2546- First Trimester
When does the first trimester occur?
conception- 12weeks
What are the three stages
ovum
embryonic
fetal
When does the ovum stage occur
conception to day 14
what are the three germ layers
1) endo: responsible for the endothelial lining of the respiratory and digestive tract
2) mesoderm: bones, teeth, cardio
3) ectoderm: epidermis, nails, CNS, PNS
what stage is the most vulnerable to tetragons
ovum
crown to rump measurement
4: 0.4-0.5, 0.4g
8: 2.5-3, 2g
12: 6-9, 19g
maternal development: reproductive system
increase of E&P
week 6: cervical softening
heavy and tingling breasts
Maternal Development: cardio
increase in CO, HR
SBP remains the same, DBP decreases sightly
Maternal Development: Renal
Increase GFR
Week 10: bladder sensitivty as pelvis and ureters dialate
Maternal Development: GI
Decrease in appetite, N&V
Increase in ARF
Common maternal symptoms
Gingivitis: inflammation of gums ** hygiene**
Pytolism
Hypermesis Gravidurim
Severe nausea and vomiting
result: weight loss, ketonuria, electrolyte imbalance
disturbed sleep pattern
HMG Treatment
Start with clear liquids and soft foods
Avoid triggers: scents, taste,etc
IV meds: pyridoxine/ doxylamine
metoclopramide
ondansetron- last resort
Types Of Pregnancy loss
Threatened- FHR is there, cervix is closed no ROM
inevitable- nothing can be done
Complete- Fetus passed, as well as placenta
incomplete- Fetus passed, the placenta is still in the uterus
missed- No viable fetus and is still in the uterus
Miscarriage: Expectant care
Consists of letting everything pass naturally
Usually takes up to a month
will be bleeding but should decrease over time
Miscarriage: Medical care
Misoprostol admin
stops progesterone
Induces pregnancy to deliver deceased fetus
Miscarriage: Surgical care
Uterus emptying
Miscarriage: Health teaching
provide emotional support
Do not try again until 2 months
Ectopic Pregnancy
when the fertilized ovum is planted out of the uterus
Usually in the fallopian tube, cervix, intraabdominal
S&S: localized pain, in the abdomen and moves to the shoulder
Cullen sign: bruising around the umbilicus
Ectopic Pregnancy: Methotrexate
Liver and kidney function
Mass must be unruptured and no fetal activity
Can only measure less than 3.5
Beta HCG: less than 5000
Folic acid blocker
IM injection- do not expel air
Nurse-independent double-check
Methotrexate Health Teaching
No sexual intercourse until Beta HCG levels are undetectable
No med stronger than acetaminophen
Avoid sun
Minimum 3mth wait until conception attempt
Hydatidiform Mole (Molar Pregnancy)
Benign growth of trophoblast cells
Grape like clusters
no viable fetus
S&S: Abdominal Pain
Prune Vaginal Bleeding
Hyperthyroid, pre-eclampsia
Molar pregnancy management
Increase in HCG levels
Grape cluster
Suction curettage intervention or spontaneously passes
Embolization is NOT recommended
Molar Pregnancy Health teaching
conception reattempt is in a year
US milestones
The gestational sac is the first structure
6 wk: FHR
8-12: dating US ** Crown to rump**, determining GA
12 wk: Fetal viability, dating, Anamolies, multiple
NT: 11-13.6 wks
Fetal Aneuploidy
one or more missing or extra chromosome
eFTS
11-14 wks
covered
US for NT and biological markers
NIPT
10-12
Criteria
Maternal Blood
CVS
10-13 wks
Removal of small tissue from placenta
Health Teaching: Nutrition
1-2 kg by the first tri, varies on BMI
Food to AVOID: deli, pasteurized, defrosting in fridge
Health Teaching: Caffeine
300mg
240mlX2- 2 cups of coffee
Health Teaching: Supplements
AVOID: vitamin A
GOOD:16-20mg of iron
Vitamin D