BETHLEHEM UNIVERSITY

FACULTY OF NURSING & HEALTH SCIENCES

Maternity Nursing
NURS 332 /Spring 2023

Preconception and Conception Period

*Definition of preconception and conception:

A basic understanding of prenatal development helps the nurse provide care to
parents during normal childbearing and better understand problems such as
infertility and birth defects. Therefore preconception means taking control and
choosing healthy habits before pregnancy to conceive a healthy infant. It means
knowing how health conditions and risk factors could affect a woman or her
unborn baby if she becomes pregnant. Preconception health is about planning for
the future and taking steps to get there. During this period, couples should aim to
improve their health to not only increase fertility, but also to foster a positive
pregnancy experience, lower the risks for many complications they may face.
Preconception is important because every woman should be thinking about her
health whether or not she is planning pregnancy. One reason is that about half of
all pregnancies are not planned. Unplanned pregnancies are at greater risk
of preterm birth and low birth weight babies. Experts agree that women need to be
healthier before becoming pregnant. By taking action on health issues and risks
before pregnancy, she can prevent problems that might affect her and her baby`s
health later on.
Preconception health is important for men, too. It means choosing to get and stay
as healthy as possible and helping others to do the same as well. As a partner, it
means encouraging and supporting the partner’s health. Taking care of his health
now will help to ensure a better quality of life for him and his family in the coming
years.
*Women and couple needs in preconception period:
There are five preconception health needs:
Mental well-being
 For both partners, a stress-reduced environment increases the chance for a healthy
pregnancy, parent and childhood. Mental health can improve birth outcomes and
lower the risk for pregnancy complications , as well as enhance the overall
pregnancy experience. Having a mentally healthy partner has a positive influence
on the mother’s well-being and therefore on the unborn child, too.
Balanced diet and folic acid
A balanced diet should be based on calorie-free beverages, vegetables, fruit, and
wholegrain products. Additionally, but in moderate amounts, dairy products, meat,
oily sea fish and eggs should be part of the diet. It is not necessary to exclude
sweets, snacks and sugary beverages completely; they should, however, be
consumed in small amounts only. Plant-based oils are generally healthier than
animal-based sources of fat. Alcohol and smoking should be avoided entirely.
Smoking should be avoided completely by women and their partners also during
the preconception period, as smoking influences fertility negatively and can harm
the unborn Baby.
If women follow a balanced diet, there is generally no need for supplements
during the preconception period, except for folic acid. This vitamin is immensely
important for the development of the baby’s neural tube, especially in the first
trimester. However, only a few food items contain folic acid. In addition to a
balanced diet, it is recommended to use the supplementation of 400µg folic acid
per day starting at least four weeks before conception
Healthy body weight
A healthy body weight is an important factor for a healthy pregnancy. A healthy
body weight is defined as a Body Mass Index (BMI) between 18.5 and 25 kg/m².
Maternal overweight, defined as a BMI of 25 kg/m² or greater, increases the risk
for diabetes as well as hypertension and pre-eclampsia, and is linked to further
complications like maternal morbidity, preterm births, macrosomia as well as
childhood overweight. Overweight in men is associated with adverse outcomes
concerning conception, i.e. lower testosterone levels and reduced fertility as well
as poor sperm Quality.
Maternal underweight with a BMI of 18.5 kg/m² or less is associated with
increased risks for other severe outcomes, such as stillbirth, preterm birth and
intrauterine growth Retardation.
 Physical activity
Adults should be physically active for 20 to 40 min every day. Physical activity
does not necessarily refer to sports, it can also be included in everyday life, e.g. 10
minutes of brisk walking during the lunch break, taking the stairs and not the
escalator, as well as cycling to work. With regard to the preconception period,
physical activity increases fertility and health-related quality of life. It also
simultaneously decreases the prevalence of depression and insulin resistance for
women with Polycystic Ovary Syndrome (PCOS) and helps to maintain a healthy
bodyweight.
Prevention, screening, and treatment of diseases
Vaccinations prevent certain diseases that can be life-threatening for an unborn
baby, e.g. measles, rubella, chickenpox and whooping cough. Having the
vaccination status checked before getting pregnant is especially important, only so-
called live vaccines are contraindicated for pregnant women.
To avoid passing on caries to their child, women and their partners should
additionally have a dental check-up during the preconception period. Both partners
need to consult the dentist and improve dental care, if necessary.
As many medicines must not be taken during pregnancy, woman planning to get
pregnant should discuss current treatments with their doctor. Adults with chronic
diseases should aim at an optimal medication regime to achieve a good metabolic
control and avoid potentially harmful situations for the baby. For example,
increased blood sugar levels in pregnant women with diabetes type 1 or 2 can
cause congenital malformations in babies. Additionally it was shown that diabetes
and hypertension reduce the men’s quality of sperm.
Assessment for preconception period:
• Physical assessment including physical examination and medical and family
history
• Immunization record including rubella, hepatitis B, and varicella.
• Complications with past pregnancies
• Identification and assistance for victims of domestic violence
• Psychosocial screening for parent readiness
*Definition of Conception period:
Natural conception is defined as:
The interaction of many factors, including correct timing between release of a
mature ovum at ovulation and ejaculation (semen expulsion) of enough healthy,
mature, motile sperm into the vagina. Although exact viability is unknown, the
ovum may survive no longer than 24 hours after its release at ovulation. Most
sperm survive no more than 24 hours in the female reproductive tract, although a
few may remain fertile in the woman’s reproductive tract up to 80 hours.
*Terminology:
✓ Gynecology: a branch of medicine that deals with the diseases and
routine physical care of the reproductive system of women
✓ Obstetrics: branch of medicine that deals with the pregnancy and
childbirth
✓ Antenatal Period: a term that means ‘before birth’ (alternative terms
are ‘prenatal’ and ‘antepartum’)
✓ Intrapartum Period: the process a woman’s body goes through when
her baby is born.
✓ Postpartum Period: a term meaning ‘after birth’ (alternative terms are
‘post-birth’ and ‘postpartum’)
✓ Prim gravida & Multigravida: The number of pregnancies.
Primagravida refers to a woman carrying her first pregnancy. Multipara
or multiparity refers to a woman who already has one baby or more.
✓ Gravida: Number of times a uterus has held a pregnancy.
✓ Para : Number of times a uterus held a pregnancy past 20 wks –
Primiparity and Multiparity
✓ Abortion : termination (end) of a pregnancy after 20 weeks from
pregnancy
✓ Miscarriage: termination (end) of a pregnancy before 20 weeks from
pregnancy
✓ Viability : the point at which a baby can be resuscitated at delivery and
can survive without significant morbidity. Many times this age of
viability is about past 24 weeks
✓ Preterm : delivering the baby between 20-37 weeks
✓ Term : when a pregnancy is in a normal duration (37–42 weeks
gestation)
✓ Post term : the pregnancy continue after the 40 weeks
 ✓ Amniotic sac : the amniotic fluid that surrounds an unborn
baby inside the uterus.
✓ Bloody show : a common symptom during late pregnancy when
a small amount of blood and mucus is released from the vagina.
A bloody show occurs because the cervix starts to soften and
thin (efface) and widen (dilate) in preparation for labor.
✓ LMP: first day from the Last menstrual period

*Pregnancy dating :

Pregnancy lasts an average of 280 days (40 weeks) from the first day of
the last menstrual period (LMP). The first day of the LMP is considered
day one of pregnancy, even though probably the lady didn’t conceive
until about two weeks later (fetal development lags two weeks behind
your pregnancy dates). If the pregnant lady has regular 28-day menstrual
cycles, there are two ways to calculate the due date:

Naegele’s rule

Naegele’s rule involves a simple calculation: Add seven days to the first day of
your LMP and then subtract three months.

For example, if the LMP was November 1, 2022:

1. Add seven days (November 8, 2022).

2. Subtract three months (August 8, 2022).
3. Change the year, if necessary (to the year 2023, in this case).

In this example, the due date would be August 8, 2022.

 4. For example the last menstrual period (LMP) began July 30, 2021 To
determine the EDD follow the following steps:
5. Subtract 3 months (June 30, May 30, April 30) = April 30, 2021
6. Add 7 days then change the year = April 30 + 7 (April has 30 days only,
thus, adding 7 days would make the EDD May 7) = May 7 (change the year)
= May 7, 2022
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.
Add +/- 2-4 weeks for the measuring. For example a fundal high measuring 36cm
determines the Gestational age of 34 or 35 or 36 or 37 or 38 weeks
Pregnancy wheel:
The other way to calculate the due date is to use a pregnancy wheel. The first step
is locating the date of the LMP on the wheel. When the lineup that date with the
indicator, the wheel displays the due date.
Remember that the due date is only an estimate of when the lady will deliver her
baby. The chances of actually having this baby on that exact date are very slim.

**Note: Sonogram – early Ultrasound at 7-13

weeks after LMP most accurate for dating
pregnancy
GPA terminology:
GPA terminology used to summarize or descrive the lady`s obstetric history:
G gravida (number of pregnancies)
P para (number of births of viable offspring) and abortion after 20 weeks
A or Ab abortus (abortions) before 20weeks which means miscarriages
nulligravida gravida 0 no pregnancies
primigravida gravida G1 P0 A0 pregnancy
nullipara G1 Para 0 A1
Example of Obstetric history:
1- G5, P3, A1 means the lady is pregnant now , had 3 pregnancy before , she has 3
children and had one abortion
2- G3 P2+1 A0 means the lady is pregnant now and had 2 pregnancies before one
of them twins ( P2+1) refers to twins .

Question: G 5 P 3 A 1

How Many Times Has The Woman Been Pregnant (Gravidity):

How Many Live Births or Stillbirths (Deaths In Utero After 20 weeks) Has
the Woman Had (Parity):

How Many Fetus Deaths in Utero Before 20 Weeks Has the Woman Had
(Abortions):