Nutrition of a pregnant woman. Diagnostic methods, features of nursing care for pregnant women What do we eat

During pregnancy in a healthy body, all organs function normally, but with increased stress. In case of non-compliance with the rules of nutrition, hygiene, overwork, the functions of the body are violated and various complications arise. Therefore, pregnant women must carefully follow all the hygiene rules aimed at maintaining and strengthening the health of a woman, the proper development of the fetus, the normal course of childbirth and the postpartum period, and preparing the woman's body for breastfeeding.

All this information is explained to pregnant women in the classes on psychoprophylactic preparation for childbirth. Their main goal is to eliminate fear and unpleasant emotions during pregnancy and childbirth, to prepare the body for childbirth and breastfeeding. Usually these are 5-6-8 sessions, which consistently cover the regimen, diet, hygiene of the pregnant woman, the physiology of pregnancy, possible complications, the course of childbirth and methods of pain relief, the course of the postpartum period and child care.

Prenatal care.

Body care is a necessary condition for the activity of the whole organism. During pregnancy, the skin works with an increased load - it performs an excretory function in place with the kidneys. Showers, wiping, washing, gymnastics, air baths are of great importance.

Pregnant women are advised to take a shower at least 1 time per week, daily wipe the body with water at room temperature. Use a pH-neutral soap for daily showers. The toilet of the oral cavity and teeth, the sanitation of carious teeth is very important. Mandatory hygiene procedures include shaving the hair in the armpits and washing them daily with warm water. Thrush fungi can vegetate there.

The toilet of the external genital organs should be carried out 1-2 times a day with warm water with a pH-neutral soap. Vaginal douching is not recommended.

Air baths should be carried out from 5-10 minutes to 15-20 minutes. at T 22-24 gr. Undosed sunbathing is contraindicated, UVI is better as prescribed by a doctor, especially for residents of the North. Bathing in the sea and the river is allowed, limited in the last 2 months of pregnancy - the risk of ascending infection.

Sleep at least 8-9 hours at night and daytime rest for 2 hours, walks in the air before going to bed are required. Air travel and long distance travel are not recommended.

Mandatory therapeutic exercises, 15-minute morning exercises. During pregnancy, exercises such as “bicycle”, “scissors”, forward bends, squats, long standing with arms raised are prohibited during pregnancy. Limit exercises to strengthen the abdominals, the main load should be on the shoulder girdle, chest, hips and perineum. "Movement is life!" Every 2 hours to move - prevention of stagnation in the lower extremities.

Preparation of the mammary glands for lactation, see above.

Clothing - comfortable and loose, preferably not made of synthetics, avoid elastic knitted fabrics, center of gravity on the shoulders, avoid tightness of the abdomen and chest. The bandage prevents overstretching of the abdominal wall and skin and keeps the fetus in the correct position in the womb. Comfortable shoes with wide heels no more than 5 cm high.

For varicose veins:

Avoid prolonged stay in one position;

during sleep and prolonged stay in one position, the legs should be at a higher level than the body;

wear elastic stockings or bandage your legs with an elastic bandage, but during sleep they must be removed;

Avoid wearing knitwear with fixing elastic bands;

avoid heat sources near the legs, sunbathing, hair removal with hot wax;

With an increase in vaginal whites:

Do an analysis to detect a vaginal or fungal infection;

In case of detection of bacterial vaginosis or infection, carry out pathogenetic treatment.

With cramps in the calf muscles perform muscle massage; recommend magnesium and calcium preparations during pregnancy and lactation (Magne B 6 , Additiva calcium, Upsavit calcium, Calcium-B 3 Nycomed); remember that the bioavailability of calcium gluconate is very low.

Sexual life at the risk of miscarriage is limited, individually - abstinence or a condom in the last 4 weeks of pregnancy - the risk of ascending infection.

Do not take medicines without the advice of a doctor or midwife. Avoid diagnostic or therapeutic x-ray exposure. Avoid contact with infectious patients with rubella, cytomegalovirus and herpes infection, chickenpox

Diet.

Nutrition should be rational and, to a certain extent, individualized in accordance with family and living conditions and the characteristics of the woman's body. In the first half, 4 meals a day are recommended: 1 breakfast - 25-30% of the diet, 2 breakfast - 10-15%, lunch - 40-50%, dinner - 15-20%. In the second half of pregnancy, 5-6 meals a day, serving size - 200g. Nutrition in the first half of pregnancy under the motto: "Eat whatever you want, and remember the adverse effects of alcohol, smoking, drugs, drugs." A varied and deliciously prepared food rich in protein and vitamins is recommended.

ü from the moment of a positive test for hCG:

Iodine - 200 mcg;

8 weeks after the last menstrual period:

Iron - 50 mg;

Calcium - 1000 mg.

Proteins should average 20-25% of the total calorie intake (in the 2nd half - 30-35%), fats - 25-30%, carbohydrates - 40-45%. Daily requirements at normal weight:

Calories - 1800-2500 kcal;

proteins - 60-90 g;

carbohydrates - 325-450 g;

Restriction of fats to 50-70 g.

In the 2nd half of pregnancy, a predominantly dairy-vegetarian diet should be observed, alternating meat, fish and vegetable days. Raw fruits, berries and vegetables are very useful. Meat - 2-3 times a week, fish more often. Supplement the amount of animal proteins with cottage cheese, eggs, cheeses, dairy products. Liquid - up to 1200 ml per day. Natural juices without preservatives, non-carbonated mineral water, tea with milk, whey are recommended. Spicy, salty foods and marinades, alcohol, spices, coffee are prohibited.

Recommended in the Northwest region food pyramid: first floor- cereals. They have a lot of vitamin B. Wholemeal bread with bran, cereals - oatmeal, rice, buckwheat, they are best cooked from whole grains due to the high iron content, pasta. Also useful are fibromed, flake (embryonic grains), which contain all trace elements, vitamins and iron. Second floor- vegetables and fruits, walnuts. Greens are high in vitamin C, reds are high in vitamin A. Strawberries and citrus fruits in moderation due to the possibility of allergies. Third floor- meat, fish and seafood, and milk and dairy products. Lamb and pork are poorly digested and are heavy foods for pregnant women. Eggs no more than 3 times a week. Fourth floor- sweets and flour products. They are in very small numbers.

Fasting days are useful for pregnant women: it is easiest to abstain from food from 18.00 one day to 18.00 another. On this day, eat only one type of fruit - most often it is apples in the amount of 1-1.5 kg or drink one type of natural juice. After a fasting day, it is advisable to eat only light food - cereals on the water, boiled vegetables.

On average, during pregnancy, a woman gains 9-12 kg in weight. The average weekly weight gain is 300-350 grams.

With a tendency to constipation:

· dairy products

Avoid a sedentary lifestyle

· for the night curdled milk or kefir, dried fruits, 100-150 gr. prunes, apples, raw carrots, give preference to green vegetables, bran supplements and fruits in the diet;

After waking up, drink a glass of non-carbonated water;

· avoid the use of products containing starch, with the exception of rice;

you can use laxatives (duphalac, mucofalk, forlax);

Use with caution during pregnancy and lactation senozides A + B (regulax, bekunis, tisasen), bisacodyl, guttalax;

Use of oils as laxatives is not recommended: they promote the absorption of fat-soluble vitamins.

For heartburn:

• recommend more frequent meals in small portions;
• try not to take carbonated drinks, coffee, hot sauces;
• prevent sharp bends;
• do not take antacids containing sodium bicarbonate (causes constipation);
• does not cause constipation taking antacids containing aluminum hydroxide in combination with magnesium (gastal, alumag, coalgel 60): have a protective effect on the mucosa of the gastrointestinal tract; do not cause constipation;
• it is advisable to use preparations only with aluminum hydroxide (phosphalugel, tisacid, alumag).

With hemorrhoids: prevent constipation, regulate stool; prescribe local ointment aurobin and / or rectal suppositories (procto-glivenol, proctosedil).

With hypersalivation carry out oral hygiene; try to swallow or spit out saliva; stop smoking; if necessary, to reduce salivation, use metacin 0.002 g 2-3 times a day.

Approximate daily diet in the first half of pregnancy:

• up to 200 g of milk or its derivatives (fermented milk products are better); eggs -1-2 pcs.;
• vegetables - 500 g;
• fruits - 200-500 g;
• 2 pieces of meat, cutlets with a replacement for sea fish, liver (120-150 g) within a week;
• bread and its products - 200 g;
• cereals or pasta - 50 g;
• limiting strong coffee and tea;

Approximate daily diet in the second half of pregnancy:

up to one liter of milk or its derivatives (fermented milk products are better);

eggs - 1-2 pieces;

vegetables - 500 g;

fruits - 200-500 g;

· 2 pieces of meat, cutlets with a replacement for sea fish, liver (200 g) within a week;

bread and its products - 200 g;

cereals or pasta - 50 g;

limiting strong coffee and tea;

Nutrition during pregnancy is different from usual, especially if the expectant mother has previously allowed herself low-quality unnatural food. The entire diet should now consist of environmentally friendly products that have undergone minimal heat treatment. It is advisable to eat only freshly prepared home-cooked meals.

The basic rules of rational nutrition include the regularity of meals, the enrichment of the body with vitamins and microelements, and the exclusion from the diet of what can harm the health of mother and child.

The expectant mother should:

1. Follow the diet:

• take food in small doses, but often - every 2-4 hours;
• healthy breakfast. In the morning, the body will be grateful for dairy products, whole grain bread, muesli, fruits. It is better to avoid eating immediately after waking up. A glass of fresh water without any additives will be most helpful;
• lunch must be complete, and not in the form of a light snack with a sandwich;
• a light dinner 2-3 hours before bedtime, consisting of a vegetable salad, kefir or fruit.

2. Eliminate harmful products:

• sweet (anything containing white sugar);
• flour (avoid white flour);
• fatty (minimize the consumption of animal fats);
• fried (only occasionally you can lightly fry food in butter);
• smoked (sausage, fish, cheese);
• carbonated drinks.

3. Beware of extremes:

• can't overeat. Do not abuse even healthy products, using them in large quantities. Get up from the table with a slight feeling of hunger, avoiding heaviness in the stomach;
• cannot be malnourished. If you've lost your appetite, don't follow him. You need to include vegetables and fruits in your daily diet that will make you want to eat. Nutritional deficiencies can lead to irreversible consequences.

4. Enrichment of the body:

• proteins are a necessary building material for the growth and full development of the embryo. It is very important to include in the daily diet foods such as eggs, chicken and turkey meat, fish, milk;
• A, E, C, D, B play an important role in the formation of the skeleton, bones, muscles of the baby. Stimulate and strengthen the mother's immunity, contribute to the normal functioning of the digestive, nervous and cardiovascular systems;
• trace elements are necessary for the formation of bones, cartilage and the normalization of hemoglobin levels, which contributes to the preservation of the fetus until the end of the term.

Consequences of malnutrition

1. For the expectant mother:

• anemia;
• bleeding;
• infectious complications.

2. In a child:

• delay in intrauterine development;
• hyperactivity;
• decreased resistance to infections;
• prematurity.

If during gestation you have gained a few extra pounds, you will certainly be interested, without harm to your health and the health of your baby!

You should know that already inside the mother, the child develops basic taste preferences that will guide him all his life. Therefore, by changing unhealthy eating habits, a woman will ensure not only normal development and birth, but also the right course in relation to a healthy lifestyle.

Moscow region

FINAL QUALIFICATION WORK

student (s) IV course 31 M group

specialty 34.02.01 Nursing (basic training)

KHATANOVA MILANA DZHAMILYEVNA

Orekhovo-Zuevo - 2016

INTRODUCTION 3

CHAPTER 1. NURSING CARE OF A PREGNANT WOMEN DURING NORMAL PREGNANCY.. 5

1.1 Changes in the body of a pregnant woman .. 5

1.2 Determining the timing of childbirth or the timing of pregnancy. ten

1.3 Maslow's pyramid of needs. 12

1.4 The main problems of a pregnant woman and their solution. 13

1.5 Features of the organization of the nursing process. eighteen

Conclusions on chapter 1. 27

CHAPTER 2. NURSING PROCESS IN NORMAL PREGNANCY.. 29

Conclusions on chapter 2. 39

CONCLUSION. 40

LIST OF USED SOURCES.. 43

INTRODUCTION

The period of expectation of a child is one of the happiest in a woman's life. However, this is a time of great responsibility. A new stage has begun - caring not for yourself, but for the child. What happens after birth is a continuation and undoubtedly depends on what happens before and during it. Understanding this fact explains why the newborn is so perfectly functioning. His ability to respond to maternal caresses, hugs, looks and voice is based on a long intrauterine acquaintance with her. Every mother dreams of happiness for her child, and every mother strives to give him something without which a full life is impossible - health and strength. The foundations of his future health are laid in his mother, therefore, taking care of health, and therefore the future of your baby, must be started even before birth, especially in the most important period for him - intrauterine. A successful pregnancy should become a strong foundation for further health and a happy life for both the mother and her child.

Pregnancy- this is a normal (physiological) process that occurs in a woman's body during fetal development.

During pregnancy, a woman's body undergoes profound transformations. With the normal development of pregnancy, all the changes that take place in the body of a woman are aimed at creating a harmonious relationship between the mother's body and the body of the developing fetus. Also, from the very first days of pregnancy, the body of a pregnant woman begins to prepare for future childbirth and breastfeeding.

Pregnancy begins at the moment of conception or fertilization and ends with childbirth. The average duration of a normal pregnancy is 280 days (40 weeks), counting from the first day of the last menstruation.

The period of fetal development is divided into three stages or trimesters:

1st trimester - up to 12 weeks

2nd trimester - 13-28 weeks

3rd trimester - 29-40 weeks

From the very first days of pregnancy, the body of a pregnant woman undergoes profound transformations. These transformations are the result of the coordinated work of almost all body systems, as well as the result of the interaction of the mother's body with the child's body.

Purpose of the study: the study of nursing care for a pregnant woman during the normal course of pregnancy

Research objectives:

· To study the activities that provide nursing care for a pregnant woman during the normal course of pregnancy.

Study of nursing care for a pregnant woman during the normal course of pregnancy.

Practical significance is that the results of the study can be used in the professional activities of a nurse.

Object of study: Nursing care of a pregnant woman in the normal course of pregnancy.

Subject of study: nursing care.

Research base: GBUZ MO "Davydovskaya district hospital".

Respondents: patients undergoing treatment at the Davydov Regional Hospital.

Research methods:

1. Work with literary sources.

2. Working with Internet resources.

3. Drawing up memos.

CHAPTER 1

Changes in the body of a pregnant woman

Changes in the reproductive system.

The most significant changes, however, occur in genitals pregnant woman. These changes prepare the female reproductive system for childbirth and breastfeeding:

The uterus of a pregnant woman increases significantly in size. Its mass increases from 50 g - at the beginning of pregnancy to 1200 g - at the end of pregnancy.

The volume of the uterine cavity by the end of pregnancy increases by more than 500 times.

The blood supply to the uterus is greatly increased.

The number of muscle fibers in the walls of the uterus increases.

The cervix is ​​filled with thick mucus that clogs the cavity of the cervical canal.

The fallopian tubes and ovaries also increase in size.

In one of the ovaries there is a "yellow body of pregnancy" - a place of synthesis of hormones that support pregnancy.

The walls of the vagina loosen up, become more elastic.

· External genital organs (small and large labia), also increase in size and become more elastic.

· Perineal tissues are loosened.

There is an increase in mobility in the joints of the pelvis and a divergence of the pubic bones.

The changes in the genital tract described above are of extremely important physiological significance for childbirth. Loosening the walls, increasing the mobility and elasticity of the genital tract increases their throughput and facilitates the movement of the fetus through them during childbirth.

Milk glands increase in size, become more elastic, tense. When pressing on the nipple, colostrum (first milk) is released.

Changes in the CNS.

1. Changes in the cortex and subcortex:

o Drowsiness,

o Tearfulness,

o Irritability,

o Insomnia,

o Nausea and vomiting.

2. Changes in smell (to smells that were pleasant).

3. Changes in touch - changes in taste sensations (chalk).

4. Changes in auditory perception - sharp sounds irritate.

External changes in the skin and mucous membranes.

1. Pigmentation on the skin:

On the face according to the type of mask "pregnant - the bridge of the nose, cheeks, around the eyes,

Nipples and areola,

· Along the white line of the abdomen.

2. Sometimes pregnancy scars (“stretch marks”, striae gravidarum) form on the skin of the lateral parts of the abdomen. In connection with the violation of the extensibility of the elastic fibers of the skin, they break, a connective tissue scar is formed. A fresh scar is purple-blue, and then it becomes whitish.

3. Acrocyanosis - blue chin, tip of the nose, ears.

4. Acromegaly - an increase in the protruding parts of the body (arms, legs, nose, ears).

5. Changes in the navel:

At 32 weeks, the navel is retracted,

At 40 weeks, the navel is convex or flattened.

Changes in the cardiovascular system.

The mother's circulatory system during pregnancy is forced to pump more blood to ensure an adequate supply of nutrients and oxygen to the fetus.

Changes:

Increases the thickness and strength of the heart muscles

the pulse and the amount of blood pumped by the heart in one minute become more frequent,

Increases the volume of circulating blood

in some cases, increased blood pressure,

The tone of blood vessels during pregnancy decreases, which creates favorable conditions for increased supply of tissues with nutrients and oxygen.

All of the above changes in the cardiovascular system completely disappear after childbirth.

Changes in the urinary system.

kidneys work hard during pregnancy. They secrete decay products of substances from the body of the mother and fetus (the waste products of the fetus pass through the placenta into the mother's blood). There may be frequent urge to urinate due to compression of the bladder by the enlarging uterus.

Changes in body weight.

In the first 2 months of pregnancy, while the baby and mother are only adapting to mutual coexistence, a woman usually does not gain weight. In addition, at this time, she may be disturbed by toxicosis, which often leads to weight loss.

So, in the 1st trimester of pregnancy, there is no intensive increase, the expectant mother usually gains 1-2 kg. The main events occur later, because the body weight of the expectant mother increases mainly in the 2nd half of pregnancy, when the weekly weight gain averages 250-300 g. If the process goes faster, this may mean the appearance of a problem - hidden, and then obvious edema (dropsy of pregnancy).

For 40 weeks of pregnancy, the expectant mother should gain 10-12 kg. It is believed that, starting from 30 weeks of pregnancy, a woman's weight increases by about 50 g per day, by 300-400 g per week and no more than 2 kg per month.

They are distributed like this:

child - 3300g;

uterus - 900 g;

afterbirth - 400 g;

amniotic fluid - 900 g;

increase in the volume of circulating blood - 1200 g;

mammary glands - 500 g;

adipose tissue - 2200 g;

tissue fluid - 2700 g.

Total: 12 100

Chapter 1 Conclusions

The nurse should also remember to ensure the safety of the conditions for the course of pregnancy, giving recommendations on sexual and physical activity, the right choice of clothing, shoes.

Optimal for the expectant mother is loose, non-constricting clothing made from natural materials. During pregnancy, low-heeled shoes should be worn; in late pregnancy, the center of gravity changes, the risk of falls increases, and the likelihood of varicose veins in the legs is high.

Maintaining the safety of pregnancy may also include the active intervention of a nurse (paramedic) in a woman's work activities, monitoring compliance with labor protection requirements, which may require interaction with the administration and medical services of the enterprise where the expectant mother works. During pregnancy, contact with aggressive chemicals, heavy lifting, prolonged standing on your feet, work associated with vibration, training, overheating or hypothermia are completely unacceptable. The woman's legitimate demands to change the nature of her work during pregnancy should certainly be supported by all those responsible for her health and antenatal care of the fetus. This can be done by a nurse (paramedic), and a midwife, and a doctor observing a pregnant woman.

An equally important activity of the family nurse (paramedic) for antenatal fetal protection is work with the environment of the pregnant woman. In particular, it is necessary to convince her family members of the harmful effects of smoking in her presence, since passive smoking is just as dangerous as active smoking, and no less leads to chronic fetal hypoxia, and ultimately to the birth of a weakened child. Of course, it is quite difficult to achieve a positive result in just words, specific actions are needed (using various methods of treating nicotine addiction, attending smoking cessation courses, etc.).

A pregnant woman should be freed from some household chores, especially those associated with lifting weights (a small child, bags of groceries), moving objects, standing for a long time (ironing clothes, hand washing), contact with detergents, disinfectants, pesticides.

Chapter 2 Conclusions

Pregnancy care is very important. Proper manipulation, observance of asepsis and antisepsis, control over the duration of pregnancy, timely examinations guarantee pregnancy and childbirth without pathologies.

CONCLUSION

Our lives are rapidly changing. Science is constantly moving forward, and thanks to technological progress, many of the problems that existed earlier have disappeared. It is impossible to list all the changes that are happening around us. The main thing remains unchanged - people continue to love, hope, give birth and raise children. And the birth of a person will always be one of the most amazing and significant events taking place in our world.

The hormones secreted by the placenta during pregnancy cause numerous physiological changes in the mother's body that ensure the proper development of the fetus, prepare the body for the upcoming birth and feeding. The nervous system of a pregnant woman is rebuilt in such a way that it subordinates the entire body to one goal - bearing a fetus. In accordance with this, physiological changes occur in its main systems. The cardiovascular system during pregnancy performs more intense work, since a "second" heart actually appears in the body - this is the placental circle of blood circulation. Here the blood flow is so great that every minute 500 ml of blood passes through the placenta. Blood pressure during pregnancy practically does not change. On the contrary, in women who have an increase before or in early pregnancy, it usually decreases. in mid-pregnancy, which is due to a decrease in the tone of peripheral blood vessels under the action of the hormone progesterone. The kidneys during pregnancy function with great stress, as they remove the metabolic products of the pregnant woman herself and her growing fetus from the body. The amount of urine excreted varies depending on the amount of liquid drunk.

During pregnancy, you need to reasonably treat the regime of work and rest. In our country, much attention is paid to the protection of labor of pregnant women. The legislation provides for their release from the moment pregnancy is established from overtime work, night shifts, business trips, work on weekends. Moderate work during pregnancy is necessary - it trains muscles, improves the activity of internal organs and thereby increases overall tone. Good sleep is very useful, so its duration should be at least 8-9 hours, preferably from 22 to 7 hours.

The upcoming birth will require a lot of physical stress from the woman. To better prepare for them, we recommend a special set of exercises that will increase the efficiency and defenses of the body to perform physical exertion during childbirth.

The diet of a pregnant woman should include food enriched with plant fiber to ensure normal bowel activity, which is often disrupted during pregnancy. A healthy diet for a pregnant woman involves excluding confectionery from the diet, in particular, sweets, jams, and sugar. Margarine and refractory animal fats are highly undesirable. They should be replaced with vegetable fats and butter. Syrups, compotes, juices, jelly, decoctions of dried fruits, fresh and frozen fruits, berries, vegetables are very useful. Proper nutrition of pregnant women should contain plant products, flour, cereals, legumes, root crops (excluding root crops with a high content of essential oils - radish, radish).

The main requirement for the hygiene of a pregnant woman is the cleanliness of the body. The skin, along with the lungs, is involved in respiration, excretes some metabolic products with sweat, which facilitates the work of the kidneys, and protects the body from the penetration of pathogenic microbes. Finally, clean skin, fresh underwear contribute to good health and cheerful mood. It is useful to take a warm shower, wipe the whole body with room temperature water daily, followed by rubbing with a hard towel. It strengthens the nervous system, improves circulation and respiration. A pregnant woman should not bathe in a hot bath, from the 32nd week of pregnancy it is forbidden to take a bath, while a shower until the very birth is considered a very useful procedure. Particular attention should be paid to the care of the mammary glands. It is also important to take care of the external genitalia. During pregnancy, you need to be in the fresh air for at least 3 hours a day. It is necessary to maintain cleanliness in the room, systematically ventilate it and do wet cleaning. The air temperature in the room should be no higher than 18-20°C.

MINISTRY OF HEALTH OF THE MOSCOW REGION

State budgetary professional educational institution

Moscow region

"Moscow Regional Medical College No. 3"

NURSING CARE OF A PREGNANT WOMEN IN NORMAL PREGNANCY

70 ways to improve your English (70 tips to improve your English) (Document)

Yashchenko V.V. The cares and joys of a farmer: over 1000 practical tips (Document)

Trubnikov Dmitry. Sea English glossary (Document)

Povny A.V. Collection of practical advice on the operation and repair of electrical equipment (Document)

Laboratory work - Calculation of the city's water supply network on 8 sheets (Laboratory work)

n1.docx

CARE OF PREGNANT WOMEN AND PARTNERS.

BASICS OF OBSTETRIC PHYSIOLOGY AND

PATHOLOGIES

ECTOPIC PREGNANCY

MISSION OF PREGNANCY

PREGNANT HYGIENE

OBSERVATION OF A PREGNANT WOMAN

NUTRITION FOR PREGNANT WOMEN

TOXICOSIS OF PREGNANT WOMEN

PARTNERSHIPS

POSTPARTUM THROMBOPHLEBITIS

THERAPEUTIC-PROTECTIVE AND SANITARY REGIME OF THE OBSTETRIC HOSPITAL

DETERMINATION OF THE DATE OF PREGNANCY AND DELIVERY
What is the duration of a normal pregnancy?
Pregnancy in a woman lasts an average of 280 days, i.e. 40 weeks, or 10

obstetric months. Pregnancy often lasts less than this period

(230-240 days).
How is the estimated due date calculated?
To calculate the due date, add 280 to the 1st day of the last menstruation.

days, i.e. 10 obstetric (or 9 calendar) months, and 7 days. Usually calculation

produce easier - from the date of the 1st day of the last menstruation count back 3

calendar months and add 7 days. For example, if the last menstrual period

started on 11.12, then, counting 3 months ago (11.11, 11.10, 11.09) and adding 7 days,

determine that the due date should be 18.09.
What are the signs of pregnancy?
When determining the duration of pregnancy and childbirth, the time of the first movement is taken into account

fetus. In primigravidas, this happens at 20 weeks, in multiparous - at 18

weeks. To the date of the first fetal movement in primigravidas, 5 obstetric

months (20 weeks), in multiparous - 5 and a half obstetric months (22

weeks). Fetal movement is a subjective sign, which is taken into account as

auxiliary.
To determine the duration of pregnancy, objective data are of great importance.

examinations: the size and shape of the uterus, the volume of the abdomen, the length of the fetus, its dimensions

heads. In the first 3 months of pregnancy, its term is determined by the size of the uterus,

after 4 months - according to the height of the uterine fundus. Later, the volume of the abdomen is measured and

dimensions of the fetus.
How does the size of the uterus change during a normal pregnancy?
At the end of the first obstetric month, the size of the uterus corresponds to approximately

chicken egg, at the end of the second month - a goose egg, at the end of the third month, the uterus reaches

newborn head size. Starting from the fourth month, the size of the uterus is judged by

the height of the fundus of the uterus. At the end of the fourth month (16 weeks), the fundus of the uterus is located on

the middle between the pubis and the navel (4 transverse fingers above the symphysis); towards the end of V

months (20 weeks) - located 2 transverse fingers below the navel; by the end of VI

months (24 weeks) - at the level of the navel, at the end of the VH month (28 weeks) - for 2-3

finger above the navel, at the end of the Vni month (32 weeks) - in the middle between the navel and

xiphoid process. The navel begins to smooth out, the circumference of the abdomen is at the level

the navel is 80-85 cm. At the end of the 9th month (36 weeks), the bottom of the uterus stands at the xiphoid

process (the highest level of standing of the uterus), abdominal circumference 90 cm, navel

smoothed. By the end of the X month (40 weeks), the uterine fundus is determined at the VIU level of the month

(midway between the umbilicus and the xiphoid process). The navel is bulging

abdominal circumference 95-98 cm.
With the same standing of the uterine fundus in VHI and X obstetric months, the abdominal circumference

different, the position of the head is different: in the 8th month, the head stands high above the entrance

in the small pelvis; in the X month, as a rule, it is lowered, and in primigravida it is pressed

or a small segment is located at the entrance to the small pelvis.
How is the length and head of the fetus measured?
The length of the fetus is measured with a tazomer: one button of the tazomer is placed on the lower pole

heads, the other - to the bottom of the uterus, the resulting value is multiplied by 2 and from it

subtract 2-3 cm (depending on the thickness of the abdominal wall). By setting the length

fetus, divide this number by 5 and get the gestational age (in the second half).
The fetal head is measured with a tazometer: the buttons of the tazomer are set to the most

protruding points of the head (usually the forehead and back of the head). Fronto-occipital size

head in the VIII month is on average 9.5 cm, at the end of the IX month - 11 cm, at the end of the X

months - 11.5-12 cm.
ECTOPIC PREGNANCY
What are the causes of an ectopic pregnancy?
An ectopic pregnancy develops when the fertilized

the egg is implanted outside the uterine cavity. Depending on the site of implantation

distinguish between tubal, ovarian and abdominal pregnancy (very rare).
The main cause of ectopic pregnancy is changes associated with

inflammation of the tubes, preventing the normal progression of the egg into the uterus:

the egg settles in the tube and implants in its wall. Usually ectopic

pregnancy is interrupted at the 5-6th week, less often at the 8th or at the beginning of the 12th

weeks.
What are the signs of an ectopic pregnancy?
Until an ectopic pregnancy is terminated, it is characterized by a delay

menstruation, nausea and other signs of normal pregnancy.
Kvass signs of spontaneous termination of an ectopic pregnancy?
Termination of pregnancy occurs according to the type of tubal abortion and according to the type of rupture

pipes. When a pipe breaks, its entire wall is destroyed, a strong

bleeding, quickly leading to severe anemia, life-threatening.
When a pipe breaks suddenly or after a slight physical strain

there is an attack of severe pain in the lower abdomen, accompanied by fainting or

semi-conscious state. The pain radiates to the shoulder, shoulder blade, anus. In connection with

profuse bleeding into the abdominal cavity, anemia rapidly increases: skin and

visible mucous membranes turn pale, breathing quickens, blood pressure

falls, the pulse becomes frequent, soft. The abdomen may be swollen, painful,

palpation is determined by the positive symptom of Blumberg-Shchetkin.
What is emergency care?
If an ectopic pregnancy is suspected, the woman should be immediately

hospitalized by the most convenient mode of transport accompanied by

medical personnel. When the diagnosis is established, immediate

operation. With a large blood loss, blood and blood-substituting fluids are transfused,

use cardiac drugs.
MISSION OF PREGNANCY
What forms of miscarriage are distinguished in clinical practice?
Pregnancy can spontaneously terminate at any time. Interrupt

pregnancy up to 28 weeks is called a miscarriage, or abortion, and at 28-38

weeks - premature birth. Abortions are divided into early (up to 16 weeks) and

late (16-27 weeks). If miscarriage recurs more than 2 times,

this indicates habitual miscarriage.
What are the reasons for miscarriage?
The causes of miscarriage are numerous, complex and may not always be

be clarified. Etiological factors include infectious and

non-communicable diseases of the mother, infantilism, neuroendocrine disorders,

artificial abortions, intoxication of the body, complications of pregnancy,

chromosomal and gene anomalies, diseases and abnormal development of sexual

organs, immunological incompatibility of maternal and fetal blood, injuries,

spermatogenesis disorders. Currently the main cause of miscarriage

consider hormonal disorders, primarily functional

insufficiency of the ovaries and placenta, as well as an infectious factor, in particular

inflammatory processes of the genitals.
What are the common symptoms of an abortion?
In case of premature termination of pregnancy in terms of early abortion, fetal

the egg gradually exfoliates from the walls of the uterus, dies and under the influence of contractions

the musculature of the uterus is expelled from its cavity in whole or in part. At the same time, as

as a rule, spotting appears and intensifies. late abortion and

preterm labor proceeds according to the type of conventional labor: smoothing occurs

and opening of the cervix, rupture of amniotic fluid, birth of the fetus and placenta.
At the beginning of an abortion, there is a feeling of heaviness or dullness, and in a number

cases of cramping pain in the lower abdomen and lower back. This is the most

frequent symptoms of miscarriage. The sensation of pain may be intermittent.

relative rest. Pain indicates irritation of the neuromuscular apparatus

uterus as a result of an increase in its tone or the occurrence of contractions. Second

symptom - bloody discharge from the genital tract, indicating

the detachment of the implant that has begun - it usually happens with early abortions, with

late abortions and premature births are noted in cases of pre-lying

placenta. The amount of discharge depends on the degree of placental abruption.
How is the threat of premature termination of pregnancy treated?
Treatment of the threat of premature termination of pregnancy is carried out in

hospital. The patient is prescribed bed rest, suppositories with papaverine 0.02-

0.03 g 2 times a day, no-shpa, vitamin B. If placental abruption continues,

bleeding intensifies, then, as a rule, curettage of the cavity is performed

uterus to remove the remnants of the fetal egg, pieces of the placenta.
PREGNANT HYGIENE
What is pregnancy hygiene?
Hygiene of pregnant women should include activities aimed at

preservation and strengthening of the health of a woman whose body is experiencing

increased loads, antenatal protection of the fetus, preparation of the woman's body

to the normal course of childbirth and the postpartum period, to lactation and breastfeeding

feeding.
What personal hygiene rules should a pregnant woman follow?
A pregnant woman should take a shower 1-2 times a week, wipe daily

body with a towel soaked in water at room temperature, wash 2 times a day

external genitalia with warm water and soap (vaginal douching is not

sunbathing. Air baths are taken at an air temperature of 20-22

° С, starting from 5-10 minutes - and gradually increasing their duration to

20-30 minutes. In summer, short-term sunbathing is useful, and in winter and autumn -

ultraviolet irradiation. Swimming is allowed in warm weather,

for a short time if the pregnancy is proceeding normally.
What is prohibited during pregnancy?
Smoking and drinking alcohol are strictly prohibited, as poisonous

tobacco smoke products and wine alcohol pass through the plantar barrier and

can cause irreparable harm to the fetus, up to the development of deformities. .
In the first 3 and in the last 2 months of pregnancy, sexual activity is prohibited in order to

prevent infections, miscarriage and premature birth.
What does breast hygiene in pregnant women include?
A pregnant woman needs to systematically prepare the nipples of the mammary glands for

future feeding to prevent their cracks and mastitis. Bras must be

comfortable, made of natural fabrics, match the size and shape of the glands. glands and

nipples are washed daily with soap and water at room temperature and wiped

hard towel. If nipples are flat or inverted, in the last 2 months

pregnancy, they are massaged: daily after lubrication with boric

vaseline, the nipple is captured by the index and thumb and pulled into

for 3-4 minutes (2-3 times).
What are the basic requirements for maternity clothes?
Pregnant women's clothing should be comfortable and free, not restrict the chest.

cage, stomach, do not squeeze the lower limbs. For varicose veins

Elastic sanitary stockings must be worn or placed over the thighs and

shin elastic bandage. From the 7th-8th month of pregnancy for prophylaxis

bandage. Shoes should be in size, with wide heels.
What are the features of the labor regime during pregnancy?
The mode of operation during the normal course of pregnancy is normal with alternation

physical, mental labor and recreation. Pregnant women shouldn't lift weights

make sudden movements, experience psycho-emotional trauma. At home and

work around it, it is necessary to create an atmosphere of attention, care and respect.

Before going to bed, the duration of which should be at least 8 hours,

walks in the fresh air, airing the room, air baths are required.
OBSERVATION OF A PREGNANT WOMAN
What is the role of clinical blood tests during pregnancy?
A clinical blood test during pregnancy is performed several times,

especially in the second half of pregnancy; repeated blood tests give

the ability to timely identify diseases that require special treatment.

All pregnant women take blood twice (in the first and second half of pregnancy)

from the cubital vein for serological examination (Wasserman reaction,

Sachs-George). Treatment of identified patients is carried out in the venereological

dispensary with mandatory involvement in the treatment of the father of the unborn child.
All patients must determine the blood type and Rh affiliation; at

Rh-negative mother often has hemolytic disease

newborn. If a pregnant woman has Rh-negative blood

need to test the blood
and the husband. Leucorrhea in the father is Rh-positive blood and the fetus has inherited

Rh-affiliation of the father, then with such a pregnancy between the mother and the fetus

there is a Rh conflict: the fetus may die in utero, be born

prematurely or with signs of hemolytic disease.
What measures are taken when there is a threat of Rh-conflict between the mother and

fruit?
To increase the resistance of the fetus to the harmful effects of Rh antibodies and

improvement of placental circulation in all pregnant women with Rh-negative

desensitizing treatment is carried out with blood (in the period of 12-14, 22-24, 32-34

week of pregnancy). Therapeutic and preventive measures are designed to

creation of the most favorable conditions for the development of the fetus: food should be

rich in proteins, vitamin C (up to 1 g per day during pregnancy with

short breaks).
What is the role of clinical urine tests during pregnancy?
The kidneys during pregnancy function with great stress, as they

remove metabolic products from the body of both the pregnant woman herself and

growing fetus. Therefore, the urine of a pregnant woman must be examined at every

attending a antenatal clinic. If protein appears in the urine, a pregnant woman

take on a special account, and with an increase in protein, they must be hospitalized.
How is the weight gain of a pregnant woman monitored?
Weighing a pregnant woman is carried out at each visit to the antenatal clinic, not

less than once a month in the first half of pregnancy and every 2 weeks in the second

half of pregnancy. Weigh a pregnant woman without clothes, after urinating

and bowel movements.
What is the rate of weight gain during pregnancy?
In the first weeks of pregnancy, body weight should not increase. From the 16th week

pregnancy is weight gain; from the 23-24th week, the increase is 200 g per

week, and from the 29th week does not exceed 300-350 g. A week before delivery, the weight is usually

decreases by 1 kg, which is associated with fluid loss by tissues. throughout the pregnancy

body weight should increase by about 10 kg (due to the weight of the fetus, amniotic

water and placenta).
NUTRITION FOR PREGNANT WOMEN
What are the basic principles of rational nutrition of a pregnant woman?
Rational nutrition contributes to the normal development of pregnancy, fetus, and

It is also a prevention of the development of large fetuses, which significantly complicate

during pregnancy, childbirth, the postpartum period, neonatal and

postnatal development of newborns.
In the first half of pregnancy, a special diet is not required. The food must be

varied, containing a sufficient amount of proteins, carbohydrates, fats, salts

and vitamins. In the first months of pregnancy are not excluded, if necessary,

spicy and salty dishes, in the second half it is recommended mainly

dairy and vegetable food. Meat and fish should be consumed 3-4 times a week.

Spicy and spicy foods are prohibited, within reasonable limits

carbohydrates, flour products, starch and liquid.
What amount of proteins, fats, carbohydrates and trace elements should be in

daily diet of a pregnant woman?
The amount of proteins and fats is introduced into the daily diet at the rate of 1.5-2 g per 1 kg

woman's body weight. Carbohydrates as the main energy material and source

formation of fats, should be no more than 500 g per day (for obesity

the amount of carbohydrates is reduced to 300-400 g per day). For prevention

late toxicosis of pregnant women table salt in the second half of pregnancy

it is necessary to limit to 5 g per day, liquid to 1-1.2 lava last weeks -

up to 0.8 liters per day. The amount of trace elements, the sources of which are milk,

cottage cheese, eggs, liver, meat, bread, nuts, buckwheat and barley groats, beets, peas,

the second half of pregnancy should be: calcium - 1.5-2 g, phosphorus - 2 g,

magnesium - 0.5 g, iron - 15-20 mg per day.
What is the importance of vitamins for a pregnant woman?

In the diet of a pregnant woman, the vitamins that are part of

a number of enzymes and performing in the body the function of catalysts for processes

metabolism. With a lack of vitamins entering the body of a pregnant woman with

products of dairy and vegetable origin, ready-made

dosage forms.
What is the significance and daily requirement of vitamins A, PP, C, E for a pregnant woman?
Vitamin A (carotene) has an effect on the uterine mucosa, promotes

its regeneration, which is especially important in the postpartum period. Daily dose - 5000

ME, in the last months of pregnancy - 10000-20000 ME.
Vitamin PP (nicotinic acid) is involved in the metabolism of sexual

hormones, in low concentrations has a depressing effect on the contractile

function of the pregnant uterus. The daily dose is 18-25 mg.
Vitamin C (ascorbic acid) - a powerful catalyst

redox processes in the body, potentiates the action

estrogens, enhances the effect of pituitrin and mammophysin on uterine contraction.

The daily dose is 100-200 mg.
Vitamin C is involved in the regulation of calcium and phosphorus metabolism, is used in

obstetric practice for the prevention of rickets in the fetus. Daily dose - 1000 ME.
Vitamin E (tocopherol) plays an important role in the normal course of pregnancy

(fertility vitamin), its deficiency leads to dysfunction of the genital

organs, sometimes to fetal death and miscarriage. The daily dose is 20-25 mg.
What is the importance and daily requirement of B vitamins for a pregnant woman?
Vitamin Bj (thiamine) is involved in the regulation of estrogen hormone metabolism, synthesis

acetylcholine, promotes proper metabolism in the nervous system, liver,

regulates water-salt metabolism. The daily dose is 10-20 mg.
Vitamin B2 (riboflavin) contributes to the normal course of pregnancy and childbirth,

used to prevent threatened abortion, enhances

redox processes in the body. The daily dose is 2-3 mg.
Vitamin B6 (pyridoxine) is essential for the metabolism of essential amino acids

(histamine and tryptophan). The daily dose is 5 mg.
Vitamin B12 (cyanocobalamin) is effective in anemia caused by diseases

gastrointestinal tract and liver, enhances the release of growth hormone.

It is used for fetal hypotrophy. The daily dose is 0.003 mg.
TOXICOSIS OF PREGNANT WOMEN
What are the main symptoms and causes of toxicosis in pregnant women?
Toxicosis of pregnant women is a multi-symptomatic condition that occurs when

violation of the processes of adaptation of the woman's body to pregnancy. Wherein

there may be significant changes in metabolism, gland function

internal secretion, cardiovascular and other systems, in the content

electrolytes, hormones.
Predispose to the occurrence of toxicosis various diseases transferred

before pregnancy or during it, malnutrition, nervous strain,

fatigue, lack of sleep.
The development of late toxicosis is based on changes in capillary

circulation and vascular tissue permeability, i.e. the main disorders

occur in the vascular system. Distinguish toxicosis of pregnant women first

half of pregnancy, or early, and second half of pregnancy, or

later.
What refers to early toxicosis of pregnant women?
Vomiting, salivation, jaundice, dermatoses.
What is pregnancy vomiting?
Vomiting of pregnant women - the most common form of early toxicosis - is repeated

several times a day, most often after meals, accompanied by nausea,

decrease in appetite. There are mild, moderate (or moderate) and

excessive (or severe) vomiting. With a mild form, vomiting is repeated 3-5 times a day.

day, usually after eating, does not affect the general condition of the pregnant woman, it is easy

treatable and resolves on its own after 2-3 months

pregnancy. The moderate form is characterized by an increase in vomiting that occurs

regardless of food intake, up to 10-12 times a day and is accompanied by a decrease

body weight, general weakness, tachycardia, dry skin, decreased diuresis. At

excessive form of vomiting is repeated up to 20 or more times a day and causes severe

the condition of the patients. Hunger and dehydration lead to exhaustion, falling

body weight, loss of strength.
How does salivation occur in pregnant women?
Salivation may accompany vomiting and occur as an independent early

toxicosis of pregnant women. Daily salivation varies, sometimes reaching 1 liter and

more. Salivation depresses the psyche of the patient, causes maceration of the skin and

mucous membrane of the lips. Significant salivation causes symptoms

body dehydration.
What is the treatment for vomiting and salivation in pregnant women?
With vomiting and salivation of pregnant women, psychotherapy is carried out,

therapeutic and protective regimen, physiotherapy (ultraviolet irradiation,

electrosleep), drug treatment (bromine with caffeine, vitamins A, group B). AT

in severe cases, hospitalization is indicated.
What is pregnancy jaundice?
Jaundice of pregnancy is rare, manifested by icteric staining of the skin,

her itching, while the liver is affected. Pregnant women with jaundice urgently

hospitalized to determine its cause.
What are dermatoses of pregnancy?
Dermatoses of pregnancy include a group of skin diseases that appear during

pregnancy and disappearing after its completion. The most common itching

pregnant women, which captures the whole body (more often localized in the area of ​​external

genital organs), causes insomnia, irritability. Less common eczema

pregnant, affecting the skin of the mammary glands or abdomen, thighs, arms. Sometimes

dermatoses of pregnant women can occur in the form of scarlatina-like rashes

skin or hives.
What conditions are related to pretoxicosis of pregnant women?
Expressed forms of late toxicosis of pregnant women are usually preceded by

conditions called pre-toxicoses. Doctor of women's consultation together with

a nurse identifies such conditions and takes measures to treat them,

to prevent more severe forms of toxicosis.
Pretoxicoses of pregnant women include such conditions in which there are:

1) increase in maximum blood pressure by 10-20 mm Hg. Art.,

minimum - by 5-10 mm Hg. Art. compared to baseline before pregnancy or

in the first 9-10 weeks of pregnancy; 2) pastosity of the shins or feet; 3) traces of protein

in urine. The state preceding toxicosis is indicated by a decrease in the daily

diuresis up to 500 ml, the presence of negative diuresis, an increase in the circumference of the lower leg,

measured at the level of 10 cm above the outer ankle, 8-10% in relation to its

size in the first half of pregnancy.
How is pretoxicosis treated?
For the treatment of pretoxicosis of pregnant women, a rational daily regimen is recommended,

appropriate diet, medications. Requires maximum

eliminate stressful situations, provide daytime rest and night sleep

lasting more than 8 hours. The amount of liquid is limited to 1 liter,

table salt up to 3-5 g. Unloading is carried out once or twice a week

g and glucose 1.0 g orally 3 times a day, oxygen cocktails or oxygen

tent. Light diuretics are used for 3-4 days.
What refers to late toxicosis of pregnant women?
Edema, nephropathy, preeclampsia, eclampsia.
What are pregnancy edema?
Water and sodium retention in tissues during pregnancy is clinically manifested by edema,

which are initially localized on the legs and feet, then can spread to

thighs, external genitalia, abdominal wall, face, upper limbs

(often observed simultaneously on the lower extremities and face). Sometimes

latent edema is formed, which is evidenced by an increase in body weight over

300-400 g per week. In 20-24% of cases, edema of pregnant women turns into nephropathy.
What is Nephropathy of Pregnancy?
Nephropathy of pregnancy is characterized by a triad of symptoms: edema, increased

blood pressure, the appearance of protein in the urine.
Pregnancy nephropathy often occurs against the background of extragenital diseases.

(hypertension, chronic nephritis, heart defects, diabetes mellitus).

Nephropathy most often develops at 32-36 weeks of gestation, although associated

its forms can be observed as early as 24-25 weeks.
What are the basic principles for the treatment of nephropathy?
Treatment of all forms of nephropathy in pregnant women, including medical and protective

regimen, a rational diet, the use of antihypertensive, diuretic,

antihistamines, improvement of microcirculation, carried out only in

hospital.
What is preeclampsia in pregnancy?
Preeclampsia is characterized by the addition of signs to nephropathy

functional disorders of the central nervous system that occur in

the result of increased intracranial pressure due to cerebral edema. Main

symptoms of preeclampsia: headache, blurred vision (flickering or "fog" in

eyes), pain in the epigastric region. Patients are usually agitated, restless or,

on the contrary, they are inhibited. Sometimes there is nausea or vomiting, the face is hyperemic

with cyanosis of the lips and wings of the nose. Most often, preeclampsia occurs against a background of severe

forms of nephropathy. Preeclampsia can be complicated by cerebral hemorrhage and

other vital organs, as well as go, sometimes quite quickly, into

eclampsia. Preeclampsia must be differentiated from acute

gastrointestinal disease and hypertensive encephalopathy. At

diagnosing preeclampsia in the antenatal clinic, the patient should be delivered

to the hospital under anesthesia for treatment. Often shown early

abortion.
What are the symptoms of eclampsia in pregnancy?
Eclampsia is the final stage in the development of late toxicosis and

characterized by seizures. Usually occurs against the background of preeclampsia. For

provocation of a seizure is sufficiently sharp light, noise, painful stimuli.

The seizure lasts 1-2 minutes and develops in a certain

sequences. In the first period (20-30 seconds) - preconvulsive -

small fibrillar twitches of facial muscles appear, spreading to

upper limb muscles. In the second period (20-30 seconds) occurs

tonic contraction of all skeletal muscles, the body stretches and tenses,

the spine is bent. Breathing and consciousness are absent, pupils are dilated,

increasing cyanosis of the skin and mucous membranes. In the third period (30-60 seconds)

clonic muscle spasms continuously following each other

trunk and limbs, the face becomes purple-blue. By the end of the attack

hoarse breathing appears, foam with an admixture of blood is released from the mouth

(biting the tongue). In the fourth period, the seizure resolves: convulsions

stop, breathing is restored, the face turns pink. The patient is in

coma, which can be of different duration, sometimes up to

next seizure. Consciousness is restored slowly. About what happened

the patient does not remember.
How is eclampsia pregnant treated and cared for?
Treatment is inpatient only. During a seizure, the nurse should

be near the patient, as it is necessary to prevent biting of the tongue and

fall injuries. To prevent biting the tongue into the patient's mouth from the side

a spoon wrapped in gauze is inserted between the molars. If appears

breathing, short-term oxygen supply is shown to eliminate hypoxia and

general anesthesia.
How is the prevention of toxicosis of pregnant women carried out?
Prevention of toxicosis of pregnant women includes the whole complex of necessary

hygiene measures, which in some cases must be carried out even before

pregnancy. For the prevention of early toxicosis,

the fight against abortion, the treatment of chronic diseases, the creation of a pregnant

emotional peace. In the prevention of late toxicosis, compliance with

rational nutrition in the second half of pregnancy, especially abstinence from

abundant intake of liquid and salt, the correct mode of work and rest,

elimination of mental and physical overload.
PHYSIOPSYCHOPROPHYLACTIC PREPARATION FOR BIRTH
What does physiopsychoprophylaxis of childbirth include?
Preparation of pregnant women for childbirth is a set of activities,

including physiotherapy exercises, ultraviolet irradiation and special

lessons.
What is the essence of psychoprophylactic preparation for childbirth?
The method of psychoprophylactic preparation of pregnant women for childbirth is based on the doctrine of

labor pain, in the formation of which not only irritation of the nervous

endings from the uterus and other genital organs, but also conditioned reflex

component associated with the effects on the second signal system. Wherein

It is recognized that the leading role in the occurrence of pain belongs to the cortex

brain.
The essence of the method is to create by means of verbal influence

more correct functional relationship between the cerebral cortex and

subcortical formations, reduce excitation in the subcortical centers and

balance the processes of excitation and inhibition in the cerebral cortex.
What is the purpose of psychoprophylactic preparation for childbirth?
The goal of psychoprophylactic preparation is to eliminate the fear of childbirth and other

negative emotions that arise during pregnancy, develop and consolidate

ideas about the birth act as a physiological and non-painful process,

bring up a new positive feeling associated with the upcoming motherhood.
How is psychoprophylactic preparation for childbirth carried out?
Psychoprophylactic preparation of pregnant women for childbirth begins with the first

visits to the antenatal clinic.
For classes on psychoprophylactic preparation of pregnant women for childbirth, which

carried out by a doctor or a specially trained midwife, a special room is allocated,

equipped with couches and teaching aids (drawings, posters, dummies). Total

5 lessons are held.
What is the role of exercise in the normal development of pregnancy?
Systematic physical education increases the body's resistance,

create a feeling of cheerfulness, strengthen the nervous system, improve the general condition,

appetite, sleep, work of the cardiovascular system, respiration, gastrointestinal

tract. Physical exercise strengthens the muscles of the abdominal wall, pelvic floor,

eliminate congestion in the pelvis and lower extremities, contribute to

the correct location of the fetus in the uterine cavity, the normal course of childbirth and

postpartum period. Physically trained women know how to manage their

breathing, which allows you to quickly and more fully saturate the body with oxygen.
How are physical education classes conducted?
Physical education classes are carried out mainly in a group way in the women's

consultations under the guidance of a physiotherapy instructor or

specially trained midwife with constant medical supervision. Allowed

performing physical exercises after appropriate training

individually at home with the condition of visiting a antenatal clinic every 10

days to check the correctness of the exercises.
Physical activity should be changed depending on the duration of pregnancy.

The duration of classes should not exceed 15-20 minutes. Study

well-ventilated and lit room in a special, unobstructed

clothes movement. If exercise makes you feel tired,

shortness of breath, increased heart rate - it is necessary to alleviate them and

consult a doctor. Jumps should be excluded from the complex of exercises,

significant straining, sudden movements.
Physical education can only be recommended to healthy women with

normal course of pregnancy.
PARTNERSHIPS
How is childcare provided?
The postpartum period lasts 6-8 weeks. Postpartum cleansing, or

lochia, the first 4 days are bloody in nature, and then turn pale, their number

gradually decreases; they have a characteristic smell of dampness. Appearance

a fetid odor indicates an incorrectly current postpartum period and

the need for appropriate remedial measures. Postpartum uterine contractions

are often painful, especially during breastfeeding. If a

they are very painful, you can give the puerperal as an analgesic

analgin, antipyrine or apply a candle with papaverine. External genitalia

the organs are washed, then dried with a dry sterile tupfer on a forceps, in

further (at home) drained with a special towel. If urination is

the first days after childbirth are somewhat difficult, hexamethyleptetramine is prescribed and

bearberry decoction. If the mother is unable to urinate on her own,

apply a heating pad to the bladder area, give a warm vessel, subcutaneously

enter magnesium sulfate, pituitrin. If these measures are unsuccessful within 7-8 hours

after childbirth, catheterization is performed as prescribed by the doctor.
In the first postpartum days, independent bowel function is difficult. On the 3rd

the day after childbirth, they put an enema or cleanse the intestines with a laxative.
Underwear and bedding should be changed every 4-5 days. If a woman is strong

sweating, linen should be changed more often. It is also necessary to change the bedding frequently (4-5

once a day), especially if the discharge is plentiful.

You can sit on the bed of the puerperal from the 2nd day of normal postpartum

period, and walking - from the 3rd day. Recently, healthy puerperas have to walk

allowed from the 2nd day after birth.
What are the characteristics of nutrition in the postpartum period?
On the first day, the puerperal receives liquid food, and on the following days passes

on a regular table. Food should be well cooked, tasty, rich

vitamins. From liquids, you can give tea, weak coffee, mineral water, fruit drink,

boiled water in a cool or warm form at the request of a woman.
Products passed by relatives must be strictly controlled

nurse. The number of products transferred and the assortment are usually

indicated in the rules of the obstetric hospital. Products must be in new

cellophane bag or wrapped in a clean napkin (clean paper).
How is the gymnastics of puerperas carried out?
In the postpartum period, gymnastics is carried out by a nurse collectively in

ward with all healthy puerperas. Gymnastic exercises haunt

the goal is to teach the puerperal to breathe correctly and deeply, to strengthen the muscles of the abdominal

press and pelvic floor, activate the muscular system and along with early

getting up to promote more brisk blood circulation. Gymnastics

is carried out daily in the morning, starting from the 2nd day after childbirth, after breakfast,

in summer - with open windows, in winter - after thorough ventilation of the ward.

Duration of classes - from 5 to 15 minutes, depending on well-being

(pulse, respiratory rate) of the puerperal. It is important that every postpartum woman continues

and regularly do gymnastics at home.
What regimen should the puerperal follow after discharge from the maternity

hospital?
In the maternity hospital, the puerperal is instructed about the rules of home regimen,

the implementation of which is checked by a nurse during patronage

home visits.
Sexual life with a normal postpartum period can be

resume no earlier than 8 weeks after birth, preliminarily

after consulting with a doctor.
The puerperal should observe the correct mode of work and rest: at home

work to be included gradually; sleep at least 8 hours a day and be sure to rest

afternoon; avoid heavy lifting and work that involves a lot of physical

load; to carry out gymnastics at first according to the scheme obtained in the maternity hospital, and

belts with water at room temperature with soap (for children), while washing and

milk glands; wash every other day in the shower with warm water and soap and a washcloth.

You can visit the bath or use the bath no earlier than 7-8 weeks after

childbirth. Mothers should wash their hands thoroughly before every feeding.

child and before eating, after cleaning the room, using the restroom, etc.

Nails should be cut short and not varnished. Morning and evening should

wash with warm water with baby soap or a solution of calendula (1 teaspoon

a spoonful of calendula tincture per 1 liter of boiled water); dry the genitals

washing with a special towel. It is necessary to observe the hygiene of linen and clothes;

change underwear every 3-4 days and bedding at least once a week; on the

put on a nightgown at night; wear a bra that is well supported and not too tight

squeezing the mammary glands, often change it; wear a bandage for 4

months after childbirth, and in some cases (with a very stretched, sagging abdomen)

Constantly. At least 3-4 hours daily should be in the fresh air,

thoroughly ventilate the room and bedding.
What diet should be followed by the puerperal after discharge

from a maternity hospital?
You need to eat fresh food. Especially useful are buckwheat and

oatmeal with milk, kefir, curdled milk, varenets, cottage cheese, honey, jam, tea with

milk, fruit and vegetable juices, berries, boiled and raw fruits after

washing them with boiled water. Do not eat spicy food, alcohol

beverages. It is important to monitor daily bowel movements.
How many days after childbirth does the puerperal visit the antenatal clinic?
The puerperal should visit the district doctor of the antenatal clinic approximately

7-10 days after discharge from the maternity hospital. In case of occurrence of any

complications (fever, bleeding, excessive engorgement

mammary glands, the appearance of painful nipple cracks, etc.) should be immediately

go to a women's clinic.
MASTITIS
What causes mastitis in the postpartum period?
In the postpartum period, acute mastitis (inflammation of the breast) is most often

It is caused by Staphylococcus aureus, which is resistant to many antibiotics.

The causative agents of infection enter the mammary gland mainly through

cracks in the nipples (lymphogenous) or through the milk ducts.
What forms of mastitis are isolated in clinical practice?
The inflammatory process captures individual lobules of the gland, and often whole

lobe (serous mastitis). If the infiltrate does not resolve, then it occurs

suppuration (purulent mastitis). In severe cases, it comes to phlegmonous

mastitis.
What are the main symptoms of mastitis?
Symptoms of the disease depend on the stage of the process. characteristic feature

mastitis in modern conditions is its late onset, mainly

after discharge of the puerperal from the hospital (at the 2-3rd week after childbirth). Mastitis

begins acutely with the appearance of pain in the affected mammary gland, a sharp rise

temperatures up to 38-39 "C. Characterized by chills and poor general health. Pain in

mammary gland gradually increases, especially when feeding a child. Gland

increases in volume, the skin in the affected area is somewhat hyperemic. At

palpation in the thickness of the gland, areas of densely elastic tissue are determined

painful textures. After 1-3 days, serous mastitis turns into

infiltrative. Under the changed area of ​​the skin begins to palpate

dense sedentary infiltrate, painful on palpation; often

there is an increase and soreness of the axillary lymph nodes.
With suppuration of the infiltrate, the general condition worsens significantly, high

temperature becomes constant, there is severe pain in

affected mammary gland, chills.
What is emergency care and treatment for mastitis?
With serous and infiltrative forms of mastitis, it is necessary to empty the milk

gland (expressing milk with hands or a breast pump). To improve outflow

milk is injected intramuscularly with 1 ml of oxytocin solution. In the initial stage

disease, short-term use of a local ice pack is acceptable - on

20-30 minutes with breaks of 20 minutes. Moving on to treatment

warming compresses with Vishnevsky ointment or butadiene ointment.

Considering the dominant role of Staphylococcus aureus in

initial forms of mastitis, semi-synthetic penicillins are prescribed:

oxacillin sodium salt, or ampicillin sodium salt, or

ampiox-sodium. With insufficient effectiveness of antibiotic therapy

sulfonamides are additionally prescribed. Along with this, the means

increasing the specific immunological reactivity of the organism:

antistaphylococcal gamma globulin 5 ml (100 IU) intramuscularly every other day;

antistaphylococcal plasma, 100-200 ml intravenously;

adsorbed staphylococcal toxoid 1 ml subcutaneously with an interval of 3-4

days, for a course of 3 injections; transfusion of blood plasma in 150-300 ml. Enter

antihistamines.
POSTPARTUM THROMBOPHLEBITIS
What is the general characteristic of postpartum thrombophlebitis?
Postpartum thrombophlebitis is an inflammation of the vein wall with subsequent

the formation of a thrombus in this area, completely or partially covering

vessel lumen.
By localization, thrombophlebitis is divided into thrombophlebitis of the veins of the uterus, veins of the pelvis and veins

hips. Thrombophlebitis of the veins of the uterus occurs on the basis of endomyometritis.
What are the main symptoms of this complication?
The general condition of the patient worsens, the pulse becomes frequent, superficial.

The discharge is bloody and quite profuse. Under adverse conditions

the process extends to the veins of the pelvis. As the process progresses

thrombophlebitis of the femoral veins occurs, which is clinically manifested on the 2nd-3rd

week after childbirth. Initially, chills, rapid pulse, high temperature,

pain in the legs, especially in the calf muscles. Locally determined smoothness

inguinal region, induration and soreness along the vein, swelling of the leg, sometimes sharply

expressed. Elevated temperature lasts 2-3 weeks, swelling - 1-2 months.
What are the possible complications of thrombophlebitis?
With an unfavorable course, thrombophlebitis can suppurate and be the main

source of septicopia. Dangerous pulmonary embolism on the soil

thrombophlebitis.
What treatment do patients receive?
Patients are shown absolute rest with a high position of the legs (with thrombophlebitis

hips). Do not use intravenous infusions. Placed on the lower abdomen

ice pack showing leeches along the affected leg vein. Antibiotics

combined with the use of antispasmodics (promedol, papaverine). In some cases

surgical operation - thrombectomy is shown.
After suffering thrombophlebitis, it is recommended to bandage the legs with an elastic

bandage or wearing elastic stockings.
THERAPEUTIC-PROTECTIVE AND SANITARY REGIME OF OBSTETRIC

HOSPITAL
What is a health care regimen?
Therapeutic-protective regime implies careful and preventive

attitude to the requests of patients, calm tone in conversation, cleanliness. it

all - the most important tasks of a nurse working in an obstetric hospital,

in the antenatal clinic and polyclinic. Positive emotions help

increase the reactivity of the body, faster recovery. pregnant,

especially in pathologically proceeding pregnancy, puerperas after

endured great physical and mental stress, which are childbirth,

need favorable conditions for rest and sleep. Need to support

appropriate room temperature. The mother should be provided with

during the day at least 8-9 hours of good sleep with mandatory continuous

night sleep for at least 6 hours. All manipulations, diagnostic and therapeutic

procedures should be carried out by a nurse painlessly.
It is necessary to try to ensure that every pregnant woman is prepared in a timely manner in

antenatal clinic, at the feldsher-obstetric station to a painless

the course of childbirth by conducting special classes - conversations according to the method

psychoprophylactic training.
What sanitary and hygienic and disinfection measures are carried out in

maternity ward?
The sanitary and hygienic maintenance of the maternity bed plays an important role in

prevention of postpartum infections. The couch in the examination room must be covered

oilcloth, which must be treated with a disinfectant solution after

examining every woman. Before the examination, each woman is laid a clean

lining diaper.
In the delivery room, an oilcloth mattress is wiped with warm water after each birth.

soapy water to remove the blood, then a solution of mercury dichloride (mercuric chloride) or

lysoform and cover with a clean lined oilcloth, and put under the woman in labor

sterile diaper. The lining oilcloth is washed in the washing room on the installed

inclined board under running warm water with soap and a brush, then washed

mercury dichloride solution (sublimate) and dried on a special rack.
Each puerperal must have an individual vessel with a number,

corresponding to the number of this bed, which is boiled once a day, and after each

use, wash with water and a disinfectant solution.
What sanitary-hygienic and disinfection measures are carried out

after discharge of puerperas from the hospital?
After discharge of the puerperal, the bed and oilcloth are washed with water and disinfectant.

solution, mattress, pillow and blanket are aired for at least a day. Disinfect

her. individual vessel, for which they first rinse with tap water, and then

steam sterilized or boiled. Linen removed from the patient should be

separately, before being sent to the laundry, it is soaked in a solution of lysol in

special tank with a lid.
In the obstetric department, as well as after feverish or dead puerperas

processing is carried out especially carefully: the beds are washed and treated with a solution

mercury dichloride, mattresses are ventilated for 2 days.

Theme number 10 Pregnancy.

1. Pregnancy. Anamnesis of life. Special anamnesis.

2. Signs of pregnancy. Diagnostic methods.

3. Physiological course of pregnancy.

4. Features of nursing care for a pregnant woman.

Pregnancy (gestation) - the state of a woman in the period between fertilization and childbirth. It is important to know that pregnancy is not a disease. The state of pregnancy is a set of biological changes that occur in the mother's body. The normal development of pregnancy is associated with a complex of adaptive reactions of a woman aimed at the optimal development of the fetus.

Anamnesis of life.

Examination of a woman who applied to the antenatal clinic about pregnancy begins with a survey to find out the state of her health and the health of the father of the child in the present and past (past diseases and their complications), social status and the presence of occupational hazards. Particular attention should be paid to the inadmissibility for a pregnant woman: smoking, drinking alcohol, drugs.

For timely preventive and curative measures, it is necessary to have information about tuberculosis, including close relatives, syphilis, gonorrhea, mental illness, etc.

Special history

Its purpose is to collect information about the presence of pregnancy in the past and their course.

Were there any disorders in the early and late stages of pregnancy in the form of salivation, nausea, vomiting, was the woman hospitalized due to these disorders.

Whether the pregnancy ended in a normal full-term fetus or in a state of asphyxia or stillbirth

How was the postpartum period

All this is recorded in the pregnant woman's card to draw up a plan for the management of the pregnant woman, to prevent and treat pregnancy complications, and to reduce the risk of having a child with health problems.

Signs of an onset pregnancy

Doubtful (subjective):

- nausea and vomiting

- heartburn

- constipation

- fatigue

probable signs, which occur usually during pregnancy, but sometimes a single sign can be observed in non-pregnant women.

- delay of menstruation for at least 10 days and dyspeptic symptoms

- swelling of the mammary glands, brown pigmentation around them, the release of colostrum from the nipple when pressed

- pigmentation of the white line of the abdomen, frontal tubercles, cheekbones, labia majora

- enlargement and change in the shape of the uterus. A vaginal two-handed examination allows you to establish pregnancy (a sign of pregnancy according to Snegirev, according to Gorvits and Gegar)

To establish pregnancy in the early stages, it is advisable to examine the woman again a week after treatment.

Laboratory research methods for the presence of pregnancy in the early stages:

Radioimmunological method for determining hemoglobin X in blood serum 5-7 days after conception

ELISA tests 1-2 weeks after conception

Ultrasound at 2-3 weeks of pregnancy. Registration of S\B fetus from 4-5 weeks.

Special test - systems that allow women to determine the presence of pregnancy on their own.

Early pregnancy detection - an important point for determining the estimated time of birth. With a 28-day menstrual cycle with ovulation on days 14-15, it is necessary to add 9 months and 7 days to the date of the first day of the last menstruation, or subtract three months from the first day of the last menstruation and add seven to the resulting number.

The duration of pregnancy is 280 days or 40 weeks from the first day of the last menstruation. If the menstrual cycle exceeds 28 days, then the duration of pregnancy increases by approximately 1 day, for each day of the menstrual cycle.

Reliable signs:

Indisputably confirm pregnancy, refer to the diagnosis of late pregnancy.

Sensation of fetal movements between 16-20 weeks after the last menstrual period

Listening to the fetal heartbeat with the help of auscultation from 17-19 weeks, the frequency of C / B 120-140 per minute, ECG, FCG, cardiotachography from 12-14 weeks

Determination by palpation of the abdomen of the parts of the fetus

Determining the length, weight of the fetus and the size of its head in various ways

At the first visit to the antenatal clinic in order to establish pregnancy in accordance with the order of the Ministry of Health of the Russian Federation of 2003 No. 50, a second visit to the doctor and obtaining laboratory tests after 7-10 days, and then visit at least 1 time per month until 28 n / g after 28 n / g 2 times a month. At each visit, a pregnant woman measures body weight, A \ D, heart rate, performs an external obstetric examination, determines the position of the position and presentation of the fetus, listens to heart sounds, counts the frequency of fetal movements (normally three movements in 30 minutes). Clinical blood test at the first visit, at 22 and 32 n / g. Clinical analysis of urine at each examination (at least 4-15 times). Blood on RW at first examination and 32 weeks of gestation. Blood for HIV infection 3 times during pregnancy. Determination of blood type and Rh factor at the first visit. With a Rh negative factor in a woman and if the husband has a positive Rh factor, blood is examined for Rh body monthly. Bacteriological examination of the detached vagina at the first visit and 32 n/g. During pregnancy, a woman should be examined by a therapist 2 times, an ophthalmologist, an ENT specialist, a dentist once and according to indications.

Physiological course of pregnancy

The body weight of a woman by the end of pregnancy increases by 10-12 kg. Weekly weight gain in the second half of pregnancy is 300- 400 gr.

The tone of the parasympathetic nervous system increases - nausea, vomiting, changes in taste, smell, hypersalivation, a tendency to dizziness, constipation appear.

A complex restructuring in the body is due to the appearance of new endocrine glands - the corpus luteum, the placenta, which produces chorionic gonadotropin, placental lactogen, estrogens and progesterone. The placenta provides transport, deposition, excretory, nutrition of the fetus, respiratory function, immunobiological protection of the fetus. The placenta together with the fetus forms the fetoplacental complex. By the end of pregnancy placenta weight is 500-600 gr., diameter 15-18 cm, thickness 2-3 cm. The placenta is connected to the fetus by the umbilical cord, in which two arteries and one vein pass. The length of the umbilical cord by the end of pregnancy is on average 50 cm. The placenta + umbilical cord and fetal membranes form the afterbirth. The fetal egg forms two shells: chorion villous and water. The cavity of the aquatic membrane is filled with amniotic fluid, their accumulation contributes to an increase in the volume of the egg, protects against injuries from outside. They contain salt protein, vitamins, hormones. In the cavity of the egg, the fetus is actively moving. Normal quantity amniotic fluid from 1 to 1.5 liters.

Respiratory system. During pregnancy, the load on the lungs increases. For the normal supply of oxygen to the fetus, the respiratory rate increases by 10% with unchanged VC.

The cardiovascular system- an increase in the network of blood vessels in the uterus, the appearance of placental circulation, displacement of the heart upward by the diaphragm, can lead to partial hypertrophy of the heart muscle, physiological tachycardia appears. Systolic and diastolic blood pressure in the second trimester decreases by 5-15 mm. RTST. Lowest at 28 weeks. Then it rises and by the end of pregnancy corresponds to the indicators before pregnancy.

Hematopoietic system. Hemoglobin content. Decreases by the third trimester. The smallest value for a period of 32-34 n / g - 110 gr. per litre.

kidneys. Their function during pregnancy changes significantly. The renal pelvis expands, the ureters lengthen and expand. At the beginning of pregnancy, women complain of frequent urination, which is due to the pressure of the pregnant uterus on the bladder. Towards the end of pregnancy, these phenomena may increase, and some women may experience involuntary release of urine when coughing and sneezing.

Support- propulsion apparatus. Changes in it occur under the action of relaxin, which is formed in the placenta. The divergence of the pubic bones by 0.5 cm is considered normal.

Milk glands. The mass increases due to the increase in the number and volume of lobules.

Nursing monitoring of the development of pregnancy consists of several stages:

Knowledge and implementation of standards for the management of pregnant women prescribed in the orders of the Ministry of Health of Russia.

Knowledge of the long-term consequences if a woman or a married couple works in adverse conditions or lives in an area polluted by man-made waste.

At the first visit to the antenatal clinic, it is necessary to determine the degree of possible risk of violations of the course of pregnancy, the health of the fetus and newborn. To this end, the midwife fills out a questionnaire, and the doctor determines the level of risk for each individual woman. According to risk indicators, a forecast is made for the health of the fetus and newborn with the development of preventive and therapeutic measures.

With the threat of termination of pregnancy, pregnancy with a negative Rh factor, the pregnant woman is hospitalized in a hospital and the nurse takes actions according to the doctor's prescriptions, and also talks with the pregnant woman about proper nutrition, daily routine, the dangers of alcohol, smoking, prepares the pregnant woman for childbirth, teaches special techniques breathing, self-anaesthesia during contractions and behavior during childbirth.

When a woman works in harmful and dangerous working conditions, a medical worker is obliged to resolve the issue of transferring a pregnant woman to easy and harmless work. (according to article 264 of the Labor Code of the Russian Federation and hygiene recommendations for the rational employment of pregnant women.)

The employer must bear social responsibility for the health of a woman of reproductive age. A woman must be employed during the first 11 days of the onset of pregnancy, since malformations of the fetus are formed at this time. To transfer to another job, she is issued a medical report (form 084\y).

A pregnant woman is obliged to follow the rules of a healthy lifestyle and not harm the unborn child.

Antenatal prophylaxis of the health of the unborn child is also carried out by the nurse of the children's polyclinic in the implementation of prenatal patronage.

Control questions and tasks on topics No. 3 and 10

1. Describe the process of fertilization, the stages of fetal development.

2. Name the critical periods of intrauterine development

3. Indicate the causes that cause disturbances in the development of the fetus and newborn.

4. How to diagnose pregnancy? List the signs of pregnancy.

5. What changes occur in a woman's body during pregnancy?

6. What measures should a medical worker take if a pregnant woman works in harmful and dangerous working conditions?

7. Compile material for a conversation with a pregnant woman on nutrition, motor mode, breast preparation for lactation.