START EVERYTHING WITH A

PRAYER
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Antepartum Period
Antenatal Nursing
0 Starts from conception and fetal development to the
beginning of labor
0 Encompasses all aspects of health care delivery of a
childbearing individual
Pregnancy
0 Maternal condition of having a
developing fetus in the body
0 Starts with fertilization and
ends with child birth; on
average, its duration is 38
weeks.
0 also called gestation

Signs & Symptoms of
Pregnancy
I think Im pregnant?!
The subjective signs
(Presumptive):
0 Remember: A.N.U.B.E.
0 Amenorrhea
0 Nausea & Vomiting
0 Urinary frequency
0 Breast tenderness and changes
0 Excessive fatigue

Im pretty
sure Im
pregnant
The objective signs (Probable):
0 C.G.H.
0 Hegars sign softening of the
lower uterine segment
0 Goodells sign softening of the
cervix
0 Chadwicks sign bluish
discoloration of vagina & cervix
cont
0 Ladins sign softening of the uterus
0 Abdominal enlargement
0 Skin pigmentation
0 Braxton-Hicks contraction intermittent contraction of
the uterus
0 Ballottement sinking and rebounding of the fetus in its
surrounding amniotic fluid in response to sudden tap on
the uterus (occurs in midpregnancy)
0 Leukorrhea increase vaginal discharge
0 Quickening occur bet. 16
th
-20
th
week
0 Positive HCG in urine or serum

Diagnostic signs (Positive)
0 Fetal heart beat
0 @10
th
-12
th
week gestation: heard
through doppler ultrasound
0 @18
th
-20
th
week gestation: heard
through fetoscope
0 Fetal movement (felt by the
examiner)
0 Positive Fetal Ultrasound
Biophysical Changes in
Pregnancy
Reproductive system
0 Endocervical glands secrete thick mucus that forms
plug or operculum (a part that serves as a cover)
0 Increase vaginal vascularization; vaginal discharge
tends to be thick, white and acidic
0 Breast size increases; nipple and areola become
darker
Respiratory system
0 Displacement of diaphragm causes shortness of
breath
0 Nasal stuffiness and epistaxis are common due to
edema and vascular congestion induced by increased
estrogen
Cardiovascular system
0 Heart displaced upward, to the left and forward
0 Blood volume increases by 30-50%; RBC volume
increases by 20-30%; hematocrit decreases by 7%
causing physiologic anemia
0 Pulse rate increases by 10-15 beats per minute
0 Supine hypotensive syndrome occurs during the
second trimester
Gastrointestinal System
0 Nausea and vomiting are common during the first
trimester
0 Ptyalism occurs; heartburn and flatulence often occur
due to reduction in gastric acidity, growing uterus and
smooth muscle relaxation
Urinary System
0 Frequency of urination occurs on the first and third
trimester due to enlargement and compression of the
gravid uterus
0 Woman is at risk for glucosuria
Integumentary system
0 Pigmentation increases in the nipple, areola, vulva,
perianal area and linea alba
0 Facial chloasma develops
0 Striae common in the abdomen
Skeletal System
0 Relaxation of pubic joints during pregnancy
0 Lumbosacral curve increases producing low back pain
Endocrine system
0 Rise in T4 and 25% increase in basal metabolic rate
0 Anterior pituitary: prolactin released for lactation
0 Posterior pituitary: releases oxytocin (uterine contraction)
and vasopressin (antidiuretic and vasoconstriction effect)
0 Increased insulin production
0 Hormones of pregnancy:
0 Human chorionic gonadotropin
0 Human placental lactogen
0 Estrogen
0 Progesterone
0 Relaxin
Pregnancy Discomfort and Relief
Measures
Discomfort Relief Measure
Morning sickness >Eat dry cracker 30 min before getting up
>Drink adequate fluids bet. Meals
>Avoid spicy, highly seasoned & fatty foods
>Small frequent meals avoid overeating
Heartburn >Bend at knees when picking up things
>Remain upright 3-4 hours after eating
>Take antacids as ordered
>No sodium bicarbonate: exacerbate heartburn!
Flatulence >Eat small frequent meals
>Avoid gas-forming foods
Frequency of
urination
>Increase fluids to replace losses except at bedtime: NOCTURIA
>Practice regular voiding
>Practice frequent washing: front to back
>Report any burning sensation, dysuria, cloudy urine, or tea-colored
urine
Discomfort Relief Measure
Fatigue >Adequate rest
>Practice good body mechanics
>Report increase fatigue a danger sign: HEART DISEASE
Constipation >Increase fluid intake
>Increase roughage
>Exercise (walking is best recommended)
>Drink warm water in the morning
Hemorrhoids >Avoid constipation and other forms of straining
>Promote comfort: sitz bath, warm compresses
>Reinsert hemorrhoids, upon APs recommendation
Faintness >Avoid sudden change in position
>2
nd
-3
rd
trimester: avoid supine position
>Gradually arise from bed
>Best position: Left lateral position in bed
Leg cramps >Adequate calcium intake: Calcium-Phosphorus imbalance=leg
cramps
>Avoid prolonged standing/sitting
>Extend and dorsiflex foot for relief
Discomfort Relief
Varicose veins >Wear elastic compression stockings
>Frequently elevate legs
Backache >Maintain good posture
>Wear low-moderate-height heels
>Avoid prolonged standing
>Pelvic rocking exercise and tailor sitting are advised
>Use supportive mattress
Pedal edema >Elevate legs frequently
>Avoid prolonged standing
>Report swelling of hands and face
Shortness of
breath
>Maintain good posture
>Avoid fatigue
>Elevate head; avoid supine
>Avoid constricting bra and other tight clothes
>Report increasing dyspnea with minimal activity or dyspnea
prior to 36 weeks
Psychological Adaptation
First Trimester
0 Denoted by ambivalence
0 Focus: Bodily changes
0 Developmental task: to accept the biological facts of
pregnancy
Second Trimester
0 The mother feels well and happy and fantasizes about
the baby
0 Focus: self and growth and development of fetus
0 Developmental task: accepts the growing fetus as
part of her
Third Trimester
0 The personal identification of the appearance of the
baby
0 Focus: baby and delivery and responsible parenthood
0 Developmental task: preparation for childbirth
Antepartal Care
A. Health History GTPALM
B. Prenatal visits
>Philippine DOH Guideline:
80% of pregnant woman should have at least 5 prenatal visits
>1
st
Trimester: monthly
>2
nd
Trimester: twice a month
>3
rd
Trimester: 4x a month
Obstetric History (GTPALM)
0 1. This is my first pregnancy. Im on my 27
th
week. I have
not been pregnant before
0 2. I am on my 43
rd
week of pregnancy. My eldest child who
is now 2 years old was born at 40 weeks and my youngest
who is now 1 year old was born at 36 weeks
0 3. I had twins who were born premature and I am not
pregnant right now
0 4. I have a child who was born full term and healthy and
another who died at birth at 39 weeks
0 5. I was pregnant but lost my baby at 16 weeks and have
not been pregnant again
Estimates in Pregnancy
0 Age of Gestation
0 McDonalds Rule
0 Bartholomews Rule
0 Estimated Fetal weight
0 Johnsons Rule
0 Estimated Fetal length
0 Haases Rule
0 Expected Date of Confinement (EDC)
0 Naegeles Rule

Calculate for EDC and AOG
0 LMP: June 5
0 LMP: January 3
0 LMP: September 19, Fundic Height: 26 cm
0 LMP: October 20, 2008; FH: 28cm
Diagnostic Tests
(DOH Standards)
0 Urinalysis
0 Blood tests
0 CBC to detect anemia, infection and assess clotting
0 Blood typing det. Blood type; r/o Rh/Blood incompatibility
0 Rubella titer
0 Hepatitis B if (+) for HBsAg (Hepatic antibody surface
antigen)
0 HIV testing
0 Syphilis screening
0 Cervical smear
0 FHR & Fundic height
Health Promotion During
Pregnancy
Bathing
0 Daily bathing Due to increased sweating and vaginal
discharge
0 Contraindicated: douching
0 Wash breasts with clear tap water to remove
colostrum secretion if present


Dressing
0 Avoid constricting clothes
0 Wear low-heeled shoes
0 Wear supportive bra

Sleep
0 Take siestas if able
0 Have rest periods during the day
0 6-8 hours of sleep
Travel
0 Early pregnancy: okay
0 Late pregnancy: have rest periods during long trips
Exercise
0 Walking is recommended

Sexual Activity
0 No restrictions unless with history of preterm labor or
history of spontaneous miscarriage
0 Less desire for coitus is common
Employment
0 Decrease physical strain, long periods of standing or
having to maintain body balance
Dental Care
0 Good brushing habits
Nutritional Needs
Expected weight gain
0 Normal weight gain (optimal is 25-35 lbs)
0 1
st
trimester: 1 lb. a month
0 2
nd
trimester: 1 lb. a week
0 3
rd
trimester: 1 lb. a week
Nutritional Requirements
0 Calories: additional 300 kcal (Mother: 2200; fetus: 300;
total: 2500 daily)
0 Carbohydrates: promote growth of fetus; sources dairy
product, veg, fruits, grains
0 Proteins: increase maternal tissue to support fetus; 60g/day
0 Fats: source of energy; 30% of caloric intake
0 Minerals: For mineralization of fetal teeth and bones; Ca
1000mg/day; Phosphorus700mg/day

Nutritional Requirements
0 Iodine: for thyroid function; 220mcg/day
0 Sodium: for proper metabolism & fluid balance
0 Magnesium: cellular metabolism; 350mg/day
0 Iron: 30mg; taken with vit. C
0 Folic Acid: needed for RBC formation; sources: fruits
& vegetable; DOH: 2 tabs/day
0 Zinc: essential for fetal growth; 11mg/day
0 Lactating: 12mg/day
0 Sources: meat, shellfish, poultry, legumes and
wholegrain
Evaluation for Fetal Well-Being
0 UTZ
0 Chorionic villi sampling
0 Amniocentesis
0 Percutaneous umbilical blood sampling
0 Maternal serum alpha-fetoprotein
0 Daily fetal movement
0 Non-stress test
0 Contraction stress test
Intra Partum Period
Theories of Labor
0 Uterine Stretch Theory
0 Oxytocin Theory
0 Progesterone deprivation theory
0 Prostaglandin theory
0 Theory of Aging placenta
Preliminary signs of Labor
0 Lightening
0 Increased activity level
0 Braxton-Hicks contraction
0 Ripening of the cervix
0 Rapture of Bag of water
0 Show
0 Progressive Fetal Descent
Quick Assessment
Status of Membrane
0 If ruptured assess with nitrazine paper or fern test
0 Danger of infection if ruptured for more than 24 hours
0 FHR Stat! and 10 minutes later to check for prolapsed
cord
0 CHECK:
0 COLOR
0 NORMAL: CLEAR
0 YELLOW: PRESENCE OF BILIRUBIN OR RH/ABO
INCOMPATIBILITY
0 GREEN: MECONIUM-STAINED = FETAL HYPOXIA; PORT
WINE = ABRUPTIO PLACENTA
Contractions
0 Frequency
0 Duration
0 Inteval
0 Intensity

Degree of Descent
0 Engagement widest diameter of presenting part has
passed through pelvic inlet
0 Station relationship of presenting part to ischial
spine
0 FLOATING presenting part above inlet
0 STATION -5 presenting part at the inlet
0 STATION 0 presenting part at ischial spine
0 STATION +4 presenting part at the outlet
Onset of Labor
Methods of Labor Stimulation
0 Breast Stimulation
0 Amniotomy
0 Oxytocin Administration
Stages of Labor
0 First Stage begins with regular, rhythmic
contractions, ends with complete effacement and
dilatation (10cm)
0 Latent 0 to 4cm
0 Active 4 to 8 cm
0 Transitional 9 to 10 cm
0 Second Stage begins with complete dilatation and
ends with birth of infant
Mechanism of Labor
E -Engagement
D -Descent
F -Flexion
I -Internal Rotation
ER -External Rotation
E - Expulsion
Stages of Labor cont
0 Third Stage begins with birth of the infant and ends
with the expulsion of the placenta
0 Fourth Stage begins with the expulsion of placenta
and ends when maternal status is stable; usually 1-2
hours postpartum
Operative Obstetrics
0 Episiotomy incision of the perineum to facilitate
birth of the infant
0 Types:
0 Midline
0 Mediolateral
Pharmacologic Pain Relief
0 Narcotic Analgesics
0 Regional anesthesia
0 Epidural Anesthesia
0 Spinal Anesthesia
0 Local Anesthesia
Post Partum Period
Definition
0 Uterus returns to non-pregnant size and shape called
involution.
0 Contraction (afterpains) shortens muscles, closes
venous sinuses and restores normal tone
Post partum Assessment
BUBBLES-HE
0 B - Breast
0 U - Uterus
0 B - Bladder distention
0 B - Bowel movement
0 L - Lochia
0 E - Episiotomy site
0 S - Sanitation and surroundings

0 H Homans sign
0 E Emotional status is distressed
Essential Objectives for
Postpartum Period
0 Promote uterine involution
0 Promote successful breastfeeding
0 Prevent common discomfort of puerperium
0 Provide psychological support
0 Prevent complication
Fundic Height
0 After birth at umbilicus
0 Day 1 (1
st
12 hours) one finger breath above
umbilicus
0 Descends by one finger breath daily until day 10
0 Day 10 below symphysis pubis, non palpable
Lochia
0 Is the sloughing of deciduas and blood and formation
of new endometrium occurs for 4 to 6 weeks until
placental site is healed
0 Day 1 to 3 Rubra
0 Day 3 to 7 Serosa
0 Day 10 alba
Maternal Physiologic
Adaptations
Reproductive System
0 Uterus returns to normal size through a gradual
process of involution
0 Cervix returns to prepregnant state by week 6 and
gradually closes
0 Ovarian function returns and vagina returns to
normal by 6 to 8 weeks but remains a bit larger before
pregnancy
0 Perineum is edematous for 1 to 2 days but complete
healing of episiotomy takes 4 to 6 weeks
Cardiovascular System
0 Cardiac output returns to non-pregnant values within
4 to 6 weeks
0 Coagulation factors tend to remain elevated in the
early postpartum
Urinary System
0 Difficulty urinating occurs due to anesthesia,
lacerations or swelling of the perineum
0 Post partum diuresis occurs within 12 hours after
childbirth
GIT Adaptation
0 GIT system returns rapidly to normal due to decline in
progesterone
0 Bowel tone remains slow for several days causing
constipation
Respiratory System
0 Relief of discomforts associated with pregnancy
0 Respiratory rate returns to normal
Integumentary System
0 Darkened pigmentations gradually fades
0 Striae gravidarum gradually fades to silvery lines
0 Profuse diaphoresis occurs reducing fluid retained in
pregnancy
Endocrine System
0 Levels of circulating estrogen and progesterone drop
quickly
0 Other hormones (HCG, HPL) decline rapidly after
birth
0 Prolactin remains elevated breastfeeding
Maternal Psychological
Adaptation
Taking in
0 24-48 hours
0 Client sleeps, depends on others to meet her needs
and relives the birth process
0 Characterized by dependent behavior
Taking hold
0 Characterized by dependent and interdependent
behavior
0 Starts on the 2
nd
to 3
rd
day postpartum up to several
weeks
0 Client concerned with her health and the infant
Letting go
0 Occurs later in the post partum period
0 Assumes responsibility and care for the newborn and
assumes the parental role
End