Antepartum Part1

8/14/2019 Antepartum Part1

1/100

1

MATERNAL & CHILD

HEALTH NURSING

ANTEPARTUM

Venice Joy Toledo - Malonzo, RN


2/100

2

Maternal and Child Health Nursing

involves care of the woman and

family throughout pregnancy and

child birth and the health promotionand illness care for the children and

families.


3/100

3

Primary Goal of MCN

The promotion and maintenance of

optimal family health to ensure

cycles of optimal childbearing andchild rearing


4/100

4

ANATOMY AND

PHYSIOLOGY OFFEMAL REPRODUCTIVE

ORGANS


5/100

5

EXTERNAL

Mons Pubis - pad of adipose tissue whichlies over the symphysis pubis covered byskin and at puberty, by short hairs;protecting the surrounding delicate tissue.

Labia Majora -two folds of skin with fatunderneath; contain Bartholins gland.

Labia Minora -two thin folds of delicatetissues; form an upper fold encircling clitoriscalled the prepuce; and unite posteriorlycalled the fourchette.


6/100

6

Clitoris - small, erectile structure at

the anterior junction of the labia minora

Vestibule narrow space seen when

the labia minora are separated.

Urethral meatus external opening of

the urethra; slightly behind and to side

are the opening of skenes gland


7/100

7

Vaginal orifice external opening of

the vagina, covered by a thin

membrane called hymen.

Perineum area from the lower

border of the vaginal orifice to the anus


8/100

8


9/100

9

INTERNAL

UTERUS A hollow pear shaped

muscular organ Serves various function

1. To receive ovum from

fallopian tube2. To provide a place for the

ovum implant

3. To offer nourishment &

protection to the growingfetus

4. To expel the fetus from themothers body when mature

It has 3 layers endometrium,

myometrium,perimetrium


10/100

10

VAGINA

a 3-4 inches long dilatable canal

located between the bladder and therectum.

it contains rugae which permit

considerable stretching without tearing

passageway for menstrual discharges,

copulation and fetus.


11/100

11

OVARIES

almond shaped,dull white sexglands near thefimbrae, kept in

place byligaments.

Produce matureand expel ovaand manufactureestrogen andprogesterone.


12/100

12

FALLOPIAN TUBES

4 inches long from each side of

the fundus, widest part (called the

ampula) spreads into fingerlikeprojections (called fimbrae).

Responsible for transport of

mature ovum to the uterus.


13/100

13


14/100

14

Related Structure

Pelvis - support and protect the reproductive

organ


15/100

15

Types/ Variation of Pelvis

Gynecoid normal female pelvis. Inlet iswell rounded forward and back. Most idealfor child birth.

Anthropoid transverse diameter isnarrow, AP diameter is larger than normal.

Platypelloid inlet is oval, AP diameter is

shallowAndroid male pelvis. Inlet has a

narrow, shallow posterior portion andpointed anterior portion.


16/100

16

Division of the Pelvis

False pelvis

Part above the pelvic brim

Serves to support the weight of the enlarged pregnant

uterus

Directs the presenting fetal part into the true pelvis

Inlet: upper border of pelvis Pelvic cavity: Curved canal with a longer posterior than

anterior wall

Outlet: Pelvic outlet is at the lower border of the true

pelvis


17/100

17

FIGURE 312 Female pelvis.A, The false pelvis is a shallow cavity above the inlet; the true pelvis is a

deeper portion of the cavity below the inlet.


18/100

18

Pelvic Measurements

Pelvic inlet

Diagonal conjugate

Measure at least 11.5 cm

Obstetric conjugate - 10 cm or

more


19/100

19

FIGURE 105 Manual measurement of inlet and outlet.A, Estimation of the diagonal conjugate, which

extends from the lower border of the symphysis pubis to the sacral promontory.B, Estimationof the

anteroposterior diameter of the outlet, which extends from the lower border of the symphysis pubis to the tip of

the sacrum. Cand D, Methods that may be used to check the manual estimation of anteroposterior

measurements.

A


20/100

20

FIGURE 105 (continued) Manual measurement of inlet and outlet.A, Estimation of the

diagonal conjugate, whichextends from the lower border of the symphysis pubis to the

sacral promontory.B, Estimation of the anteroposterior diameter of the outlet, which

extends from the lower border of the symphysis pubis to the tip of the sacrum. Cand D,

Methods that may be used to check the manual estimation of anteroposterior

measurements.

B


21/100

21

FIGURE 105 (continued) Manual measurement of inlet and outlet.A, Estimation of the

diagonal conjugate, whichextends from the lower border of the symphysis pubis to the sacral

promontory.B, Estimationof the anteroposterior diameter of the outlet, which extends from the

lower border of the symphysis pubis to the tip of the sacrum. Cand D, Methods that may be used

to check the manual estimation of anteroposterior measurements.

C

D


22/100

22

Pelvic Measurements

Pelvic outlet

Anteroposterior diameter

Should be 9.5 to 11.3 cm

Transverse diameter should

be 8 to 10 cm


23/100

23

FIGURE 106 Use of a closed fist to measure the outlet. Most examiners know the distance between their

first and last proximal knuckles. If they do not, they can use a measuring device.


24/100

24

Breast

Consist of glandular,fibrous, and adiposetissue.

Grow & Develop

from stimulation ofsecretion from thehypothalamus,anterior pituitary andovaries.

Provide nourishmentto the infant andtransfer maternalantibodies duringbreast feeding


25/100

25

MenstrualCycle
http://rds.yahoo.com/_ylt=A0S0205ueG5KMPIAQciJzbkF;_ylu=X3oDMTBqYWdlNjBlBHBvcwMxOARzZWMDc3IEdnRpZAM-/SIG=1h3pelln6/EXP=1248840174/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DMENSTRUATION%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=500%26h=463%26imgurl=static.flickr.com%252F185%252F388935663_1fb840ebc7.jpg%26rurl=http%253A%252F%252Fwww.flickr.com%252Fphotos%252Festherase%252F388935663%252F%26size=169k%26name=day%2B96%2Bperiod%2Bpa...%26p=MENSTRUATION%26oid=728d22582e404a8e%26fr2=%26fusr=estherase%26lic=1%26no=18%26tt=28704%26sigr=11he235la%26sigi=11enjcii5%26sigb=12hdufcjm


26/100

26

Female Reproductive Cycle

Purpose:

To bring an ovum to maturity and renew the

uterine tissue bed that will be responsive to

its growth once its fertilized Menarche

First menstruation

May occur early as age of 7 or late as age 17


27/100

27

The menstrual cycle

Varies from woman to woman

average length of cycle is 28 days fromthe beginning of one menstrual flow to

the beginning of next.

aveverage length of the menses is 2 to

7 days


28/100

28

Initiated by the release of LUTEINIZING

HORMONE RELEASING HORMONE, also

known as gonadotropin releasing hormone

from the hypothalamus Under the influence of LHRH, the anterior

lobe of pituitary produces two hormone:

a. Follicle stimulating hormone

b. Luteinizing hormone


29/100

29

Characteristics of Normal Menstruation

Period

1. Menarche average onset 12 -13 years

2. Interval between cycles average 28 days

3. Cycles 23 35 days

4. Duration average 2 7 days; range 1 9

days

5. Amount average 30 80 ml ; heavy

bleeding saturates pad in


30/100

30

Phases of menstrual cycle

Menstrual phase (days 1-5)

Estrogen and progesterone level

decrease

FSH levels rise, and steady levels of LH

influence the ovary to secrete estrogen

Menstrual flow begins


31/100

31

Proliferative (follicular) phase (6-13 days)

Estrogen production increases, leading

to proliferation of endometrium andmyometrium in preparation for possibleimplantation of ovum

Follicle secrete estradiol

FSH stimulates graafian follicleFSH production decreases before

ovulation (around day 14)


32/100

32

Secretory (Luteal) (days 14-25)

The corpus luteum forms under the

influence of LH

Estrogen and progesterone production

increases

The endometrium id prepared for

implantation of fertilized ovum


33/100

33

Ischemic (days 26-28)

The corpus luteum degenerates if

conception doesnt occur

Estrogen and progesterone levels

decline if conception doesnt occur


34/100

34

A i t d T


35/100

35

Associated Terms

1. Amenorrhea - temporary cessation of

menstrual flow

2. Oligomenorrhea - markedly diminished

menstrual flow3. Menorrhagia - excessive bleeding during

regular menstruation

4. Metrorrhagia - bleeding at completelyirregular intervals

5. Polymenorrhea - frequent menstruation

occurring at intervals of less than 3 weeks


36/100

36

BEGINNING OF

PREGNANCY


37/100

37

Process of Conception

Fertilization

1. Union of the ovum and spermatozoon

2. Other terms: conception, impregnation or fecundation

3. Normal amount of semen/ejaculation= 3-5 cc = 1 tsp.

4. Number of sperms: 120-150 million/cc/ejaculation

5. Mature ovum may be fertilized for 12 24 hrs afterovulation

6. Sperms are capable of fertilizing even for 3 4 days

after ejaculation (lifespan of sperms 72 hrs)


38/100

38

FIGURE Sperm penetration of an ovum.A, The sequential steps of oocyte penetration by a spermare depicted

moving from top to bottom.B, Scanning electron micrograph of a human sperm surrounding a human ovum (750).

The smaller spherical cells are granulosa cells of the corona radiata. Scanning electron micrograph used with

permission from Nisson, L. (1990). A child is born. New York: Dell publishing.


39/100

39

FIGURE 72(continued) Sperm penetration of an ovum.A, The sequential steps of oocyte penetration by a

sperm are depicted moving from top to bottom.B, Scanning electron micrograph of a human spermsurrounding a

human ovum (750). The smaller spherical cells are granulosa cells of the corona radiata. Scanning electron

micrograph used with permission from Nisson, L. (1990). A child is born. New York: Dell publishing.(Photo

Lennart Nilsson/Albert Bnniers Folag AB)


40/100

40

Implantation

Once implantation has taken place, the uterineendometrium is now termed deciduas

Occasionally, a small amount of vaginal bleedingoccurs with implantation due to breakage ofcapillaries

Immediately after fertilization, the fertilized ovum orzygote stays in the fallopian tube for 3 days, duringwhich time rapid cell division (mitosis) is takingplace. The developing cells now called blastomereand when about to have 16 blastomere calledmorula.


41/100

41

Morula travels to uterus for another 3 4

days

When there is already a cavity in the morula

called blastocyt finger like projections calledtrophoblast form around the blastocyst, which

implant on the uterus

Implantation is also called nidation, takes

place about a week after fertlization


42/100

42

FIGURE During ovulation the ovum leaves the ovary and enters the fallopian tube. Fertilizationgenerally occurs

in the outer third of the fallopian tube. Subsequent changes in the fertilizedovum from conception to implantation

are depicted.


43/100

43

Placentation

In placentation, the chronic villi invade

the decidua

This becomes the fetal portion of the

future placenta


44/100

44

Stages of Fetal Development

Preembryonic period

Begins with fertilization and lasts about 3

weeks

As the zygote passes through the fallopiantube, it undergoes a series of mitotic division,

or cleavage

Once formed, the zygote develops intomorula and then blastocyst, eventually

attached to the endometrium.


45/100

45

Embryonic Period

Begins with the 4th week of gestation andends with the 7th week

The zygote now called an embryo, begins to

take on a human shape Germ layers develop, giving rise to organ

system

The embryo is highly vulnerable to injury from

maternal drug use, certain maternal

infections, other factors


46/100

46

Fetal Period

Begins with 8th week of gestation and

continues until birth

During this period, the embryo now calledfetus, matures, enlarges, and grows heavier.

The head of the fetus is disproportionately

larger than its body.

The fetus also lacks subcutaneous fat


47/100

47

Embryonic & Fetal Structures

Decidua

Refers to endometrial lining during pregnancy

Provides a nesting place for the developing

ovum


48/100

48

Fetal membranes

The chorion is the fetal membrane closest tothe uterine wall:

- It gives rise to placenta

- It forms the outer wall of blastocyst

- Vascular projections, called chronic villi,arise from its periphery

Amnion is the thin, though inner fetalmembrane that lines amniotic sac, gives riseto umbilical cord supported by Whartons

jelly


49/100

49

Embryonic germ layers

Three layers develop during the embryonic

period

Ectoderm outermost layer

Mesoderm middle layer Endoderm inner most layer; differentiation

of endoderm results in formation of epithelium

lining respiratory and digestive tracts


50/100

50

FIGURE Endoderm differentiates to form the epithelial lining of the digestive and respiratory tractsand associated

glands.


51/100

51

Amniotic sac

Gradually increases in size and surrounds theembryo

Contains fluid, called amniotic fluid

Purpose1. Protection shield against pressure and

temperature changes

2. Can be used to diagnose congenital

abnormalities intrauterine amniocentesis

3. Aid in the descent of fetus during active labor


52/100

52

Umbilical cord

Serves as the lifeline from the embryo to theplacenta

Measures from 30.5 90 cm in length & 2 cm in

diameter at full term

Contains AVA (2 artery 1 vein)

artery carries blood from fetus to placenta

vein returns blood to the fetus from the

placenta Contains whartons jelly, jellatenous substance

that helps prevent kinking of the cord in utero

Blood flows through the cord at about 400ml/min


53/100

53

Placenta

A flat disk shaped structure formed from thechorion, chronic villi, and adjacent decidua

basalis

Contains 15-20 subdivison called cotyledons It supplies fetus with carbohydrates, water,

fats, protein, minerals & inorganic salts

It transfer passive immunity via maternal

antibodies


54/100

54

Maternal portion

Consists of deciduas basalis and its circulation

Surface appears red and flesh-like

Fetal portion Consists of the chorionic villi and their

circulation

The fetal surface of the placenta is covered by

the amnion

Appears shiny and gray


55/100

55

FIGURE Maternal side of placenta (Dirty Duncan).


56/100

56

FIGURE 7 Fetal side of placenta (Shiny Shultz).


57/100

57

FETAL GROWTH &

DEVELOPMENT


58/100

58

Fetus Growth & Development

4 weeks: 46 mm, brain formed from

anterior neural tube, limb buds seen,

heart beats, GI system begins

6 weeks: 12 mm, primitive skeletal

shape, chambers in heart, respiratory

system begins, ear formation begins


59/100

59

12 weeks: 8 cm, ossification of skeleton

begins, liver produces red cells, palate

complete in mouth, skin pink, thyroid

hormone present, insulin present in pancreas

16 weeks: 13.5 cm, teeth begin to form,

meconium begins to collect in intestines,

kidneys assume shape, hair present on scalp


60/100

60

FIGURE The fetus at 20 weeks weighs 435 to 465 g and measures about 19 cm. Subcutaneousdeposits of

brown fat make the skin a little less transparent. Woolly hair covers the head,and nails have developed on

the fingers and toes. Use with permission from Nilsson, L. (1990). A child is born. New York: Dell Publishing.

(Photo Lennart Nilsson/Albert Bnniers Folag AB)


61/100

61

20 weeks: 19 cm, myelination of spinal cordbegins, suck and swallow begins, lanugocovers body, vernix begins to protect thebody

24 weeks: 23 cm, respiration and surfactantproduction begins, brain appears mature

28 weeks: 27 cm, nervous system beginsregulation of some functions, adipose tissueaccumulates; nails, eyebrows, and eyelidsare present; eyes are open

36 weeks: 35 cm, earlobes soft with littlecartilage, few sole creases


62/100

62

40 weeks : 40 cm, adequate surfactant,

vernix in skin folds and lanugo on shoulders,

earlobes firm, sex apparent

Weight about 3,000 to 3,600 g (6 lb., 10 oz. to7 lb., 15 oz.)

Varies in different ethnic groups

Skin has a smooth, polished look

Hair on head is coarse and about 1 inch long

Body and extremities are plump

Focus of Fetal Development


63/100

63

Focus of Fetal Development

First Trimester period of organogenesis

Second Trimester period of continued fetal

growth and development; rapid increaseinlength

Third Trimester period of most rapid growth

and development because of the deposition

of subcutaneous fat


64/100

64FIGURE 7 The actual size of a human conceptus from fertilization to the early fetal stage. The embryonic stage

begins in the third week after fertilization; the fetal stage begins in the ninth week.

Fetal Development: What Parents


65/100

65

Fetal Development: What Parents

Want to Know


66/100

66


67/100

67

Fetal Blood Circulation

The fetus is connected by the umbilical cord to the

placenta, the organ that develops and implants in the

mother's uterus during pregnancy.

Through the blood vessels in the umbilical cord, the

fetus receives all the necessary nutrition, oxygen, and life

support from the mother through the placenta.

Waste products and carbon dioxide from the fetus aresent back through the umbilical cord and placenta to the

mother's circulation to be eliminated.


68/100

68


69/100

69

Placenta

Umbilical vein (composed of two arteries and

one vein AVA)

Liver

Ductus Venosus (First Shunt)


70/100

70

Inferior Vena Cava

Right Atrium

Foramen Ovale (Second Shunt)

Left Atrium

Left Ventricle


71/100

71

Aorta

To upper half of the fetal body only

Upper Extreme

Brain

Heart

Pulmonary

Upper part of the GUT


72/100

72

Then this blood is recollected

with less oxygen and then it goes to

the

Superior Vena Cava


73/100

73

Right Atrium

Right Ventricle

Pulmonary Artery (but lungs are collapsed;

Surfactant inadequate and amniotic fluid ispresent)

Ductus Arteriosus


74/100

74

Descending Aorta

Supply the lower half of the fetal body

Blood is recollected

Hypogastric Artery

Umbilical Artery

Placenta


75/100

75

SHUNTS

When the baby is delivered, the shunts are

normally removedDuctus Venosus

Foramen ovale


76/100

76

Two (2) types of Closure

Functional ClosureAnatomic Closure


77/100

77

FORAMEN OVALE

Closed functionally immediately after birth or

IMMEDIATELY AFTER CORD IS CLAMPEDAnatomically, it can persist up to one (1) year

after delivery


78/100

78

Therefore, in auscultation in twenty-eight (28) dayold baby There is a MURMUR

This is Normal

This is NOT A PATHOLOGIC MURMUR

It is a SYSTEMIC / INNOCENT MURMUR

A PHYSIOLOGIC MURMUR IN NEONATES


79/100

79

DUCTUS ARTERIOSUS

Functional Closure

Ten to ninety-six hours (10 96 hrs) after birth

or approximately four (4) days

Anatomically

Two to three months (2 3 mos.)


80/100

80

Normal Adaptation to Pregnancy

SystemicChanges

1 Cardiovascular/ Circulatory changes
http://rds.yahoo.com/_ylt=A0S020pEd25K9nkAslWJzbkF;_ylu=X3oDMTBqMDkzMnFjBHBvcwM2NARzZWMDc3IEdnRpZAM-/SIG=1kojf283d/EXP=1248839876/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DPREGNANT%252BWOMEN%2526b%253D61%2526ni%253D20%2526ei%253Dutf-8%2526pstart%253D1%2526fr%253Dyfp-t-152%26w=1387%26h=2100%26imgurl=www.dsf.health.state.pa.us%252Fhealth%252Flib%252Fhealth%252Ffamilyhealth%252Fpregnant_woman.jpg%26rurl=http%253A%252F%252Fwww.dsf.health.state.pa.us%252Fhealth%252FCWP%252Fview.asp%253FA%253D179%2526Q%253D237093%26size=417k%26name=pregnant%2Bwoman%2Bj...%26p=PREGNANT%2BWOMEN%26oid=5c2521a3d814a3cc%26fr2=%26no=64%26tt=66430%26b=61%26ni=20%26sigr=124l8b3q6%26sigi=12c1101kv%26sigb=1375m3mi6


81/100

81

1. Cardiovascular/ Circulatory changes

a. Physiologic anemia of pregnancy

30-50% gradual increase in total cardiac

volume (peak 6th month) causing drop in

Hemoglobin and Hematocrit values (inc onlyin plasma volume)


82/100

82

Consequences of increased cardiac volume:

1. easy fatigability & shortness of breath due

increase cardiac workload

2. slight hypertrophy of the heart3. systolic murmurs due to lowered blood

viscosity

4. nosebleeds may occur due to congestion ofnasopharynx


83/100

83

b. Palpitations

caused by the SNS stimulation during early

part of pregnancy; increased pressure of the

uterus against the diaphragm during thesecond half of pregnancy

c Edema of the lower extremities & varicosities

due to poor circulation caused by the

pressure of the gravid uterus on the blood

vessels of the lower extremities


84/100

84
http://rds.yahoo.com/_ylt=A0S02030eW5KRRAA7cWJzbkF;_ylu=X3oDMTBpdnJhMHUzBHBvcwMxBHNlYwNzcgR2dGlkAw--/SIG=1is65th9a/EXP=1248840564/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dvaricose%252Bveins%252Band%252Bpregnancy%2526fr%253Dyfp-t-152%2526fr2%253Dsg-gac%26w=400%26h=496%26imgurl=static.howstuffworks.com%252Fgif%252Fhow-to-cope-with-varicose-veins-3.jpg%26rurl=http%253A%252F%252Fhealth.howstuffworks.com%252Fhome-remedies-for-varicose-veins1.htm%26size=18k%26name=how%2Bto%2Bcope%2Bwith...%26p=varicose%2Bveins%2Band%2Bpregnancy%26oid=e0df180bc0f27f78%26fr2=sg-gac%26no=1%26tt=137%26sigr=125ejqncc%26sigi=1227vs32b%26sigb=133jaulrrhttp://rds.yahoo.com/_ylt=A0S02030eW5KRRAA7sWJzbkF;_ylu=X3oDMTBpZTByOGFiBHBvcwMyBHNlYwNzcgR2dGlkAw--/SIG=1jh8ae1jd/EXP=1248840564/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dvaricose%252Bveins%252Band%252Bpregnancy%2526fr%253Dyfp-t-152%2526fr2%253Dsg-gac%26w=400%26h=320%26imgurl=www.theholisticcare.com%252Fcure%252520diseases%252FImages%252Fvaricose%252520veins.jpg%26rurl=http%253A%252F%252Fwww.theholisticcare.com%252Fcure%252520diseases%252FVaricose%252520Veins.htm%26size=24k%26name=varicose%2Bveins%2Bj...%26p=varicose%2Bveins%2Band%2Bpregnancy%26oid=202ee9014e304344%26fr2=sg-gac%26no=2%26tt=137%26sigr=1236riv6a%26sigi=123in757h%26sigb=133jaulrrhttp://rds.yahoo.com/_ylt=A0S020uIeW5KxFoBfImJzbkF;_ylu=X3oDMTBpdnJhMHUzBHBvcwMxBHNlYwNzcgR2dGlkAw--/SIG=1hgaagoop/EXP=1248840456/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DPREGNANCY%252B%252BEDEMA%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=500%26h=333%26imgurl=static.flickr.com%252F3107%252F2438453829_7624844ddb.jpg%26rurl=http%253A%252F%252Fwww.flickr.com%252Fphotos%252Funderwaterclownconspiracy%252F2438453829%252F%26size=124k%26name=Edema%26p=PREGNANCY%2B%2BEDEMA%26oid=c26796d98a6f99c0%26fr2=%26fusr=%252AApril%252A%26no=1%26tt=95%26sigr=122tvurdg%26sigi=11gljad8k%26sigb=12lek3hvjhttp://rds.yahoo.com/_ylt=A0S020uIeW5KxFoBgomJzbkF;_ylu=X3oDMTBpZm5udGl1BHBvcwM1BHNlYwNzcgR2dGlkAw--/SIG=1hij7fv0q/EXP=1248840456/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DPREGNANCY%252B%252BEDEMA%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=375%26h=500%26imgurl=static.flickr.com%252F3231%252F2855804589_671779db4d.jpg%26rurl=http%253A%252F%252Fwww.flickr.com%252Fphotos%252Fchristopherandtia%252F2855804589%252F%26size=103k%26name=Soooo%2Bswollen%26p=PREGNANCY%2B%2BEDEMA%26oid=ddc98d1b50bf5258%26fr2=%26fusr=christophera...%26no=5%26tt=95%26sigr=11q49jk82%26sigi=11g6mp1p9%26sigb=12lek3hvj


85/100

85

d. Vaginal and rectal varicosities

due to pressure on blood vessels of the

genitalia

e. Predisposition to blood clot formation due to increased level of circulating fibrinogen

as a protection from bleeding implication: no

massage


86/100

86

2. Gastrointestinal Changes

a. Morning sickness nausea and vomiting in the 1st

trimester due to HCG or due to

increased acidity or emotional factors

b. Hyperemesis gravidarum excessive nausea & vomiting which

persists beyond 3 months causing

dehydration, starvation and acidosis
http://rds.yahoo.com/_ylt=A0S020mVem5KRPYARq6JzbkF;_ylu=X3oDMTBpdnJhMHUzBHBvcwMxBHNlYwNzcgR2dGlkAw--/SIG=1ggvn5rpr/EXP=1248840725/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DMORNING%252BSICKNESS%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=200%26h=200%26imgurl=www.i-am-pregnant.com%252Fimages200%252F32051299.jpg%26rurl=http%253A%252F%252Fwww.i-am-pregnant.com%252Fencyclopedia%252FM%252FMorning-Sickness%26size=12k%26name=32051299%2Bjpg%26p=MORNING%2BSICKNESS%26oid=88025f41ef402550%26fr2=%26no=1%26tt=14740%26sigr=11sgpb4uq%26sigi=11cvdheih%26sigb=12lpsb87ohttp://rds.yahoo.com/_ylt=A0S020mVem5KRPYASa6JzbkF;_ylu=X3oDMTBpc2ozM2gzBHBvcwM0BHNlYwNzcgR2dGlkAw--/SIG=1gkbbv21n/EXP=1248840725/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DMORNING%252BSICKNESS%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=250%26h=148%26imgurl=www.pregnancywizard.com%252Fmorning-sickness.jpg%26rurl=http%253A%252F%252Fwww.pregnancywizard.com%252Fsigns-symptoms%252Fmorning-sickness.php%26size=7k%26name=morning%2Bsickness...%26p=MORNING%2BSICKNESS%26oid=fefc6bc89dc74cd8%26fr2=%26no=4%26tt=14740%26sigr=122lp3mq5%26sigi=11cjub7kp%26sigb=12lpsb87o


87/100

87

c. Constipation and Flatulence

GI displacement slows peristalsis &

gastric emptying time; inc

progesterone
http://rds.yahoo.com/_ylt=A0S0204re25Kt_AAF3aJzbkF;_ylu=X3oDMTBqMjRpazg1BHBvcwMxMARzZWMDc3IEdnRpZAM-/SIG=1h3entmkf/EXP=1248840875/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dtoilet%252Bbowl%252Bcartoons%2526fr%253Dyfp-t-152%26w=200%26h=156%26imgurl=static.flickr.com%252F2%252F1995419_9318f8a098.jpg%26rurl=http%253A%252F%252Fwww.flickr.com%252Fphotos%252Fjesus_loves%252F1995419%252F%26size=8k%26name=Spongebob%2Bon%2Btoi...%26p=toilet%2Bbowl%2Bcartoons%26oid=9abea7aa2d7dfbea%26fr2=%26fusr=Cannie%2BKor%26no=10%26tt=2118694%26sigr=11h6i7l3c%26sigi=11avlks9s%26sigb=12ghck6dj


88/100

88

d. Hemorrhoids

due pressure of enlarged uterus
http://rds.yahoo.com/_ylt=A0S020yme25KmK8A4hWJzbkF;_ylu=X3oDMTBpc2ozM2gzBHBvcwM0BHNlYwNzcgR2dGlkAw--/SIG=1hqna1329/EXP=1248840998/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253Dthrombosed%252Bexternal%252Bhemorrhoids%2526fr%253Dyfp-t-152%26w=203%26h=132%26imgurl=www.bosa.co.kr%252Flink%252F3684-20p3.jpg%26rurl=http%253A%252F%252Fwww.bosa.co.kr%252Fspecial%252Fview.asp%253Fboard_pk%253D14696%2526page%253D6%2526what_board%253D24%26size=10k%26name=3684%2B20p3%2Bjpg%26p=thrombosed%2Bexternal%2Bhemorrhoids%26oid=7f11f9d88c8c1b5e%26fr2=%26no=4%26tt=33%26sigr=12aseo4je%26sigi=111mbtq2k%26sigb=12rpgs33fhttp://rds.yahoo.com/_ylt=A0S020lne25KWwYBSa6JzbkF;_ylu=X3oDMTBqNzBoY2J0BHBvcwMxNARzZWMDc3IEdnRpZAM-/SIG=1mjukri04/EXP=1248840935/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DHEMORRHOIDS%2526js%253D1%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=294%26h=308%26imgurl=www.luckyworld.net%252Fbbs%252Fdata%252Fplay_04%252FHemorrhoids1USdepartmentofhealtha.jpg%26rurl=http%253A%252F%252Fwww.luckyworld.net%252Fbbs%252Fboard.php%253Fid%253Dplay_04%2526page%253D6%2526s_name1%253D%2526div%253D1%2526s_name%253Doff%2526s_title%253Don%2526s_cont%253Doff%2526orderby%253Dheadnum%2526order2%253Dasc%2526no%253D725%26size=12k%26name=Hemorrhoids1USde...%26p=HEMORRHOIDS%26oid=c3f00d400ec9c992%26fr2=%26no=14%26tt=13376%26sigr=14bs8afdu%26sigi=1290hfgh8%26sigb=12ltjr5tc


89/100

89

e. Heartburn

due to increased progesterone and

decreased gastric motility causing

regurgitation through gastric sphincter

3 i Ch
http://rds.yahoo.com/_ylt=A0S0203Fe25KLRAAO2.JzbkF;_ylu=X3oDMTBpdDZuNzZrBHBvcwM5BHNlYwNzcgR2dGlkAw--/SIG=1iojkb556/EXP=1248841029/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DHEARTBURN%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=200%26h=150%26imgurl=blogs.abcnews.com%252Fgma%252Fimages%252F2008%252F06%252F02%252Fnm_heartburn_080602_mn.jpg%26rurl=http%253A%252F%252Ffeeds.feedburner.com%252F%257Er%252FAbcNews_GMAMentionedOnAir%252F%257E3%252F303038122%252Flearn-how-to-co.html%26size=8k%26name=nm%2Bheartburn%2B080...%26p=HEARTBURN%26oid=c67e6c46567e24a6%26fr2=%26no=9%26tt=32266%26sigr=12q2a3v2l%26sigi=122nqm8h7%26sigb=12eu2t6tj


90/100

90

3. Respiratory Changes

a. Shortness of Breath

due to inc. oxygen consumption and

production of carbon dioxide during the 1st

Trimester; and increased uterine size pushingthe diaphragm crowding chest cavity


91/100

91

4. Urinary Changes

a. Urinary frequency

felt during the 1st trimester due to the

increase blood supply to the kidneys and then

on the 3rd trimester due to pressure on thebladder.

b. Decreased renal threshold for sugar

due to increased production of

glucocorticoids which cause lactose and

dextrose to spill into the urine; and inc.

progesterone

5 M l k l t l h
http://rds.yahoo.com/_ylt=A0S020stfG5KFGEBTVKJzbkF;_ylu=X3oDMTBpc2ozM2gzBHBvcwM0BHNlYwNzcgR2dGlkAw--/SIG=1i1niljdt/EXP=1248841133/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DSTANDING%252BPREGNANT%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=150%26h=150%26imgurl=www.freeprintablecoloringpages.net%252Fthumbs%252FAt_The_Doctor%252FStanding_Pregnant_Woman.png%26rurl=http%253A%252F%252Fwww.freeprintablecoloringpages.net%252Fcategory%252FAt_The_Doctor%26size=3k%26name=Standing%2BPregnan...%26p=STANDING%2BPREGNANT%26oid=5e4471b03ca5aaa8%26fr2=%26no=4%26tt=423%26sigr=120k6vmvd%26sigi=12jmeb8cl%26sigb=12mpg7b48


92/100

92

5. Musculoskeletal changes

a. Pride of Pregnancy

due to need to change center of gravity result

to lordotic position

b. Waddling gait due to increased production of hormone

relaxin, pelvic bones becomes more movable

increasing incidence of falls

c. Leg cramps

due to pressure of gravid uterus, fatigue,

muscle tenseness, low calcium and

phosphorus intake
http://rds.yahoo.com/_ylt=A0S020stfG5KFGEBTVKJzbkF;_ylu=X3oDMTBpc2ozM2gzBHBvcwM0BHNlYwNzcgR2dGlkAw--/SIG=1i1niljdt/EXP=1248841133/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DSTANDING%252BPREGNANT%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=150%26h=150%26imgurl=www.freeprintablecoloringpages.net%252Fthumbs%252FAt_The_Doctor%252FStanding_Pregnant_Woman.png%26rurl=http%253A%252F%252Fwww.freeprintablecoloringpages.net%252Fcategory%252FAt_The_Doctor%26size=3k%26name=Standing%2BPregnan...%26p=STANDING%2BPREGNANT%26oid=5e4471b03ca5aaa8%26fr2=%26no=4%26tt=423%26sigr=120k6vmvd%26sigi=12jmeb8cl%26sigb=12mpg7b48


93/100

93

d. Increased size and activity of adrenal cortexincreasing circulating cortisol, aldosterone,

and ADH which affect CHO and fat

metabolism causing hyperglycemia.

e. Gradual increase in insulin production but

there is decreased sensitivity to insulin during

pregnancy

6 E d i Ch


94/100

94

6. Endocrine Changes

a. Addition of the placenta as an endocrineorgan producing HCG, HPL, estrogen and

progesterone

b. Moderate enlargement of the thyroid due toincreased basal metabolic rate

c. Increased size of the parathyroid to meet

need of fetus for calcium
http://rds.yahoo.com/_ylt=A0S0205mfG5KM_gAIc.JzbkF;_ylu=X3oDMTBpcWpidGtpBHBvcwM4BHNlYwNzcgR2dGlkAw--/SIG=1gatak5os/EXP=1248841190/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DWEIGHING%252BSCALE%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=220%26h=220%26imgurl=www.umm.edu%252Fweightloss%252Fimages%252Fweight-scale.jpg%26rurl=http%253A%252F%252Fwww.umm.edu%252Fweightloss%252Fonline_resources.htm%26size=14k%26name=weight%2Bscale%2Bjpg%26p=WEIGHING%2BSCALE%26oid=9a7217201e986d2a%26fr2=%26no=8%26tt=41868%26sigr=11iep1n3q%26sigi=11edds63f%26sigb=12j3g824u


95/100

95

7. Weight Change

a. First Trimester 1.5 to 3 lbs normal weight

gain

b. 2nd and 3rd trimester 10 11 lbs pertrimester is recommended

c. Total allowable weight gain during throughout

pregnance is 20 25 lbs or 10 12 kgs.

d. Pattern of weight gain is more important thanthe amount of weight gained.

8 E i l
http://rds.yahoo.com/_ylt=A0S0205mfG5KM_gAIc.JzbkF;_ylu=X3oDMTBpcWpidGtpBHBvcwM4BHNlYwNzcgR2dGlkAw--/SIG=1gatak5os/EXP=1248841190/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DWEIGHING%252BSCALE%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=220%26h=220%26imgurl=www.umm.edu%252Fweightloss%252Fimages%252Fweight-scale.jpg%26rurl=http%253A%252F%252Fwww.umm.edu%252Fweightloss%252Fonline_resources.htm%26size=14k%26name=weight%2Bscale%2Bjpg%26p=WEIGHING%2BSCALE%26oid=9a7217201e986d2a%26fr2=%26no=8%26tt=41868%26sigr=11iep1n3q%26sigi=11edds63f%26sigb=12j3g824uhttp://rds.yahoo.com/_ylt=A0S0206SfG5KrPMALH.JzbkF;_ylu=X3oDMTBqamdoM3Q5BHBvcwMxMgRzZWMDc3IEdnRpZAM-/SIG=1ij3h6afe/EXP=1248841234/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DPOST%252BPARTUM%252BBLUES%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=266%26h=357%26imgurl=www.planet.vertbaudet.com%252Fphotos%252Fbomastersite%252Fimages%252F129%252F357x480.aspx%26rurl=http%253A%252F%252Fwww.planet.vertbaudet.com%252Fbaby-blues-depression-post-partum-comment-le-surmonter.htm%26size=16k%26name=357x480%2Baspx%26p=POST%2BPARTUM%2BBLUES%26oid=d3e0c25532193d34%26fr2=%26no=12%26tt=158%26sigr=12romgc2v%26sigi=125r4ut9q%26sigb=12mrhp8pi


96/100

96

8. Emotional responses

a. 1st trimester: some degree of rejection,disbelief, even depression because of its

future implication -> give health teachings on

body changes and allow for expression of

feelings

b. 2nd trimester: fetus is perceived as a

separate entity and fantasizes appearance

c. 3rd trimester: best time to talk about layette,and infant feeding method. To allay fear of

death let woman listen to the FHT.

COMMON EMOTIONAL
http://rds.yahoo.com/_ylt=A0S02070fG5KMfYAv4CJzbkF;_ylu=X3oDMTBpc2VvdmQ2BHBvcwM3BHNlYwNzcgR2dGlkAw--/SIG=1ivnlq4f3/EXP=1248841332/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DSAD%252BPREGNANT%252BWOMAN%2526js%253D1%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=228%26h=148%26imgurl=i.dailymail.co.uk%252Fi%252Fpix%252F2006%252F09%252Fpregwomsad_228x148.jpg%26rurl=http%253A%252F%252Fwww.dailymail.co.uk%252Fpages%252Flive%252Ffemail%252Farticle.html%253Fin_article_id%253D406974%26size=10k%26name=pregwomsad%2B228x1...%26p=SAD%2BPREGNANT%2BWOMAN%26oid=4ae9bfe6038847fc%26fr2=%26no=7%26tt=33%26sigr=12etpj7au%26sigi=11mm1mo3l%26sigb=12snbuhqdhttp://rds.yahoo.com/_ylt=A0S020q8fG5KlYAA4FOJzbkF;_ylu=X3oDMTBqdGFzdWxiBHBvcwMxNQRzZWMDc3IEdnRpZAM-/SIG=1j8mqlosf/EXP=1248841276/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DPOSTPARTUM%252BBLUES%2526js%253D1%2526ni%253D21%2526ei%253DUTF-8%2526y%253DSearch%2526fr%253Dyfp-t-152%26w=300%26h=350%26imgurl=media.canadianfamily.ca%252Fimages%252Fcf_postpartum_main_.jpg%26rurl=http%253A%252F%252Fwww.canadianfamily.ca%252Farticles%252Farticle%252Fantepartum-depression-baby-blues%26size=16k%26name=cf%2Bpostpartum%2Bma...%26p=POSTPARTUM%2BBLUES%26oid=b4a581519a35a368%26fr2=%26no=15%26tt=261%26ni=21%26sigr=12epgignj%26sigi=11md0vibt%26sigb=139qj8ee5http://rds.yahoo.com/_ylt=A0S0206SfG5KrPMALH.JzbkF;_ylu=X3oDMTBqamdoM3Q5BHBvcwMxMgRzZWMDc3IEdnRpZAM-/SIG=1ij3h6afe/EXP=1248841234/**http%3A//images.search.yahoo.com/images/view%3Fback=http%253A%252F%252Fimages.search.yahoo.com%252Fsearch%252Fimages%253Fp%253DPOST%252BPARTUM%252BBLUES%2526ei%253Dutf-8%2526fr%253Dyfp-t-152%26w=266%26h=357%26imgurl=www.planet.vertbaudet.com%252Fphotos%252Fbomastersite%252Fimages%252F129%252F357x480.aspx%26rurl=http%253A%252F%252Fwww.planet.vertbaudet.com%252Fbaby-blues-depression-post-partum-comment-le-surmonter.htm%26size=16k%26name=357x480%2Baspx%26p=POST%2BPARTUM%2BBLUES%26oid=d3e0c25532193d34%26fr2=%26no=12%26tt=158%26sigr=12romgc2v%26sigi=125r4ut9q%26sigb=12mrhp8pi


97/100

97

RESPONSES DURING PREGNANCY

Stress decrease in responsibilitytaking is the reaction to the stress of

pregnancy not the pregnancy itself

affects decision making abilities

Couvade syndrome men

experiencing nausea/vomiting,backache due to stress, anxiety and

empathy for partner


98/100

98

Emotional labile moodchanges/swings occur frequently due to

hormonal changes

Change in Sexual Desire may

increase or decrease needs correct

interpretation not as a loss of interestin sexual partner

Appropriate Relief Measures


99/100

99

Appropriate Relief Measures

Urinary frequency Increase fluid intake during day

Decrease fluid intake in the evening

Fatigue: Plan rest periods and ask for helpfrom family or support persons

Breast tenderness: Wear well supporting bra

Common Obstetric Terminology


100/100

gy

(contd)

Nullipara: Woman who has had no births atmore than 20 weeks gestation

Primipara: Woman who has had one birth atmore than 20 weeks gestation

Multipara: Woman who has had two or morebirths at more than 20 weeks gestation

Stillbirth: Infant born dead after 20 weeksgestation

Multigravida: Woman in second or anysubsequent pregnancy

Antepartum Part1

Documents

Transcript of Antepartum Part1