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Prenatal Care

Antepartum

Prenatal Assessment Schedule

  • First trimester (0-12 weeks): Monthly visits
  • Second trimester (13-27 weeks): Monthly visits until 28 weeks
  • Third trimester (28-40 weeks): Every 2-3 weeks until 36 weeks, then weekly

Fundal Height Measurements

  • 12 weeks: At top of symphysis pubis
  • 20 weeks: At level of umbilicus
  • 36 weeks: At lower border of rib cage

Presumptive Signs of Pregnancy

  • Amenorrhea
  • Nausea and vomiting (due to rising hCG)
  • Breast tenderness and enlargement
  • Quickening (16-19 weeks)
  • Urinary frequency
  • Fatigue

Probable Signs of Pregnancy

  • Goodell's sign (softening of cervix)
  • Chadwick's sign (bluish discoloration of cervix and vagina)
  • Hegar's sign (softening of lower uterine segment)
  • McDonald's sign (ease in flexing uterine body against cervix)
  • Positive pregnancy test (hCG in blood/urine)
  • Braxton Hicks contractions

Positive Signs of Pregnancy

  • Ultrasound evidence of fetus
  • Fetal heart tones detected
  • Fetal movement felt by examiner

Weight Gain Recommendations

  • First trimester: 2-5 lb (1-2.5 kg)
  • Second and third trimesters: <1 lb (0.5 kg) per week
  • Total: 25-30 lb (11-13.5 kg)
  • Multiple gestation: 35-45 lb (15.5-20.5 kg)

Nutritional Requirements

  • Iron supplement: 30-60 mg daily (to prevent anemia)
  • Folic acid: 400-800 mcg daily (prevents neural tube defects)
  • Calcium: 1000-1300 mg daily
  • Fluid intake: at least 8 glasses (2000 ml) daily

Patient Education

  • Avoid alcohol, tobacco, illicit drugs
  • Limit caffeine intake
  • Avoid high-sodium foods (fluid retention)
  • Add fiber to prevent constipation and hemorrhoids
  • Pelvic-tilt exercises for backache
  • Kegel exercises for perineal muscle strength

Discomforts and Management

  • Nausea/vomiting: Eat small, frequent meals; avoid greasy/spicy foods; dry crackers before rising
  • Heartburn: Avoid lying down after meals; elevate head of bed
  • Backache: Pelvic tilt exercises; good posture
  • Constipation: Increase fiber and fluid intake; regular exercise
  • Leg cramps: Dorsiflex foot; increase calcium/magnesium intake
  • Varicose veins: Elevate legs; avoid crossing legs; support hose

📝 NCLEX Priority Points

  • Fundal height in cm = weeks gestation (after 12 weeks)
  • Folic acid 400-800 mcg daily prevents neural tube defects
  • Weight gain: 25-35 lb total; <1 lb/week after first trimester
  • Kick counts: 10 movements in 2 hours - report decreased fetal movement

💊 Key Medications & Interventions

  • Prenatal vitamins: Iron (prevents anemia), Folic acid (prevents neural tube defects)
  • Rh immune globulin: Given at 28 weeks and within 72 hours postpartum if Rh negative
  • Glucose screening: 24-28 weeks for gestational diabetes

Source: AWHONN, ACOG Guidelines. For educational purposes only. Always follow facility protocols and current clinical guidelines.