NSE 13A/B Chapter 30: NSE 13 Week 11&12 PREGNANCY AND NEONATE JARVIS NOTES

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NSE 13 Week 11/12
Pregnancy and the Newborn
Readings: Jarvis Ch. 30, PDF on D2L
Weekly Objectives:
1. Self-review anatomy and physiology
Pregnancy and the endocrine placenta
o First day of period is day 1
o First 14 days of cycle follicle(s) develop and mature
o Dominant follicle grows fast and rupture on day 14 beginning of ovulation
o Fertilization happens in fallopian tube if ovum meets viable sperm
o Cells of follicle make up the corpus luteum “yellow body” makes hormones
o Progesterone hormone prevents uterine lining from degrading keeps rich vascular
supply for ovum implantation
o Fertilized ovum known as blastocyst special cells (chorion) produce human chorionic
gonadotropin (hCG) to keep progesterone production, viable corpus luteum
Corpus luteum will continue to make estrogen and progesterone until placenta
takes over at about 3 months’ gestation
o Day 20-24 is implantation, vaginal bleeding may occur
o Layer of blastocyst cells become placenta
Works like an endocrine organ and makes hormones
Help fetus grow/develop and prepares body for birth and breastfeeding
Progesterone: keep endometrial lining, increase alveoli of breast, keeps uterus
inactive
Estrogen: duct formation of breasts, increase uterus weight, increase oxytocin
receptors on uterus in preparation for birth
o Pregnancy is about 280 days from first day of last period 40 weeks/9 months
First trimester: first 12 weeks
Second trimester: 13-27 weeks
Third trimester: 28 weeks to birth
o Term gravida (G) describes someone who has been pregnant
1st pregnancy: primigravidia
Not 1st: multigravida
Parity pregnancy with birth past 20 weeks’ gestation “age of viability”
Nulliparous woman is pregnant for the first time (G1 P0) primipara after
given birth once after 20 weeks’ gestation (G1 P1) and multipara after more
than 1 birth (i.e. G2 P2)
o Preterm labor/birth between 20 and 37 weeks’ gestation
o Loss before 20 weeks is an abortion spontaneous or induced
G(gravida), T(term), P(preterm), A(abortion) and L(living) i.e. G6T3P0A2L3
sixth pregnancy, 2 before 37 weeks or later and 2 miscarriages
Changes during normal pregnancy
- 3 types of signs/symptoms:
1) Presumptive experienced signs i.e. nausea, fatigue, tender breasts
2) Probable discovered by examiner i.e. enlarged uterus
3) Positive direct effect of fetus i.e. fetal heart tones, cardiac activity
o 1st semester changes
Small amt of bleeding when ovum implants can be mistaken for period
hCG test is positive after implantation around first missed period
tingling/tenderness of breast rising estrogen cause mammary growth and
progesterone causes alveoli
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chorionic somatomammotropin aka hPL made by placent, syimulate growth of
breasts and lactation and glucose-sparing effect to save for baby (may lead to
gestational diabetes)
nausea and fatigue common during this stage
hypertrophy of uterine muscles and enlargement of uterus blood and lymph
vessels estrogen and progesterone affect
Hegar’s Sign uterus gets globular, soft and flexes over cervix
Goodell’s Sign increase vascularity, congestion and edema lead to soft cervix
Chadwick’s Sign – cervix may become bluish purple during 1st pregnancy
BP rises in early pregnancy and drops again at 7 weeks’ gestation
Fetal period begins at week 9 (embryonic period ends) FHTs can be
heard at this point using Doppler
5 weeks gestational sac visible through ultrasound
Blighted ovum fertilized egg gets placenta but no embryo (hCG
level rises then drops)
o 2nd trimester changes
12-16 weeks nausea, vomiting, fatigue, urinary frequency decrease
18-20 weeks fetal movement begins
Breast enlarge and veins visible
Colostrum ‘first milk’ yellow in color, has proteins and minerals
but les carbs fat than regular milk (laxative effect on newborn) rich in
antibodies; may leak during pregnancy
Melanocyte stimulated by hormone and areolae/nipples darken (from 2nd month)
also causes darkening of midline of abdomen aka linea nigra
Stretch marks may be on breasts, abdomen aka striae gravidarum
BP levels drop slightly may cause dizziness, fainting
Enlarge uterus displaces stomach and progesterone causes esophageal sphincter
to change both lead to heartburn
Gallstones may form as gallbladder empties slowly and increased cholesterol
levels
Progesterone increases respiration efforts O2 carrying capacity increases
Shortness of breath may occur as CO2 partial pressure drops
Estrogen rise in thyroxine transport, enlarge thyroid due to vascularity
Hyperthyroidism increases risk of miscarriage, pre-eclampsia, LBL, preterm
baby, and abruption of placenta
Decreased vascular resistance increase nose bleeds, gums hypertrophy and
bleeding aka ‘gingivitis of pregnancy’
o 3rd trimester changes
Blood volume increases significantly (30-45% higher than prepregnancy)
Increased erythrocyte mass and erythropoiesis increase in plasma volume
causes drop of hematocrit
Uterus enlarges, diaphragm rises, ribs widen at base increase in SOB
Heart displaces increase in CO, stroke volume and force of contraction, pulse
increase by 15-20 bpm, systolic murmur may be heard in over 95% of women
Edema in legs enlarge uterus disrupt venous return and low colloid osmotic
pressure (worse with prolonged standing)
Varicosities may form or worsen (runs in families) due to progesterone which
relaxes vessels, uterus also compresses IVC and pelvic vessels veins clog in
legs, vulva and rectum (aka hemorrhoids, worse w constipation progesterone
relaxes bowels)
Lordosis lumbar spine curve inwards, shift of center of balance (increases
backaches)
Slumped shoulders, and flexion of neck forward due to heavier breasts (this
compresses median and ulnar nerves leading to ache/numb hands and arms) aka
carpal tunnel syndrome
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“lightening” or “dropping” – 2 weeks before labor,
engagement in 1st time pregnancies presenting part moves
down into pelvis
- Leads to lower fundus, frequent urination, more
vaginal secretions, more lung capacity
- Multigravida fetus can move down at any time,
or not until labor
- To prepare for labor uterus thins and opens
(dilate)
Mucus plug thick, in cervix, barrier during pregnancy,
expelled throughout time before and during labor
After 42 weeks post-term
o Determining gestational age
EDB is about 266-280 post conception or 40 weeks after first day of last period
Must know LMP to figure out EDB
Can be determined using: Nagele’s Rule
- Add 7 days to LMP and take away 3 months
o Weight gain during pregnancy
Weight fetal height, amniotic fluid, placenta,
increased size of uterus, increased BV, increased
extravascular fluid, maternal fat stores and increase
breast size 62% water, 30% fat and 8% protein (25%
is fetus, 11% placenta/amniotic fluid and rest is
mother)
2. Outline the developmental changes, cultural considerations and health promotion strategies
Developmental considerations
o Teen pregnancy increase risk of psychological and medical complications
o May also have little support, limited access to prenatal care, low SES or rural Aboriginal
community
o May not have complete education less change of getting job/gaining independence
o Medical risks poverty, low nutrition, substance use, increased risk of STIs, poor health
prior, emotional/physical partner abuse
o Increased risk for pre-eclampsia and LBW
o Often seek medical care later in pregnancy
o Age of first pregnancy rising in Canada lower fertility rate (less viable eggs) increases in
Down syndrome and multiple pregnancies
o Older women may already have existing conditions (i.e. high BP, diabetes, obesity)
increases risk of intrauterine growth restriction (IUGR) and pre-eclampsia
Cultural and Social considerations
o Genetic disorders predisposed to certain populations:
Mutations of hemaglobinopathies (i.e. sickle cell anemia, alpha + beta thalassemia)
People living in malaria-prone areas Africa, Mediterranean, middle east, india,
Southeast Asia and southern China
o Tay-Sachs disease
Safe motherhood: Global pregnancy outcomes
3. Outline and practice subjective questions. Identify critical findings
Subjective Data
1. Menstrual History
a. First day of most recent ‘normal’ menstrual cycle
b. PMS, length of period, flow, cramping, age of menarche
2. Gynecological history
a. Cervix or uterus surgery
i. Cervical surgery can affect integrity and dilation during labor
ii. Uterine surgery increase risk of abnormal placenta implantation
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Document Summary

5 weeks gestational sac visible through ultrasound: blighted ovum fertilized egg gets placenta but no embryo (hcg level rises then drops, 2nd trimester changes. 12-16 weeks nausea, vomiting, fatigue, urinary frequency decrease. Lightening or dropping 2 weeks before labor, engagement in 1st time pregnancies presenting part moves down into pelvis. Leads to lower fundus, frequent urination, more vaginal secretions, more lung capacity. Multigravida fetus can move down at any time, or not until labor. Increased risk for pre-eclampsia and lbw: often seek medical care later in pregnancy, age of first pregnancy rising in canada lower fertility rate (less viable eggs) increases in. Southeast asia and southern china: tay-sachs disease, safe motherhood: global pregnancy outcomes, outline and practice subjective questions. End by asking if she has any other questions/concerns: critical findings. 27: verbally report and document subjective and objective data. Pregnancy: describe normal changes and distinguish possible abnormal findings in the pregnant woman.

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