CARE OF THE MOTHER

& THE FETUS

DURING THE PERINATAL PERIOD

NCM 107 – MATERNAL AND CHILD NURSING

MA. NEL P. MAGSINO, MN
NCM 107 –Class Instructor
1st Semester S. Y. 2021-2022
 LENGTH OF PREGNANCY
A. DAYS – 267 TO 280
B. CALENDAR MONTHS – 9
C. WEEKS – 40 ( BEST TO EXPRESS GESTATIONAL AGE
OR LENGTH IN PREGNANCY , EXPECTED DATE OF
CONFINEMENT- FETUS IS 40 WKS OLD)
D. TRIMESTERS – 3
E. LUNAR MONTHS - 10
PHYSIOLOGIC ADAPTATIONS IN PREGNANCY

GRAVIDA – number of times pregnant, regardless of duration,

including the present pregnancy.
 NULLIGRAVIDA – a woman who is not now & never has
been pregnant.
 PRIMIGRAVIDA- pregnant for the first time
 MULTIGRAVIDA – pregnant for second or subsequent time.
PARA - number of pregnancies that lasted more than 20 weeks,
regardless of outcome; no of deliveries.
 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 wks gestation.
 MULTIPARA - a woman who has had two or more births at
more than 20 weeks gestation..... Twins or triplets count as 1
para
THE PSYCHOLOGICAL TASKS OF PREGNANCY
PSYCHOLOGICAL DESCRIPTION
CHANGES
1st Trimester Woman and partner both spend time recovering from
Task: Accepting the pregnancy shock of learning they are pregnant and concentrate
of what it feels like to be pregnant. A common reaction
is AMBIVALENCE or feeling of pleased and not
pleased about the pregnancy.
2nd Trimester Woman and partner move through emotions such as
Task: Accepting the baby NARCISSISM and INTROVESION as they
concentrate on what it will feel like to be a parent.
Role-playing and increased dreaming are common.
3rd Trimester Woman and partner grow impatient with pregnancy as
Task: Preparing for the baby they ready themselves for birth.
and end of pregnancy
 COMMON DISCOMFORTS OF PREGNANCY AND
RELIEF MEASURES
DISCOMFORTS RELIEF MEASURES

Morning Sickness  Eat dry crackers ( carbohydrates) or toast in the morning

30 mins before getting up
 Drink adequate fluids between meals.
 Avoid highly spicy, fatty foods.
 Eat small frequent meals; avoid overeating
 Avoid fatty, highly seasoned foods.
Heartburn  Bend at the knees and NOT at the waist when picking
things from the floor.
 Remain upright 3 to 4 hours after eating.
 Avoid taking sodium bicarbonate
 Take aluminum-bearing antacids ( Amphogel) as
ordered.
Frequency of  Increase fluids to replace losses except at bedtime to prevent
Urination nocturia
 Practice regular voiding.
 Practice frequent flushing: “ front to back”
 Report any burning sensation, dysuria, cloudy urine, or tea-
colored urine
Fatigue  Have adequate rest and sleep ( 8 hrs average night sleep)
 Avoid prolonged standing.
 Practice good body mechanics (posture)
 Report increasing fatigue with regular activities – a danger
sign of heart disease
Constipation  Increase fluid intake ( 6 to 8 glasses of water per day)
 Increase roughage in the diet ( daily fruits and vegetables)
 Regular exercise (best is walking)
 Observe daily and regular bowel movement
 Drink warm water in the morning
Backache  Maintain good posture
 Wear flat shoes.
 Avoid prolonged standing
 Pelvic rock exercise and tailor sitting are advised
 Use supportive mattress
 Wear maternity girdle in selected situations as recommended.
Pedal edema  Assume left-lateral position/ elevation of legs frequently to
promote venous return.
 Avoid prolonged standing
 No round/ constricting garters.
 Report swelling of hands and face
Shortness of  Maintain good posture
breath  Avoid fatigue
 Elevate head by several pillows in sleep, avoid supine position.
 Avoid constricting bra and other tight clothes.
 Report increasing dyspnea with minimal activity or dyspnea prior
to 36 weeks ( with normal pressure on the diaphragm)
Hemorrhoids  Avoid constipation and other forms of straining
 Promote comfort: sitz bath, warm compresses.
 Reinsert hemorrhoids, upon recommendation of physician.
Faintness/ Supine  Avoid sudden changes in the position
Hypotension  Avoid supine position in 2nd to 3rd trimesters
Syndrome/ Vena  Arise from a bed from a lateral position and gradually.
Cava Syndrome  Avoid staying in one position for a long time.
 Assume frequent left lateral positions in bed
Leg cramps  Include adequate calcium in the diet; calcium phosphorus
imbalance is the recognized most important cause of leg cramps
 Avoid prolonged standing and sitting
 Dorsiflex the foot while extending the leg; this hyperextends the
involved muscle causing relief.
Varicose veins  No round garters around the abdominal and legs; avoid knee-
high stockings.
 Wear supportive panty hose.
 Frequent elevation of legs and hips is advised
 INTRAPARTAL POSTPARTAL
PRENATAL CARE
CARE CARE

 Care of the  Theories of labor  Care of the

Mother during  Nursing process Mother after
pregnancy  Early Essential & delivery
 Care of the Fetus Newborn care  Immediate care of
(EENC) the newborn
PRENATAL
CARE
“Antenatal Care”

Is a type of Preventive
HEalthcare
What is Prenatal Care?
Prenatal care is when you get
checkups from a health care
professional (doctor, nurse, or
midwife) throughout your
pregnancy.
Routine Prenatal Care
Prenatal screening and diagnosis
 has played a part in reducing the
frequency of
 maternal death,
 miscarriages,
 birth defects,
 low birth weight,
 neonatal infections and
 other preventable health problems.
Traditional Prenatal Care Schedule

 Monthly visits during the first two trimesters (from

the 1st week to the 28th week)
 Fortnightly visits from the 28th week to the 36th
week of pregnancy
 Weekly visits after 36th week to the delivery, from
the 38th week to the 42nd week
 Assessment of parental needs and family
dynamics
 Traditional Prenatal Care Schedule

 Monthly visits during the first two trimesters (from

the 1st week to the 28th week)
 Fortnightly (every two weeks) visits from the 28th
week to the 36th week of pregnancy
 Weekly visits after 36th week to the delivery, from
the 38th week to the 42nd week
 Assessment of parental needs and family
dynamics
 PRENATAL MANAGEMENT
FIRST VISIT – as soon as the mother missed a
menstrual period when pregnancy is suspected.

SCHEDULE OF VISITS
 First 32 weeks - monthly
 32 to 36 weeks -Twice a month ( every 2 weeks)
from or every 2 weeks during 8th month
 9 months to delivery- 4X times a month or
weekly during
 A. GTPAL / GTPALM
Gravida = the no. of pregnancy including the present one.
Term= the total no of infants born at term 37 or more up to
42 weeks.
Preterm= the total no. of infants born before 37 weeks
Abortions= the total no. of spontaneous or induced
abortions
Living= the total no. of children currently living
Multiple pregnancies= the total of multiple pregnancies
 B. GPAb
Gravida = the no. of pregnancy including the present
one.
Para = the number of pregnancies that reaches the age
of viability – in 24weeks regardless of whether babies
born alive or not.
Example: A woman who has been pregnant 3 times,
has had two deliveries after 24 weeks gestation, and
has had one abortion; the abbreviation would be G3,P2,
Ab1.
1. Internal Gynecologic Exam and expected date of
2. Weight, vital signs, confinement EDC by using the
auscultation of fetal heart Naegel’s/ Neagle’s Rule
rate (FHR)
3. palpation of fetal outline
(LEOPOLD’s MANEUVER) ,
measurement of fundal
height as correlation for
appropriate progress of
pregnancy, determine fetal
length, calculation of fetal
weight in grams and age of
gestation (AOG)
Gaining Too Much Weight in
Pregnancy
o High birth weight
o Cesarean delivery
o Gestational diabetes
o Delivery complications like
shoulder dystocia
o Preeclampsia
o Possibly develop diabetes
in the future
o Post-pregnancy weight
retention
Gaining Too Little
Weight in Pregnancy
o Low birth weight
o Premature birth
o Breastfeeding
problems
o Lowered immunity
o Developmental delays
o Obesity during
childhood
 LEOPOLD’S MANEUVER
Are performed in pregnancy after the uterus becomes large
enough to allow differentiation of fetal parts by palpation.
● FIRST MANEUVER (FUNDAL GRIP) - Identifies the part of
the fetus that lies over the inlet into the pelvis .
○ CEPHALIC (head) & BREECH ( pelvis) – commonest
presentation
○ LIE of the fetus – the relationship between the long axis
of the fetus and the long axis of the mother – either
longitudinal or transverse, but occasionally oblique.
○ When the fetal head is in the fundus, it will feel hard,
smooth globular , mobile and ballotable.
○ When the breech is in the fundus, it will feel soft, irregular,
round and less mobile.
 LEOPOLD’S MANEUVER
• SECOND MANEUVER- UMBILICAL GRIP
 Identifies the relationship of the fetal body part to the front, back or sides
of the maternal pelvis.
 Finding the position
 The back will feel firm, smooth, convex, resistant
 The small parts ( arms and legs ) will feel small, irregularly placed, and
maybe actively or possibly mobile.

• THIRD MANEUVER- PAWLICK’S GRIP • Identifies the most dependent

part of the fetus – that is the part that lies nearest to the cervix.
 Finding the PRESENTING PART
 It is the part of the fetus that first contracts the finger in the vaginal
examination, most commonly the head or breech.
 The head will feel hard, smooth, and mobile if not engaged. Immobile if
engaged.
 The breech will feel soft and irregular
 LEOPOLD’S MANEUVER

• FOURTH MANEUVER- PELVIC GRIP • Identifies the greatest

prominence of the fetal head palpated over the brim of the
pelvis. When the head is flexed ( flexion attitude), the forehead
forms the cephalic prominence. When the head is extend
(extension attitude), the occiput becomes the cephalic
prominence.
 ESTIMATES OF PREGNANCY
 Naegele’s rule, derived from a German obstetrician, subtracts 3
months and adds 7 days to calculate the estimated due date
(EDD).
 Naegele’s rule involves a simple calculation: Add seven days to
the first day of your LMP and then subtract three months.
o First, determine the first day of your last menstrual period.
o Next, count back 3 calendar months from that date.
o Lastly, add 1 year and 7 days to that date.
For example, if your LMP was November 1, 2017:
 Add seven days (November 8, 2017).
 Subtract three months (August 8, 2017).
 Change the year, if necessary (to the year 2018, in this
case).
In this example, the due date would be August 8, 2018.
Fundal height, also known as
McDonald's Rule, is a
measurement of the size of the
uterus during pregnancy.
 It is measured in centimeters
as the distance from the top of
the pubic bone (specifically, a
joint called symphysis pubic)
to the top of the uterus (called
fundus).
 As such, it is properly called
a symphysis pubis fundal
height (SFH).
As the pregnancy progresses, the uterus expands in the abdomen
with its top moving up by about 4 centimeters per month, an
equivalent of two finger-widths.
After the 20th week and until the 36th week of pregnancy, the
fundal height measurement usually matches the number of
weeks of pregnancy. This means that for a woman at the 26th
week of pregnancy, the fundal height measurement should be
about 26 cm (give or take 2 cm).
Weeks 12-14: top of uterus is right above pubic bone level
Weeks 20-22: top of uterus is at the level of belly button (navel)
Weeks 36-40: top of uterus is right under the ribs
Weeks 36-40: as baby drops lower into the pelvis, top of uterus
regresses by about 4 cm to the 36-32cm level
 How to Measure Fundal Height with a Measuring Tape
● Locate the top of the pubic bone by hand (it is right above the pubic
hair line).
● Locate the top of the uterus by hand (it will feel like a firm ball).

● Place the beginning of a

measuring tape at the top of
the uterus.
● Bring the tape down until
the top of the pubic bone.
● Record the distance
between the two points as
fundal height.
 How to Measure Fundal Height with the Finger Method
● Locate the top of the uterus by hand.
● Count by how many finger-widths is the top of the uterus located
below or above the belly button. Keep in mind that two finger widths
represent one month, or four weeks.
● Remembering that the
uterus should be at belly
button level at 20-22 weeks,
add (if top of uterus is above
belly button) or subtract (if
top of uterus is below belly
button) the number of weeks
from the previous step.
● Record the resulting number
as fundal height.
"Haase rule", a formula for suggesting the age of a human fetus
or newborn from its length (fetal length in centimeters during the
first 3 to 5 months of pregnancy correlates to the square of the
age in months, and during the second half of pregnancy the age
in months is multiplied by 5). It is also referred to as "Haase's
formula" (Haase-Formel).

First five months of For the second half of

pregnancy: square
the month.
• EX: How long is a
threemonth- old
fetus? 3X3 = 9 cm
pregnancy : Multiply
month by 5.
• EX: How long is a 7
month old fetus? 7 X 5 =
35 cm.
NEEDS DURING PREGNANCY
1. NUTRITION
 Appropriate weight gain
 A balanced diet
 Regular exercise
 Appropriate and timely vitamin and mineral
supplementation
NEEDS DURING PREGNANCY
2. IMMUNIZATIONS IMMUNITY- is the resistance that an
individual has against disease. As a general rule, immunizations
are best avoided during pregnancy.
 Immunizations with attenuated live viruses ( including
mumps and rubella vaccines) should not be given during
pregnancy because of their teratogenic effect on the
developing embryo.
 Vaccinations with killed viruses ( including varicella,
hepatitis, influenza, tetanus, and diptheria vaccines) may be
given during pregnancy.
SCHEDULE OF TETANUS TOXOID IMMUNIZATIONS

SCHEDULE OF TETANUS TOXOID IMMUNIZATIONS

FOR WOMEN AS PER DOH (Phils.)
TT1 – as early as possible during pregnancy
TT2 – at least 4 weeks later- 80% protection for 3 yrs
TT3 – at least 6 months later-95% protection for 5 y
TT4 – 1 year later – 99% protection for 10 y
TT5 – at least 1 year later – 99% protection -lifetime •

BENEFITS OF TETANUS TOXOID:

1. INFANTS: Protection from neonatal tetanus
2. 2. MOTHER: Protection from tetanus
 TO BE
CONTINUED
ON SATURDAY