PRENATAL PERIOD / PRENATAL

MANAGEMENT
(Part 5)
COMMON DISCOMFORTS OF PREGNANCY AND
RELIEF MEASURES
Complete Physical Examination: includes internal gynecologic examination and
bimanual examinations.

Internal Examination (IE): detects early signs of pregnancy:

Chadwick’s sign, Goodell’s and Hegar’s sign. The following are
the preparation for IE:
» Explanation
» Void before IE
» Proper postioning: Lithotomy
» Equal height of padded stirrups
» Simultaneous placing of legs on stirrups
» No pressure on the popliteal region
» Draping
» Instruction: position hands across the chest; correct breathing,
slow, chest breaths
Internal Examination (IE):

DON’TS:

» Any activity that can increase intra-abdominal

pressure (i.e, squeezing of nurse’s hands,
breath-holding)
» Distracting woman’s attention from focused
breathing/relaxation techniques
» Any impediment to communication
Important concerns of physical examinations

» Breasts – look for breast changes, adequacy

of breasts for breastfeeding, any abnormal
signs.
» Abdomen
» Fundic height
» Leopold’s maneuvers: are a systematic
method of observation and palpation to
determine fetal presentation and position.
Preparation for Leopold’s Maneuvers are as
follows:

» Explain the procedure and the need for it.

» Ensure proper position: dorsal recumbent with knees
slightly flexed to relax abdominal muscles.
» Drape accordingly.
» Nurse’s hands should be warm to prevent contracting
mother’s abdominal muscles resulting in difficult
palpation.
» Apply gentle, firm palpations using the palm of the
hands.
LEOPOLD’S MANEUVER
LEOPOLD’S MANEUVER
LEOPOLD’S MANEUVER
Sources of Maternal Weight Gain
HYGIENE OF PREGNANCY

A. NUTRITION
1. Always start with diet history when it comes to giving nutritional
instruction to the mother.
2. Nutritional Profit should include the following:
a. Pre-pregnant and current nutritional status.
b. Dietary habits: junk, empty-caloric foods, regularity of meals, peer
pressure, adequacy of food/available finances, cultural and religious
restrictions.
c. Pica: persistent ingestion of inedible substances (e.g. clay, dirt,
starch, chalk), and/or substances of little nutritional value; a
psychobehavioral disorder (Rainville, 1998). Effects are displacement
of nutritious food, interference of nutrient absorption, and anemia.
d. Mother’s knowledge of nutritional needs and the daily
recommended allowances.
e. Physical findings indicative of poor nutritional status such as:
Anemia, underweight/overweight states
Dull hair
Dry/scaly skin
Pale/dull mucus membrane/conjunctiva
f. Factors/conditions requiring special attention such
as:
» Young, adolescent mother
» Primigravidity
» Low pre-pregnant weight
» Obesity
» Low socioeconomic status/economic deprivation
» Pre-pregnant debilitating condition
» Vegetarians-lack essential protein and minerals; may
need vitamin B12 supplement
» Successive pregnancies; short interval between
pregnancies
» Education-not so much what they know (may receive
nutritional teaching) but how much they earn (spells
adequate finances) to buy essential foods.
3. Nutrients Needs should include the following:

a. CALORIES
» Non-pregnant requirement: 1,800 to 2,200 Kcal/day
» Additional caloric requirement per day: 300 Kcal/day
» Usual daily caloric need in pregnancy: 2,100 to 2,500; never less than
1,800 Kcal/day
» Avoid ‘empty’ calories like soft drinks

b. PROTEIN: body-building food; additional 30 g/day to ensure 74 to 76

g/day. Rich food sources include: milk, meat, fish, poultry, and eggs.

c. CARBOHYDRATES: sufficient intake is necessary for added energy

needs; avoid ‘empty’ calories like soft drinks.

d. FIBER: taken from fruits and vegetables to prevent constipation

e. FATS: high-energy foods for absorption of vitamins A, D, E, and K.

Avoid too much fat to prevent vomiting and heartburn.
g. ESSENTIAL MINERALS AND VITAMINS

IRON: most important mineral that must be taken in

supplementary amount
» 18 mg/day in non-pregnant state; supplementary in
pregnancy: 30 to 60 mg/day
» Sources: liver (best source) and other red meats, green leafy
vegetables, egg yolk, cereals, dried fruits and nuts.
» Needed to increase maternal RBC mass and for fetal liver
storage in the third trimester.
» Intake of iron-fortified multivitamins to ensure essential levels.

CALCIUM
» Need for maternal calcium and phosphorus metabolism and
fetal bone and skeletal growth
» 1,200 mg/day, equivalent to 1 quart of milk a day (4 glasses)
» Sources: milk and milk-products and broccoli (which carries
the same amount of calcium as milk)
SODIUM: most abundant cation in extracellular fluid
» Need in pregnancy for tissue growth and development
» Contained in most kinds of foods
» Should not be restricted without serious indications

FOLIC ACID
» Needed to meet increased metabolic demands in
pregnancy and for production of blood products
» Deficiency may cause fetal anomalies/neural defect
and bleeding complications
» Sources: liver, dark green leafy vegetables
VITAMINS: water-soluble vitamins (C and B) and fat-
soluble vitamins (A, D, E, and K).

Major Food Sources:

» Vitamin C: citrus fruits and vegetables like broccoli, bell peppers, and
tomatoes.

» Vitamin B Group: legumes, beans, nuts, whole grain, oatmeal, pork,

beef, fish, liver, organ meats, eggs, and green leafy vegetables.

» Vitamin A: milk and dairy products, dark green and dark yellow fruits
and vegetables, eggs and liver.

» Vitamin D: milk and foods fortified with vitamin D; egg yolk; fish.

» Vitamin E: nuts, seeds, wheat germ, whole grain products, green

leafy vegetables, vegetable oils.

» Vitamin K: meats, liver, cheese, tomatoes, peas, and egg yolk.

Physical Signs and Symptoms of Adequate
Pregnancy Nutrition
BATH

» Daily bath if desired.

» Avoid soaps on nipples: with drying effect.
» Towel-dry breasts: increases integrity/toughness of
nipples.
» Tub bath: may cause injuries from accidental slipping as
pregnant women have difficulty maintaining balance.
» Usually contraindicated except when there is care in
getting into and out of bathtub; nonskid rubber mat on
bathtub floor helps to prevent falls.
» Douching: not needed to manage vaginal discharge
(Leucorrhea is estrogen-included.); daily bath will
suffice.
CLOTHING

» Loose, comfortable clothes, of cotton material

for more comfort.
» No constrictions around breasts, abdomen,
legs, no round garters.
» Flat-heeled shoes for comfort and balance.
» Support panty hose for varicosities (avoid
knee-length stockings).
» Supportive, cotton-lined brassiere.
» Maternity girdle as necessary.
SLEEP AND REST

» Assess activities to identify need for rest and

sleep.
» Average number of hours of sleep is 8 hours;
may need 1 to 2 hours of afternoon nap. In the
second half of pregnancy, advise to avoid the
supine position in bed.
» Plan rest time during the day.
» At work, get to stand and walk about for few
minutes at last once in every 2 hours (If task
requires prolong standing, there should be
time to walk about and sit at intervals).
TRAVELING

» Long distance travel by land needs stop-overs so

pregnant women can get out of the car and walk.
Seatbelts are needed.
» Traveling by air requires pressurized planes; in late
pregnancy, airlines will require a medical certificate
indicating fitness to travel by air.
» Best time to travel is during the second trimester
because:
» The pregnant woman is most comfortable.
» The danger of abortion is not great.
» The threat of premature labor is at a minimum.
» Journeys close to term are discouraged.
EXERCISES

CLEANSING BREATHING: deep relaxed breath, like a sigh. Can be

practiced in pregnancy; used in labor to signal the beginning of uterine
contractions.

PELVIC ROCK: the most important exercise for comfort during

pregnancy. Purposes:
» Increases flexibility of the lower back
» Strengthens the abdominal muscles
» Shifts center of gravity back to uterine spine
» Relieves backache, improves posture and appearance in late
pregnancy

Pelvic rocking is helpful in relieving backache during pregnancy and labor. To do

this, a woman first hollows her back and then arches it.
SQUATTING/TAILOR-SITTING: strengthens perineal
muscles; makes pelvic joints more pliable.

Squatting helps to stretch the muscles of the pelvic floor. Notice that the feet are
flat on the floor for optimal perineal stretching.

Tailor sitting stretches perineal muscles to make them more supple. Notice that
the legs are parallel so that one does not compress the other. A woman could
use this position for television watching, telephone conversations, or playing
with an older child.
ABDOMINAL BREATHING: utilizes the diaphragm
primarily and not the chest muscles; helpful during the
first half of labor, and, when used together with total
relaxation, can carry women through most of the first
stage.

KEGEL: improves the tone of pubococcygeal, perineal,

vaginal, and pelvic floor muscles. In uterine prolapse,
cystocele and rectocele, this can be done every hour.
PANTING: best for crowning period and actual
delivery of the baby leaving the work to be
accomplished by the uterus. Only by panting
can the mother be kept from pushing in the
transition phase of labor, pushing should be in
the second stage of labor EXCEPT during
CROWNING.
MARITAL RELATIONS/COITUS

1. Changes in normal sexual response are related to the physiologic changes of

pregnancy
» First Trimester: less interest in sex due to fatigue, nausea, or adaptation to
pregnancy.
» Second Trimester: interest in sex may increase as this trimester is the most
comfortable period.
» Third Trimester, near term: less interest due to the discomforts brought about by
positional difficulty and abdominal size.

2. Generally no contraindications except in the presence of :

» Premature rupture of membranes
» Premature labor, bleeding
» Deeply engaged head in late pregnancy
» Incompetent cervix

3. In healthy, pregnant women, sexual intercourse usually does no harm.

» Like any other activity, avoid fatigue; exercise moderation and hygiene.
» Couple may need counseling regarding more comfortable positions. The
traditional man-on-top position is uncomfortable for many couples.
» Suggested positions: side lying and the woman-on-top position.
EMPLOYMENT

» The pregnant woman may continue working provided

the work, work area, and work conditions do not
pose hazards to the health of mother and fetus.
» Safety and rest are two most important considerations
in deciding whether or not the pregnant woman should
continue working.
» Whether standing or sitting at work, the pregnant should
be advised to stop and walk about every few hours to
improve circulation of blood.
» Adequate periods of rest should be provided during the
workday.
» Women with previous complications that are likely to be
repetitive like SGA, premature labor, or abortions,
probably should minimize physical work.
CARE OF THE TEETH

» Regular examination of the teeth and gums should be

part of the prenatal general physical examination.
Dental carries require prompt management in
pregnancy, but major dental surgeries should be
postponed for the postpartal period.

» Because of the estrogen effect on vascularity, the gums

of pregnant women are painful and swollen. Instruct on
the use of soft bristled toothbrush and gentle brushing.
» The concept that dental carries are aggravated by
pregnancy is not supported by literature. There is no
tooth loss secondary to pregnancy.
S-A-D HABITS OF PREGNANCY

Smoking. Pregnancy women should not smoke.

Effects of tobacco use

1. Increased risk of SGA
2. Prematurity
3. Infant mortality
4. Spontaneous abortion
5. Placenta previa/abruption placenta
6. Premature rupture of membranes

Causes of adverse effects of smoking

7. Nicotine, a vasoconstrictor, causes reduced placental perfusion.
8. The increased of carbon monoxide causes functional inactivation of
maternal and fetal hemoglobin.
9. Smokers have decreased plasma volume.
10.Smokers have reduced appetite, resulting to decreased caloric
intake.
Alcohol. Alcohol ingestion by pregnant women is likely to
cause fetal abnormalities. Alcohol is the leading
known teratogen in the Western world.

Effects of chronic alcoholism: fetal alcohol syndrome

(FAS). Heavy use of alcohol (2 or more drinks/day) has
10% risk of producing FAS, characterized by:
1.Retardation/delays
2.Mental retardation
3.Craniofacial defects (FAS facies):
4.Cardiovascular defects
5.Limb defects
6.Impaired fine and gross motor function
Caffeine: reduce intake of coffee, tea, colas,
and cocoa to 300 mg of caffeine per day or no
more than 2 to 3 servings per day (US FDA).

Drugs should only be taken by pregnant women

prescribed by their physicians. Drugs
prescribed in pregnancy should have benefits
or advantage outweighing the risks. The best
recommendation: no medication is taken
during pregnancy unless absolutely
necessary and prescribed.