Pregnancy

Early signs

These signs typically appear, if at all, within the first few weeks after conception.
Although not all of these signs are universally present, nor are all of them diagnostic by
themselves, taken together they may be useful to make a presumptive diagnosis of
pregnancy.

• Presence of human chorionic gonadotropin (hCG) in the blood and urine,

detectable by laboratory or home testing; this is the most reliable early sign of
pregnancy
• Missed menstrual period
• Implantation bleeding, light spotting that occurs at implantation of the embryo in
the uterus, in the third or fourth week after LMP
• Increased basal body temperature sustained for over two weeks after ovulation
• Chadwick's sign, a darkening of the cervix, vagina, and vulva
• Goodell's sign, a softening of the vaginal portion of the cervix
• Hegar's sign, a softening of the cervical isthmus

Later signs

• Linea nigra, a darkening of the skin in a vertical line on the abdomen, caused by
hyperpigmentation resulting from hormonal changes; it usually appears around
the middle of pregnancy
• Steadily increasing abdominal swelling, the most visible sign of pregnancy

Symptoms
Physical symptoms of pregnancy vary. Of the symptoms listed, not all will occur for
every woman, and individuals may well experience different symptoms during different
pregnancies. The following is a list of the most common symptoms.[4]

First trimester

• Breasts may feel swollen, sore, or tender.

• Pregnancy sickness may cause nausea and vomiting. It is also known as morning
sickness, although it may occur at any time of the day or night.
• The sense of smell may be heightened.
• Cravings for and aversions to certain foods may be experienced. Food aversions
may exacerbate pregnancy symptoms.
• Fatigue is a common symptom in early pregnancy. It results from increased
progesterone and may be compounded by increased blood volume, which can
result in lower blood pressure and lower blood sugar.
 • Dizziness and fainting may be experienced, particularly after standing up quickly.
These symptoms are caused by lower blood pressure and lower blood sugar.
• Frequent mild headaches may occur, caused by increased blood circulation
• Constipation is a common symptom caused by increased progesterone, which
slows the activity of the large intestine.
• Increased urination is caused by pressure of the growing uterus against the urinary
bladder.
• Emotional lability, including dysphoria, crying spells, and mood swings. These
mood changes are triggered by the effect of pregnancy hormones on mood
regulation in the brain.

Other symptoms may be experienced specifically during the later stages, such as:

• Lower backache. Balance and ease of walking may be affected.

• Many women will get flatulent and gassy.
• Some may have difficulty in walking and balance.
• Some women may experience haemorrhoids and rectal irritation.
• Some women report hair loss, others have more body or "facial" hair.
• Sensitivity in teeth, higher risk for gum disease.

Contact lens/spectacle prescriptions may be affected.

Some women during pregnancy experience mental disturbances more severe than typical
mood swings. Psychological stress during pregnancy is associated with an increase in
other pregnancy symptoms.

Women who are considering becoming pregnant, or who are pregnant, should eat a
balanced diet and take a vitamin and mineral supplement that includes at least 0.4
milligrams (400 micrograms) of folic acid. Folic acid is needed to decrease the risk of
certain birth defects (such as spina bifida).

Pregnant women are advised to avoid all medications, unless the medications are
necessary and recommended by a prenatal health care provider. Women should discuss all
medication use with their providers.

Pregnant women should avoid all alcohol and drug use. They should not smoke. They
should avoid herbal preparations and common over-the-counter medications that may
interfere with normal development of the fetus.

Prenatal visits are typically scheduled:

• Every 4 weeks during the first 32 weeks of gestation

• Every 2 weeks from 32 to 36 weeks gestation
• Weekly from 36 weeks to delivery
Weight gain, blood pressure, fundal height, and fetal heart beats (as appropriate) are
usually measured and recorded at each visit, and routine urine screening tests are
performed.

Common or expected health problems of pregnant women

Nausea and Vomiting
One of the first discomforts experienced in pregnancy, which generally occurs in the
morning is nausea and vomiting. It is attributed to the great hormonal changes during the early
stages of pregnancy.
Nursing interventions consist of advising the patient:
(1) To eat small, frequent meals instead of three large meals.
(2) To drink liquids (such as 7-Up™ or ginger ale) between meals instead of with
meals.
(3) To eat a few crackers or toast before getting out of bed in the morning.
(4) That the nausea and vomiting should subside in the second trimester of
pregnancy, but if not, she MUST report this condition to her health care provider.

Hyperemesis Gravidarum and Heartburn

Hyperemesis gravidarum refers to persistent severe nausea and vomiting which results in
dehydration, ketouria, and possible weight loss.

Heartburn occurs more frequently as pregnancy advances as a result of decreased

peristalsis and pressure of the growing fetus on the stomach.
Nursing interventions consist of advising the patient to:
(1) Not to lie flat after eating. Sitting or walking helps gravity move the food
through the gastrointestinal tract.
(2) Drink a glass of milk about 1/2 hour before eating. This will inhibit the
secretion of stomach acid.
(3) Avoid eating or drinking gas-forming foods or fluids (cabbage, beans, cokes,
etc.).
(4) Not take any antacid unless ordered by her obstetric (OB) practitioner or
physician. Sodium bicarbonate and Alka-Seltzer™ contain high amounts of
sodium.
(5) Eat small, frequent, non-spicy, non-fried meals and drink adequate fluids.

Infections
There are many types of infection which the patient can contact during pregnancy.
However, the most prevalent infections are urinary track infections, venereal diseases, and
human immunodeficiency virus (HIV).
(1) Urinary track infections. Infections of the urinary track are common during
pregnancy. The infections are caused by the narrowing of the lower urethra and
dilation of the upper urethra. This action results in a slowing of urination, which
increases the risk of infection.
(2) Venereal diseases. Venereal disease (VD) or sexually-transmitted disease
(STD) refers to one of a number of infectious diseases that are transmitted
through sexual contact and may be localized or systemic. Common types of VD
are gonorrhea, syphilis, venereal warts, and herpes simplex type II.
Microorganisms from these diseases can cross the placenta barrier, placing the
fetus at risk.
 (3) Human immunodeficiency virus. The transmission of human
immunodeficiency virus occurs primarily through the exchange of body fluids
(blood, semen, and perinatal events). Severe depression of the cellular immune
system characterizes acquired immune deficiency syndrome (AIDS). Exposure to
the virus has a significant impact on the woman's pregnancy, the newborn's
feeding method, and the newborn's health status.
Nursing implications include the following:
(1) Teach the patient to attend scheduled prenatal appointments.
(2) Inform the patient of specific lab tests that will be obtained for early detection
of diseases (VDRL, gonorrheal culture, and HIV blood tests).
Varicosities (Varicose Veins)
Varicosities refer to dilated, tortuous veins that result from incompetent values within
those veins. The valves close incompetently or not at all. Blood is thus permitted to seep
backward rather than being propelled always toward the heart. This seepage causes further
congestion of the part with venous blood and further distention of the veins.
Nursing implications include the following.
(1) Encourage the patient to lie down with her hips/legs elevated periodically
throughout the day.
(2) Inform the patient that elastic stockings applied before rising may lessen
discomfort.
(3) Inform the patient of proper nutritional habits to avoid constipation.
(4) Inform the patient not to bear down with bowel movements.
(5) Inform the patient to avoid prolonged sitting or standing greater than 15
minutes without a change of position.
(6) Inform the patient not to massage her legs.
(7) Inform the patient to discuss possible surgical treatment of varicosities if
persistent after pregnancy.

Diabetes and Pregnancy-Induced Hypertension (PIH)

Maternal acidosis refers to a complex disorder of carbohydrates, fat, and protein
metabolism caused primarily by a relative or complete lack of insulin secretion by the beta cells of
the pancreas. Although there is an overall improvement in the perinatal outcome of the well-
managed diabetic pregnancy, there is still a significant risk for neonatal morbidity. The most
common cause of fetal death associated with diabetes is maternal acidosis.
Diabetic patients are at risk for developing preeclampsia. They also have a risk of a
difficult delivery as a result of the large size of the baby.
Nursing implications are as follow.
(1) Test patient's urine for glucose with clinitest tabs as ordered by OB
practitioner or physician.
(2) Administer oral hypoglycemic medications or insulin as ordered by the OB
practitioner or physician.
(3) Teach the patient the left lateral-recumbent position to rest. This position
improves intrauterine blood flow and may decrease the occurrence of
preeclampsia.
(4) Apply all nursing implications learned for the care of an adult with diabetes.

Hypertension-Pregnancy-Induced (PIH) is another name for preeclampsia or eclampsia.

It is a serious, statistically important disorder characterized by the development after the twentieth
week of gestation of hypertension, with albuminuria or edema or both. The exact cause of PIH is
unknown.
Nursing Implications.
(1) Inform the patient to record her weight weekly and to notify the clinic if there is
an excessively amount of weight gained.
(2) Inform the patient to avoid foods high in sodium content. This will reduce
water retention/edema.
 (3) Inform the patient that prevention of preeclampsia is essential to a healthy
pregnancy and keeping scheduled OB appointments is a must.

Substance Abuse
Battered Pregnant Women
Rhogam® Incompatibility
RhoGAM® incompatibility occurs when the Rh-negative pregnant patient carries an Rh-
positive fetus. The patient's body reacts to the "foreign" fetus blood type. The mother produces
antibodies that in-turn causes destruction of the fetus red blood cells (hemolysis). Hemolysis of
the fetus red blood cells deprives the fetus of oxygen (erythroblastosis fetalis).
Ectopic Pregnancy
Placenta Previa and Abruptio Placentae
Placenta previa is hemorrhage resulting from the low implantation of the placenta on the
interior uterine wall. It is common in multiparous mothers. The cause is unknown.
Nursing implications are listed below.
(1) Teach the patient to report any painless vaginal bleeding.
(2) Monitor vital signs. Hypovolemic shock may be present.
(3) Monitor fetal heart tones per orders.
Abruptio placentae is hemorrhage resulting from the detachment of the placenta.
Hypertension may cause this. It may occur any time during pregnancy. If the placenta becomes
detached prior to the 20th week of gestation it is called a spontaneous abortion.
Nursing implications are listed below.
(1) Record amount and character of vaginal bleeding.
(2) Maintain thorough peri-care to keep the mother feeling clean.
(3) Monitor the fetal heart tones per order. Deceleration indicates diminishing
placental function.
(4) Monitor the mother's vital signs per OB practitioner's or physician's orders.
Death occurs from hypovolemic shock.
(5) Monitor IV fluids per order. IV fluids will be administered to replace fluid
volume.

Abortion
Prolapsed Umbilical Cord
Premature Labor and Birth