NLE Antepartum, Intrapartum & Postpartum Care — Normal Pregnancy: Physiologic & Psychological ChangesRevision Notes

Exam Tips

• NLE questions often ask: 'Which of the following is a POSITIVE sign of pregnancy?' — the answer will always be one of: FHT heard, fetal movement felt by the examiner, or fetus seen on ultrasound.
• Questions about Goodell's, Hegar's, and Chadwick's signs frequently appear. Link each to its anatomical location as a memory anchor.
• When a question mentions 'the nurse palpates fetal movement' vs. 'the mother reports feeling fetal movement' — the first is POSITIVE, the second is PRESUMPTIVE.
• Remember the week for Doppler FHT detection: 10–12 weeks (Doppler); 18–20 weeks (fetoscope).

Key Points

• Signs of pregnancy are classified into three groups based on how reliably they confirm pregnancy — from least (presumptive) to most (positive/diagnostic).
• PRESUMPTIVE signs are SUBJECTIVE — felt by the woman herself. They are the LEAST reliable because each can have another cause.
• Key presumptive signs: amenorrhea, nausea and vomiting (morning sickness), breast tenderness, urinary frequency, fatigue, and QUICKENING (first fetal movement felt by the mother — approximately 18–20 weeks in primigravida; approximately 16 weeks in multigravida).
• PROBABLE signs are OBJECTIVE — observed by the examiner. They are more reliable but still NOT conclusive proof of pregnancy.
• Key probable signs (memorize with their specific anatomical location): Goodell's sign = softening of the CERVIX; Hegar's sign = softening of the LOWER UTERINE SEGMENT (isthmus); Chadwick's sign = BLUISH-VIOLET discoloration of the cervix and vagina.
• Other probable signs: ballottement (fetus rebounds when isthmus is tapped), Braxton Hicks contractions (painless, irregular practice contractions), abdominal enlargement, pigmentation changes, and a POSITIVE PREGNANCY TEST (hCG-based — probable, NOT positive, because rare non-pregnant conditions can elevate hCG).
• POSITIVE (DIAGNOSTIC) signs — only THREE exist and they are the ONLY conclusive proof of pregnancy: (1) Fetal Heart Tones (FHT) HEARD by the examiner — Doppler by 10–12 weeks, fetoscope by 18–20 weeks; (2) Fetal movement FELT BY THE EXAMINER (not the mother); (3) Visualization of the fetus on ULTRASOUND (as early as 5–6 weeks).
• NLE CRITICAL: A positive urine or serum pregnancy test is a PROBABLE sign, NOT a positive/diagnostic sign.

Definitions

Section Title

Signs of Pregnancy: Presumptive, Probable, and Positive

Common Mistakes

• Classifying a POSITIVE PREGNANCY TEST as a 'positive' (diagnostic) sign — it is a PROBABLE sign.
• Forgetting that quickening (felt by the MOTHER) is PRESUMPTIVE, but fetal movement felt by the EXAMINER is POSITIVE/DIAGNOSTIC.
• Confusing Goodell's (cervix), Hegar's (isthmus/lower segment), and Chadwick's (color change). Use anatomical anchors to memorize each.
• Assuming all probable signs together confirm pregnancy — they do NOT. Only the three positive signs are diagnostic.
• Stating that Braxton Hicks contractions are abnormal — they are normal and begin early in pregnancy, just often unfelt until the third trimester.

Exam Tips

• For any NLE question about maternal position with dizziness or hypotension → LEFT LATERAL position is the answer.
• When asked about 'normal' cardiovascular changes, expect blood volume UP 40–50%, HR UP 10–15 bpm, and BP slightly DOWN in the second trimester.
• Heartburn, constipation, and hemorrhoids all share one root cause: PROGESTERONE relaxing smooth muscle — use this to answer 'why' questions.
• Any question involving a pregnant woman lying supine who develops dizziness or fetal bradycardia → think SUPINE HYPOTENSIVE SYNDROME.
• GI nausea peaks when hCG peaks — FIRST TRIMESTER. This is why morning sickness usually resolves by 12–16 weeks.

Key Points

• ALL body systems adapt during pregnancy. Most changes are driven by hormones: hCG (first trimester), progesterone (relaxes smooth muscle throughout), estrogen (increases vascularity and growth), and hPL (insulin resistance in later pregnancy).
• CARDIOVASCULAR: Blood volume increases 40–50% (plasma rises more than red blood cells) → PHYSIOLOGIC ANEMIA OF PREGNANCY (dilutional). This is NORMAL. Cardiac output rises 30–50%; resting heart rate increases 10–15 bpm.
• ANEMIA IN PREGNANCY: Diagnosed when Hgb <11 g/dL in the first or third trimester, or <10.5 g/dL in the second trimester.
• BLOOD PRESSURE normally decreases slightly in the second trimester (due to progesterone-induced vasodilation), then returns to baseline near term. A BP of ≥140/90 mmHg is abnormal and warrants assessment for gestational hypertension or pre-eclampsia.
• SUPINE HYPOTENSIVE (VENA CAVA) SYNDROME: The heavy gravid uterus compresses the inferior vena cava when the woman lies on her back → decreased venous return → hypotension and dizziness. INTERVENTION: Position the woman in LEFT LATERAL (left side-lying) position.
• Hypercoagulability (clotting factors increase) is protective for delivery but raises the risk of DEEP VEIN THROMBOSIS (DVT) and pulmonary embolism — the nurse must teach signs of DVT (calf pain, redness, swelling).
• RESPIRATORY: Oxygen consumption increases ~20%. Progesterone stimulates the respiratory center → deeper, more frequent breathing → normal mild respiratory alkalosis. The rising uterus displaces the diaphragm upward → dyspnea (especially near term) and nasal stuffiness/epistaxis.
• GASTROINTESTINAL: Progesterone relaxes ALL smooth muscle → slowed gastric emptying and peristalsis → heartburn (pyrosis), constipation, and hemorrhoids. Nausea/vomiting is driven by hCG (peak first trimester). Ptyalism (excessive salivation) is normal. PICA (craving non-food items) must be assessed and addressed.
• RENAL: GFR increases → urinary frequency and mild glycosuria (normal trace amounts). Persistent significant glycosuria warrants screening for gestational diabetes mellitus (GDM).
• INTEGUMENTARY: Striae gravidarum (stretch marks), linea nigra (dark midline of abdomen), chloasma/melasma gravidarum ('mask of pregnancy' — darkening of the face), and darkened areolae — all from increased melanin-stimulating hormone.
• MUSCULOSKELETAL: Relaxin hormone softens pelvic ligaments → waddling gait and pelvic girdle pain near term. The shifted center of gravity causes lordosis (increased lumbar curve — 'pride of pregnancy posture') and low back pain.
• METABOLIC: Insulin resistance increases in the third trimester (driven by hPL) to shunt glucose to the fetus. This is WHY some women develop gestational diabetes.

Definitions

Section Title

Maternal Physiologic Changes by Body System

Common Mistakes

• Calling physiologic anemia of pregnancy 'pathologic' — it is NORMAL and EXPECTED due to dilution.
• Forgetting that blood pressure DECREASES slightly in the second trimester — students sometimes expect it to always rise during pregnancy.
• Placing the woman in RIGHT lateral position to relieve supine hypotension — the correct answer is ALWAYS LEFT lateral to move the uterus off the inferior vena cava.
• Confusing leukorrhea (normal) with signs of vaginal infection — the key differentiators are color, odor, and associated symptoms.
• Attributing constipation and heartburn to diet alone — the primary PHYSIOLOGIC cause is progesterone-induced smooth muscle relaxation.

Exam Tips

• Teratogen questions always tie to the EMBRYONIC period (weeks 3–8). If a question asks 'when is the fetus most vulnerable to teratogens?' — answer: embryonic period / weeks 3–8 / first trimester.
• L/S ratio ≥ 2:1 = MATURE lungs = SAFE for birth. Ratio <2:1 = risk for respiratory distress syndrome.
• The umbilical cord AVA mnemonic: like a 'highway' — 2 lanes going out (arteries carry DEOXYGENATED blood from fetus to placenta), 1 lane coming in (vein carries OXYGENATED blood from placenta to fetus). Note: fetal arteries carry deoxygenated blood — opposite of adult.
• Term = 37–42 weeks. Preterm = 20–<37 weeks. Post-term = >42 weeks. These definitions are used in GTPAL recording.

Key Points

• Fetal development has THREE stages: Pre-embryonic (weeks 1–2: fertilization, cleavage, implantation), Embryonic (weeks 3–8: organogenesis — ALL major organ systems form), and Fetal (week 9 to birth: growth and maturation of formed structures).
• THE EMBRYONIC PERIOD (WEEKS 3–8) IS THE PERIOD OF GREATEST VULNERABILITY TO TERATOGENS. Exposure to drugs, alcohol, radiation, infections (TORCH), or environmental toxins during this window can cause major structural malformations. This is why early prenatal care and avoidance of teratogens is critical.
• Fetal heart beat begins at approximately weeks 3–4 gestation; audible by Doppler at 10–12 weeks and by fetoscope at 18–20 weeks.
• Fetal sex is distinguishable on ultrasound by approximately 12 weeks.
• Quickening (movement felt by mother): 18–20 weeks (primigravida); ~16 weeks (multigravida).
• Vernix caseosa (waxy white coating) and lanugo (fine body hair) develop in mid-pregnancy to protect fetal skin.
• SURFACTANT production becomes adequate by approximately 34–36 weeks. The LECITHIN-TO-SPHINGOMYELIN (L/S) RATIO is the gold standard lab test for fetal lung maturity: L/S ratio ≥ 2:1 indicates MATURE lungs.
• AGE OF VIABILITY: approximately 24 weeks — the earliest gestational age at which a fetus may survive outside the uterus with intensive care.
• TERM is defined as 37–42 weeks. FULL TERM is 39–40 weeks and 6 days.
• Amniotic fluid volume at term is approximately 500–1,000 mL. Oligohydramnios (<300–500 mL) suggests fetal renal problems; polyhydramnios (>2,000 mL) suggests fetal swallowing problems (e.g., tracheoesophageal fistula, anencephaly) or gestational diabetes.
• UMBILICAL CORD: Contains 2 arteries and 1 vein (AVA mnemonic). A single umbilical artery (1 artery, 1 vein) warrants closer newborn assessment as it is associated with renal and cardiovascular anomalies.
• FETAL CIRCULATION SHUNTS (close after birth with first breaths): Ductus venosus (bypasses liver), Foramen ovale (right-to-left atrial shunt, bypasses lungs), Ductus arteriosus (pulmonary artery to aorta, bypasses lungs). Failure of these to close = congenital defects (PDA, ASD).
• PLACENTA is fully functional by ~12 weeks. It secretes hCG, hPL, estrogen, and progesterone. It is the organ of exchange: oxygen, nutrients in; CO2, waste out.

Definitions

Section Title

Fetal Development: Key Milestones and Teratogen Vulnerability

Common Mistakes

• Stating that the fetal period (weeks 9+) has the highest teratogen risk — this is WRONG. The EMBRYONIC period (weeks 3–8) carries the highest risk for major structural malformations.
• Confusing quickening timing: primigravida = 18–20 weeks; multigravida = ~16 weeks. Mixing these up is a common NLE error.
• Saying the umbilical cord has 2 veins and 1 artery — it is 2 ARTERIES and 1 VEIN (AVA = Artery-Vein-Artery).
• Incorrectly stating L/S ratio ≥ 2:1 means immature lungs — it means MATURE lungs (ready for birth).
• Forgetting that the placenta is not fully functional until 12 weeks — hCG from the corpus luteum maintains the pregnancy until then.

Formulas

Exam Tips

• NLE will give you an LMP and ask you to calculate the EDD. Practice multiple examples using different months, especially those requiring borrowing (e.g., LMP in January, February, March — subtracting 3 months crosses into the previous year).
• Example edge case: LMP = February 2, 2026 → Subtract 3 months = November 2, 2025 → Add 7 days = November 9, 2025 → EDD: November 9, 2025 (no year change needed because we went BACK in the calendar). Verify your year arithmetic carefully.
• For GTPAL questions, identify the current pregnancy first (it adds 1 to G but nothing to T, P, or A yet). Then tally each prior pregnancy outcome.
• Remember the fundal height landmarks as a story: at 12 weeks the uterus just reaches the PUBIC BONE (symphysis); at 20 weeks it is at the BELLY BUTTON (umbilicus); at 36 weeks it is near the RIBS (xiphoid).

Key Points

• NAEGELE'S RULE is the standard method for calculating the Estimated Date of Delivery (EDD) or Expected Date of Confinement (EDC). Formula: Take the FIRST DAY of the LAST MENSTRUAL PERIOD (LMP) → SUBTRACT 3 MONTHS → ADD 7 DAYS → ADD 1 YEAR.
• Naegele's rule assumes a regular 28-day menstrual cycle. It is less accurate for women with irregular cycles — early ultrasound is more reliable in those cases.
• WORKED EXAMPLE: LMP = August 10, 2025 → Subtract 3 months = May 10, 2025 → Add 7 days = May 17, 2025 → Add 1 year = EDD: May 17, 2026.
• McDONALD'S RULE (Fundal Height): After approximately 20 weeks, the fundal height in CENTIMETERS roughly equals the gestational age in WEEKS (±2 cm). Example: Fundal height = 28 cm ≈ 28 weeks gestation.
• FUNDAL HEIGHT LANDMARKS (memorize): Symphysis pubis = ~12 weeks; Umbilicus = ~20 weeks; Xiphoid process = ~36 weeks. NOTE: Near term (~36–38 weeks), LIGHTENING (fetal head descends into the pelvis) causes the fundus to DROP slightly — the woman can breathe more easily but experiences increased pelvic pressure and urinary frequency.
• GTPAL SYSTEM records obstetric history: G = Gravida (total number of times pregnant, including current); T = Term births (≥37 weeks); P = Preterm births (20–36 weeks and 6 days); A = Abortions/pregnancy losses (<20 weeks, spontaneous or induced); L = Living children.
• EXAMPLE: A woman is currently pregnant. She had one previous delivery at 39 weeks (that child is living). GTPAL = G2 T1 P0 A0 L1.
• GRAVIDA vs PARA: Gravida = total pregnancies. Para = number of deliveries after 20 weeks (regardless of whether the baby was born alive or dead, or the number of babies in a multiple pregnancy). A twin delivery = Para 1, not Para 2.
• Normal GESTATIONAL AGE categories: Preterm = 20–<37 weeks; Term = 37–42 weeks; Post-term = >42 weeks.

Definitions

Section Title

Estimating the Due Date: Naegele's Rule, McDonald's Rule, and GTPAL

Common Mistakes

• Using the LAST day of the LMP instead of the FIRST DAY — Naegele's rule always starts from the FIRST DAY.
• Forgetting to add the 1 year (advancing the year) — this will give an EDD that is 1 year too early.
• In GTPAL, counting a set of twins as T2 or P2 — one delivery (regardless of the number of fetuses) = ONE in the T or P column. The number of babies affects the LIVING CHILDREN count.
• Confusing Gravida and Para: A woman who is pregnant for the first time is G1, Para 0 (nullipara). She becomes Para 1 after delivery.
• Not knowing that McDonald's rule only applies AFTER 20 weeks — before 20 weeks, fundal height landmarks (symphysis, umbilicus) are more useful.

Exam Tips

• When an NLE question presents a first-trimester woman saying 'I don't know if I want this baby' or 'I feel both excited and scared' — the correct response is THERAPEUTIC VALIDATION: 'It is normal to have mixed feelings early in pregnancy.'
• Know the trimester-emotion pairs: First = Ambivalence; Second = Acceptance/Introspection; Third = Preparation/Nesting.
• Rubin's four maternal tasks may be directly tested. Memorize: Safe passage, Acceptance, Binding-in, Giving of oneself.
• NANDA nursing diagnoses relevant to pregnancy psychology: Anxiety (related to role transition), Disturbed Body Image (related to physiologic changes of pregnancy), Readiness for Enhanced Family Coping.

Key Points

• Pregnancy is a maturational and developmental CRISIS — not a pathological crisis — requiring significant role adjustment. Reva Rubin described four MATERNAL TASKS that all pregnant women work through.
• RUBIN'S MATERNAL TASKS: (1) Ensuring SAFE PASSAGE for self and baby; (2) Seeking ACCEPTANCE of the baby by significant others; (3) BINDING-IN (developing attachment to the fetus as a real person); (4) GIVING OF ONESELF (accepting the sacrifices of parenthood).
• FIRST TRIMESTER (Weeks 1–12) — emotional hallmark is AMBIVALENCE. Even in a planned and wanted pregnancy, it is NORMAL for a woman to feel conflicting emotions (excitement + anxiety, happiness + doubt). The focus is on SELF ('Am I really pregnant? How will this affect me?'). Frequent nausea and fatigue reinforce self-focus.
• SECOND TRIMESTER (Weeks 13–28) — emotional hallmark is ACCEPTANCE. QUICKENING makes the pregnancy real and tangible, promoting ATTACHMENT. The woman becomes more INTROSPECTIVE, may fantasize about the baby, and begins 'binding-in.' This is the most comfortable trimester physically.
• THIRD TRIMESTER (Weeks 29–40) — emotional hallmark is PREPARATION ('nesting' behavior). The woman focuses on PREPARING (setting up the nursery, attending birth classes, stocking supplies). Anxiety about labor, delivery, and parenting is common. Readiness to end the pregnancy ('I just want it to be over') is NORMAL.
• COUVADE SYNDROME: The partner (typically the father) experiences pregnancy-like symptoms (nausea, weight gain, backache, fatigue). This is a recognized psychological phenomenon reflecting deep empathic involvement in the pregnancy.
• BODY IMAGE changes are significant — the nurse should acknowledge the woman's feelings about her changing body without dismissiveness.
• MOOD LABILITY (emotional ups and downs) is hormonally driven and normal. However, the nurse must screen for PRENATAL DEPRESSION — as common as postpartum depression and often underrecognized.
• INTIMATE PARTNER VIOLENCE (IPV/VAWC) screening is essential — pregnancy can be a trigger for abuse or worsening abuse. In Philippine nursing practice, RA 9262 (Anti-Violence Against Women and Their Children Act) mandates awareness and reporting.
• NURSING ROLE: Involve the partner and family, provide anticipatory guidance for each trimester, validate normal psychological responses, and screen for perinatal mood disorders and IPV.

Definitions

Section Title

Psychological Changes and Maternal Tasks of Pregnancy

Common Mistakes

• Treating first-trimester AMBIVALENCE as a sign of rejection of the baby or postpartum depression risk — ambivalence is NORMAL in the first trimester.
• Failing to screen for prenatal DEPRESSION — students focus on postpartum depression and forget that depression is equally common and treatable during pregnancy.
• Not including the PARTNER in prenatal nursing care — Philippine family-centered care models (and standard obstetric nursing) emphasize partner and family involvement.
• Attributing ALL mood changes to psychological instability — most are HORMONALLY DRIVEN and normal; persistent, impairing symptoms warrant further assessment.
• Forgetting to apply Maslow's Hierarchy when prioritizing nursing diagnoses in pregnancy — physiologic needs (e.g., Imbalanced Nutrition, Risk for Injury from falls/dizziness) take priority over psychosocial needs in most NLE priority questions.

Exam Tips

• For ANY back pain in pregnancy → PELVIC TILT EXERCISES + low-heeled shoes.
• For leg cramps → DORSIFLEX the foot (pull toes toward shin) to stop the cramp.
• The difference between NORMAL edema (ankles, feet, third trimester) and DANGEROUS edema (face, hands, with headache) is a frequent NLE discrimination question.
• Nausea resolves by 12–16 weeks — if a woman is still having severe vomiting beyond this, suspect hyperemesis gravidarum.
• Morning sickness management: dry crackers BEFORE rising from bed = most effective single recommendation.

Key Points

• Teaching relief measures for the common discomforts of pregnancy is core prenatal nursing. The nurse must distinguish between EXPECTED DISCOMFORTS (for which self-care measures suffice) and DANGER SIGNS (which require immediate medical attention).
• NAUSEA AND VOMITING (Morning Sickness): Eat small, frequent meals (every 2–3 hours). Choose dry, bland carbohydrate foods (crackers, plain toast) — especially BEFORE getting out of bed in the morning. Avoid an empty stomach, strong odors, fatty or spicy foods, and large meals. Typically resolves by 12–16 weeks. Persistent, severe vomiting with weight loss = HYPEREMESIS GRAVIDARUM (a danger sign requiring medical care).
• HEARTBURN (PYROSIS): Eat small, frequent meals. Remain UPRIGHT for at least 30 minutes after eating. Avoid fatty, spicy, and acidic foods. Sleep with head elevated. Antacids only as directed by the healthcare provider (avoid sodium bicarbonate — may cause alkalosis and sodium retention).
• CONSTIPATION: Increase FIBER and FLUID intake. Maintain moderate physical activity. Note: iron supplementation commonly worsens constipation — forewarning the woman improves adherence.
• BACKACHE (Low Back Pain): Teach pelvic TILT exercises (a key NLE exercise for back pain). Wear LOW-HEELED, supportive footwear. Use proper body mechanics for lifting. Avoid prolonged standing.
• LEG CRAMPS: DORSIFLEX the foot (pull toes upward toward the shin) and stretch the calf to relieve an acute cramp. Ensure adequate CALCIUM and MAGNESIUM intake. Avoid pointing the toes.
• VARICOSITIES AND EDEMA: Elevate legs when resting. Avoid crossing the legs at the knee. Avoid prolonged STANDING or SITTING. Rest in LEFT LATERAL position. Wear supportive (not constrictive) stockings. Ankle edema in the third trimester is NORMAL; edema of the FACE and HANDS warrants assessment for pre-eclampsia.
• URINARY FREQUENCY: NORMAL — explain to the woman it is due to the growing uterus compressing the bladder. Teach her to REPORT DYSURIA (painful urination), burning, fever, or chills, which may indicate a URINARY TRACT INFECTION (UTI) — a common and serious pregnancy complication.
• NASAL STUFFINESS AND EPISTAXIS (nosebleeds): Due to hormonal vascular engorgement of nasal mucosa. Use a humidifier, saline nasal spray, and gentle blowing. Usually not serious.

Definitions

Section Title

Common Discomforts of Pregnancy and Relief Measures

Common Mistakes

• Recommending sodium bicarbonate for heartburn — it can cause sodium retention and metabolic alkalosis in pregnancy.
• Telling a woman with leg cramps to 'point her toes' — this WORSENS the cramp. Teach DORSIFLEXION (toes toward nose).
• Dismissing a complaint of urinary frequency without asking about associated dysuria, fever, or chills — UTI is a significant pregnancy complication that can precipitate preterm labor.
• Teaching the woman that ALL edema in pregnancy is normal — FACIAL and HAND edema is a warning sign for pre-eclampsia.
• Not warning the woman that iron supplementation causes constipation — this is a key reason why women stop taking iron supplements.

Exam Tips

• NLE loves clustering pre-eclampsia signs: HEADACHE + VISUAL CHANGES + FACE/HAND EDEMA + HYPERTENSION = pre-eclampsia. Any one of these alone = report immediately.
• Epigastric or RUQ pain in a pregnant woman after 20 weeks = PRE-ECLAMPSIA/HELLP until proven otherwise. Do NOT assume it is just heartburn.
• Convulsions in pregnancy = ECLAMPSIA = position the woman safely (on her side), call for help, protect airway, prepare magnesium sulfate.
• Any vaginal bleeding in pregnancy = DANGER SIGN regardless of the amount or color — always report.
• The nurse's first response to any obstetric emergency (bleeding, seizure, absent FHT, cord prolapse) = NOTIFY THE PHYSICIAN immediately while implementing emergency nursing measures.

Key Points

• Teaching pregnant women which signs require IMMEDIATE reporting is a core nursing responsibility and a high-yield NLE topic. These signs may indicate serious complications that threaten fetal or maternal life.
• VAGINAL BLEEDING (any amount): May indicate miscarriage (before 20 weeks), placenta previa (painless, bright red), or abruptio placentae (painful, dark). Always a danger sign.
• GUSH OR LEAKING OF FLUID FROM THE VAGINA: Possible premature rupture of membranes (PROM). Risk: umbilical cord prolapse, ascending infection (chorioamnionitis), and preterm labor.
• SEVERE OR PERSISTENT HEADACHE, BLURRED VISION, or SPOTS/FLASHES BEFORE THE EYES: Cardinal signs of PRE-ECLAMPSIA affecting the central nervous system and retinal vasculature.
• EDEMA OF THE FACE AND HANDS (especially with headache): Sign of pre-eclampsia — pathologic edema from protein loss and vascular changes.
• EPIGASTRIC OR RIGHT UPPER QUADRANT (RUQ) PAIN: Sign of SEVERE PRE-ECLAMPSIA or HELLP SYNDROME (Hemolysis, Elevated Liver enzymes, Low Platelets) — hepatic capsule stretching.
• PERSISTENT SEVERE VOMITING: Hyperemesis gravidarum — risk of dehydration, electrolyte imbalance, and ketosis.
• FEVER AND CHILLS: Sign of infection — can cause preterm labor.
• PAINFUL URINATION (DYSURIA): Urinary tract infection — one of the most common infections in pregnancy; can trigger preterm labor if untreated.
• ABSENT OR MARKEDLY DECREASED FETAL MOVEMENT after quickening: Possible fetal compromise or fetal distress — requires immediate evaluation. Normal: baby should move at least 10 times in 2 hours (Cardiff count-to-ten method).
• REGULAR UTERINE CONTRACTIONS BEFORE 37 WEEKS: Signs of PRETERM LABOR — requires urgent evaluation and possible tocolysis.
• CONVULSIONS/SEIZURES: ECLAMPSIA — a life-threatening obstetric emergency. Priority: airway, prevent injury, administer magnesium sulfate as ordered, notify the physician immediately.

Definitions

Section Title

Prenatal Danger Signs: Report Immediately

Common Mistakes

• Teaching that any ankle edema is a danger sign — ANKLE edema in the third trimester is NORMAL. FACIAL and HAND edema is the danger sign for pre-eclampsia.
• Ignoring decreased fetal movement because the woman says 'the baby is just sleeping' — always take decreased fetal movement seriously and advise immediate evaluation.
• Not recognizing EPIGASTRIC PAIN as a pre-eclampsia danger sign — students associate epigastric pain with GI issues but in pregnancy it must be screened for HELLP.
• Treating a gush of fluid as normal — always assess for rupture of membranes, as leaking amniotic fluid is never normal before labor and carries serious risks.
• Confusing Braxton Hicks (irregular, painless, do not increase in frequency) with true preterm labor contractions (regular, painful, increasing in frequency).

Exam Tips

• Normal FHR = 110–160 bpm. Memorize this range — it appears in many NLE questions.
• NANDA priority nursing diagnosis in pregnancy using Maslow: Physiologic needs FIRST. Example: A pregnant woman with severe nausea, dizziness, and poor intake → Priority = Imbalanced Nutrition / Deficient Fluid Volume BEFORE Anxiety.
• Folic acid = BEFORE conception + first 12 weeks = neural tube defect prevention. This is a public health AND clinical nursing point.
• Leopold's maneuvers sequence: FOUR maneuvers, each with a specific purpose. Commonly tested as 'which maneuver identifies the presenting part?' = Pawlik's grip (3rd maneuver).
• Under RA 9173, the nurse must practice within scope. Nursing actions in prenatal care = assessment, health education, referral, and supportive care — NOT prescribing medications or performing obstetric procedures without appropriate authorization.

Key Points

• The nurse's role in normal pregnancy is primarily EDUCATION, REASSURANCE, SURVEILLANCE, and COORDINATION — not treatment.
• INITIAL PRENATAL ASSESSMENT: Confirm and date the pregnancy (history of LMP, cycle regularity, pregnancy test, Naegele's rule, and early ultrasound if available); complete obstetric history using GTPAL; baseline vital signs and weight; physical examination including fundal height assessment.
• ONGOING PRENATAL MONITORING at every visit: Vital signs (especially blood pressure — screen for gestational hypertension), weight (monitor for adequate gain and patterns), fundal height (McDonald's rule after 20 weeks), fetal heart rate (normal FHR: 110–160 bpm), fetal position (Leopold's maneuvers in the third trimester), urinalysis (protein, glucose), and review for danger signs.
• LEOPOLD'S MANEUVERS (4 maneuvers performed in the third trimester): (1) Fundal Grip — identifies fetal part in the fundus; (2) Umbilical Grip — identifies fetal back and small parts; (3) Pawlik's Grip — identifies presenting part above the inlet; (4) Pelvic Grip — determines degree of engagement. Used to determine fetal lie, presentation, position, and engagement.
• PSYCHOSOCIAL ASSESSMENT: Screen for depression, anxiety, readiness for motherhood, social support, and intimate partner violence (IPV/VAWC — RA 9262 in Philippine context).
• HEALTH EDUCATION per trimester: First trimester — cope with nausea, take prenatal vitamins (folic acid 400–800 mcg/day to prevent neural tube defects), avoid teratogens; Second trimester — attachment activities, comfort measures, nutrition; Third trimester — prepare for labor, breastfeeding, newborn care, birth planning.
• FOLIC ACID is critical in the PERICONCEPTIONAL period (1 month before conception and first 12 weeks) to prevent NEURAL TUBE DEFECTS (e.g., spina bifida, anencephaly).
• REINFORCE: All prenatal appointments (as per the Philippine DOH's recommended minimum of 8 prenatal care contacts), iron and folic acid supplementation, tetanus toxoid immunization (as per Expanded Program on Immunization), and nutrition counseling.
• Under RA 9173 (Philippine Nursing Act of 2002), the nurse has a legal mandate to practice competently, safely, and within the scope of nursing practice. In prenatal care, this includes patient education, assessment, referral, and coordination — all without exceeding physician orders.

Definitions

Section Title

Nursing Assessment and Management During Pregnancy

Common Mistakes

• Forgetting that the NORMAL FHR range is 110–160 bpm — not 120–160 or 100–160.
• Not applying NANDA nursing diagnoses in pregnancy scenarios. Common relevant diagnoses: Imbalanced Nutrition: Less than Body Requirements; Risk for Injury; Anxiety; Knowledge Deficit (Deficient Knowledge); Constipation.
• Failing to recognize that in Philippine prenatal care context, the DOH recommends 8 prenatal contacts (not just 4) per updated guidelines — this reflects the Philippine maternal health care framework.
• Not addressing folic acid BEFORE conception — waiting until the first prenatal visit (often 8–12 weeks) misses the critical neural tube closure window (3–4 weeks gestation).
• Neglecting to teach fetal kick counting as part of prenatal education — it is a cost-free, accessible tool highly relevant in Philippine community and rural healthcare settings.