3. 3
Dr. Soad Abd El Salam Ramadan
• Chairman of obstetrics &woman health
nursing department
• Pre. Vice dean for students &Education
Affairs
Faculty of nursing
Benha University
4/5/2018 Dr. Soad Abd El Salam Ramadan
4.
5. Pregnancy
A normal physiologic event that may complicated
by pathologic processes dangerous to the health
of the mother and fetus in only 5-20% .
When a woman is pregnant, the period of time
from conception until the baby is born is called the
antepartum (prenatal or antenatal) period .
ante- and pre- mean “before”
partum and natal mean “birth”
Postpartum - after delivery
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6. Terms related to Pregnancy
Gravida- a woman has been pregnant
(including this pregnancy), regardless of
duration or outcome.
Para- pregnancies a woman has
completed past 20 weeks, regardless of
whether infant is born alive or dead (refers to
number of pregnancies, not fetuses).
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7. Multipara- a woman who has given birth 2
or more times over 20 weeks gestation
Multigravida- a woman who has been
pregnant more than once
Nullipara- a woman who has never
completed a pregnancy past 20 weeks
Primipara- a woman giving birth for the first
time of a pregnancy that has lasted at least 20
weeks
Primigravida- a woman who is pregnant for
the 1st time
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8. Definition of Antenatal care
comprehensive health supervision of a
pregnant woman before delivery
Or it is planned examination, observation
and guidance given to the pregnant
woman from conception till the time of
labor.
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9. Goals
To reduce maternal and perinatal
mortality and morbidity rates
To improve the physical and mental
health of women and children
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10. Objectives
1- To ensure that the pregnant woman and her fetus are in
the best possible health.
2-Early detection and prevention of complications of
pregnancy.
3-Educate women on danger and emergency signs &
symptoms.
4-Prepare the woman and her family for childbirth
5- Give education & counseling on family planning
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11. The antepartum period lasts
approximately 9 months (280 days-40
weeks) and is divided into three
trimesters of 3 months each
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12. Trimesters
Gestation - period of time for intrauterine
fetal development ( GW)
1st trimester
0-3months(13WK)
2ndTrimester
4-6 months(14-26WK)
3rdTrimester
7-9 months(27-40WK)
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13. Schedule for Antenatal Visits:
The first visit or initial visit should be made
as early is pregnancy as possible.
Return Visits:
Once every month till 7th month.
Once every 2 weeks till the 9th month
Once every week during the 9th month,
till labor.
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15. History
Personal history
Family history
Medical and surgical history
Menstrual history
Obstetrical history
History of present pregnancy
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16. Menstrual history
-Ask about
-1-Last menstrual period (LMP).
-2-Regularity and frequency of menstrual cycle.
-3-Contraception method used .
-4-Calculate expected date of delivery (EDD) as
1st day of LMP −3 months +7 days, and change the
year.
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17. Estimating due date
EDD- (estimated date of delivery)
Nagele’s Rule
Subtract 3 months
Add 7 days from the 1st day of the LMP
Correct the year if necessary
Example- LMP September 20th, 2016.
Subtract 3 months- June 20th
Add 7 days- June 27th
Change the year if necessary- EDD= June
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18. Obstetric History
Gravidity? Parity? abortion, and living
children.
➢ Weight of infant at birth & length of
gestation.
➢ Type of delivery, location of birth, and type
of anesthesia.
➢ Maternal or infant complications.
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19. 1-Chronic conditions : as diabetes mellitus,
hypertension, and renal disease ,cardiac
disease.
2-Prior operation: as cesarean section,
genital repair, and cervical cerclag.
3-Allergies, and medications.
4-Accidents involving injury of the bony
pelvis
Medical and surgical history:
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20. History of present pregnancy
History suggesting e.g. Diabetes,
hypertension and ante partum hemorrhage.
Ask about episodes of fever or chills
Ask about pain or burning sensation on
urination.
Abnormal vaginal discharge, itching at the vulva
or if partner has a urinary problem.
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21. IMMEDIATE ASSESSMENT
for emergency signs.
Vaginal bleeding
Severe abdominal or pelvic pain
Severe headache with visual disturbance
Persistent vomiting
Unconscious/Convulsion
Severe difficulty in breathing
High grade Fever
Looks very ill
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23. Weight measurement
Maternal height and weight measurements to
determine body mass index(BMI).
Maternal weight should be
measured at each
antenatal visit
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24. Check for pallor or anemia.
1-Look for palmar pallor.
2-Look for conjunctival pallor
3-Count respiratory rate in
one minute.
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25. Blood pressure measurement
Measure BP in sitting position.
If diastolic BP is 90 mm Hg or
higher repeat measurement after
6 hour rest.
If diastolic BP is still 90 mm Hg or
higher ask the woman if she has:
• Severe headache
• Blurred vision
• Epigastric pain
Check urine for protein.
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26. Physical Examinations
Height of over 150 cm indication of an
average-sized pelvis
The approximate weight gain during
pregnancy is 12 kg.; 2kg in the first 20
weeks and 10 kg in the remaining 20
weeks ( 0.5 kg per week until term).
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27. Obesity (more than 20 kg above the
weight-height formula) leads to an
increased risk of gestational diabetes,
pregnancy-induced hypertension and
thrombo-embolic disorders
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28. Local Examination
The uterus may be higher than expected
due to large fetus, multiple pregnancy,
polyhydrammnios or mistaken date of last
menstrual period.
The uterus may be lower than expected due
to small fetus, intrauterine growth
retardation, oligohydramnios or mistake
date of last menstrual period.
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29. Uterine Size :-
12 weeks- Symphysis pubis
16 weeks- Midway between symphysis pubis and umbilicus
20-22 weeks- Umbilicus
20-32 weeks- 1 cm above umbilicus
for every 1 week
By the end of 36th week should
touch the xiphoid process and can
make breathing difficult
About 2 week before term (38 week) for
a primigravida the fetal head settle into
the pelvis to prepare for birth, this termed lightening.
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30. Fetal heart sound is heard by sonicaid as
early as 10thweek of pregnancy.
Fetal heart sound is heard by Pinard' s
fetal stethoscope after the 20thweek of
pregnancy.
The normal fetal heart rate is 120-160
beats/min
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34. Investigations:
Urine should be tested for sugar,
ketones and protein.
Hemoglobin will be repeated:
At 36 weeks of gestation.
Every 4 weeks if Hb is < 9 g/dl.
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35. Fetal kick count
The pregnant woman reports at
least 10 movements in 12 hours.
Absence of fetal movements
precedes intrauterine fetal death
by 48 hours.
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36. Health Teaching during the First
Trimester
Physiological changes
during pregnancy
Weight gain
Fresh air and sunshine
Rest and sleep
Diet
Daily activities
Exercises and relaxation
Hygiene
Teeth
Bladder and bowel
Sexual counseling
Smoking :
Medications
Infection
Irradiation
Occupational and
environmental hazards
Travel
Follow up
Minor discomforts
Signs of Potential
Complications
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37. Exercise should be simple, mild exercise avoid
lifting heavy weights
A tooth can be extracted during pregnancy,
but local analgesia is recommended
Catheter and enema should be avoided.
Smoking may lead to ptyalism, nervousness
and hyper emesis and make pregnant woman
at increased risk of chest infections and
thrombo-embolic disorders
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38. Pregnant woman should avoid contact with
infectious diseases especially rubella or
(German measles) because it has deleterious
effects on the fetus
Pregnant woman should avoid exposure to x-
ray or irradiation because of possible
teratogenic effects on the fetus such as birth
defects or childhood leukemia
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39. Supplementation
1-Folic acid 0.4 mg tab daily
2- iron (ferrous sulphate or gluconate )300
mg/daily
3- Ca 1200mg /daily
4-
•-Those with a normal balanced diet
•probably don’t need extra vitamins
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40. Medications During Pregnancy
• Antibiotics - some OK, some not
• Local anesthetics - OK
• Local with epinephrine - not OK
• Aspirin - not OK
• Immunizations - some are OK,
some are not
• Antimalarial - some OK, some are
not
• Narcotics - OK except for addiction
issue
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41. Provide advice on each visit
1.Diet and weight gain
2.Medication
3.Avoid Radiation exposure
4.Self-care during pregnancy
5.Minor complaints.
6.Family planning Breastfeeding
7.Birth place preparation and anticipation of
complication& Emergency situations.
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42. At each visit
1-Questions about fetal movement
2-Ask for danger signs during this pregnancy
3-Ask patient if she has any other concerns
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