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PRENATAL CARE contraception and

breastfeeding
-care of a pregnant woman
3. Care Provision
-comprehensive health supervision of  Iron and sulfate forate
a pregnant woman before delivery supplements, tetanus
toxoid immunizations,
-it is planned examination, psychosocial support and
observation and guidance given to record keeping.
the pregnant woamn from
conception till the time of labor. Goal of Prenatal Care

WHO  To optimize the health of


the woman and the fetus
-emphasized that mothers should and to increase the odds
observe the quantity and periodity that fetus must be born
of prenatal visits. healthy to a healthy
mother
~Goal in the Philippines
OBJECTIVES:
 To have 80 % of pregnant
women with atleast 4 prenatal  Maintenace of health of
visits. “study found that birth mother during pregnancy.
outcomes for women who  Identification of high risk cases
receive no prenatal care 2-4x and appropriate
worse than those who management.
received prenatal care.”  Prevent development of
complications.
(In 2015 around 830 woman died
 Decrease maternal and infant
everyday from problems in
mortality and morbidity.
pregnancy and childbirth)
 Remove the stress and worries
3 MAIN CATEGORIES of the mother regarding the
delivery process
1. Assessment
 Teach the mother about child
–history taking, physical
care, nutrition, vanitation and
examinatin, laboratory test to
hygiene.
identify problems/ risk factors
 Advice about family planning.
2. Health Promotion
 Nutrition, planning the birth,
information on danger signs
of pregnancy,
PROVIDERS OF PNC  Social profile
 Gynecologic
 Doctor
 Ostetric history
 Nurse
 Physical assessment
 Midwife
 Measurent of fundal height
Schedule for antenatal visits  Fetal heart sounds
 Pelvic examination
 The first or initial visit should  Examinating the pelvic size
be made as early in  Laboratory assessment
pregnancy as possible.
Signs and symptoms
Return visits:
 PRESUMPTIVE SIGNS
 Once every month till - Subjective changes that
28 weeks are experienced and
 Once every 2 weeks reported by the woman.
till the 36 weeks - Least reliable indicators of
 Once every weeks, pregnancy. It includes:
till labor o Amenorrhea
o Morning sickness
The world health organization (WHO)
o Fatigues
recommends a minimum of four
o Breast changes
antenatal visits
o Quickening
 1st visit 4 months o Frequency of
 2nd visit 6 months micturation
 3rd visit 8 months o Skin changes
 4th visit 9 months
AMENORRHEA

- Absence of menstruation in
ASSESSMENT woman of reproductive
age
First prenatal visit – longest confirm or
- Since 9 months during
rule out pregnancy history
pregnancy periods are not
 Demographic data occurred
 Chief complaint - If any type of bleeding is
 Family profile occurred during 9 months
 History of past illness shot not be confused with
 History of family illness the commonly met
pathological bleeding
Example: threatened abortion FATIGUE

MORNING SICKNESS - Frequent in early


pregnancy and subside
- Present in about 50% cases,
around 12-14 weeks of
mostly during first
pregnancy with bringing
pregnancy
renew energy.
- Nausea and vomiting
begins about 6 weeks after UTERINE CHANGES
the last menstrual period
A. Size shape and consistency
and usually disappear
Uterus enlarged to:
about 14 weeks
o Size of hens eggs at 6th
- Due to the high level of
week
pregnancy hormones.
o Size of cricket ball at 8th
Hyperemisis Gravidarum- weeks
excessive vomiting o Size of fetal head at 12
weeks
FREQUENCY OF
o Pyriform shape of non-
MICTURATION(urination)
pregnant uterus
- Resting of bulky uterus of becomes globular by
the fundus of the bladder 12th week
because of anteverted o There may be
position of uterus asymmetrical
- Is present during 8-12 weeks enlargement of uterus if
of pregnancy and subside there is lateral
after 12 weeks implantation.
o One half is more firm
BREAST DISCOMFORT than other half
- Present during 4th week in QUICKENING
the form of feeling of:
o Tenderness - Fetal movement felt by
o Tingling mother
o Fullness Primi- 5th month
o Increase in size Multi- 4th month
o Pigmentation of areola
Linea nigra
o Picking sensation
- Line of dark pigment on the
abdomen
Melasma Fetal outline felt by the
examiner- can be palpated in
- Dark pigment on face
abdomen
Striae gravidarum

- Red streaks of abdomen


 POSITIVE(+)
- Sonographic evidence of
fetal outline can be seen
 PROBABLE SIGNS and measured in sonogram
- Can be documented by - Fetal heart is audible
the examiner - Fetal movement felt by the
- More reliable than examiner
presumptive
FAMILY PROFILE
Serum laboratory test- blood
serum reveal the presence of o Size of house –space for
hCG baby’s bed, upstairs restriction
o Level of education- level of
Chadwick’s sign- color teaching
change of the vagina from o Occupation- heavy lifting,
pink to purple long standing
o Support people
Goodell’s sign- softening of
the cervix HISTORY OF PAST ILLNESS
Hegar’s sign- softening of the Allergies- more likely to breastfeed
lower uterine segment than bottlefeed
Braxtons hicks contraction- Drug sensitivity
periodic uterine tightening
Previous surgery- adhesions may
Balloment- when lower uterine interfere with uterine growth
segment is tapped on a
bimanual examination, the OBSTETRIC HISTORY
fetus can be felt to rise against
1. Past medical surgical history-
abdominal wall
some medical conditions may
Sonographic evidence of have impact on the course of
gestational sac- characteristic the pregnancy or the
ring is evident pregnancy may have an
impact on the medical - medication history
conditions. Examples: - illicit drugs
o Heart disease - domestic vilence
o Hypertension
GYNECOLOGICAL HISTORY
o DM
o Epilepsy - menstruation
o Thyroid disease - menarche
o Bronchial - cycle
asthma - interval
o Any previous - part surgery of
surgery reproductive treat
o Kidney - duration
diseases - amount
o UTI - discomfort
o Autoimmune
disease OBSTETRIC HISTORY
o Psychiatric
Gravidity – the number of time a
disorder
woman has been pregnant
o Hepatitis
o Blood GP SYSTEM
transfution
Gravida and para- terms used to
HISTORY OF FAMILY ILLNESS describe a womans childbearing
history
- to identify potential
problems Gravid – means pregnant
- health history-chronic and
Gravida- the no. Of times the
infections,
woman has been pregnant
genetic/congenital
anomalies Nulli-null or none
- heredity(thalassemia),
multigestation Primi-first or one

SOCIAL PROFILE Multi-many

- nutrition, elimination, sleep,


recreation, interpersonal
interactions
- smoking
- alcohol intake
- important in deciding when
to schedule certain test or
NULLIGRAVIDA, PRIMIGRAVIDA,
procedures
MULTIGRAVIDA
- subtract 3 months, and 7
Para- the no. Of infants delivereed days and add 1 year
after 20 weeks gestation, born dead
LNMP- the basis of the first day
or alive
of computing EDD
Age of viability- the earliest age at
which fetuses could survive
ESTIMATES IN PREGNANCY
Abortion-any pregnancy
terminatedd before the age of Determining Age of Gestation
viability; miscarriage
- the no. of days since LMP to
Multiple births- count as one delivery the present day divided by
regardless of the number of infants 7
delivered
example:
GTPAL SYSTEM
a pregnant woman comes to
Gravida- a woman who is of has clinic for initial prenatal check
been pregnant regardless of length up. Her LMP was july 20, 2019.
of pregnancy The present days is September
13, 2019.
TPAL- more detailed description of
para

T- no. of infants born at 37 weeks


before 42 weeks

P- no. of infants born at 20 weeks


and before 37 weeks

A – no. of pregnancies that end in MC DONALD’S RULE


spontaneous or therapeutic abortion
- a measure of the size of the
prior to 20 weeks
uterus used to assess
L- no. of children currently alive - fetal growth and
development during
ESTIMATED DATE OF DELIVERY
pregnancy
Nagele’s rule
Example:

A fundic height of 28cm, and


the fetus is not engaged.

28cm -11 x 155 = 2635 grams

formula:
OBSTETRIC HISTORY

o history of delivery
BARTOLOME’S RULE o medications taken
o prenatals
- estimates AOG by the
o complications (spotting,
relative position of the
swelling,
uterus in the abdominal
infection,surgery)
cavity.
o anesthesia
32-34 cm (34-38 weeks)

30-32 cm (30-34 weeks)


PHYSIOLOGICAL CHANGES
28 cm (26-30 weeks)
Womans body- make tremendous
24 cm (22-24 weeks) changes to accommodate a
pregnancy. Maintain all vital
20 cm (20-22 weeks) functions of the body and of the
growing fetus.

Structural of hormonal
JOHNSON’S RULE
1. Reproductive changes
- used to estimate the weight
- no shedding of endometrial
of the fetus in grams
lining, uterus expands of
formula: estrogen, Broxton hicks’s
- increase vascularity and in
fundic height in cm = n x k
glandular (E & P)-
k is constant = always 155 responsible for Hegar’s,
Goodell’s, Chadwick’s
n is 12 if the fetus is engaged - thick mucuos plug- protects
11 is the fetus is not yet uterine cavity from
engaged infection
- Light headed, dizzy, pale,
clammy
Breast
5. Respiratory changes
- tender, tingling, increases in - Vasocongestion of URT
size lining- common cold nasal
- produce congestion and voice
colostrum(foremilk) a thick changes, nosebleed
yellow fluid rich in - Uterus pushes up to
antibodies and CHON diaphragm- dyspneic
2. Endocrine changes - Increase thoracic diameter
- pituitary gland enlarge by 6. Musculoskeletal
135% - Pregnancy alters the center
- prolactin increases- initiates of gravity
lactation - Lordosis counterbalance
- oxyticin- responsible for the effect of protruding
uterine contraction, abdomen
stimulates - Low back ache increased
- thyroid gland increase in curvature
size, increase feed for - Increased mobility in pelvic
insulin joints- low back discomfort
3. Hematologic changes 7. GI changes
- Blood volume increases 40- - Ptyalism- large increase in
45%, are high level= 12.5g saliva production
- Venoustasis and - Pyrosis(heartburn)
hypercoagulability- - Delayed gastric emptying
protects woman from and decreased peristalsis
blood loss during delivery 8. Urinary chages
4. Cardiovascular changes - Glycosuria- kidney tubules
- increased workload due to may not reabsorb muck
demands of uterus and glucose
other organs - Urinary frequency- 10th
- BP decreases- 2nd trimester, week first and second
HR rises by 10-15 bpm trimester pressure to the
- Woman lie flat- uterus bladder
compress the aorta and 9. Integumentary changes
vena cava against the - Chloasma
spine - Linea nigra
- Striae- response to Turn to side first before getting out of
glucocorticoid level bed, squat, bring knees up to chest,
avoid strenuous exercises.

5.URINARY FREQUENCY - pressure on


DISCOMFORS OF PREGNANCY
bladder
1. N/V - acue on arising
-first tri and lightening (descent of
*eat chicken cracker, dry toasts, 5-6 uterus into the pelvic cavity)
small meals, avoid strong odors,
- KEGEL'S contract the muscles
gingers, peppermint, CHON, avoid
around the vagina and hold for 10
high fat, greasy, fried, spicy
sec
2. HEARTBURN- acute burning
-stop midstream urine
sensation in the epigastric and
sternal regions 6.VARICOSITIES- occurs in obese,
multipara
-REVERSE PERISTALTIC WAVES causes
regurgitation of acidic stomach -weight of uterus compresses the
contents into esophagus veins returning from legs-vessel
dilate-valves become stretched and
- eliminate smoking and coffee,
incompetent- engorged, inflamed
remin upright for an hour, deep
and painful
breath
-avoid crossing legs, constricting
3. BACKACHE- 3rd tri, stooping or
clothing- impedes blood return
bending strains muscles
-elevate legs above hip level
-correct posture (headup and
shoulders back and body -apply support hose or support
mechanics, exercise, avoid high stockings before rising
heeled shoes squat rather than
-walk around every 2 hours to
bend, shoulder circling, pelvic rock,
stimulate blood flow and relieve
tailor sitting
discomfort
4.ROUND LIGAMENT PAIN- sharp pain
7. HEMORRHOIDS- varicosities of the
in the side of inguinal area resulting
rectum
from softening and stretching of the
ligament from hormones and uterine -constipation, prolonged sitting
growth. standing
-establish a regular pattern of bowel -daily bath or shower, wear cotton
elimination underwears

-drink plenty of water, eat foods rich 12. BREAST TENDERNESS - minimal
in fiber and exercise regularly and transient

8 CONSTIPATION - hard, dry that are -wear bra with wide shoulder strap
difficult to pass for support

-persist from several weeks or longer 13. PALMAR ERYTHEMA (PALMAR


reduced intestinal motility PRURITIS) - redness and itching

-foods high in fiber - unpeeled fresh -due to increased estrogen levels


fruits, vegetables, cereals, oatmeal,
-calamine lotions
restrick cheese
14. ANKLE EDEMA- Swelling of ankle
9.LEG CRAMPS- painful contraction
and feet caused by reduced
of the muscles of the lower legs
circulation due to uterine pressure
-Imbalance of serum, calcium, and fluid retention
phosphorus, low in magnesium
-as long as proteinuria and
-extend legs, keep knee straight, hypertension are absent
bend foot toward the body
-left side lying, elevates legs

10. HEART PALPITATION

-Acing, pounding, skipped/added a


beat-palpitation d/t circulatory
adjustments necessary to HEALTH PROMOTION DURING
accommodate increase blood PREGNANCY
supply
*SELF CARE NEEDS-separate fact
-gradual, slow movement from fiction
11. LEUKORRHEA- whitish, viscous 1.BATHING
vaginal discharge - response to high
estrogen and increased blood *TUB BATH- vagina is closed, water
supply to vagina and cervix entering the cervix is minimal except
when membranes rupture, vaginal
bleeding, cervix is open
*WATER TEMP- no documented *Women with hx miscarriage,
effects on initiation of labor ruptured membranes, vaginal
bleeding
2. BREAST CARE- larger bra for
increased breast size *decrease desire for sex-increase
estrogen
*wash breast with clear tap water. If
Breast Milk is profuse, place gauze or *as abdomen increases- need for
breast pads new position- side lying, superior

3. DENTAL CARE- routine exam and *caution women with non-


cleaning monogamous sexual partner

*TOOTH DECAY- occurs from the 7. EXERCISE - prevents circulatory


action of bacteria to sugar stasis

4. PERINEAL HYGIENE - douching-can *ACOG american college of


lead to infection, alters pH of vagina obstetrics and gynecologist -
average well nourished women
5. DRESSING - maternity wardrobe
exercise for 30 mins daily
*avoid garters, girdles, knee high
*5 mins warm up , 20 mins "active
stockings- impedes lower extremity
stimulus", 5 mins "cool down"
circulation. Shoes with low to
moderate heel to minimize *depends on womans
backache cardiopulmonary fitness

6. SEXUAL ACTIVITY *exercising too strenuously - continue


talking while exercising - SOB
MYTH
*swimming - relieves backache
*coitus on the expected date
initiates labor *walking- best exercise

*orgasm will initiate labor 8. SLEEP - growth hormone secretion


is at the highest level
*coitus during fertile days of a cycle
will cause 2nd pregnancy *drink a glass of milk

*coitus might cause rupture of *awakened- due to fetal movement,


membranes pyrosis, dsypnea

FACTUAL *sims position


9. EMPLOYMENT

*exposure to toxic susbstance,


excessively physical strain, long
standing

*PUBLIC LAW 95-5555 - pregnancy


discrimination act 1978 requires
employers to treat pregnant women
the same way they do all other
workers a job applicants

10. TRAVEL

*early labor, eat cooked food, rest


periods for long trips, driving women
- use seat belts, comfort behind
steering wheel, plane

10.