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Lecture 10 Maternal health and newborn health Calculating Due-Dates

• To calculate a pregnant women’s due- date you must take the fist day of the

menstrual period, add 7 days, and subtract 3 months First day of the last menstrual period + 7 days – 3 months = Due-date

- Example: Her last menstrual period was June 10

th through June 15 th . When would you expect her due date to be?June 10 th (first day) + 7 days – 3 months = March 17 th

Weight Gain during Pregnancy

• The total weight gain during a full term pregnancy is expected to be 28 lbs., plus or

minus 3

• 1-2 lb. difference is okay
• 3 lb. difference, need to have an assessment
• 4 lb. difference is trouble

Proper Weight Gain During Pregnancy TrimesterExpected weight gain First trimester (1 - 12 weeks) 1 lb. each month (total of 3 lbs. in the first 12 weeks)

Second trimester (13 - 27 weeks) 1 lb. each week (total of 9 lbs. in 9 weeks) Third trimester (week 27 – birth)1 lb. each week This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 18:29:09 GMT -05:00 https://www.coursehero.com/file/26890768/Lecture-10-Maternal-health-and-newborn-healthdocx/ This study resource was shared via CourseHero.com

- How to calculate:

• Take the week of gestation – 9 = ideal weight gain

[Question] A woman is at 28 weeks gestation and has gained 22 lbs. What do you know about this weight?

• She’s just fine
• She’s under weight
• She’s over weight
• She could be either way, do an assessment

28 (weeks) – 9 = 19 lbs.[Question] A woman is at 31 weeks gestation and has gained 15 lbs. what do you know about this weight?31 (weeks) – 9 = 22 lbs.

• This woman’s weight gain is 7 lbs. under her ideal weight. A biophysical

profile needs to be completed to rule out the death of the unborn baby.Fundal Height

• The fundus is the top part of the uterus.
• It is not palpable until week 12 (can’t be felt during the first trimester)
• After the first trimester (week 13) the fundus should be palpable under the

umbilicus.

- If a woman is at 12 weeks gestation and has gained 10 lbs. she is either:

• Not at 12 week and has been pregnant for longer

- Has a molar pregnancy: A non-viable fertilized egg implants in the

uterus and causes gestational trophoblastic disease where tumors grow from what would have been the placenta.[Scenario] A woman who is positively pregnant comes into the emergency room unconscious after a severe car accident. You do not know what week gestation she is.You palpate for the fundus but cannot feel anything. From this you determine she is in the first trimester.

• Priority nursing care is focused on saving the mothers life.
• The fundus is at the level of the umbilicus (belly button) at 20 – 22 weeks gestation
• The date of viability is 22 – 24 weeks.

[Scenario] A woman who is positively pregnant comes into the emergency room unconscious after a severe care accident. You do not know what week gestation she is. You palpate for the fundus and you feel it at or below her umbilicus. From this you determine she is in the second trimester.

• Priority nursing care is focused on saving the mothers life. This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 18:29:09 GMT -05:00

https://www.coursehero.com/file/26890768/Lecture-10-Maternal-health-and-newborn-healthdocx/ This study resource was shared via CourseHero.com

• The fundus is above the level of the umbilicus after 24 - 27 weeks gestation.

[Scenario] A woman who is positively pregnant comes into the emergency room unconscious after a severe care accident. You do not know what week gestation she is. You palpate for the fundus and you feel it above her umbilicus. From this you determine that she is in the third trimester and the baby is at the age of viability.

• Priority nursing care is focused on saving the unborn baby’s life.

Signs of Pregnancy

• There are three categories for signs of pregnancy

- Possible: not a good indicator of pregnancy

- Presumptive: not a good indicator of pregnancy

- Positive: Confirmed pregnancy

• Positive signs of pregnancy means that the pregnancy is confirmed, possible and

presumptive signs are not good indicators that a woman is pregnant.

- Four positive signs of pregnancy:

• Fetal skeleton observed on x-ray
• Fetal presence on ultrasound
• Auscultation (Doppler) of a fetal heart rate (heard between 8 – 12 weeks)
• When the examiner palpate fetal movement or outline
• Most obstetric information has a range where something occurs because no

pregnancy is the same. You must be carful in reading obstetric questions because there can be 3 different questions for every fact.

• When would you first… (beginning of a range)

[Example] When would you first auscultate a fetal heart? 8 weeks

• When would you most likely… (middle of the range)

[Example] When would you most likely auscultate a fetal heart? 10 weeks

• When should you by… (end of the range)

[Example] When should you auscultate a fetal heart by? 12 weeks

- Quickening: When the mother feels the baby kicking.

• Quickening is felt between 16 – 20 weeks
• When should you first feel quickening? 16 weeks
• When would you most likely feel quickening? 18 weeks
• When should you feel quickening by? 20 weeks

- The “maybe” signs (possible/presumptive) of pregnancy:

• All blood and urine tests
• Chadwick’s sign, Goodell’s sign, Hegar’s sign This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 18:29:09 GMT -05:00

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• Chadwick’s, Goodell’s, and Hegar’s signs occur in alphabetical order.

- Chadwick’s sign: A cervical color change to cyanosis (blue)

- Goodell’s sign: A cervical softening

- Hegar’s sign: A uterus softening

Pregnant Patient Teaching

• You must teach the pregnant women the pattern of prenatal office visits. Good

prenatal care is a major factor is reducing infant mortality.

• The pregnant woman needs to visit her prenatal office once a month

(considered 4 weeks) until week 28. (Whole first and second trimester)

• At week 28 to week 36 she needs to visit her prenatal office once every 2

weeks.

• From week 36 to week 42 she needs to visit her prenatal office every week.
• After week 42 she needs to have a Cesarean section or be induced.

[Example] A woman comes to her prenatal visit at 12 weeks gestation. Her next visit prenatal visit will be at week 16, then week 20, then week 24, then week 28. After week 28 she must go to prenatal visits every 2 weeks. Her next prenatal visit will then be week 30, then week 32, then week 34, the week 36. After week 36 she must have prenatal visits weekly until week 42 or birth. Her next prenatal visit will be week 37, week 38, week 39, week 40, week 41. On week 42 she will have a Cesarean section or be induced if the baby has not been born yet.

- You must teach the pregnant women that her hemoglobin levels will fall:

• Normal female hemoglobin level is 12 – 16
• In the first trimester the hemoglobin can fall to 11 (normal)
• In the second trimester the hemoglobin can fall to 10.5 (normal)
• In the third trimester the hemoglobin can fall to 10 (normal)

- You must teach the pregnant women the discomforts of pregnancy:

- First trimester:

• Morning sickness – treat with dry carbohydrates before getting up,

out of bed in the morning.

- Urinary incontinence: void every 2 hours

- Second trimester:

- Difficulty breathing: teach tripod position

- Back pain: teach pelvic tilt exercises

- Third Trimester:

- Urinary incontinence: void every 2 hours

- Difficulty breathing: teach tripod position.

• Back pain: teach pelvic tilt exercises This study source was downloaded by 100000796901680 from CourseHero.com on 03-26-2021 18:29:09 GMT -05:00

https://www.coursehero.com/file/26890768/Lecture-10-Maternal-health-and-newborn-healthdocx/ This study resource was shared via CourseHero.com