Unit 3: Conception and Pregnancy
Anatomy and physiology of pregnancy
★ Medical: considers birth an illness, the outcome is measured in perinatal and
maternal mortality rates and the mother is a passive patient.
★ Normal: considers birth a normal process, the outcome is measured in holistic terms
and the mother is an active participant.
★ Only 6-8% of all pregnancies are high risk
★ Midwives view pregnancy and birth as normal life events during which the woman
needs special attention, support, guidance, and care to prevent problems (holistic)
**When we treat women like pregnancy is a normal life event, there are better outcomes**
Most Important Nursing Intervention
★ Talk & LISTEN to your patients!!
★ Don’t ignore pt’s feelings/recommendations
★ We are caring for the baby, father, family, etc.
Conception and Fetal Development
★ First trimester – conception to 13 weeks.
○ At the very beginning of pregnancy, the uterus is smaller than the size of an egg
○ At 4-6 weeks, it’s only a little bigger
★ Second trimester – 14- 26 weeks.
○ By 20 weeks, the uterus and baby have grown, so mom can feel the baby move
★ Third trimester – 27-40 weeks.
Stages of Prenatal Development
★ The most critical time for prevention of problems is 3 months prior to fertilization
○ Folic Acid (350 mcg daily!!!!!!) prior to pregnancy can prevent cleft lips/palates
■ Don't start after pregnant, won’t really help b/c everything that causes
the defects has already done it’s thug
○ Control of pre-existing health conditions (Lupus, asthma, DM, HTN)
How do we know someone is pregnant?
★ Presumptive Signs (subjective)
○ Period absent (amenorrhea), really tired (fatigue), enlarged/sore breast,
urination increased, N/V
○ Movement of fetus in uterus…woman perceives fluttering sensation in her lower
abdomen…this is referred to as “quickening”
, ■ Quickening can occur at 16 weeks for 2nd time moms and around 20
weeks for 1st time moms
★ Probable Signs (objective)
○ Positive pregnancy test
○ Ballottement- when you push on baby in mom’s stomach and feel it push against
your hand
○ Outline of fetus can be palpated
○ Braxton Hicks Contractions
○ A softening of the cervix “Goodell’s Sign” (6-8 weeks of gestation)
■ Feels like earlobe during pregnancy, like nose when not pregnant
○ Blush color to the vulva, cervix, and vagina due to increased blood flow (4 weeks
gestation) “Chadwick’s Sign”
○ Lower uterine segment (LUS) becomes soft “Hegar’s Sign” (6-12 week of
gestation)
○ Enlarged uterus
How do we know someone is pregnant?
★ Positive means conclusive, definite, or absolute
★ “FETUS”
○ Fetal movements felt by doctor or nurse
○ Electronic device detects fetal heart sounds (Doppler)
○ The delivery of the baby
○ Ultrasound detects the fetus
○ See visible movement of the baby by the doctor or nurse
Naegele’s Rule for EDD (estimated delivery date)
★ Add seven days to the first day of patient’s LMP
★ Then subtract three months
○ For example, if patient’s LMP was November 1, 2017:
■ Add seven days (November 8, 2017)
■ Subtract three months (August 8, 2018)
GTPAL = a complete OB HX
★ Gravida: number of pregnancies a woman has had
○ A multiple gestation counts as a single pregnancy
★ Term: # pregnancies carried to 37 weeks.
★ Preterm: # pregnancies between 20 weeks to 36 6/7 weeks.
★ Abortion: # pregnancies losses before 20 weeks.
, ○ We do not differentiate between elective and spontaneous abortions
○ We do not use “miscarriage”
★ Living: # living children
Prenatal Visit
★ The following should be checked at each visit: vitals, weight, FHT, uterine size,
domestic violence screen, urine dip for protein & glucose, encourage breastfeeding,
review danger signs, review labs
★ 11 to 14 weeks – screening for aneuploidy (down syndrome, etc.) via blood sample
○ Optional termination if the baby has problems - your patient should never know
your beliefs.
★ 15 to 20 weeks - offer anatomic survey ultrasound (18 – 20 weeks), multiple marker
screening (heart, kidneys, GI)
★ 24 to 28 weeks - glucose Screen, Rhogam if RH Negative (Rhogam lasts 20 weeks, mom
may need another dose after pregnancy)
○ If mom is negative and baby is negative, body goes into panic and tries to fight it
off
○ If mom is positive, baby’s blood type doesn’t matter
★ 32 to 34 weeks - repeat STI Screening
★ 36 weeks- screen for Group B Strep
○ Positive: tx with 2 does of ABX before delivery is possible, if not, baby will get IV
ABX after delivery
Normal Discomforts of Pregnancy (pg 196)
★ 1st trimester
○ Breast pain, tenderness, enlargement
○ Urgency and frequency
○ Fatigue, n/v, excess saliva, mood swings, vaginal d/c
○ Gingivitis, hyperemia, hypertrophy, bleeding, tenderness of the gums.
★ 2nd trimester
○ Boobs get darker, acne, oily skin, spider nevi, pruritis
○ Palpitations, supine hypoT, bradyC, faint, syncope
○ Cravings, GERD, constipation, gas, bloating
○ Varicose veins, h/a, periodic numbness, round ligament pain, back pain, pelvic
pressure
★ 3rd trimester
○ SOB, dyspnea, insomnia
○ Mood swings, anxiety
Anatomy and physiology of pregnancy
★ Medical: considers birth an illness, the outcome is measured in perinatal and
maternal mortality rates and the mother is a passive patient.
★ Normal: considers birth a normal process, the outcome is measured in holistic terms
and the mother is an active participant.
★ Only 6-8% of all pregnancies are high risk
★ Midwives view pregnancy and birth as normal life events during which the woman
needs special attention, support, guidance, and care to prevent problems (holistic)
**When we treat women like pregnancy is a normal life event, there are better outcomes**
Most Important Nursing Intervention
★ Talk & LISTEN to your patients!!
★ Don’t ignore pt’s feelings/recommendations
★ We are caring for the baby, father, family, etc.
Conception and Fetal Development
★ First trimester – conception to 13 weeks.
○ At the very beginning of pregnancy, the uterus is smaller than the size of an egg
○ At 4-6 weeks, it’s only a little bigger
★ Second trimester – 14- 26 weeks.
○ By 20 weeks, the uterus and baby have grown, so mom can feel the baby move
★ Third trimester – 27-40 weeks.
Stages of Prenatal Development
★ The most critical time for prevention of problems is 3 months prior to fertilization
○ Folic Acid (350 mcg daily!!!!!!) prior to pregnancy can prevent cleft lips/palates
■ Don't start after pregnant, won’t really help b/c everything that causes
the defects has already done it’s thug
○ Control of pre-existing health conditions (Lupus, asthma, DM, HTN)
How do we know someone is pregnant?
★ Presumptive Signs (subjective)
○ Period absent (amenorrhea), really tired (fatigue), enlarged/sore breast,
urination increased, N/V
○ Movement of fetus in uterus…woman perceives fluttering sensation in her lower
abdomen…this is referred to as “quickening”
, ■ Quickening can occur at 16 weeks for 2nd time moms and around 20
weeks for 1st time moms
★ Probable Signs (objective)
○ Positive pregnancy test
○ Ballottement- when you push on baby in mom’s stomach and feel it push against
your hand
○ Outline of fetus can be palpated
○ Braxton Hicks Contractions
○ A softening of the cervix “Goodell’s Sign” (6-8 weeks of gestation)
■ Feels like earlobe during pregnancy, like nose when not pregnant
○ Blush color to the vulva, cervix, and vagina due to increased blood flow (4 weeks
gestation) “Chadwick’s Sign”
○ Lower uterine segment (LUS) becomes soft “Hegar’s Sign” (6-12 week of
gestation)
○ Enlarged uterus
How do we know someone is pregnant?
★ Positive means conclusive, definite, or absolute
★ “FETUS”
○ Fetal movements felt by doctor or nurse
○ Electronic device detects fetal heart sounds (Doppler)
○ The delivery of the baby
○ Ultrasound detects the fetus
○ See visible movement of the baby by the doctor or nurse
Naegele’s Rule for EDD (estimated delivery date)
★ Add seven days to the first day of patient’s LMP
★ Then subtract three months
○ For example, if patient’s LMP was November 1, 2017:
■ Add seven days (November 8, 2017)
■ Subtract three months (August 8, 2018)
GTPAL = a complete OB HX
★ Gravida: number of pregnancies a woman has had
○ A multiple gestation counts as a single pregnancy
★ Term: # pregnancies carried to 37 weeks.
★ Preterm: # pregnancies between 20 weeks to 36 6/7 weeks.
★ Abortion: # pregnancies losses before 20 weeks.
, ○ We do not differentiate between elective and spontaneous abortions
○ We do not use “miscarriage”
★ Living: # living children
Prenatal Visit
★ The following should be checked at each visit: vitals, weight, FHT, uterine size,
domestic violence screen, urine dip for protein & glucose, encourage breastfeeding,
review danger signs, review labs
★ 11 to 14 weeks – screening for aneuploidy (down syndrome, etc.) via blood sample
○ Optional termination if the baby has problems - your patient should never know
your beliefs.
★ 15 to 20 weeks - offer anatomic survey ultrasound (18 – 20 weeks), multiple marker
screening (heart, kidneys, GI)
★ 24 to 28 weeks - glucose Screen, Rhogam if RH Negative (Rhogam lasts 20 weeks, mom
may need another dose after pregnancy)
○ If mom is negative and baby is negative, body goes into panic and tries to fight it
off
○ If mom is positive, baby’s blood type doesn’t matter
★ 32 to 34 weeks - repeat STI Screening
★ 36 weeks- screen for Group B Strep
○ Positive: tx with 2 does of ABX before delivery is possible, if not, baby will get IV
ABX after delivery
Normal Discomforts of Pregnancy (pg 196)
★ 1st trimester
○ Breast pain, tenderness, enlargement
○ Urgency and frequency
○ Fatigue, n/v, excess saliva, mood swings, vaginal d/c
○ Gingivitis, hyperemia, hypertrophy, bleeding, tenderness of the gums.
★ 2nd trimester
○ Boobs get darker, acne, oily skin, spider nevi, pruritis
○ Palpitations, supine hypoT, bradyC, faint, syncope
○ Cravings, GERD, constipation, gas, bloating
○ Varicose veins, h/a, periodic numbness, round ligament pain, back pain, pelvic
pressure
★ 3rd trimester
○ SOB, dyspnea, insomnia
○ Mood swings, anxiety
