Care of the Mother and fetus during Perinatal care

Prenatal Care: This involves regular check-ups and medical assessments during pregnancy to
monitor the health of both the pregnant person and the developing fetus. Prenatal care includes
screenings, ultrasounds, and discussions about nutrition, exercise, and birth planning.
Terms: lightening- At the end of the third trimester, the baby settles, or drops lower, into the
mother's pelvis

linea nigra- a dark line that develops on your stomach during pregnancy.

LMP- Last Menstrual Period melasma- increase in the amount of melanin your body triggered by hormones.
Antenatal/ prenatal – before birth
Montgomery’s tubercles - tubercles around your nipples
Postnatal- after birth
Ballottement- method of diagnosing pregnancy, in which the uterus is pushed with a
GTPAL- stands for Gravidity (number of pregnancies including current), Term (number of finger to feel whether a foetus moves away and returns again
pregnancies carried to 37+ weeks), Preterm (number of pregnancies carried between 20
and 36.6 weeks), Abortion (number of losses prior to 20 weeks), and Living (number of
living children) Braxton Hicks contractions – uterine contraction / false labor.
Leopold’s maneuver
couvade syndrome – symptoms the husband experiences on the onset of pregnancy
Cephalocaudal- head to toe
diastasis recti - the separation of the rectus abdominis muscles during and after
Organogenesis- organ formation pregnancy
Surfactant- a phospholipid substance in the lungs, preventing alveolar collapse and
improving the infant’s ability to maintain respirations in the outside environment at birth. Goodell’s sign - softening of the cervix
(24th week)
Hegar’s sign- softening of the lower segment of the uterus
Meconium- a collection of cellular wastes, bile, fats, mucoproteins, mucopolysaccharides
vernix caseosa -lubricating substance that forms on the fetal skin lightening- At the end of the third trimester, the baby settles, or drops lower, into the
Birthing Plan: birthing preferences, where to deliver, pain manangement, normal or cs, mother's pelvis
etc.
Ballottement- method of diagnosing pregnancy, in which the uterus is pushed with a linea nigra- a dark line that develops on your stomach during pregnancy.
finger to feel whether a foetus moves away and returns again.
Braxton Hicks contractions – uterine contraction / false labor. melasma- increase in the amount of melanin your body triggered by hormones.

couvade syndrome – symptoms the husband experiences on the onset of pregnancy Montgomery’s tubercles - tubercles around your nipples
Goodell’s sign - softening of the cervix Leukorrhea- vaginal discharge
Hegar’s sign- softening of the lower segment of the uterus Sims position - left side sleeping position for pregnant mothers
Gestational age:
1st trimester- 0 to 12 weeks
2nd trimester- 13- 24 weeks
3rd trimester-25 to 40weeks
Preterm- 36 weeks and below
Early-term- 37-39weeks
Full-term-39-40 weeks
Late-term- 41-42 weeks
Post-term- 42weeks or more

Stages of Fetal Development

Pre-embryonic (first 2 weeks, beginning with fertilization)
Embryonic (weeks 3 through 8)
Fetal (from week 8 through birth)
Embryonic and Fetal Structures
• THE DECIDUA OR UTERINE LINING
• CHORIONIC VILLI
• THE PLACENTA
Endocrine functions of the Placenta
• Human Chorionic Gonadotropin
• Progesterone
• Estrogen
• Human Placental Lactogen (Human Chorionic Somatomammotropin)
 THE UMBILICAL CORD
THE AMNIOTIC FLUID
Provides circulatory pathwaysthat connects the embryo to the chorionic villi of the placenta
Where does it come from?
transport oxygen and nutrients to the fetus from the placenta and to return waste products from the fetus to the
How many amniotic fluid 800-1200ml on term
placenta
Purposes: shield the fetus from pressure and blow, change in temperature,
It is about 53 cm (21 in.) in length at term and about 2 cm (0.75 in.) thick. The bulk of the cord is a gelatinous
allows muscular development, allows fetus to move
mucopolysaccharide called Wharton jelly, which gives the cord body and prevents pressure on the vein and arteries
What is hydramnios ?
that pass through it.
What is oligohydramnios?
An umbilical cord contains only one vein (carrying blood from the placental villi to the fetus) and two arteries
(carrying blood from the fetus back to the placental villi).
Fetal Organ Development
a.. Ectoderm:
- CNS (brain and spinal cord)
- Skin, hair nails, tooth enamels
- Sense organ
- Mucous membrane of the anus, mouth and nose
- Mammary glands
b. Mesoderm:
-supporting structures of the body (connective tissue, bones,
cartilage, muscle, ligaments and tendons)
-upper portion of the urinary system (kidneys and ureters)
-Reproductive system
-Heart, lymph and circulatory system and blood
c. Endoderm:
-lining of pericardial, pleura and peritoneal cavities
-lining of the gastrointestinal tract, respiratory tract, tonsils,
parathyroid, thyroid, -
-Resp system, CNS
Fetal Development
Fetal Blood Circulation
Blood arriving at the fetus from the placenta is highly oxygenated. This blood enters the fetus through the umbilical
vein (which is still called a vein even though it carries oxygenated blood because the direction of the blood is toward
the fetal heart). Specialized structures present in the fetus then shunt blood flow to first supply the most important
organs of the body: the liver, heart, kidneys, and brain. Blood flows from the umbilical vein to the ductus venosus, an
accessory vessel that discharges oxygenated blood into the fetal liver, and then connects to the fetal inferior vena cava
so oxygenated blood is directed to the right side of the heart. Because there is no need for the bulk of blood to pass
through the lungs, the bulk of this blood is shunted as it enters the right atrium into the left atrium through an opening
in the atrial septum called the foramen ovale. From the left atrium, it follows the course of adult circulation into the
left ventricle, then into the aorta, and out to body parts. As the majority of blood cells in the aorta become
deoxygenated, blood is transported from the descending aorta through the umbilical arteries (which are called arteries
because they carry blood away from the fetal heart) back through the umbilical cord to the placental villi, where new
oxygen exchange takes place.
The mother and the Fetus
1. Physical exam: A physical examination of the mother is the second step in evaluating fetal health.

• Assess maternal weight and general appearance because both obesity and underweight are clues that the mother’s nutrition may not be adequate for sound fetal growth.

• Bruises may indicate intimate partner violence that could have bruised the fetus as well.

• An elevated blood pressure may be the beginning of hypertension of pregnancy, which can restrict fetal growth.

• As a fetus grows, the uterus expands to accommodate its size. Although not evidence grounded, typical fundal (top of the uterus) measurements are:
- Over the symphysis pubis at 12 weeks
- At the umbilicus at 20 weeks
- At the xiphoid process at 36 weeks
- McDonald’s rule, another symphysis–fundal height measurement. Typically, tape measurement from the notch of the symphysis pubis to over the top of the uterine fundus as a woman
lies supine is equal to the week of gestation in centimeters between the 20th and 31st weeks of pregnancy (e.g., in a pregnancy of 24 weeks, the fundal height should be 24 cm)

2. FHT- fetal heart beat.

• -heard as early as 10th to 11 week

• - done routinely at every prenatal visit past 10th weeks

• -normal value 110-160bpm

3. Daily fetal movement ( Kick counts)

- Quickening-fetal movement that can be felt by the mother
- occurs at approximately 18 to 20 weeks of pregnancy and peaks in intensity at 28 to 38 weeks
- a healthy fetus moves with a degree of consistency at about 10 times per hour.
- In contrast, a fetus who is not receiving enough nutrients because of poor maternal nutrition or placental insufficiency has greatly decreased movements.

4. Rhythm Strip Testing. Help the woman into a semi- Fowler’s position (either in a comfortable lounge chair or on an examining table or bed with an elevated backrest) to prevent her uterus from
compressing the vena cava and causing supine hypotension syndrome during the test. Attach an external fetal heart rate monitor abdominally. Record the fetal heart rate for 20 minutes.
5. NST/ CTG:
-measures the response of the fetal heart rate to fetal movement. Position the woman and attach both a fetal heart rate and a uterine contraction monitor. Instruct the woman to push the button
attached to the monitor (similar to a call bell) whenever she feels the fetus move. This will create a dark mark on the paper tracing at these times.
-When the fetus moves, the fetal heart rate should increase approximately 15 beats/min and remain elevated for 15 seconds. It should decrease to its average rate again as the fetus quiets.
-The test is said to be reactive (healthy) if two accelerations of fetal heart rate (by 15 beats or more) lasting for 15 seconds occur after movement within the time period. The test is nonreactive
(fetal health may be affected) if no accelerations occur with the fetal movements. The results also can be interpreted as nonreactive if no fetal movement occurs or if there is low short-term fetal
heart rate variability (less than 6 beats/min) throughout the testing period.

6. Vibroacoustic Stimulation -For acoustic (sound) stimulation, a specially designed acoustic stimulator is applied to the mother’s abdomen to produce a sharp sound of approximately 80 dB at a
frequency of 80 Hz, thus startling and waking the fetus

7. Ultrasound
-Diagnose pregnancy as early as 6 weeks gestation.
-Confirm the presence, size, and location of the placenta and amniotic fluid.
-Establish a fetus is growing and has no gross anomalies such as hydrocephalus;
anencephaly; or spinal cord, heart, kidney, and bladder concerns.
-Establish the sex if a penis is revealed.
-Establish the presentation and position of the fetus.
-Predict gestational age by measurement of the biparietal diameter of the head or
crown-to-rump measurement.
-Discover complications of pregnancy
-After birth, a sonogram may be used to detect a retained placenta or poor uterine involution in the new mother.
Biophysical Profile
Biophysical profiles may be done as often as daily during a high-risk pregnancy. The fetal scores are as follows:
 A score of 8 to 10 means the fetus is considered to be doing well.
 A score of 6 is considered suspicious.
 A score of 4 denotes a fetus potentially in jeopardy.
 The Pregnant Mother

Signs of pregnancy: Body Changes in Pregnancy:

 Breast Tenderness
 Palmar Erythema
• 1. PRESUMPTIVE SYMPTOMS – subjective
 Nausea, Vomiting, Constipation, and Pyrosis
 Fatigue
• 2. PROBABLE SIGNS – objective  Muscle Cramps
 Hypotension
a. Laboratory test - use of a venipuncture or a urine specimen to
detect the presence of human chorionic gonadotropin (hCG), a  Varicosities
hormone created by the chorionic villi of the placenta, in the  Hemorrhoids
urine or blood serum of the pregnant woman. Because these  Heart Palpitations
tests are only accurate 95% to 98% of the time, positive  Frequent Urination
results from these tests are considered probable rather than
 Abdominal Discomfort
positive signs.
 Leukorrhea
b. Home Pregnancy Tests- have a high degree of accuracy if the
 Muscular/Skeletal Discomfort
instructions are followed.
 Headache
 Dyspnea
 Ankle Edema
• 3. POSITIVE SIGNS positive signs of pregnancy
 Demonstration of a fetal heart separate from the mother’s
 Fetal movements felt by an examiner
 Visualization of the fetus by ultrasound
 FOR PRENATAL CARE
1. ASSESSMENT
• Get the mothers demographic data.(name, age, address, employment, etc)
•Document: LMP, s/s of pregnancy that is experienced, if the pregnancy is intended, educational level, job, What is the mother’s lifestyle? EXERCISE DURING PREGNANCY
Does she smoke? Exercise? On medications? Or any chronic illness. 1.Prenatal Yoga
•Obtain a detailed past and present health and sexual history including screening for the risk of teratogen (any factor that may adversely affect 2.Perineal and Abdominal Exercises
the fetus) exposure as well as any concerns a woman has about her pregnancy. 3.Tailor Sitting
2. NURSING DIAGNOSIS 4.Squatting
• Although most women probably have used a home pregnancy kit to find out if they are pregnant, the first prenatal visit officially confirms this, 5.Pelvic Floor Contractions (Kegel Exercises)
so nursing diagnoses usually focus on the response of a woman and her family to that information. Examples include:
6.Abdominal Muscle Contractions
•Decisional conflict related to desire to be pregnant
7.Pelvic Rocking
•Risk for ineffective coping related to confirmation of unintended pregnancy Nursing diagnoses appropriate to prenatal care include: 8.Breathing exercise
• Health-seeking behaviors related to guidelines for nutrition and activity during pregnancy
Deficient knowledge regarding exposure to teratogens during pregnancy Health-seeking behaviors related to strong cultural desire to have a
healthy child Risk for injury to fetus related to lifestyle choices
3. OUTCOME IDENTIFICATION AND PLANNING
•Be certain to reserve sufficient time at prenatal visits so care can be thorough and there is enough time to set realistic goals and expected
outcomes with both a birthing parent and her partner, if needed. Establishing a pattern of regular appointments is crucial to the provision of
effective, individualized prenatal care, so be certain a patient schedules an appointment for a following visit. Ask if she has transportation to
the healthcare facility because lack of transportation can be a major reason women don’t consistently attend prenatal care.
• It will be important to emphasize the need to visit reliable websites as not all websites about pregnancy are evidence based or monitored by a
healthcare provider of any type. Refer patients and their families to helpful websites and other resources when appropriate with what you say
and with the views of the patient’s obstetric healthcare provider. In addition, reinforce to the woman that she should feel free to call or e-mail
the healthcare setting between visits with any problems or questions. Some women may feel reluctant to “bother” a healthcare provider outside
of scheduled visits unless you give them this permission.
4. IMPLEMENTATION
An important nursing intervention at prenatal visits is teaching women and their families about a safe pregnancy lifestyle. Women often
discount prepared lists, believing their pregnancy is too personal to be a condition for which there are routine lists of advice. Advice, therefore,
needs to be individualized for each woman. For visual learners, it can be helpful to offer a woman and her partner pamphlets that cover the
same topics discussed verbally. Be certain all printed materials you give to families are consistent with what you say and with the views of the
patient’s obstetric healthcare provider.
5. OUTCOME EVALUATION
•Evaluation during prenatal visits should concentrate on a woman’s initial understanding of the goals for care during pregnancy and assessing
outcomes established for specific concerns. Examples of expected outcomes include: Couple state they have reached a mutual decision to both
stop smoking. Patient states she feels well informed about the common body changes of pregnancy and actions to take to relieve any
discomfort these cause. Patient lists ways to avoid exposure to teratogens at her work site during pregnancy.
Sample Documentation
Physical Exam
on lithotomy position, with the use of vaginal speculum and ky lubricant
Birthing Plan

1. Labor and Delivery Environment: Preferences for the atmosphere in the labor and delivery room, such as lighting, music, and aromatherapy.
2. Pain Management: Choices for pain relief methods, such as natural methods, epidurals, or other medical interventions.
3. Labor Positions: Desired positions for labor and pushing, including preferences for mobility and movement.
4. Support People: Who the individual wants present during labor and delivery, such as partners, family members, or a doula.
5. Medical Interventions: Preferences for medical interventions like inductions, episiotomies, and fetal monitoring.
6. Cesarean Birth Preferences: If a cesarean section is anticipated, preferences for anesthesia, presence of a support person, and post-operative care.
7. VSD, VBAC, Water Birth
8. Delayed Cord Clamping: Preferences for when the umbilical cord is clamped and cut after birth.
9. Skin-to-Skin Contact: Desires for immediate skin-to-skin contact between the birthing parent and the baby.
10.Breastfeeding and Feeding Preferences: Whether the individual plans to breastfeed or formula-feed, and preferences for feeding the baby soon
after birth.
11.Postpartum Care: Preferences for rooming-in with the baby, circumcision (if applicable), and any special care instructions.
12.Emergency Situations: Guidance on preferences in case unexpected medical complications arise.
13.Cultural or Religious Considerations: Any specific cultural or religious practices to be observed during the birthing process.
14.Photography and Videography: Whether the individual is comfortable with photography or videography during labor and delivery.
TERATOGENIC MATERNAL INFECTIONS
• Malaria . During pregnancy, women can transmit malaria to a fetus. A number of drugs, such as
chloroquine (Aralen) in the first trimester and mefloquine (Lariam) in the second or third
trimesters, are helpful
• Toxoplasmosis a protozoan infection, is spread most commonly through contact with uncooked
meat, although it may also be contracted through handling cat stool in soil or cat litter.
• Rubella (German Measles) the teratogenic effects on a fetus can be devastating, such as hearing
impairment, cognitive and motor challenges, cataracts, cardiac defects (most commonly patent
ductus arteriosus and pulmonary stenosis), restricted intrauterine growth (i.e., small for
gestational age), thrombocytopenic purpura, and dental and facial clefts, such as cleft lip and
palate.
• Herpes Simplex Virus (Genital Herpes Infection) If the infection takes place in the first
trimester, severe congenital anomalies or spontaneous miscarriage can occur. If the infection
invades during the second or third trimester, there is a high incidence of premature birth,
intrauterine growth restriction, neurologic disease, and continuing infection of the newborn at
birth. Acyclovir (Zovirax) or valacyclovir (Valtrex) can both be safely administered to women
who develop lesions during pregnancy as well as to their newborns at birth.
• Cytomegalovirus (CMV), a member of the HSV family. It is not sexually transmitted but spreads
from person to person by droplet infection such as occurs with sneezing. If a woman acquires a
primary CMV infection during pregnancy and the virus crosses the placenta, the infant may be
born with severe neurologic challenges (e.g., hydrocephalus, microcephaly, or spasticity) or with
eye damage (e.g., optic atrophy or chorioretinitis), hearing impairment, or chronic liver disease.
The newborn’s skin may be covered with large petechiae (i.e., “blueberry- muffin” lesions).
• Syphilis If syphilis is detected in the mother and treated with an antibiotic such as intramuscular
benzathine penicillin (Bicillin L-A) in the first trimester, a fetus is rarely affected. If left untreated
beyond the 18th week of gestation, hearing impairment, cognitive challenge, osteochondritis, and
fetal death are possible.
• Potentially Teratogenic Vaccines Live virus vaccines, such as measles, human papillomavirus
(HPV), mumps, rubella, and poliomyelitis (Sabin type), are contraindicated during pregnancy
because they may transmit a viral infection to a fetus.
• Teratogenic Drugs Many women assume the rule of being cautious with drugs during pregnancy
applies only to prescription drugs and continue to take over-the-counter drugs or herbal
supplements freely during pregnancy. Although not all drugs cross the placenta (heparin, for
example, does not because of its large molecular size), most do.
• Herbs American ginseng, used to improve general well-being, has been associated with birth
defects; and St. John’s wort, an herb taken as a mood enhancer, can interfere with the action of
seizure-control drugs, such as phenytoin (Dilantin) and phenobarbital (Phenobarb), and so should be
avoided by women prescribed such drugs
• Alcohol Evidence confirms that when women consume a large quantity of alcohol during
pregnancy, their babies demonstrate a high incidence of characteristic congenital craniofacial
deformities including short palpebral fissures, a thin upper lip, an upturned nose, as well as
cognitive impairment fetal alcohol spectrum. Fetuses cannot remove the breakdown products of
alcohol from their body. The large buildup of these leads to vitamin B deficiency and accompanying
neurologic damage.
• Tobacco Low birth weights in infants of smoking mothers result from vasoconstriction of the
uterine vessels, an effect of nicotine. This limits the blood supply to a fetus. Secondary smoke, or
inhaling the smoke of another person’s cigarettes, may be as harmful as actually smoking because of
inhaled carbon monoxide.
• Metal and Chemical Hazards Pesticides and carbon monoxide, such as from automobile exhaust,
should be avoided as these are examples of chemical teratogens. Arsenic, a byproduct of copper and
lead smelting, used in pesticides, paints, and leather processing; formaldehyde, used in paper
manufacturing; and mercury, used in the manufacture of electrical apparatuses and found in high
proportions in swordfish and tuna, are all teratogens that can be found at work sites.
• Radiation Rapidly growing cells are extremely vulnerable to destruction by radiation. Radiation
produces a range of malformations depending on the stage of development of the embryo or fetus
and the strength and length of exposure.
• Hyperthermia and Hypothermia Hyperthermia to a fetus can be detrimental to growth because it
interferes with cell metabolism. This can occur from the use of saunas, hot tubs, or tanning beds;
from a work environment next to a furnace, such as in welding or steel making; or from a high
maternal fever early in pregnancy (4 to 6 weeks).
• Maternal Stress There is some evidence that a pregnancy filled with anxiety and worry beyond the
usual amount could produce physiologic changes through their effects on the sympathetic division
of the autonomic nervous system. The primary change this would cause includes constriction of the
peripheral blood vessels (i.e., a fight-or-flight syndrome). If the anxiety is prolonged, the
constriction of uterine vessels (the uterus is a peripheral organ) could substantially interfere with the
blood and nutrient supply to a fetus.
Leopolds Maneuver

https://www.youtube.com/watch?v=KQ3L1n5XiLw&t=11s