks & flattens the lower back
against the floor for one minute.

DIFFERENT TYPES OF BREATHING TECHNIQUES

A. Abdominal breathing ( during latent phase of Stage 1 Labor)

1. Used until labor is more advanced

2. The abdomen moves outward during inhalation and downward during exhalation
3. The rate remains slow, with approximately six to nine breaths per minute

B. Pant-pant-blow( during Transitional Phase of Stage 1 Labor)

1. Used in advanced labor

2. A more rapid pattern, consisting of two short blows from the mouth followed by a longer blow
3. All exhalations are a blowing motion