Ni Ketut Alit A Nursing Faculty Airlangga University Surabaya East Java

1. Ni Ketut Alit A Nursing Faculty Airlangga University Surabaya East Java Nursing Management During Pregnancy

2. REFERENCES • Bobak LM & Jensen MD (1993) Maternity & Gynecologyc Care, The Nurse and The Family 5thed , St Luis : CV Mosby Company. • Bobak LM , Lowdwrmilk D.L, Jensen. M.D, Perry J.E, (1993) Maternity Nursing, St Luis : CV Mosby Company. • Mattson Susan & Smith Judi E (2000). Core Curriculum for Maternal – Newborn Nursing. 2nd ed. Philadelphia. W.B. Saunders Company. • Wiknyosastro,H. Saifudin, A.B, Reachimhadhi, T.Eds ( 1997 ) IlmuKebidanan , Jakarta YayasanBinaPustakaSarwonoPrawiroharjo. • Journals and article related to..

3. Conception, Fetal Development, Gestational Risk and Fetal Well-being Factors affecting fetal well-being: • Quality of sperm or ovum • Intrauterine environment • First trimester exposure to hazardous agents • Maternal nutrition, hyperthermia, chronic diseases including diabetes, thyroid, cardiac, and circulatory • Substance abuse • Known or unknown infections

4. Barriers to Prenatal Care • Sociodemographics • Insurance/finances • Inadequate care providers for low income • Delay in onset of prenatal care • Cultural factors • Transportation • Attitudes

5. Preconception Care • Immunization status • Underlying medical conditions • Reproductive health care practices • Sexuality and sexual practices • Nutrition • Lifestyle practices • Psychosocial issues • Medication and drug use • Support system

6. KSPR (Kartu Score PudjiRohjati)Card for risk detection of Pregnacy

8. 1st Prenatal Visit • Establishment of trusting relationship • Focus on education for overall wellness • Detection and prevention of potential problems • Comprehensive health history, physical examination, and laboratory tests

9. Comprehensive Health History • Reason for seeking care • Suspicion of pregnancy • Date of last menstrual period • Signs and symptoms of pregnancy • Urine or blood test for hCG • Past medical, surgical, and personal history • Woman’s reproductive history: menstrual, obstetric, and gynecologic history

10. Menstrual History • Menstrual cycle • Age at menarche • Days in cycle • Flow characteristics • Discomforts • Use of contraception

11. Menstrual History • Date of last menstrual period (LMP) • Calculation of estimated or expected date of birth (EDB) or delivery (EDD) • Nagele’s rule • Use first day of LNMP 11/21/11 • Subtract 3 months 8/21/11 • Add 7 days 8/28/11 • Add 1 year 8/28/12 = EDB • Gestational or birth calculator.

12. Obstetric History • Gravida: a pregnant woman • Gravida I (primigravida): first pregnancy • Gravida II (secundigravida): second pregnancy, etc. • Para: a woman who has produced one or more viable offspring carrying a pregnancy 20 weeks or more • Primapara: one birth after a pregnancy of at least 20 weeks (“primip”) • Multipara: two or more pregnancies resulting in viable offspring (“multip”) • Nullipara: no viable offspring; para 0

13. Obstetric History • Terminology • G (gravida): the current pregnancy • T (term births): the number of pregnancies ending >37 weeks’ gestation, at term • P (preterm births): the number of preterm pregnancies ending >20 weeks or viability but before completion of 37 weeks • A (abortions): the number of pregnancies ending before 20 weeks or viability • L (living children): number of children currently living

14. Physical Examination • Vital signs • Head-to-toe assessment • Head and neck • Chest • Abdomen, including fundal height if appropriate • Extremities • Pelvic examination • Examination of external and internal genitalia • Bimanual examination • Pelvic shape: gynecoid, android, anthropoid, platypelloid • Pelvic measurements

15. Laboratory Tests • Urinalysis • Complete blood count • Rhfactor • TORCH test • Hepatitis B surface antigen • HIV test • Ultrasound

16. Follow-up Visits • Visit schedule: • Every 4 weeks up to 28 weeks • Every 2 weeks from 29 to 36 weeks • Every week from 37 weeks to birth

17. Follow-up Visits • Assessments • Weight & BP compared to baseline values • Urine testing for protein, glucose, ketones, and nitrites • Fundal height • Quickening/fetal movement • Fetal heart rate • Teaching: danger signs

18. 1st Trimester Discomforts • Urinary frequency or incontinence • Fatigue • Nausea and vomiting • Breast tenderness • Constipation • Nasal stuffiness, bleeding gums, epistaxis • Cravings • Leukorrhea

19. 2nd Trimester Discomforts • Backache • Varicosities of the vulva and legs • Hemorrhoids • Flatulence with bloating

20. 3rd Trimester Discomforts • Return of 1st trimester discomforts • Shortness of breath and dyspnea • Heartburn and indigestion • Dependent edema • Braxton Hicks contractions

21. Nursing Management To Promote Self-Care • Personal hygiene • Avoidance of saunas and hot tubs • Perineal care • Dental care • Breast care • Clothing • Exercise

22. Nursing Management To Promote Self-Care • Sleep and rest • Sexual activity and sexuality • Employment • Travel • Immunizations and medications

23. Danger Signs Of Pregnancy !!! Assess and report immediately: • Vaginal bleeding in any amount - May indicate placenta previa • Premature rupture of membranes - Predisposes mom and baby to infection • Edema of face or hands, abdominal pain, epigastric pain - Consider preeclampsia • Severe, persistent headaches and visual disturbances - Consider preeclampsia

24. Danger Signs in Pregnancy Report any of the following immediately: • Fever and/or chills • Painful urination • Persistent nausea & vomiting • Change in, or absence of fetal movement for 6-8 hrs.

25. Preparation for Labor, Birth, and Parenthood • Perinatal education • Childbirth education • Lamaze (psychoprophylactic) method: focus on breathing and relaxation techniques • Bradley (partner-coached childbirth) method: focus on exercises and slow, controlled abdominal breathing • Dick-Read (natural childbirth) method: focus on fear reduction via knowledge and abdominal breathing techniques

26. Preparation for Labor, Birth, and Parenthood • Options for birth setting • Hospitals: delivery room, birthing suite • Birth centers • Home birth • Options for care providers • Obstetrician • Midwife • Health provider

27. Preparation for Labor, Birth, and Parenthood • Feeding choices • Breastfeeding: advantages and disadvantages • Bottle feeding: advantages and disadvantages • Teaching • Final preparation for labor and birth

28. Care For Better Health