Exam 2 Health Promotions in Pregancy Flashcards
Promoting Healthy Behaviors during pregnancy helps to assure
maternal well-being
Fetal well- being
Best chance for good pregnancy outcome
NP role: Anticipatory guidance for pregnant women
provide factual information, dispel "old wives tales"
Explain risks/benefits
Promote healthy behaviors
Provide referrals as needed
Desired Weight Gain During Pregnancy
25-35lbs- women with normal pre-pregnancy BMI (singleton Pregnancy)
multiple births- recommended weight gain is higher
Recommendations for wt gain in pregnancy based on prepregnancy BMI
BMI Recommended wt gain low (less than 19.8) 28-40 lbs Normal (19.8-26) 25-35lbs. High (26-29) 15-25lbs Obese (>29) 15+ lbs.
Distribution & amount of Maternal Wt Gain
Breast 1.5-3lbs Fetus 7.5 lbs Uterus 2.5 lbs Body fluid 4 lbs Placenta 1.5 lbs Amniotic fluid 2 lbs Body fat 7 lbs blood volume 4 lbs
Nutrition- Research - factors affecting fetal growth
prenatal malnutrition, smoking, maternal dz
When 2 factors- smoking & maternal dz are controlled - difference in birth wt are directly related to nutrition during pregnancy
Maternal factors that have been shown to relate to birth wt are
prepregnancy wt.
wt gain during pregnancy
Correlation with birth wt
poor maternal wt gain associated with low birth wt
low birth wt has been shown to correlate with increased incidence of
perinatal morality (stillbirth, neonatal death) small head circumference mental retardation cerebral palsy learning problems/disabilities visual and hearing defects neurologic defects poor infant growth & development
health promotion in pregnancy Exercise
Generally, pregnant woman does not have to limit exercise, however avoid
becoming excessively fatigued
doing any activity that may risk injury to herself or her fetus
Aerobic exercise
women accustomed to aerobic exercise prepregnancy should be allowed to continue but should not begin new activity or increase their level or intensity
Women that continue prepregnancy exercise have been found to have
shorter active labor
fewer cesarean births
less fetal distress in labor
Women who have been sedentary before pregnancy
should not take part in aerobic exercise that is any more strenuous than walking
should consult with their primary care provider before starting
All pregnant women & exercise
avoid exercise that involves extended time in the supine position in the 2nd & 3rd trimester.
Discontinue exercise if they have any signs of oxygen deprivation- extreme fatigue, dizziness, extreme shortness of breath
should not exercise if exercise might adversely affect any obstetrical or medical condition, such as incompetent cervix, risk factors for PTL, PIH
Travel
No contraindication to travel for pregnant women, unless they have medical or obstetrical complications
Contraindicated for travel
May be contraindicated for women with
cardiovascular conditions complicated by pregnancy,
congenital or acquired heart dz,
multiple gestations after 22wk, or incompetent cervix.
long distant travel
may not be advisible when pregnancy is complicated by threatened abortion,
vaginal bleeding,
history of preterm labor,
or other obstetrical complications
Travel by car
car travel often tiring
frequent rest stops necessary to assist with maintenance of circulation to extremities
Travel by air
ACOG, 2002 can fly safely up to 36 wks
to decrease risk for thrombophlebitis during flights 1. wear support hose, 2. periodically exercise the legs & ankles- walking in the aisles if possible
Wearing seat belts
should wear lap & shoulder seatbelts to decrease any risk for maternal injury
Place lap portion of the seatbelt over the upper portion of thigh, under abdomen.
Position shoulder harness between breast
Both belts should be snugly applied
Seatbelts also will decrease exaggerated flexion of the women’s torso, which may lessen the risk for placental separation
Dental care
Good dental care is important
Studies show that active periodontal dz increases client’s risk for pre-eclampsia
Schedule dental checkup in early pregnancy & tell dentist to assist in avoiding teratogenic substances
Dental x-ray ok if lead apron fully covers abdomen
Sexual Issues
Although there is no reason why the healthy woman need abstain from intercourse or orgasm during pregnancy, some sources suggest that women should avoid coitus and orgasm in the last 4 weeks of pregnancy.
Sexual issues
Intercourse or orgasm is contraindicated in cases of known placenta previa, or ruptured membranes.
Amniotic sac provides protection from infection; once it has ruptured → risk for infection ↑.
Sexual issues
Women who are predisposed to preterm labor or threatened abortion may choose to avoid intercourse.
Nipple stimulation, vaginal penetration, or orgasm may cause uterine contractions secondary to the release of prostaglandins and oxytocin.
sex in late pregnancy
In later stages of pregnancy as the abdomen is significantly enlarged, alternate positions for sexual intercourse may be more comfortable for some women.
Positions that may increase comfort include the woman in the superior position or a side-by-side position.
If woman experiences discomfort from vaginal penetration, the couple may find alternative methods of sexual expression, such as cuddling, masturbation, or oral sex.
