MATERNAL AND

FETAL WELL-
BEING
GROUP MEMBERS:
Ivy Marie C. Grifon
Marl Gale M. Tahum
Julia V. Teves
Flourence J. Zafran
 OBJECTIVES
After 1 hour (60 minutes) of ward class presentation
accompanied with varied teaching- learning activities, BSN
Level II students of Prenatal Rotation will be able to obtain
knowledge to enhance skills and to develop the attitude towards
caring of client or pregnant woman with varying conditions
under a normal framework and apply ethical and moral
considerations with all interventions.
 TABLE OF CONTENTS

I. INTRODUCTION
II. FETAL GROWTH AND DEVELOPMENT
III. DIET/ SUPPLEMENT/ NUTRITIONAL NEEDS
IV. FOOD AND ACTIVITIES TO BE AVOIDED
V. SUMMARY OR CONCLUSION
VI. GAMES
VII.REFERENCES
 INTRODUCTION
Pregnancy in Woman’s Perspectives
• From the moment a woman finds out that she is
pregnant, she faces a future marked by dramatic
changes.

• In coping with these changes, she needs to make

adjustments in her daily life.

• Pregnancy is a special time of wonder and personal

growth.
 The Mother and the Fetus
• The health of a fetus and the health of a mother are in
intricately linked

• A woman who eats well and takes care of her own health
during pregnancy provides a healthy environment for
fetal growth and development.

• health education plays a major role in promoting

maternal and fetal health.
The Mother and the Fetus
● The health of a fetus and the health of a mother are in
intricately linked.

● A woman who eats well and takes care of her own

health during pregnancy provides a healthy
environment for fetal growth and development.

● Health education plays a major role in promoting

maternal and fetal health.
Significance Prenatal Nursing Care
● Effective prenatal care is such an
important means to improve women’s
health.
● Pregnancy outcomes can be improved by
following modern recommendations for
personal health maintenance
FETAL GROWTH
AND
DEVELOPMENT
Stages of Fetal Development
 
Fertilization: The Beginning of Pregnancy
 
Fertilization (also referred to as conception and
impregnation) is the union of an ovum and a
spermatozoon. This usually occurs in the
outer third of a fallopian tube, termed the
ampullar portion (Taylor & Badell, 2011).
 Terminologies Used in Fetal Growth
•  
Ovum - from ovulation to fertilization
• Zygote - from fertilization to implantation
• Embryo - from implantation to 5–8 weeks
• Fetus - from 5–8 weeks until term
• Conceptus - developing embryo and placental structures throughout
pregnancy
• Age of viability - the earliest age at which fetuses survive if they are born
is generally accepted as 24 weeks, or at the point a fetus weighs more than
500–600 g
 Implantation
Approximately 8 to 10 days
after fertilization, the
growing structure makes
contact with the uterine
endometrium, resulting in
implantation.
MILESTONES OF FETAL
GROWTH
AND DEVELOPMENT
 End of Fourth Gestational Week
● Length: 0.75 cm
● Weight: 400 mg
● The spinal cord is formed and fused at midpoint.
● Head is large in proportion and represents about 1/3 of entire
structure
● Rudimentary heart appears as a prominent bulge on the anterior
surface
● The arms and legs appear as bud-like structures
● Eyes, ears and nose are discernible
 End of Eighth Gestational Week
● Length: 2.5 cm (1 in.)  
● Weight: 20 g
● Organogenesis is completed.
● Now has a septum and valves and beats rhythmically
● Facial features are discernible
● External genitalia are forming, but sex is not yet
05
distinguishable by simple observation
● Eyes, ears and nose are discernible
● A sonogram shows a gestational sac, which is diagnostic
of pregnancy
 End of 12th Gestational Week (First Trimester)
• Length: 7 to 8 cm
• Weight: 45 g
• Nail beds are forming on fingers and toes.
• Sex is distinguishable on outward appearance.
• The heartbeat is audible through Doppler technology.
• Urine secretion begins but may not yet be evident in amniotic fluid.
• Some reflexes, such as the Babinski reflex, are present.
• Bone ossification centers begin to form.
• Spontaneous movements are possible.
• Tooth buds are present.
 End of 16th Gestational Week
• Length: 10 to 17 cm
 
• Weight: 55 to 120 g
• Fetal heart sounds are audible by an ordinary stethoscope.
• Liver and pancreas are functioning.
• The fetus actively swallows amniotic fluid, demonstrating
an intact but uncoordinated swallowing reflex; urine is
present in amniotic fluid.
• Sex can be determined by ultrasonography
 End of 20th Gestational Week
• Length: 25 cm  
• Weight: 223 g
• Spontaneous fetal movements can be sensed by the mother.
• Antibody production is possible. Passive antibody transfer from
mother to fetus begins.
• Hair, including eyebrows, forms on the head; vernix caseosa begins to
cover the skin.
• Meconium is present in the upper intestine.
• Brown fat, a special fat that aides in temperature regulation, begins to
form behind the kidneys, sternum, and posterior neck.
• Definite sleeping and activity patterns are distinguishable as the fetus
develops biorhythms that will guide sleep/wake patterns throughout
life.
 
 End of 24th Gestational Week (Second
Trimester)
• Length: 28 to 36 cm
• Weight: 550 g
• Meconium is present as far as the rectum.
• Active production of lung surfactant
begins.
• Eyelids are now open; pupils react to light.
• Hearing can be demonstrated by response
to sudden sound.
 End of 28th Gestational Week
• Length: 35 to 38 cm
• Weight: 1,200 g
• Lung alveoli are almost mature; surfactant can be
demonstrated in amniotic fluid.
• Testes begin to descend into the scrotal sac from the
lower abdominal cavity.
• The blood vessels of the retina are formed but thin
and extremely susceptible to damage from high
oxygen concentrations (an important consideration
when caring for preterm infants who need oxygen).
 End of 32nd Gestational Week
• Length: 38 to 43 cm
• Weight: 1,600 g
• Active Moro reflex is present.
• Fingernails reach the end of fingertips.
• Subcutaneous fat begins to be deposited
• Fetus responds by movement to sounds outside the
mother’s body.
• Iron stores, which provide iron for the time during
which the neonate will ingest only breast milk after
birth, are beginning to be built.
 End of 36th Gestational Week
Length: 42 to 48 cm
• Length: 42 to 48 cm
• Weight: 1,800 to 2,700 g
• Amount of lanugo begins to diminish.
• Body stores of glycogen, iron, carbohydrate,
and calcium are deposited.
• Additional amounts of subcutaneous fat are
deposited.
• Sole of the foot has only one or two crisscross
creases, compared with a full crisscross pattern
evident at term.
 End of 40th Gestational Week (Third
Trimester)
• Length: 48 to 52 cm (crown to rump, 35 to 37 cm)
• Weight: 3,000 g
• Fingernails extend over the fingertips.
• Fetus kicks actively, sometimes hard enough to cause
the mother considerable discomfort.
• Fetal hemoglobin begins its conversion to adult
hemoglobin.
• Vernix caseosa is fully formed.
• Creases on the soles of the feet cover at least two
thirds of the surface.
Origin and Development
of Organ Systems
Age: 2 - 3 Weeks
 Age: 2-3 Weeks

Groove forms along middle back as cells thicken; neural

tube forms from closure of neural groove.

Beginning of blood circulation,

tubular heart begins to form during
third week.
Liver begins to function.

Formation of kidneys beginning.

Nasal pits forming.

Thyroid tissue appears.

Optic cup and lens pit have formed,
pigment in eyes.

Auditory pit is now

enclosed structure
Age: 4 - 6 Weeks
 Age: 4-6 Weeks
Bone rudiments present, primitive skeletal shape forming,
muscle mass begins to develop, ossification of skull and jaws
begins.

Chambers present in heart; groups

of blood cells can be identified.

Oral and nasal cavities and upper lip formed; liver begins to
form red blood cells.
Trachea, bronchi, and lung buds present.

Formation of external, middle, and

inner ear continues.

Embryonic sex glands appear.

Age: 7 - 8 Weeks
 Age: 7-8 Weeks
Digits formed, development of muscles in trunk, limbs,
and head; some movement of fetus now possible.

Development of heart essentially complete; heartbeat can be heard with

Doppler at 8–12 weeks.

Male and female external genitals appear similar until

end of ninth week.
 Age: 7-8 Weeks

External, middle, and inner ear

assuming final forms.

Completion of lip fusion.

Age: 12 Weeks
 Age: 12 Weeks
Clear outlining of miniature bones: process of
ossification is established throughout fetal body,
appearance of involuntary muscles in viscera.

Completion of palate. Digestive tract

appearance of muscles in gut, bile secretion
begins, liver is major producer of red blood cells.

Lungs acquire definitive shape.

 Age: 12 Weeks
- Skin: Pink and delicate
- Endocrine system: Hormonal secretion
from thyroid, insulin present in pancreas.
- Immunologic system: Appearance of
lymphoid tissue in fetal thymus gland.
Age: 16-18 Weeks
 Age: 12 Weeks
Teeth beginning to form hard tissue that will become
lateral incisors.

Fetal heart tones audible with fetoscope at 16-20 weeks.

Myelination of spinal cord begins.

Fetus actively sucks and swallows amniotic fluid;

peristaltic movements
begin.
 Age: 16-18 Weeks
- Skin: Lanugo covers entire body; brown fat begins to form;
vernix caseosa begins to form.

- Immunologic system: Detectable levels of fetal antibodies.

- Blood formation: Iron is stored and bone marrow

isincreasingly important
Age: 32 Weeks
 Age: 32 Weeks
More reflexes present

Distal femoral ossification centers present.

Labia major and minora equally prominent

Scrotum small and few rugae present.

 Age: 32 Weeks
- Skin: Pale; body rounded, lanugo disappearing hair
fuzzy or woolly, few sole creases; sebaceous glands
active and helping to produce vernix caseosa.

- Ears: Earlobes soft with little cartilage.

Age: 38-40 Weeks
 Age: 38-40 Weeks

Decreased risk of respiratory distress from inadequate

surfactant production.

Fungus scrotum

Labia majora well developed

and minora small or completely covered.
 Age: 32 Weeks
- Skin: Smooth and pink, vernix present in skin folds,
moderate to profuse silky hair, lanugo on shoulders and
upper back, nails extend over tips or digits, creases cover
sole.

- Ears: Earlobes firmer due to increased cartilage.

 BIOPHYSICAL PROFILE
A biophysical profile is more reliable than any assessment predicting fetal
well-being (Lalor et al., 2009). It is commonly referred to as a fetal Apgar
because the
suggest scoring
that you and system
your babyisrequire
identical to the Early
more testing. Apgar score
or quick determined at birth
delivery
may be indicated in particular instances.
on infants. The test is usually done after 32 weeks of pregnancy, but it can also
be done after week 24 if your pregnancy is far enough along to consider
delivery. A poor biophysical profile score may suggest that you and your baby
require more testing. Early or quick delivery may be indicated in particular
instances a fetal Apgar because the scoring system is identical to the Apgar
score determined at birth on infants.
 BIOPHYSICAL PROFILE
ASSESSMENT DEFINITION INSTRUMENT CRITERIA FOR A
SCORE OF 2
Fetal reactivity Measure short-term Nonstress test Two or more fetal heart
central nervous system rate accelerations of at
function. Results of this least 15 beats/min
portion of the test above baseline and of
(nonstress test) are 15 sec duration occur
interpreted as reactive with fetal movement
or nonreactive. over a 20-min time
period.
Fetal breathing Measure the short-term Ultrasound At least one episode of
movements function of the central 30 sec of sustained
nervous system. fetal breathing
movementswithin 30
min of observation.
Fetal body Separate movements Ultrasound At least three separate
movement of the body or limbs, episodes of fetal limb
including fine motor or trunk movement
movements. within a30-min
observation.
Fetal tone Opening or closing of Ultrasound The fetus must extend
the hands and mouth, and then flflex the
extension and flexing of extremities or spine at
the limbs, or least once in 30 min.
repositioning or rotation
of the trunk of the body.
Amniotic fluid Assess the placental Ultrasound A range of amniotic
volume function's long-term fluid between 5 and 25
sufficiency. cm must be present.
DIET / SUPPLEMENT /
NUTRITIONAL NEEDS
IVY MARIE C. GRIFON, SN
What is the Relationship Between
the Nutritional Status of the Mother
and Her Fetus ?
• A woman’s nutritional status before
and during pregnancy can significantly
influence her own health and that of
her unborn child.
• A woman needs a well-balanced food
consumption to provide nutrients for
herself and a growing fetus.
 Nutritional Requirements
1. ENERGY (CALORIE) NEEDS
 An additional 300 calories, or a total caloric intake of 2,500 calories, is recommended to
meet the increased needs of pregnancy.

Factors affecting caloric requirement:

 prepregnant weight
 height
 maternal age
 activity

 health status
 Obtain carbohydrate calories from complex carbohydrates rather than
simple carbohydrates

 Consider her lifestyle.

 A woman needs protein calories and iron and other essential nutrients.

 Prepare snacks such as carrot sticks or cheese and crackers

 Assessing the pregnant woman if she is gaining weight.

 2. PROTEIN NEEDS
 Fetal development, blood volume expansion, and growth of other
maternal tissues, overall energy metabolism

 During pregnancy, the need for protein increases to 71 g daily

Examples:
• Complete proteins - Meat, poultry, fish, yogurt, eggs, and milk
• Complementary proteins - beans and rice, legumes and rice, or beans
and wheat

 Women who have allergies to milk or lactose intolerant or practices

vegetarianism may find soy milk and soy cheeses acceptable..
 3. FAT NEEDS
 Essential fatty acids are important for the development of the central
nervous system of the fetus [Omega-3 fatty acids and
docosahexaenoic acid (DHA) ]

 Reduce the risk of preterm birth preeclampsia, and low birth weight

 Enhances the development of the fetal and infant brain

 Pregnant women should ingest 200 to 300 mg of omega-3 fatty acids

daily

Sources:
• oily fish, soybean oil, canola oil, flaxseeds and their oil, walnuts
 4. VITAMIN NEEDS
Fat-soluble vitamins
Vitamin A - new cell growth, healthy skin, oral health, and vision in dim light

Sources:
• dark green and yellow
vegetables; liver, milk,
butter, cheese, and eggs
Fat-soluble vitamins
Vitamin D - calcium absorption,
formation of bones and teeth, and
possibly for immune system
functioning.

Sources:
• fortified milk, cheese, eggs,
and salmon
Fat-soluble vitamins
Vitamin E - synthesis of nucleic acids required
in the formation of red blood cells in the bone
marrow; antioxidant

Sources:

• vegetable fats and oils, whole grains, greens,

and eggs

Vitamin K - normal blood clotting

Sources:

• Green leafy vegetables and liver

Water-soluble vitamins
The B Vitamins - thiamine (B1), riboflavin (B2),
niacin, folic acid, pantothenic acid, vitamin B6,
and vitamin B12
 respiration, glucose oxidation, and energy
metabolism
 Folic acid, or folate, - normal growth,
reproduction, and lactation and prevents the
macrocytic, megaloblastic anemia of pregnancy

Sources:
• pork, liver, milk, potatoes, enriched breads, and
cereals, whole grains, meat, peanuts, etc.
 5. MINERAL NEEDS
Calcium and Phosphorus

 Mineralization of fetal bones and

teeth, energy and cell production,
and acid–base buffering.

Iodine

 Iodine deficiency is the most

widespread nutritional cause of
impaired brain development
Zinc

 Normal fetal growth and development as well as milk production

during lactation.

Magnesium

 Cellular metabolism and structural growth.

Iron

 A woman needs iron to build an increased red cell volume for

herself and to protect against iron lost in blood at birth.
6. FIBER NEEDS
 Constipation can occur during pregnancy because
bowel peristalsis slows.

 Fiber also has the advantage of lowering cholesterol

levels and may remove carcinogenic contaminants from
the intestine.

Sources:
• fruit, broccoli, and asparagus
7. FLUID NEEDS

 Extra amounts of water are needed during

pregnancy to promote kidney function

 Eight glasses of fluid daily

 It’s Game time!

NUTRI-SPIN
The name of the participants will be inputted in the
spinning wheel. Once his/ her name was chosen by fate,
he/she will have to answer the question about diet/
supplement/ nutritional needs.
 TAHUM

ZAFRAN
TEVES
TAHUM
ZAFRAN
 QUESTION # 1

In deliberating a well-balanced food consumption to provide nutrients for the

pregnant mother and a growing fetus, ____________ is a must.

A. increasing the quantity B. increasing the quality C. increasing the quantity & quality

ANSWER: B
 QUESTION # 2

Factors affecting caloric requirement, EXCEPT:

A. maternal age B. activity C. prepregnant weight D. NONE OF THE ABOVE

ANSWER: D
 QUESTION # 3

This nutritional requirement is necessary for fetal development, blood volume

expansion, growth of other maternal tissues, and overall energy metabolism.

A. Protein B. Fat C. Vitamin D. Mineral

ANSWER: A
 TAHUM
TEVES
TAHUM
ZAFRAN
TEVES
TEVES

ZAFRAN
TAHUM
 QUESTION # 4

__________ has the advantage of lowering cholesterol levels

and may remove carcinogenic contaminants from the intestine.

A. Fiber B. Fluid C. Vitamins D. Minerals

ANSWER: A
 QUESTION # 5

Dietary intake of __________ during pregnancy may be beneficial to both the mother
and the fetus by reducing the risk of preterm birth, preeclampsia, and low birth
weight, as well as enhancing the development of the fetal and infant brain.

A. docosahexaenoic acid (DHA) B. complementary proteins

C. complex carbohydrates D. B Vitamins

ANSWER: A
 Food and
Activities
to be Avoided
Foods to be Avoided!
ALCOHOLic beverages - alcoholic beverages is
known to have their potentially teratogenic effects
on a fetus.

Foods that Contains Food Additives - a lot of food

additives have an unknown effect. It is risky to
consume foods containing food additives for it may
cause harm to a fetus.
Food to Limit
 Excess Seafood
Recommended Dietary Intake / Suggested
Serving :

✓ 12 ounces of seafood or shellfish (2 to 3

meals) per week for their omega-3 and
iodine content.

FISH THAT MUST BE AVOIDED:

SHARK SWORDFISH KING MACKEREL

OR TILEFISH
Caffeine is a central nervous system
stimulant capable of increasing heart rate,
urine production in the kidney, and secretion
of acid in the stomach (Rolfes, Pinna, &
Whitney, 2009.

Alternatives if a woman have difficulty Coffee

omitting these foods in her diet. Recommended Dietary Intake /
 Decaffeinated coffee (alternative for regular Suggested Serving :
coffee) • Less than 3 cups daily
✓ Herbal tea
✓ Green tea
Caffeine facts in foods
• Cup of Coffee - 120 mg of caffeine
• Cup of hot Chocolate - 10 mg of caffeine
• Baking chocolate - 35 mg of caffeine
 ARTIFICIAL
SWEETENERS
Although the sweetener aspartame has been
licensed for consumption by the US Food
and Drug Administration and appears to be
safe during pregnancy, pregnant women
should avoid high doses of the substance
until its safety is appropriately validated.
 Weight Loss Diets
Liquid-restricting diets and/or
diets combined with weight-loss
medicines are hazardous during
pregnancy because they can cause
fetal ketoacidosis and poor growth.
ACTIVITIES TO BE AVOIDED
 Activities that cause
jerky or bouncy
movements

The jerky or bouncing movements these

activities cause leads to placental abruption.
Contact Sports
Placental abruption, or the early detachment
of the placenta from the uterine wall, is a risk of contact
sports.

Pregnant women are also more vulnerable to injury

because their ligaments loosen due to hormonal changes in
the body.

Possible Outcomes of
Placental Abruption:

• Preterm birth.
• Pregnancy loss, or stillbirth.
Sports that involve altitude change
Avoid any activity that brings you above 6,000 feet
unless you already live at a high altitude area
already.

Scuba diving, on the other hand, is off-limits due

to the risk of decompression sickness for your
baby, so postpone your next dive until you're no
longer pregnant.
Activities with a fall risk or abdominal
injury
Pregnant women should avoid any activity that puts
them at risk of falling after the first trimester. Since the
center of gravity moves during pregnancy as the belly
develops, even a slight fall can result in injury.
EXAMPLES:
 Gymnastics
 Downhill skiing
 Snowboarding,
 Ice Skating
 Strenuous Racket Games
 Horseback Riding
 Outdoor Cycling
Hot tubs, saunas and overheating

Hot tubs can cause hyperthermia, or an

excessively high body temperature, which can
lead to congenital defects.

Additional activities that may cause the body

temperature to rise too high include:
• hot yoga or Pilates
• sunbathing for too long
• exposure to extreme heat
• strenuous exercise
• dehydration
• heavy lifting
 Exercises that involve lying flat on your
back
After the fourth month, it's off-limits because the weight of
your expanding uterus may compress major blood veins,
restricting circulation to both you and your baby. As a
result, you may feel queasy, dizzy, and out of breath.
 Back bends or other contortions
Movements involving deep flexion or extension of
joints (such as deep knee bends) can put you at risk for
injury.

Holding your breath

This activity is not advised to be
do during pregnancy. Both you
and your baby require a steady
supply of oxygen.
Motionless standing

Can limit blood

flow, so avoid
them.
It’s Game time!

The participants will act as the pregnant

woman's husband in a given scenario; they
must identify the activities and foods that the
expectant mother must avoid or limit. If the
participant fails to pick the activities or foods
their wife should avoid, the husband
(participant) will be identified as a loser
husband in the game.
1. Rose is your wife; she told you that she would have a drink.
Five beverages are in your refrigerator: apple juice, pineapple
juice, iced coffee, coconut water, and alcoholic wine. Which
among these drinks should you puck away from your wife?
Iced coffee and alcoholic wine.
2.Your wife wants to eat a fish for a source of
omega 3. There are four available fish in the
market. These are tilapia, swordfish, milkfish,
and king mackerel, which among these fishes
are high in mercury and should not be eaten
by your wife?
sword fish and king mackerel.
3. Your pregnant wife asked you to
accompany her outdoors, for she will
be doing some physical activities. She
mentioned five activities that she is
planning to do: outdoor cycling, horse
riding, walking, low-impact aerobics
classes, and contact sports. Which
among these activities should she
avoid?
outdoor cycling, horse riding, and
contact sports.
4. Rose, your pregnant wife
asked you to get her some
food, which is not allowed
for her among these foods?
Foods: Banana, hotdog, ice
cream, spinach salad, and
wheat bread.
hotdog and ice cream.
 5. You and your wife decided to go to
the beach this weekend to relax. The
following are the activities that you and
your wife can do on the beach. Which
among these activities are prohibited
for her?

Activities in the beach:

Scuba diving.
Build a sand castle
Read a book as you both sit in a beach chair
with umbrella.
Sunbathing
Sunset viewing
scuba diving and sunbathing
 4-5 correct answers

YOU WIN! YOURE A

RESPONSIBLE HUSBAND!
 Less than 3 correct answers

YOU LOSE! YOU’RE A LOSER

HUSBAND
 SUMMARY OR CONCLUSION
• The concept of maternal and fetal well-being prompts the pillar of
prenatal care.
• The biophysical profile monitors the fetus's movement, muscle
tone, reactivity, breathing movement, and amniotic fluid volume.
• During pregnancy, a woman must eat adequately to not only
support her own nutrition but also to supply enough nutrients so
the fetus can grow.
• There are certain foods and activities or exercises that pregnant
women must avoid to ensure the safety of the fetus growing
inside them.
 REFERENCES
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WOMAN'S HEALTH (across the lifespan) (9th ed.). Library of Congress Cataloging-in-Publication Data.
doi:ISBN-13: 978-0-13-210907-9
De Bellefonds, C. (2019). Exercises to Avoid During Pregnancy. What to Excpect.https
://www.whattoexpect.com/pregnancy/exercise-safety
Fletcher, J. (2018, August 24). What to avoid during pregnancy.Medical News Today.
https://www.medicalnewstoday.com/articles/322873
Hibbeln, J., Gregory, S., Iles-Caven, Y., Taylor, C. M., Emond, A., & Golding, J. (2018). Total mercury exposure
in early pregnancy has no adverse association with scholastic ability of the offspring particularly if the mother
eats fish. Environment international, 116, 108–115. https://doi.org/10.1016/j.envint.2018.03.024
Miles, K. (2021, October 4). What activities should I avoid during pregnancy?. Baby Center.
https://www.babycenter.com/pregnancy/health-and-safety/what-activities-should-i-avoid-during-pregnancy_722
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