Care of Mother, Child at Risk or with Problem

Pregnancy
NAME OF TRANS MAKER: SHELA BALUNSAT
NAME OF PROFESSOR: MS. FELITA LACERONA

OUTLINE about 10 to 14 days after conception. Implantation bleeding

I.Pregnancy IV. Types of Pregnancy occurs around the time you would expect to have a
A. Signs and A. Intrauterine menstrual period. However, not all women have it.
Symptoms pregnancy
B. Pregnancy B. Tubal pregnancy Cramping. Some women experience mild uterine cramping
Nutrition C. Intra-abdominal early in pregnancy.
C. Discomfort pregnancy
During D. Singlet pregnancy
Pregnancy E. Multiple pregnancy Constipation. Hormonal changes cause your digestive
II. Antepartum Care F. Lupus pregnancy system to slow down, which can lead to constipation.
A. Components of G. High-Risk pregnancy
Obstetric H. Molar pregnancy Food aversions. When you're pregnant, you might become
History During more sensitive to certain odors and your sense of taste might
Prenatal Visit change. Like most other symptoms of pregnancy, these food
III. Ectopic Pregnancy preferences can be chalked up to hormonal changes.
A. Clinical Nasal congestion. Increasing hormone levels and blood
Manifestation production can cause the mucous membranes in your nose
B. Assessment and to swell, dry out and bleed easily. This might cause you to
Diagnostic have a stuffy or runny nose.
Finding
PREGNANCY NUTRITION
I. PREGNANCY
- term used to describe the period in which a fetus The Academy of Nutrition and Dietetics recommends the
develops inside a woman's womb or uterus. following key components of a healthy lifestyle during
Pregnancy usually lasts about 40 weeks, or just over 9 pregnancy:
months, as measured from the last menstrual period to
delivery. Health care providers refer to three segments  Appropriate weight gain
of pregnancy, called trimesters
 A balanced diet
SIGNS AND SYMPTOMS  Regular exercise
 Appropriate and timely vitamin and mineral
Missed period. If you're in your childbearing years and a supplementation
week or more has passed without the start of an expected
menstrual cycle, you might be pregnant. However, this DIETARY AND CALORIC RECOMMENDATIONS
symptom can be misleading if you have an irregular To maintain a healthy pregnancy, approximately 300 extra
menstrual cycle. calories are needed each day. These calories should come
Tender, swollen breasts. Early in pregnancy hormonal from a balanced diet of protein, fruits, vegetables and whole
changes might make your breasts sensitive and sore. The grains. Sweets and fats should be kept to a minimum. A
discomfort will likely decrease after a few weeks as your healthy, well-balanced diet can also help to reduce some
body adjusts to hormonal changes. pregnancy symptoms, such as nausea and constipation
Nausea with or without vomiting. Morning sickness, which
can occur at any time of the day or night, often begins one to FLUID INTAKE DURING PREGNANCY
two months after you become pregnant. However, some
women feel nausea earlier and some never experience it.
While the cause of nausea during pregnancy isn't clear, Fluid intake is also an important part of pregnancy nutrition.
pregnancy hormones likely play a role. Follow these recommendations for fluid intake during
Increased urination. You might find yourself urinating more pregnancy:
often than usual. The amount of blood in your body
increases during pregnancy, causing your kidneys to process  You can take in enough fluids by drinking several
extra fluid that ends up in your bladder. glasses of water each day, in addition to the fluids
Fatigue. Fatigue also ranks high among early symptoms of in juices and soups. Talk to your health care
pregnancy. No one knows for certain what causes provider or midwife about restricting your intake of
sleepiness during the first trimester of pregnancy. However, caffeine and artificial sweeteners.
a rapid rise in the levels of the hormone progesterone during  Avoid all forms of alcohol.
early pregnancy might contribute to fatigue.

Moodiness. The flood of hormones in your body in early

pregnancy can make you unusually emotional and weepy.
Mood swings also are common. IDEAL FOODS TO EAT DURING PREGNANCY

Bloating. Hormonal changes during early pregnancy can
cause you to feel bloated, similar to how you might feel at the
start of a menstrual period.
Light spotting. Light spotting might be one of the first signs
of pregnancy. Known as implantation bleeding, it happens
when the fertilized egg attaches to the lining of the uterus —
 Vegetables: carrots, sweet potatoes, pumpkin, spinach,
cooked greens, tomatoes and red sweet peppers (for
vitamin A and potassium)
 Fruits: cantaloupe, honeydew, mangoes, prunes,
bananas, apricots, oranges, and red or pink grapefruit
(for potassium)
 Care of Mother, Child at Risk or with Problem
Pregnancy
NAME OF TRANS MAKER: SHELA BALUNSAT
NAME OF PROFESSOR: MS. FELITA LACERONA
 Dairy: fat-free or low-fat yogurt, skim or 1% milk, soymilk
(for calcium, potassium, vitamins A and D)
 Grains: ready-to-eat cereals/cooked cereals (for iron and
folic acid)
 Proteins: beans and peas; nuts and seeds; lean beef,
lamb and pork; salmon, trout, herring, sardines and
pollock
PRENATAL VITAMIN AND MINERAL SUPPLEMENTS
Most health care providers or midwives will prescribe a
prenatal supplement before conception or shortly afterward
to make sure that all of your nutritional needs are met.
However, a prenatal supplement does not replace a healthy
diet.
The Importance of Folic Acid
The U.S. Public Health Service recommends that all women
of childbearing age consume 400 micrograms (0.4 mg) of
folic acid each day. Folic acid is a nutrient found in:
 Some green leafy vegetables
 Most berries, nuts, beans, citrus fruits and fortified
breakfast cereals
 Some vitamin supplements.
Folic acid can help reduce the risk of neural tube defects,
which are birth defects of the brain and spinal cord. Neural
tube defects can lead to varying degrees of paralysis,
incontinence and sometimes intellectual disability.
Folic acid is the most helpful during the first 28 days after
conception, when most neural tube defects occur.
Unfortunately, you may not realize that you are pregnant
before 28 days. Therefore, your intake of folic acid should
begin before conception and continue throughout your
pregnancy. Your health care provider or midwife will
recommend the appropriate amount of folic acid to meet your
individual needs.
For example, women who take anti-epileptic drugs may need
to take higher doses of folic acid to prevent neural tube
defects. They should consult with their health care provider
when considering trying to conceive.
DISCOMFORTS DURING PREGNANCY
 Nausea and Vomiting
 Heart Burn
 Backache/ Back pain
 Round Ligament Pain
 Urinary Frequency and Loss of Urine Varicosities
 Constipation Hemorroids
 Leg Cramps
 Dependent Edema
II. ANTEPARTUM CARE
- Antenatal care (ANC) can be defined as the care
provided by skilled health-care professionals to pregnant
women and adolescent girls in order to ensure the best
health conditions for both mother and baby during
pregnancy.
- critical opportunity for health providers to deliver care,
support and give information to pregnant women. Works
to help improve birth outcomes in low-resource settings.
- Prenatal care, also known as antenatal care, is a type of
preventive healthcare. Its goal is to provide regular
check-ups that allow doctors or midwives to treat and
prevent potential health problems throughout the course
of the pregnancy and to promote healthy lifestyles that
benefit both mother and child.
the usual schedule for prenatal assessment in normal
pregnancy is as follows:
- Conception to 28 weeks – every 4 weeks
- 29 to 36 weeks – every 2 weeks
- 37 weeks to birth – weekly
The Benefit of antenatal care to mother and baby
- According to Pattinson , ANC benefits both the
mother and the baby; it assists in screening,
diagnosing and managing or controlling the risk factors
that might adversely affect the pregnant women and/or
the pregnancy outcome.
COMPONENTS OF OBSTETRIC HISTORY DURING
PRENATAL VISIT:
1. Menstrual History and EDD
A complete menstrual history is necessary to establish the
estimated date of delivery (EDD) and therefore the
gestational age of the fetus and any given time.
Nagele’s Rule
Nagele’s rule is used to determine the EDD on the basis of
the first day of the last menstrual period or LMP. To calculate
the date of birth in this rule, subtract 3 months from the first
day of LMP then add 7 days and change the year. Modified
McDonald’s Rule
McDonald’s Rule or method is used to determine the age of
gestation by measuring from the fundus (obtaining the fundal
height) to the symphysis pubis. The distance in centimeters
will determine the age of gestation from 16- 38 weeks.
2. Gynecologic and Contraceptive History
Any previous history of gynecologic problems should be
identified.
> STDs should be treated.
> Infertility problems with past or current pregnancy should
be discussed.
> A detailed history of contraceptive methods is important.
Any woman who becomes pregnant should stop taking
hormonal contraceptives and consult with a health care
provider.
3. Family History
➢ a family provides valuable information about the general
health of the family, including chronic diseases such as
diabetes and heart disease and infections such as
tuberculosis and hepatitis.
➢ It may also reveal information about pattern of genetic or
congenital anomalies.
4. Partner’s Health History
 Care of Mother, Child at Risk or with Problem
Pregnancy
NAME OF TRANS MAKER: SHELA BALUNSAT
NAME OF PROFESSOR: MS. FELITA LACERONA

➢The partner’s history may include significant health
problems such as genetics abnormalities, chronic illness.
➢ Tobacco use by the partner increases the risk for upper
respiratory tract infections for both the mother and the infant
from exposure to passive smoke.
➢Father’s blood type and Rh factor are important if the
mother is Rh – negative or type O because blood
incompatibility between the mother and fetus is possible.
5. Psychosocial History
> The psychosocial history, including mental health,
substance abuse, risk for violence or abuse, and coping
abilities, should be elicited during the initial visits.
6. Nutritional Assessment
➢ Review of dietary intake of iron and iron supplements
➢ 24-hour diet recall
➢ Comparison of pre pregnancy weight with weight gained
during
the pregnancy
• During the pregnancy, a total weight gain of 24 to 30 lb. is
recommended
• A normal pattern of weight gain is 1.5 lb. in the first 10
weeks; 9
lb. at 20 weeks; 19 lb. by 30 weeks; and 27.5 lb. by 40
weeks.
• Nondietary factors affecting weight gain include increased
blood
pressure and excess fluid retention.
7. Physical Examination:
a. Vital Signs: BP –
There is a decrease in BP during first and 2nd trimesters,
which normalizes by the third trimester. A BP of 140/90 mm
Hg or higher may indicate chronic hypertension or pre-
eclampsia and requires additional evaluation.
-Pulse, Respiration, Temperature
b. Cardiovascular system
observation for venous congestion which can develop into
varicosities and edema.
c. Musculoskeletal System
Body mechanics and changes in posture and gait should be
addressed
d. Height and weight
An initial weight is recorded to establish a baseline for
evaluation for weight gain through out pregnancy.
The body mass index should be calculated. Women who are
underweight before pregnancy are at risk for having low-birth
weight infants.
e. Abdomen
Fundal height and fetal heart tone assessment
The fetal heart rate should be auscultated, counted and
recorded. If the pregnancy is advanced enough. (10 to 12
weeks by doppler; 18 to 20 weeks by fetoscope.)
f. Neurologic system
Deep tendon reflexes should be evaluated because
hyperreflexia is associated with complications of pregnancy
g. Integumentary System
-hormone-induced hyperpigmentation (melasma, linea nigra,
and stretch mark (striae)
h. Endocrine System
i. Gastrointestinal System
– The growing baby crowds the mother’s stomach and can
cause indigestion and heartburn. She may also feel short of
breath because the baby crowds her lungs.
Dental plaque may increase, and a temporary increase in
tooth mobility may occur. Bowel sound may be diminished
because of the effects of the
progesterone on smooth muscle.
j. Urinary System
- Small amount of glucose may indicate physiologic “spilling”
that occur during normal pregnancy.
k. Reproductive System
➢Internal Reproductive Organs. – A speculum is inserted to
see the walls of the vagina and the cervix. The cervix is pink
in nonpregnant woman and bluish purple in a pregnant
woman. (Chadwick’s sign). The external cervical os is closed
in primigravida’s but one fingertip maybe admitted in
multigravidas.
➢There is softening of the cervix (Goodell’s sign)
III. ECTOPIC PREGNANCY
- The incidence of ectopic pregnancy and the risk of death
due to ectopic pregnancy are decreasing. However,
ectopic pregnancy remains the leading cause of
pregnancy-related death in the first trimester (ACOG,
2018). Ectopic pregnancy occurs when a fertilized ovum
(a blastocyst) becomes implanted on any tissue other
than the uterine lining, most commonly along the
fallopian tube (ACOG, 2018) (see Fig. 50-7).
- Possible causes of ectopic pregnancy include
salpingitis, peritubal adhesions (after pelvic infection,
endometriosis, appendicitis), structural abnormalities of
the fallopian tube, previous ectopic pregnancy, previous
tubal surgery, multiple previous induced abortions, and
tumors that distort the tube (ACOG, 2018). Additional
risk factors include use of tobacco products, IUD
- use, history of PID, and use of fertility drugs to induce
ovulation (ACOG, 2018).
- Risk factors are important, but all women need to be
educated about early treatment and have a high index of
suspicion in the case of a period that does not seem
normal, the presence of pain, or pain with a suspected
pregnancy. Women may have fatal hemorrhage with
ruptured ectopic pregnancies if they delay seeking
attention or if their primary providers are not alert to the
possibility of this diagnosis.
Sites of ectopic pregnancy.
 Care of Mother, Child at Risk or with Problem
Pregnancy
NAME OF TRANS MAKER: SHELA BALUNSAT
NAME OF PROFESSOR: MS. FELITA LACERONA
CLINICAL MANIFESTATIONS
Signs and symptoms vary depending on whether tubal
rupture has occurred. Delay in menstruation from 1 to 2
weeks followed by slight bleeding (spotting) or a report of a
slightly abnormal period suggests the possibility of an ectopic
pregnancy. Symptoms may begin late, with vague soreness
on the affected side (probably due to uterine contractions
and distention of the tube), and may proceed to sharp,
colicky pain. Most patients experience some pelvic or
abdominal pain and some spotting or bleeding.
Gastrointestinal symptoms, dizziness, or lightheadedness
may occur. Patients may think the abnormal bleeding is a
menstrual period, especially if a recent period occurred and
was normal.
If implantation occurs in the fallopian tube, the tube becomes
more and more distended and can rupture if the ectopic
pregnancy remains undetected for 4 to 6 weeks or longer
after conception. When the tube ruptures, the ovum is
discharged into the abdominal cavity, and the woman
experiences agonizing pain, dizziness, faintness, and
nausea and vomiting due to the peritoneal reaction to blood
escaping from the tube. Dyspnea and symptoms of shock
may occur, and the signs of hemorrhage—rapid and thready
pulse, decreased blood pressure, subnormal temperature,
restlessness, pallor, and sweating—are evident. Later, the
pain becomes generalized in the abdomen and radiates to
the shoulder and neck because of accumulating
intraperitoneal blood that irritates the diaphragm.
ASSESSMENT AND DIAGNOSTIC FINDINGS
- Ectopic pregnancies must be diagnosed promptly to
prevent life-threatening hemorrhage, which is the major
complication of rupture. During vaginal examination, a
large mass of clotted blood that has collected in the
pelvis behind the uterus or a tender adnexal mass may
be palpable, although there are often no abnormal
findings. If an ectopic pregnancy is suspected, the
patient is evaluated by sonography and human chorionic
gonadotropin (hCG) levels. Serial hCG tests may be
needed (Tulandi, 2019). The levels of hCG (the
diagnostic hormone of pregnancy) double in early
normal pregnancies every 3 days but are reduced in
abnormal or ectopic pregnancies. A less-than-normal
increase is cause for suspicion. Transvaginal
ultrasound, the usual method of diagnosis, can detect a
pregnancy between 5 and 6 weeks from the time of the
last menstrual period. Detectable fetal heart movement
outside the uterus on ultrasound is firm evidence of an
ectopic pregnancy.
- Occasionally, the clinical picture makes the diagnosis
relatively easy. However, when the clinical signs and
symptoms are inconclusive, laparoscopy may be
required for definitive diagnosis (Tulandi, 2019).
IV. IV. OTHER TYPES OF PREGNANCY
INTRAUTERINE PREGNANCY   
- A typical pregnancy, when the fetus(es) implant inside
the uterus, and the placenta attaches to the uterine
muscle inside the uterus
TUBAL PREGNANCY   
 This is a type of ectopic pregnancy
 This type of pregnancy occurs when a fertilized egg
implants in the fallopian tube instead of the uterus 
 This type pregnancy is not viable and must be
terminated if a miscarriage does not occur naturally on
its own
INTRA-ABDOMINAL PREGNANCY   
 These types of pregnancies tend to occur following a
previous C-section
 The C-section scar can weaken and tear, and the fetus
may slip into the abdominal cavity
 Whether or not the pregnancy is viable depends on the
gestational age of the fetus when the tear occurs
SINGLET PREGNANCY   
 This is a pregnancy in which one egg meets one sperm
and one fetus develops
MULTIPLE PREGNANCY   
 This may occur when multiple eggs are fertilized at the
same time, or when two sperm enter one egg or when
one egg is fertilized by one sperm that divides into two
zygotes
 Fraternal twins are the result of more than one egg
being fertilized, or one egg being fertilized by two sperm
 Identical twins are the result of one egg splitting into
multiple zygotes
 Multiples may be more likely when fertility treatments
are used
LUPUS PREGNANCY   
 This is a pregnancy carried by a woman with the
autoimmune disease lupus, in which blood clotting is a
complication 
HIGH-RISK PREGNANCY   
 Pregnancies with an increased risk of complications are
considered high-risk
 This includes women: 
o Over the age of 35
o With diabetes 
o With other health conditions that affect
pregnancy
o Pregnancy with multiples 
 Care of Mother, Child at Risk or with Problem
Pregnancy
NAME OF TRANS MAKER: SHELA BALUNSAT
NAME OF PROFESSOR: MS. FELITA LACERONA

o Who need to take medications to control

medical conditions that could affect the fetus
o With a history of previous pregnancy
complications

MOLAR PREGNANCY   

 A complete molar pregnancy occurs as a result of

the placenta forming in the uterus without a fetus to
support
 A partial molar pregnancy occurs when two sperm
fertilize one egg, but two fetuses do not develop
 The placenta is abnormal and the fetus has too
many chromosomes which always results in a
spontaneous abortion as the fetus cannot develop
safely