ANTENATAL CARE

Presumptive Signs

• Amenorrhea – for 3 consecutive mos.
• Breast Changes – nipples larger and more pigmented; breast may be enlarged w/ more prominent veins; small elevations on the areola may appear (Montgomery’s Tubercles)
• Skin Pigmentation
• Melasma/Chloasma – brownish facial pigmentation
• Linea Nigra – dark vertical line on the abdomen below xiphoid process
• Striae Gravidarum – stretch marks that appear on abdomen, buttocks, thighs
• Nausea and Vomiting – “morning sickness”, 2-6 weeks after conception and may disappear at the end of the 1st trimester, caused by rising levels of hCG
• Fatigue
• Frequency of Urination – caused by pressure of the expanding uterus on the urinary bladder
• Enlargement of Abdomen – noticed around 12 weeks due to expanding uterus
• Quickening – sensations of fetal movement

 Probable Signs

• Hegar’s Sign – softening of lower uterine segment
• Chadwick’s Sign – bluish/purplish discoloration of the vagina
• Goodell’s Sign – softening of the cervix
• Braxton-Hicks Contractions – “false labor”, periodic uterine tightening
• Ballottement – sinking and rebounding of fetus in surrounding amniotic fluid in response to palpation
• Positive for hCG – during urine or blood test
• Sonographic Evidence of Gestational Sac - not totally positive; may be indicative of hydatidiform mole
• Fetal Outline Felt by Examiner

Positive Signs

• Fetal Heart Tones
• 18-20 weeks by fetoscope
• 10-12 weeks by Doppler stethoscope
• Fetal Movement Felt by Examiner
• Sonographic Evidence

 Psychologic Maternal Changes

• Ambivalence – mixed emotions, fear and excitement
• Emotional Liability – frequency of changes in emotional state, mood swings
• Body Image Changes – changes in woman’s perception of her body image, may be positive or negative
• Introversion and Passivity – needs to rest and do quiet things
• Primary Narcissism – causes woman to consider her own needs

Physiologic Maternal Changes

• Other than the presumptive, probable and positive signs, other changes include:
• Formation of OPERCULUM (vaginal plug near the cervix)
• Cessation of oogenesis
• Change in center of gravity
• Decreased bladder capacity and tone
• Hemorrhoids
• Ptyalism (excessive salivation)
• Gum tissue may swell and easily bleed
• Increased O2 requirements
• Supine Hypotension Syndrome
• Increased circulation

 Discomforts

• First Trimester
• N/V – dry crackers, avoid empty or full stomach, increase protein intake
• Frequent Urination – Kegel’s exercises
• Second Trimester
• Spider Nevi – avoid prolonged standing
• Leukorrhea – use sanitary pads
• Third Trimester
• Shortness of Breath – good posture and rest
• Braxton-Hicks Contractions – rest, breathing, ambulate
• Leg Cramps – ambulate
• Ankle Edema – elevate hips and legs
• Supine Hypotension Syndrome – side lying position during sleep

Care for a Pregnant Mother

• Increase Fe, Ca, Folic Acid intake
• Iron - increased O2 requirement and blood levels due to growing fetus
• Calcium - to avoid growing fetus from drawing calcium from mother's bones
• Folic Acid (Vit B9) - prevents neural tube defects
• Wear a support bra
• Nap/rest every AM/PM
• Medium to low heel shoes
• Avoid prolonged standing
• No constrictive clothing
• Wear cotton underwear
• Regular breast care
• Left side-lying position when lying down
• Regular exercise
• Dry crackers for N/V

Prenatal Check-Up Schedule

• Every 4 weeks for the 1^st-32^nd week
• Every 2 weeks for the 32^nd-36^th week
• Every week for the 36^th week up to delivery

Psychological Tasks of the Mother

• 1^st Trimester – accepting the pregnancy
• 2^nd Trimester – accepting the baby
• 3^rd Trimester – preparing for parenthood

Cervical Consistency

• Not pregnant – feels like the tip of nose
• Pregnant – feels like earlobes
• About to give birth – feels like butter