ANTEPARTUM

DAHLIA A. BISNAR, RN, MN, RM

 Objectives
 After mastering the contents of this chapter, you should be able to:
1. Describe common psychological and physiologic changes that
occur with pregnancy and the relationship of the changes to
pregnancy diagnosis.
 2. Identify National Health Goals related to preconception
counseling and prenatal care that nurses can help the nation
achieve.
 3. Use critical thinking to analyze how the physiologic and
psychological changes of pregnancy affect family functioning, and
develop ways to make nursing care more family-centered.
 4. Assess a woman for the psychological and physiologic changes
that occur with pregnancy.
 5. Formulate nursing diagnoses related to the psychological and
physiologic changes of pregnancy.
 Antepartum
 the period between
conception and the
onset of labor.
ANTEPARTUM CARE
Refers to the medical and
nursing care given to the
pregnant woman between
conception and the onset of
labor.
 The primary factor in the
improvement of maternal
morbidity and mortality.
GOALS of antepartal care:
 To determine that woman is
pregnant.
 Educate and treat other medical
conditions that maybe present.
 Diagnose and treat complications of
pregnancy.
 Ensures a nutritious diet.
PURPOSES of prenatal Visit
 To prevent complications and accident
during child birth.
 To determine or identify mothers and
infants at risk.
 To insure the optimum health of both
mother and the baby.
 To provide medical, psychological, and
sociological support to the mother.
 To educate mother about self-care and
infant care.
 NATIONAL HEALTH GOALS

 Increase abstinence from alcohol, cigarettes,

and illicit drugs among pregnant women from
baselines of 87%, 90%, and 96% to 95%, 99%,
and 100%.
 • Reduce maternal deaths from a baseline of 9.9
per 100,000 live births to a target of 4.5 per
100,000.
 • Increase the proportion of pregnant women
who receive early and adequate prenatal care
from a baseline of 74% to a target of 90%
(http://www.nih.gov).
For a healthy pregnancy, your doctor will
probably want to see pregnant woman on the
following recommended schedule of prenatal
visits:

Weeks 4 to 28: 1 prenatal visit a month.

Weeks 28 to 36: 1 prenatal visit every 2 weeks.
Weeks 36 to 40: 1 prenatal visit every week
RISKS FACTORS THAT REQUIRE MORE VISIT

 Age: less than 18 years old & more than 35

years old.
 those with pre-existing health problems
(comorbidity)
 Medical problems that develop during the
pregnancy – preeclampsia, GDM
 Risk of preterm labor
ROLE OF PREGNANCY
CARE:

-is an important
service that
helps protects
the mother,
fetus and
newborn.

jlviray'08
 DURATION OF PREGNANCY

Preterm- < 37 weeks

Full term-38-40 weeks

Post term- > 40 weeks

Abortion - < 20 weeks

 TERMS RELATED TO
PREGNANCY STATUS
 VIABLE- Capable of
developing, @ 24 wks
of gestation.

> is the ability of a

fetus to survive
outside the uterus.

24 weeks/ 6 months
PSYCHOLOGICAL CHANGES OF PREGNANCY

 Pregnancy is such a huge change in a woman’s life

that it brings about more psychological changes
than any other life event besides puberty (Rojas,
Wood, & Blakemore, 2007).

 Social Influences
 Cultural Influences
 Family Influences
 Individual Influences
PSYCHOLOGICAL CHANGES OF PREGNANCY
SIGNS OF PREGNANCY

Diagnosis of Pregnancy
 PRESUMPTIVE - speculation or unconfirmed.
 PROBABLE - likely to be the reason…probably…very likely.
 POSITIVE - conclusive, definite, or absolute.

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SIGNS OF PREGNANCY
 PRESUMPTIVE
Amenorrhea
emesis/nausea
Fatigue
Voiding frequency
Breast tenderness
Skin changes – linea negra, Striae gravidarum,
melasma
Quickening - Fetal movement felt by woman

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SIGNS OF PREGNANCY

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 SIGNS OF PREGNANCY

 PROBABLE
(+) Pregnancy test
Abdominal enlargement
Goodell’s sign - softening of the cervix
Chadwik’s sign – bluish discoloration of vulva, cervix
& vagina
Hegar’s sign - softening of the lower uterine segment
Braxton hicks contractions – false labor contractions
Ballottement -bouncing back of the fetus against the fingers
when the uterus is pushed during palpation.

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SIGNS OF PREGNANCY

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 SIGNS OF PREGNANCY
 POSITIVE
(+) fetal heart tone
Evidence on Ultrasound of
Fetal outline

Fetal movement felt by the

examiner

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 PHYSIOLOGIC CHANGES
UTERUS
> uterus increases in length, depth, width, weight, wall thickness,
and volume.
 Length increases from approximately 6.5 to 32 cm.

 • Depth increases from 2.5 to 22 cm.

 • Width expands from 4 to 24 cm.

 • Weight increases from 50 to 1000 g.

 • Early in pregnancy, the uterine wall thickens from about 1 cm

to about 2 cm; toward the end of pregnancy, the wall thins to

become supple and only about 0.5 cm thick.
 exact shape of the expanding uterus is influenced by the

position of the fetus inside.

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 PHYSIOLOGIC CHANGES
CERVIX
 the cervix of the uterus becomes more vascular and
edematous.
 mucous plug, called the operculum, acts to seal out bacteria
during pregnancy and therefore helps prevent infec tion in
the fetus and membrane.
 Goodell’s sign
VAGINA
 Under the influence of estrogen, the vaginal epithelium and
underlying tissue become hypertrophic.
 Increase vaginal discharges.
 Vaginal secretions during pregnancy fall from a pH of greater
than 7 (an alkaline pH) to 4 or 5 (an acid pH). This occurs
because of the action of Lactobacillus acidophilus - increase
the lactic acid content of secretions to prevent bacterial
invasion. Favors the growth of Candida albicans
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 PHYSIOLOGIC CHANGES
BREASTS
 feeling of fullness, tingling, or tenderness in her
breasts because of the increased stimulation of
breast tissue by the high estrogen level in her
body.
 areola of the nipple darkens, and its diameter
increases from about 3.5 cm (1.5 in) to 5 or 7.5 cm
(2 or 3 in).
 By the 16th week, colostrum, the thin, watery,
high-protein fluid that is the precursor of breast
milk, can be expelled from the nipples.

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 PHYSIOLOGIC CHANGES
INTEGUMENTARY SYSTEM
 striae gravidarum - pink or reddish
streaks
 linea nigra - A narrow, brown line may
form, running from the umbilicus to the
symphysis pubis
 melasma (chloasma), or the “mask of
pregnancy.”
 Vascular spiders or telangiectases -
small, fiery-red branching spots.
 increase in perspiration
 Palmar erythema (redness and itching)
may occur on the hands from the increased
estrogen level.

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 PHYSIOLOGIC CHANGES
RESPIRATORY SYSTEM
 marked congestion, or “stuffiness,” of the
nasopharynx.
 Upward pressure is put on the diaphragm – shortness
of breath
 Residual volume (the amount of air remaining in the
lungs after expiration) is decreased up to 20% by the
pressure of the diaphragm.
 Tidal volume (the volume of air inspired) is increased
up to 40% as a woman draws in extra volume to
increase the effectiveness of air exchange.
 Total oxygen consumption increases by as much as
20%.
 breathing rate is more rapid than usual (18–20
breaths per minute), this is normal for pregnancy
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 PHYSIOLOGIC CHANGES

CARDIOVASCULAR SYSTEM
 the total circulatory blood volume of a woman’s body
increases by at least 30% and as much as 50%.

 Blood loss at a normal vaginal birth is about 300 to 400

mL; blood loss from a cesarean birth can be as high as
800 to 1000 mL.

 pseudoanemia early in pregnancy - plasma volume increases

faster than red blood cell production, the concentration of
hemoglobin and erythrocytes may decline

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PHYSIOLOGIC CHANGES
CARDIOVASCULAR SYSTEM

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PHYSIOLOGIC CHANGES
CARDIOVASCULAR SYSTEM
 Peripheral Blood Flow.
 During the third trimester of pregnancy, blood flow to the lower
extremities is impaired by the pressure of the expanding uterus
on veins and arteries. This resistance to blood flow in the venous
system can lead to edema and varicosities of the vulva,
rectum, and legs.

 Supine Hypotension Syndrome.

 When a pregnant woman lies supine, the weight of the growing
uterus presses the vena cava against the vertebrae, obstructing
blood flow from the lower extremities. This causes a decrease in
blood return to the heart and, consequently, decreased cardiac
output and hypotension (Fig. 10.8). A woman experiences this
hypotension as lightheadedness, faintness, and palpitations
(Bernstein & Weinstein, 2007).The condition is potentially
dangerous because it can cause fetal hypoxia.
PHYSIOLOGIC CHANGES
GASTROINTESTINAL SYSTEM
 nausea and vomiting
Interventions: drinking ginger or peppermint tea, avoid oily foods, eat dry
crackers.

 heartburn may result from reflux of stomach contents into the

esophagus, caused by upward displacement of the stomach by
the uterus, and a relaxed cardioesophageal sphincter, caused by
the action of relaxin, an enzyme produced by the ovary.
Interventions:
> a tablespoon of honey mixed in a glass of warm milk may
neutralize heartburn-causing acid.
> ginger was a good remedy for an upset stomach, it can reduce
inflammation and prevent stomach acid from traveling up the
esophagus.
PHYSIOLOGIC CHANGES

 GASTROINTESTINAL SYSTEM
 Uterus enlargement may pushes the stomach & intestines to
sides of abdomen---slow intestinal peristalsis leading to
increased heartburn, constipation and flatulence.

 Relaxin may contribute to decreased gastric motility

 Pressure from the uterus on veins returning from the lower

extremities can lead to hemorrhoids.
Hemorrhoids - are swollen, enlarged veins that form inside and
outside the anus and rectum.
PHYSIOLOGIC CHANGES

 GASTROINTESTINAL SYSTEM
Constipation
Intervention:
Drink plenty of fluids.
More fiber in your diet. Choose high-fiber foods, such as fruits,
vegetables, and whole grains.
Getting regular exercise/activity.
PHYSIOLOGIC CHANGES

 GASTROINTESTINAL SYSTEM
 Hemorrhoids

 Intervention:

Avoid prolong standing or sitting.

Getting regular exercise/activity.
Eat high-fiber foods to prevent constipation.
Do Kegel exercises.
Soak bottom with warm water.
Check with your doctor about taking an over-the-
counter pain reliever or a stool softener or using a
hemorrhoid cream
PHYSIOLOGIC CHANGES

 Urinary System
 alterations in fluid retention and renal, ureter, and bladder
function.

 Changes in the urinary system result from: • Effects of high

estrogen and progesterone levels • Compression of the bladder
and ureters by the growing uterus • Increased blood volume •
Postural influences

 Fluid Retention.
to provide sufficient fluid volume for effective placental
exchange, a total body water increases to 7.5 L; this requires the
body to increase its sodium reabsorption.
PHYSIOLOGIC CHANGES
 Urinary System
Renal Function
- kidneys may increase in size, changing their structure and ultimately
affecting their function.
- The glomerular filtration rate (GFR) and renal plasma flow begin to
increase in early pregnancy to meet the increased needs of the circulatory
system.

Ureter and Bladder Function.

- - increase in urinary frequency during the first 3 months of pregnancy
- - ureters increase in diameter and the bladder capacity increases to about
1500 mL.
- - Pressure on the urethra may lead to poor bladder emptying and bladder
infection.
PHYSIOLOGIC CHANGES

 Skeletal System
 Calcium and phosphorus needs are increased during pregnancy,
because the fetal skeleton must be built.
 softening of a woman’s pelvic ligaments and joints - passage of
the baby at birth.

 “Waddling gait” - wide stance when walking for good balance.

 lordosis (forward curve of the lumbar spine) or “pride of

pregnancy”
- pregnant woman tends to stand straighter and taller to change her center of
gravity and make ambulation easier.
 ….

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