Lecture Notes on Prenatal Care / Health Teachings

Prepared By: Mark Fredderick R Abejo R.N, MAN 1

Clinical Instructor

Heartburn Increased Pats of butter

PRENATAL CARE and progesterone before meals
which dec. Avoid fried ,
HEALTH TEACHINGS gastric fatty foods
motility Sips of milk at
causing frequent
esophageal intervals.
Basic Concepts in Pregnancy reflux. Small,
frequent meals
Signs of Pregnancy: taken slowly.
 Presumptive Signs Bends at the
Amenorrhea – absence of menses knees, not at
Nausea and Vomiting the waist
Increased breast sensitivity and breast changes Take antacids
Increased pigmentation Constipation Due to Increased
Constipation displacemen fluids and
Frequent urination t of the roughage in the
Quickening stomach and diet.
Abdominal enlargement intestines; Regular
iron elimination
 Probable Signs supplements time.
Uterine enlargement Increase
Hegar’s Sign exercise
Goodell’s Sign Avoid enemas,
Chadwick’s Sign harsh laxatives
Ballottement and mineral oil.
Braxton Hick’s contraction Hemorrhoids Pressure of Warm sitz
Positive Pregnancy Test growing bathing
fetus, High fiber diet
 Positive Signs Increase and increase
Fetal Heart Tone venous fluid.
X-ray or Ultrasound of fetus pressure Sit on soft
Palpable fetal movements pillow
Urinary Increase Sleep on the
Discomforts of Pregnancy Frequency blood supply side at night.
to the Limit fluid
Changes Reason Health kidney/ intake during
Teachings Pressure of evening
Nausea and Increased Dry crackers enlarged Bladder
Vomiting HCG 30 min. before uterus in the training
arising 3rd Tri
Small, Backache From Back exercise
frequent, low exaggerated (pelvic rock)
fat meals lumbo- Wear low-
Liquids bet. sacral heeled shoes.
meals curving Avoid heavy
during lifting
Avoid anti-
pregnancy.
emetics.
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN 2
Clinical Instructor

Leg Cramps Increase Frequent rest Presumptive Signs of Pregnancy

pressure of with feet
gravid fetus, elevated
low calcium Regular
exercise like
walking
Increase milk
intake
Ankle Edema From Elevate legs at
venous least twice a
stasis day.
Sleep on left
side
Varicose From faulty Elevate feet
Veins valves or when sitting.
weakened Use support
vessel walls hose
Apply elastic
bandage
Avoid use of
constricting
garters
Shortness of From Sleep with feet
breath pressure on elevated or on
diaphragm regularly.
Nasal Elevated Direct pressure
stuffiness and Estrogen to the nasal
epistaxis levels area
Avoid blowing
of nose.
Fatigue Due to Get regular
hormonal exercise
changes Sleep as much
as needed.
Avoid
stimulants.
Breast Increase Wear well
Tenderness estrogen and fitted bra
progesterone Warm
level compress
Increased Due to Consult
Vaginal hyperplasia physician if
discharges of mucosa infection is
and increase suspected
mucus Wash carefully
production and keep it dry.
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN 3
Clinical Instructor

Formula Used In Providing Estimates In

Pregnancy
C. Estimated Fetal Weight
A. To estimate the EDC
Given the Use Formula
Given the Use Formula Rump-to- Standard Rump-to-crown
Last Menstrual Nagele’s Rule First day of crown length Formula length in utero cm.
Period (LMP) LMP – 3 in utero cm. x 100 = weight in
months + 7 gm
days Johnson’s FH (cm)
Date of Primi: Ruler - 11 (if unengaged )
Quickening Q + 4 months - 12 ( if engaged ) x
+ 20 days 155

Multi:
Q + 5 months Measuring the Fundic Height
+ 4 days

B. To estimate the AOG

Given the Use Formula

Fundic Height McDonald’s Height in cm
rule
FH x 2/7 =
duration in
months

FH x 8/7 =
Duration in
weeks

Fundus Height at Various week

Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN 4
Clinical Instructor

PRENATAL VISIT High Risk Factors During Pregnancy

Maternal Health Program of the DOH Life of woman and fetus has significantly
is tasked to reduced the maternal mortality increased risk of disability or death.
ratio by three-quarters by 2015:
MMR of 112/100,000 live births in 2010 Generally, these are:
MMR of 80/100,000 live births in 2015 - abnormal fetal position or presentation
- age 35 years or younger than age 15 years
Strategic Thrusts for 2005-2010 - bleeding during pregnancy
Launch and implement the Basic Emergency - drug or alcohol dependent
Obstetric Care or BEMOC. The BEMOC - hydramnios
strategy entails the establishment of facilities - hypertension of pregnancy
that provide emergency care for every 125,000 - infection of mother
population. - maternal illness
Improve the quality of prenatal and postnatal - past history of difficult delivery
care - post cesarean birth
Reduce women’s exposure to health risks - potential for blood incompatibility
through the institutionalization of responsible
parenthood and provision of appropriate health Medical History and current status:
care package to all women of reproductive ages. - obstetrical history, current status
LGU’s, NGOs and other stakeholders must - Psychosocial risks, maternal behaviors and
advocate for health through resource generation adverse lifestyle.
and allocation of health services for the mother - smoking
and the unborn. - caffeine: 3 or more cups of coffee
- alcohol: no safe dose
Prenatal Clinic Visits - drugs
- abuse and violence
Schedule of first visit is as soon as the woman
- Psychological status
missed her menstrual period and pregnancy is
- working more than 10 hours, heavy lifting
suspected
- standing more than 4 hours.
First 32 weeks : once a month
32-36 weeks : twice a month Socio-demographic risks:
36-40 weeks : every week - low income
- lack of prenatal care
- height less than 145 cm ( 4’9”)
Length of Pregnancy - parity more than 5
- marital status
267-280 days - residence
38-42 weeks (ave.40 weeks) - ethnicity
9 calendar months
10 lunar months Environmental risks:
3 trimester - infection
First Trimester: Period of Organogenesis - radiation
Second Trimester: Most comfortable for mother - chemicals
with continued fetal growth. - physical; extreme heat more than 38.9 c,
Third Trimester: Period of rapid fetal growth noise, vibration and atmospheric pressure,
bec. of rapid deposition of fats
iron and calcium.
 Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN 5
Clinical Instructor

Components of a Prenatal Visits TPAL

T = Full Term Babies
Initial interview P = Premature
Health history A = Babies Abortion
- Menstrual history: menarche, regularity, L = Living Children
frequency and duration of flow and last period.
- Obstetrical history; all pregnancy, outcome, Physical Examination
complication, contraceptives use, sexual history Review of System
Pelvic Examination
Danger Signs of Pregnancy ( Cardinal Rule: EMPTY BLADDER )
- Vaginal Bleeding
- Swelling of the face or finger
- Severe headache  Internal Exam (I.E) to determine:
- Blurring of vision Hegar’s Sign – softening of the uterus
- Flashes of lights Goodell’s Sign – softening of the cervix
- Pain in the abdomen Chadwick’s Sign – bluish discoloration of
- Persistent vomiting vagina.
- Chills and fever
- Sudden escape of fluids from the vagina
- absence of fetal heart tone

Demographic data
Chief concern
Family profile
History of past illnesses
 Ballotement – fetus will bounce when
History of family illness
lower uterine segment is tapped
Gynecologic history
sharply
Obstetric history ( on the 5th month )
Review of systems
Support person’s role

 Fetal Heart Rate Assessment

- Doppler Ultrasound ( 10-12 weeks )
- Stethoscope ( 18-20 weeks )
Expected Rate: 120-160 bpm
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
 Pelvic Measurement are preferably done
th
after the 6 lunar month.
Xray Pelvimetry is the most effective
method of diagnosing cephalopelvic
disproportion. But since Xrays are
teratogenic, the procedure can be done
only two weeks before EDC.
Types of Pelvis
 Papanicolau ( Pap Smear) –
cytological examination to
diagnose cervical cancer.
A.
B
6
Classification of Findings
Class 1 – absence of abnormal cells
Class 2 – abnormal cell but no evidence of
malignancy.
Class 3 – cytology suggestive of malignancy
Class 4 – cytology strongly suggestive of
malignancy
Class 5 – conclusive for malignancy
Clinical Stages of Cervical Cancer
Stage 1 - Cancer confined to the cervix
Stage 2 - CA extends beyond the cervix into
the vagina
Stage 3 - metastasis to the pelvic wall
Stage 4 - metastasis beyond pelvic wall into
the bladder and rectum.
1 : Nulligravida cervix
2 : Cervix after childbirth
3 : “Stellate” cervix seen after mild
cervical tearing.
1 : Herpes II
2 : Chancre of syphilis
3 : Erosion or infection
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN
Clinical Instructor
 Leopold, Maneuvers – are a systematic
methods of observation and palpation to
determine fetal position, presentation, lie and
attitude which helps in predicting course of
labor
Preparatory Steps:
1. Palpate with warm hands.
2. Use palms, not fingertips.
3. Woman should lie in supine position with
knees flexed slightly.
4. Done with empty bladder.
Procedure:
1st Maneuver
to determine presenting part
facing the head part of the pregnant woman,
palpate for fetal part found in the fundus to
determine presentation.
( a hard, smooth, ballotable mass at the fundus
means fetus is breech presentation )
2nd Maneuver
7
to determine fetal back
still facing the head part of the mother, palpate
side to locate the fetal back.
a feel smooth hard resistant surface is the back
part. ( best place to hear the FHT )
a number of angular nodulation are knees and
elbows.
3rd Maneuver
to determine engagement and mobility of
presenting part.
still facing the head part of the mother, grasp
the lower portion of the abdomen just above the
symphysis pubis to find out degree of
engagement.
4th Maneuver
to determine fetal attitude and descent.
Now facing the feet of the mother, press
fingers downward on both sides of the uterus
above the inguinal ligaments to determine
degree of flexion of fetal head.
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN 8
Clinical Instructor

 Benedict’s Test Nutritional Assessment

Test for glycosuria, a sign of possible - Food preferences and eating habits
gestational diabetes. - Cultural and religious influences
Urine should be collected before breakfast - Education and occupational level
results:
Blue - no sugar
Green - +1 sugar
Yellow - +2 sugar Assessing Maternal Weight Gain
Orange - +3 sugar
Red - +4 sugar

Vital Signs During Pregnancy

Blood Pressure : limit increase is 10/15

mmHg systolic – diastolic above baseline BP.
Pulse : 60 -90 beats per min.
Respiration : 16 – 24 cycles per min.
Temperature : 36.2 – 37.6 C ( 97-100 F )

PRENATAL
HEALTH TEACHINGS

Nutritional Health During Pregnancy

Nutrition – most important aspect

Weight Gain
11.2 to 15.9 kg. ( 25 – 30 lb )
recommended as an average weight gain in
pregnancy.
2 – 4 lbs during 1st trimester
11 – 14 lbs during 2nd trimester
8-11 lbs from the 3rd trimester
Note:
Pattern of weight gain is more important
than amount of weight gain.
Computation of Caloric Equivalents
Women who need special attention:
Pregnant teenagers Carbohydrates X 4
Low pre-pregnant weight and obese Proteins X 4
Low income women Fats X 9
Successive pregnancies
Vegetarians
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN 9
Clinical Instructor
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN 10
Clinical Instructor

Food Sources Pregnat 10,000 1 For 4 Vit. A

women IU cap / weeks should
Protein Meat, fish, eggs, milk, poultry, with day upon not be
cheese, beans, mongo night diagnosis given to
Vit. A Eggs, carrots, squash, all green blindness woman
leafy vegetables who
Vit. D Fish, liver, egg, milk, margarine already
Note: excess vit.D may lead to taking
fetal cardiac problem vit. that
also
Vit. E Green leafy vegetables, fish, corn
contain
Vit. C Tomatoes, guava, papaya, citrus
Vit. A
fruits
Folic Acid Asparagus, organ meat, green
leafy vegetables Iron Supplementation
Vit. B ( foods rich in protein )
Calcium and Milk, cheese, green leafy Target Prep. Dose / Remarks
Phosphorus vegetables, whole grains, Duration
seafood, tofu Pregnant Coated 1 tab/day for
Iron Pork liver, lean meat, kamote Women Tab. 6 months or
leaves, soybeans, seaweeds, contains 180 days
mongo 60 mg during A dose of
Iodine Iodized salt, seafood, milk, egg, elemental pregnancy 800 mcg
bread iron with period folic acid
400 mg OR is still
Micronutrient Supplementation folic acid 2 tab/day if safe to
prenatal pregnant
consultation woman
Vitamin A Supplementation are done
during the
Target Prep. Dose Duration Remarks 2nd/3rd
Pregnant 10,000 1 Start from Vit. A trimester
Women IU cap the 4th should Lactating Coated 1 tab / day for
2x a month of not be Women Tab. 3 months or
week pregnancy given to contains 90 days
until woman 60 mg
delivery who elemental
already iron with
taking 400 mg
vit. that folic acid
also
contain Iodine Supplementation
Vit. A
Post 200,000 1 One dose Vit.A Target Prep. Dose / Duration
Partum IU cap only (200K
Women Iodized oil 1 capsule for 1
Women within 4 IU)
15-45 capsule with year
weeks should
yrs.old 200 mg.
after not be to
iodine
delivery pregnant
women.
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN 11
Clinical Instructor

TeTox Routine Immunization of Dont’s During Pregnancy

Pregnant Women
Smoking Causes vasoconstriction,
Vaccine Minimum Percent Duration of leading to low birth weight
Interval Protected Protection babies
TeTox 1 As early as Drinking Alcohol When excess can cause
possible respiratory depression in
during newborn and fetal
pregnancy withdrawal syndrome.
TeTox 2 4 weeks 80% infant will Delayed fetal growth and
after be development
Minimum TeTox 1 protected Drugs are dangerous
required Drugs st
by neonatal especially during 1 Tri.
TeTox for
pregnant tetanus Thalidomide Causes amelia or
mother 3 years phocomelia (short or no
protection extremities
for the Steriods Can cause cleft palate and
mother abortion
TeTox 3 6 months 95 % infant will Cough Can cause enlargement of
after be suppressant fetal thyroid gland leading
TeTox 2 protected to tracheal compression and
by neonatal dyspnea at birth
tetanus Vit.K Cause hemolysis and
5 years hyperbilirubinemia
protection Aspirin Causes bleeding disorder
for the Streptomycin Cause damage to the 8th
mother cranial nerve
TeTox 4 1 year 99 % infant will Tetracycline Causes staining of the tooth
after be enamel and inhibits growth
TeTox 3 protected of long bones
by neonatal Cocaine Causes abruption placenta,
tetanus preterm labor and fetal
10 years death
protection Amphetamines Can cause jitteriness and
for the poor feeding at birth
mother Marijuana Increase incidence of
TeTox 5 1 year after 99 % all infant respiratory infection
TeTox 4 born to that Narcotics Small gestational age,
mother will increase rate of fetal distress,
be meconium aspiration,
protected abnormal fetal liver and lung
lifetime tissue
protection Inhalants Cardiac irregularities,
for the severe respiratory
mother depression.
Lecture Notes on Prenatal Care / Health Teachings
Prepared By: Mark Fredderick R Abejo R.N, MAN 12
Clinical Instructor

Sexual Activity
Sexual desires continue
pregnancy, but levels change:
During the First Trimester: there is a decrease
in sexual desire because the woman is more
preoccupied with the changes in her body.
During the Second Trimester: there is an
improvement in sexual desire because the
woman has adapted to the growing fetus.
During the Third Trimester: there is another
decrease in sexual desire because the woman is
afraid of hurting the fetus.
Note:
Sex in moderation is permitted during
pregnancy but not during the last 6 weeks since
there is increased incidence of postpartum
infection in women who engage in sex during the
last 6 weeks.
Traveling
throughout
No travel restriction, but postpone a trip during
the last trimester.
On long rides, 15 – 20 minute rest period every
2-3 hours to walk about or empty the bladder is
advisable.
Exercises
Chief Aim : To strengthen the muscles used in
labor and delivery
Should be done in moderation
Should be individualized: according to age,
physical condition, customary amount of
exercise and stage of pregnancy
Recommended Exercises

Recommended Position Squatting Increase circulation in the

- side by side position perineum, make pelvic joints
- woman on top more pliable .
- entrance at the back (dog’s style ) When standing from squatting
- side on the back position, raise buttocks first
before raising the head to prevent
Sex is CONTRAINDICATED postural hypotension
Tailor Strengthens the thighs and
Sitting stretches perineal muscles to
Spotting or bleeding
make them more supple.
Ruptured BOW
Pelvic Rock Maintains good posture
Incompetent cervical OS
Relieve abdominal pressure
Deeply-engage presenting part
and low back pain
Placenta previa
Strengthens abdominal
History of spontaneous miscarriage
muscles
Modified Relieve pelvic pressure and
knee-chest cramps in the thighs and
Employment position buttocks
Relieves discomfort from
hemorrhoids.
As long as the job does not entail handling
Shoulder- Strengthens muscles of the chest
toxic substance or lifting heavy objects or
circling
excessive physical and emotional strain, there is
Walking BEST EXERCISE
no contraindication to work.
Kegel Relieve congestion and
Advise pregnant women to walk about every
discomfort in pelvic region.
few hours of her work day during long periods
of standing or sitting to promote circulation. Tones up pelvic floor muscles