THE PREGNANCY EXPERIENCE

Fall 2010Debbie Perez, RN, CNS, MSN

Tiny FeetTiny Feet

SituationSituation

Mr. and Mrs. Andrews visit the Mr. and Mrs. Andrews visit the clinic and tell the nurse that clinic and tell the nurse that

Mrs. A has “missed two Mrs. A has “missed two menstrual periods, has urinary menstrual periods, has urinary frequency, and is tired all of the frequency, and is tired all of the

time”. time”.

First Prenatal VisitFirst Prenatal Visit

What is the most important What is the most important thing that the nurse can do at thing that the nurse can do at this first prenatal visit?this first prenatal visit?

Most important intervention for the nurse is to:

MAKE THE PATIENT WELCOME !MAKE THE PATIENT WELCOME !

Why?Why?

FIRST PRENATAL VISIT

Now that the couple has Now that the couple has been welcomed to the been welcomed to the clinic, one of the first clinic, one of the first things that must be done is things that must be done is to confirm that Mrs. A is to confirm that Mrs. A is pregnant.pregnant.

Mrs. A says that she used a Mrs. A says that she used a home pregnancy test and the home pregnancy test and the results were positive.results were positive.

What are some of the What are some of the advantages and advantages and disadvantages of using home disadvantages of using home pregnancy testing? pregnancy testing?

Home Pregnancy TestingHome Pregnancy Testing

AdvantagesAdvantages• Easily available

• Uncomplicated

• Convenient

• Have a greater than 97% accuracy

• Minimal time

DisadvantagesDisadvantages• Must be able to follow the

directions as described or can lead to improper collection and errors in performing or reading the test

• False positive results – anticonvulsants, aspirin,

tranquilizers, marijuana• False negative results –

diuretics, promethazine• Expensive

What other types of pregnancy What other types of pregnancy tests might be utilized to confirm tests might be utilized to confirm the pregnancy? the pregnancy?

Confirm the PregnancyConfirm the Pregnancy

Pregnancy Tests

All tests rely on detection of HCG

Urine Hema-agglutination Inhibition Tests

Radioimmune assay Tests

EnzymeImmunoassay Tests

It is confirmed that Mrs. Andrews is pregnant.

The nurse will continue with the assessment of physiological

and psychological needs of the family.

Assessment begins at the initial visit and continues throughout

pregnancy.

Legal ImplicationLegal Implication

Nurses must exercise caution when discussing obstetric history with the expectant mother in the presence of her family or significant other.

The confidentiality of the pregnant woman must always be protected.

Why?

Health History Assessment

Collect information about:• Obstetric History -- Current and past pregnancies

• Menstrual History – Is there regularity?

• Family history--genetic and environmental factors that affect health

• Medical history-- diabetes, heart

Perform Physical Examination including a Pelvic Examination (Pap test, measurements, cervical culture)

Perform Laboratory Studies• Hgb., Hct, Type, Rh, CBC, Rubella, Hepatitis, HIV

Pelvic MeasurementPelvic Measurement

Calculation of Gravida and ParityCalculation of Gravida and Parity

Obstetrical Status• Gravida = number of times

pregnant regardless of duration or outcome

• Parity = number of deliveries after the age of viability (20 weeks).

** It is not the number of babies delivered, but the number of deliveries

Calculation of ParityCalculation of Parity

Further Breakdown into TPALFurther Breakdown into TPAL

• T = TermT = Term

• P = PretermP = Preterm

• A = AbortionsA = Abortions

• L = Living childrenL = Living children

Check Yourself !Check Yourself !

The nurse obtained the following data from Mrs. Andrews. She has five year old twins that delivered at 35 weeks, a three year old son that delivered at 39 weeks, and a miscarriage last year at 12 weeks gestation.

What is her gravida and parity?What is her gravida and parity using the TPAL

system?

Mr. and Mrs. Andrews are both excited about Mr. and Mrs. Andrews are both excited about the pregnancy. It is her fourth so she is the pregnancy. It is her fourth so she is considered a Gravida 4, Para 2 accoding to considered a Gravida 4, Para 2 accoding to the prior scenario.the prior scenario.

They ask the nurse “When is the baby due”?They ask the nurse “When is the baby due”?

How will you calculate this? How will you calculate this?

Calculation of E. D. C. Calculation of E. D. C.

Nagele’s Rule First day of last Menstrual Go back 3 months Add 7 days

Mrs. Andrews tells you her last menstrual period began on July 18.

Her baby is due on ____________.

TEST YOURSELFTEST YOURSELF

Mrs. B. began her menses onJanuary 21. What is her E.D.C.using Nagele’s Rule?

Mrs. C. started her menses onJune 27. What is her E.D.C. using Nagele’s Rule?

Problem SolvingProblem Solving

If Mrs. Andrews did not know If Mrs. Andrews did not know the first day of her last the first day of her last menstrual period, what menstrual period, what method of calculation would method of calculation would you use? you use?

McDonald’s Rule Use Fundal height measurement,

measure from the symphysis to the top of the fundus.

Months = measure cm. X 2/7 Weeks = measure cm. X 8/7

Mrs. Andrew’s fundal height is 7 cm. How far along is she?

AssessmentAssessment

The nurse continues with The nurse continues with assessment of Mrs. Andrews assessment of Mrs. Andrews and gathers data regarding and gathers data regarding presumptive, probable, and presumptive, probable, and positive signs of pregnancy.positive signs of pregnancy.

Presumptive Signs of PregnancyPresumptive Signs of Pregnancy

Cessation of Menstruation Breast changes -- tenderness Nausea and Vomiting Frequent Urination Quickening Fatigue

Probable Signs of PregnancyProbable Signs of Pregnancy

Enlargement of the Abdomen Hegar’s Sign Goodell’s Sign Braxton-Hicks contractions Ballottment Outline of the fetus by abdominal palpation Positive Pregnancy Test Chadwick’s Sign Increases Pigmentation Ausculation of Uterine and Fetal Souffle

Positive Signs of PregnancyPositive Signs of Pregnancy

Ausculation of fetal heart tones

Active fetal movement felt by trained Practitioner

Ultrasound showing fetal outline and fetal heart beat

Conclusion of VisitConclusion of Visit

You have completed Mr. and Mrs. Andrew’s You have completed Mr. and Mrs. Andrew’s first prenatal visit. first prenatal visit.

it is important to discuss information that will it is important to discuss information that will help ensure a good outcomehelp ensure a good outcome

Conclusion of VisitConclusion of Visit

Patient Teaching

Diet Counseling

Referrals

Danger Signals

Date of next visit

Danger SignalsDanger Signals

Vaginal Bleeding Fluid from the Vagina Abdominal Pain Increased Temperature Dizziness, Blurred vision or Double Vision Persistent Vomiting Edema Headache Dysuria Absence of Movement of the Baby

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The EndThe End

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