MATERNAL 28-39 Flashcards
The average length of pregnancy is
280 days (40
weeks), 10 lunar months, or 9 calendar months),
To calculate the EDD by Naegele’s rule
count
backward 3 calendar months from the month in
which the last menstrual period occurred. Using
the date of the first day of this menses, add 7
days. Change the year, if necessary
The following are ways to date the pregnancy
when LMP is unknown.
inspection and palpation of the breasts for normal
Questionable changes include
recent lumps or
masses that feel hard or fixed, dimpling,
redness, edema, ulceration and nipple
retraction or elevation.
Subsequent prenatal assessments, pregnancy, prenatal
visits are scheduled every ___weeks for the first 28 weeks
4
Subsequent prenatal assessments, pregnancy, prenatal
visits are scheduled every _ weeks from 28 to 36 weeks, and then weekly until
delivery
2
During the course of the pregnancy, a total
weight gain of ____ lb. is recommended
24 to 30
A normal pattern of weight gain is lb. in the
first 10 weeks,
lbs. at 20 weeks,
lbs. by 30
weeks, and
lbs. by 40 weeks.
1.5
9
19
27.5
(excessive salivation) occurs, probably as
a local reaction to the influence of estrogen
Ptyalism
(increased vaginal discharge that is
white in color) results from the increased activity
of vaginal epithelial cells as they prepare for
distention during the birth process.
Leukorrhea
Ankle Edema
Rest your feet elevated. Avoid standing for long periods Avoid restrictive garments on the lower half of your body-
Backache
Apply local heat. Avoid long periods of standing. Stoop to pick up objects.
Paracetamol in usual adult dose may help. Wear low-heeled shoes
Breast tenderness
Wear a supportive bra. Decrease the amount of caffeine and carbonated beverages ingested.
Constipation
Increase fiber in your diet.
Drink additional fluids.
Have regular time for bowel movements
Difficulty sleeping
Drink a warm, caffeine -free drink before bed and practice relaxation techniques.
Fatigue
Schedule a rest period daily. Have a regular bedtime routine.
Use extra pillows for comfort.
Faintness
Move slowly. Avoid crowds. Remain in a cool environment.
Lie on your left side when at rest.
Headache
Avoid eye strain. Visit your eye doctor. Rest with a cool cloth on your forehead. Take Paracetamol in regular adult dose, as needed. Report frequent
Heartburn
Eat small, frequent meals each day. Avoid overeating, as well as spicy, fatty and fried foods.
Hemorrhoids
Avoid constipation and straining with a bowel movement take a sitz bath. Apply a witch hazel compress
Leg cramps
Avoid pointing your toes. Straighten your leg and dorsiflex your ankle.
Nausea
Eat six small meals per day rather than three. Eat a piece of dry toast or some crackers before getting out of bed. Avoid foods or situations that worsen the nausea. If it persists, report the problem to your primary care provider.
Some expectant fathers develop a cluster of
signs and symptoms of pregnancy similar to the
mother. This is called
couvade syndrome.
- noted at 20 weeks in Primi & 16 weeks in
multigravidas
Quickening
Three periods of three months each.
Months are the first trimester
Months are the second trimester
Months are the third trimester
1 - 3
4 - 6
7 - 9
Prenatal development is often measured in
lunar
months
Each lunar month consists of days, organized into
four weeks of seven days each.
28
a pregnancy is lunar months long
10
Assessment of Fundic Height
McDonald’s Rule
Fundic height (cm) x 2/7 = AOG in lunar months
Fundic Height (cm) x 8/7 = AOG in weeks
another symphysis-fundal height measurement
(not thoroughly reliable) is an easy method of
determining mid pregnancy growth.
McDonald’s Rule
Estimates AOG by the position of the uterus in the
abdominal cavity
Bartholomew’s Rule
Bartholomew’s Rule
12 weeks
symphysis pubis
Bartholomew’s Rule
16 weeks
halfway bet. Umbilicus & SP
Bartholomew’s Rule
20 weeks
level of umbilicus
Bartholomew’s Rule
24 weeks
2 FB above umbilicus
Bartholomew’s Rule
30 weeks
half way bet umbilicus & xiphoid process
Bartholomew’s Rule
36 weeks
level of xiphoid process
Bartholomew’s Rule
40 weeks
just below xiphoid process
Estimates the weight of fetus in grams relative to
height of the fundus
Fetal weight = fundic height (cm) – N x K
K – 155 (constant)
N – 12 if engaged, 11 if not yet engaged
Johnson’s Rule
To determine the length of fetus in cm.
1st half of pregnancy (1 to 5 lunar months ) - square
the no. of months
2nd half of pregnancy (6 to 10 lunar months) - multiply
the no. of months by 5
Hasse’s Rule
FH = 34 cm 34cm multiply by 8 divided by 7
Ans. = 38 to 39 weeks
34cm multiply by 2 divided by 7
Ans.= 9 to 10 lunar months
MC Donald’s Rule
Women train for the role of expectant parent and
interact with babies and children.
B. Psychosocial Stages of Pregnancy
Anticipatory stage
Women fully assume the pregnancy role and initially
may seek help from family members,
B. Psychosocial Stages of Pregnancy
Honeymoon stag
The pregnancy role is fully exercised; the expectant
parent validates the adequacy of the current role.
B. Psychosocial Stages of Pregnancy
Plateau stage
The termination stage precedes and includes
termination of the pregnancy role (i.e. Labor and birth
of the infant (although the pregnancy role may
terminate in other ways))
B. Psychosocial Stages of Pregnancy
Disengagement
Common emotional reactions of the woman or the
couple to pregnancy include the following:
Ambivalence, fear, fantasies, or
anxiety
First trimester.
Common emotional reactions of the woman or the
couple to pregnancy include the following:
Well-being, increased need to learn
about fetal growth and development, narcissism,
passivity, or introversion (may seem egocentric and
self-centered)
Second trimester
Common emotional reactions of the woman or the
couple to pregnancy include the following:
Feels awkward, clumsy, unattractive;
becomes more introverted; or reflects on own
childhood.
Third trimeste
refers to the medical and nursing
care given to the pregnant woman between
conception and the onset of labor
Antepartum care
The total energy cost of pregnancy is __ calories.
85, 000
Protein requirements increase to provide sufficient
amino acids for fetal development, increased blood
volume, and breast and uterine tissue growth; the
recommended daily allowance is ____ more than
nonpregnant needs
30 g/d
Commonly recommended prenatal nutritional
supplements contain vitamins
B6, D, E, and C; folic
acid; pantothenic acid; iron; calcium; magnesium;
zinc, and copper
causes relaxation of the smooth muscle,
including the gastrointestinal tract, and reduced
motility, allowing more nutrients to be absorbed
Progesterone c
increases water retention.
Estrogen
is implicated in nausea
HCG
FHR usually is auscultated at the __
region with a Doppler ultrasound transducer at 10 to
12 weeks’ gestation.
midline suprapubic
An FHR of ____ beats per minute can be
distinguished from the slower maternal heart rate by
palpating the mother’s pulse while auscultating the
FHR.
120 to 160
Serial sonograms provide useful information when
assessing fetal growth and well being.
Ultrasonography (sonograms)
Measurement of fundal height (Mcdonald rule)
Assessment begins during the ___ trimester when
the fundus is palpable at the level of the umbilicus
second
Measurement of fundal height (Mcdonald rule)
Assessment begins during the second trimester when
the fundus is palpable at the level of the umbilicus (at
_weeks) and continues until it reaches the xiphoid
process (at _weeks)
20
36
Measurement of fundal height (Mcdonald rule)
Measurement involves using a nonelastic, flexible
measuring tape, placing the zero point on the
___border of the ____, and
stretching the tape across the abdomen at the
midline to the top of the __
superior , symphysis pubis
fundus.
In primigravida (first-time mothers), quickening
normally is detected between _
gestation.
18 and 20 weeks’
In multigravidas, quickening may occur as early as __
week
16
is typically described as a light fluttering
feeling; it may be mistaken for flatus
Quickening
may be used during the antepartum period to
evaluate fetal status. It can demonstrate fetal heart
rate changes in response to fetal movement and
spontaneous or induced uterine contractions .
EFHM
Common EFHM studies are the
nonstress test (NST)
and the contraction stress test (CST).
This test would not be performed until about 38+
weeks and only if there were other indications of a
problem like the biophysical profile or MSAFP
Contraction Stress Test (CST)
Other procedures
also referred to as “kick counts”
assessed by the mother, and a is placed on the
monitor strip.
Fetal heart rate in relation to fetal movement is
explained. There should be a slight rise in fetal
heart rate immediately before movement
Fetal activity determination
Other procedures
help monitor fetal status
For example, serum human chorionic
gonadotropin indicates a viable fetus, and serum
estriol and human placental lactogen reflect fetal
homeostasis.
Routine maternal urinalysis & serum assays
Other procedures
Includes MSAFP, human chorionic gonadotropin,
and unconjugated estriol. Together they increase
the detection of trisomy 18 and trisomy 21
performed between 15 and 22 weeks and are
considered positive, if all three markers are low.
Further testing for karyotyping is usually offered.
Triple screening
Other procedures
a first trimester (10 to 12 weeks) alternative to
amniocentesis for prenatal diagnosis of genetic
abnormalities.
accomplished by needle aspiration of a sample of
chorionic villi, either by the transcervical on
transabdominal route.
CVS
Other procedures
can determine fetal maturity, and detect certain
birth defects (eg. Down syndrome or spina bifida),
hemolytic disease of the newborn, and sex and
chromosomal abnormalities
Amniocentesis
Other procedures
also called cordocentesis
may be performed in the second or third
trimesters to investigate or treat conditions
requiring direct access to the fetal vascular
system
Percutaneous umbilical blood sampling (PUBS)
Other procedures
enables direct fetal visualization through a
fetoscope; a fiberoptic optical instrument,
inserted through the abdominal and uterine walls
to identify fetal developmental abnormalities.
The fetoscope can retrieve tissue and blood
samples to detect hemophilia or other disorders
and may be used for some types of fetal surgery
Fetoscopy
