Maternal Adaptations to Pregnancy

Question 1

3 phases of pregnancy

Answer 1

1. Antepartum: the period of time from conception to the onset of labor
2. Intrapartum: the phase that includes the onset of labor through delivery of the placenta
3. Postpartum: also known as the puerperium, the 6-week period of time after delivery in which maternal physiological changes of pregnancy return to their pre-pregnant state

Question 2

3 trimesters during antepartum

Answer 2

First trimester – Conception to 12 weeks’ gestation
Second trimester – Week 13 through week 26
Third trimester – Weeks 29 through around 40 weeks’
gestation

Question 3

First trimester - development & symptoms

Answer 3

Physical discomforts of nausea, vomiting, fatigue, urinary frequency

Most important one for fetal and placental development – all frameworks and structures are formed.

Fetus makes complex facial expressions, hands touch mouth up to 50 times per hour.

At 10 weeks, fetus has its own unique fingerprints, knee joints have arrived.

Anything ingested by Mom can lead to problems with the fetus or with the pregnancy.

Fetus has taste buds all over the mouth, sucks its thumb.

Question 4

Second trimester - development & symptoms

Answer 4

Client feels well and excited.

Fetal movement is felt around 16-20 weeks.

Fetal development is primarily one of growth and maturation.

Question 5

Third trimester - development & symptoms

Answer 5

Increased discomfort with breathing, urination, etc.

Eager to be done and see the baby.

Question 6

Nursing care of the pregnant patient

Answer 6

Counsel

Support

Provide anticipatory guidance about what’s normal, and danger signs.

Not all clients want the same detail or have the same understanding – “read” the client and individualize information.

Not all clients are excited about being pregnant. (. The nurse must ask open-ended questions to elicit the woman’s feelings about the
pregnancy)

Question 7

Calculating the due date - Naegele’s Rule

Answer 7

1) First, determine the first day of your last menstrual period (LMP).
2) Next, count back 3 calendar months from that date.
3) Lastly, add 1 year and 7 days to that date.

Ex:
- LMP April 10, 2023
- Count back 3 months to January 10, 2023
- Add 1 year and 7 days to get January 17, 2024

Question 8

Routine Prenatal Work

Answer 8

Complete cell blood count

Blood type and Rh & Antibody screen

Rubella titer

HIV

Hepatitis B surface antigen status

STD/serology screening (syphilis)

Question 9

Cues for Routine Prenatal Work

Answer 9

Complete cell blood count
* Low H&H could indicate anemia and nutrition education is important
* Low platelets could indicate clotting disorder
* Unusually elevated WBC could indicate recent or ongoing infection

Blood type and Rh & Antibody screen
* ABO incompatibility – Mother type O, baby type A or B or AB – risk of newborn jaundice
* Rh incompatibility – Mother Rh negative, baby Rh positive – Rhogam indicated around 28 weeks.

Rubella titer
* Education about risk for rubella infection
* Need for rubella immunization after delivery

HIV
* Early maternal treatment in pregnancy, newborn treatment after birth

Hepatitis B surface antigen status
* Early maternal treatment in pregnancy, newborn treatment after birth

STD/serology screening (syphilis)
*Early maternal treatment in pregnancy, newborn treatment after birth

Question 10

Additional Prenatal Lab Testing

Answer 10

Fetal fibronectin—if symptoms of preterm labor
Herpes culture – if indicated
Blood glucose studies – around 24 weeks
Toxicology screening – if indicated
TB testing – if indicated

TORCHS titers
*Toxoplasmosis
*Other infections like HIV, syphilis, parvovirus B19 (fifth disease), varicella (chickenpox) and (Zika).
*Rubella
*Cytomegalovirus (CMV).
*Herpes Simplex Virus (HSV)
*Syphilis

Question 11

Normal Key Changes Per Trimester

Answer 11

First trimester
* Baby’s body structure and organs develop.
* Maternal changes: nausea, fatigue, breast tenderness, frequent urination.

Second trimester
* Many of the unpleasant symptoms of early pregnancy subside.
* Uterus is generally at level of umbilicus at 20 weeks
Somewhere between 16-20 weeks, expect “quickening”—fetal movements.
* Increased energy and better sleep, back pain, leg cramps, constipation, heartburn, excessive salivation, round ligament pain
* Stronger physical and emotional connection with baby.
* Ultrasound can determine the gender of the baby as early as 14 weeks, although some doctors may perform the first ultrasound between 18 and 20 weeks.

Third trimester
* Anxious for the birth of the baby.
* Shortness of breath, hemorrhoids, urinary incontinence, varicose veins, sleeping problems.
* Baby’s bones are fully formed, and the baby’s organs are capable of functioning on their own.
* Baby’s body turns into a head-down position for birth

Question 12

Vital signs in pregnancy

Answer 12

First trimester
* HR: 63 to 105
* RR: 8 to 24
* T: 96 to 100

Second trimester
* HR: 67 to 112
* RR: 8 to 24
* T: 96 to 100

Third trimester
* HR: 64 to 113
* RR: 8 to 24
* T: 96 to 100

Question 13

8 general adaptations of pregnancy

Answer 13

1. Hyperdynamic (continuous change and activity)
2. Hypermetabolic – all systems are go, go, go!
3. Hypervolemic
4. Hypercoaguable – clot maker to the max
5. Low resistance circulatory system
6. Compensatory respiratory alkalemia
7. Diabetogenic
8. Balance issues

Question 14

All maternal changes in normal pregnancy are designed to ____________.

Answer 14

Support the fetus.
* Many of the changes may be misinterpreted as disease.
* The key difference is often measured in the degree of
change.
* CHANGES often occur at the expense of the mother in an
effort to protect the fetus from environmental stresses

Question 15

Overall guidelines for pregnancy care

Answer 15

Therapeutic management is aimed at maintaining optimal oxygen delivery and consumption.

This can by done by assuring that fluid volume, hemoglobin and oxygen are all maximized.