Presumptive, Probable and Positive Signs of Pregnancy - Essay Example

? Presumptive, Probable and Positive Signs of Pregnancy Presumptive Signs When a woman is pregnant, there are several presumptive signs that occur. In the very early stage, there are subjective signs that the woman experiences. These signs do not confirm a pregnancy, because there could be many other things that might cause these same signs. When there are several different signs that occur at the same time, however, these signs can be diagnostic of pregnancy. The first sign is amenorrhea, which essentially means that the woman stops getting her period. This is especially true with women who have fairly regular cycles. If there are one or two missed periods, then this can suggest pregnancy. Morning sickness is another presumptive sign of pregnancy. Although this is referred to as morning sickness, this is really a misnomer, as the nausea that is associated with early pregnancy can occur anytime during the day. The variations that a woman might have is that certain foods might taste differently than before, and certain odors might also cause nausea. The nausea that is associated with pregnancy often occurs beginning in the sixth week after the first day of the last menstrual period and this nausea may last for 6 to 12 weeks, often ending at the beginning of the second trimester. Some women may still experience nausea and vomiting after this time frame, but this is not usual. Other signs of early pregnancy include excessive fatigue, which may begin a few weeks after the first day of the last menstrual period, and this excessive fatigue may last throughout the first trimester. Urinary frequency is another sign of early pregnancy, in the first trimester. This is because the uterus is enlarging, which puts pressure on the bladder. The urinary frequency often disappears after the first trimester, as the uterus rises higher in the abdomen, then returns towards the end of pregnancy, as the uterus once again puts pressure on the bladder. Breast changes are another presumptive sign of pregnancy. This means that the breasts may become enlarged, there might be tingling and tenderness, and the aureolas might become darker. The veins in the breasts may become more visible to the naked eye. These changes are especially pronounced in women who have fair skin. Another presumptive pregnancy sign is quickening, which is fetal movement. This might be a fluttering in the abdomen that increases in duration and frequency. This starts occurring around the 16th week, so this is really a presumptive sign that is a second trimester sign. The movement eventually become distinctly fetal movements, as the woman first starts feeling movements that do not necessarily mean pregnancy, progressing to movements that definitely do mean pregnancy - such as the baby kicking and turning. Another sign of early pregnancy is libido changes – this might mean that the woman either wants to have more sex, or doesn’t want to have as much sex as she did before she became pregnant. A woman might also experience strange cravings – the old cliche is that a woman might suddenly crave pickles and ice cream together, but the cravings can be something more subtle. Perhaps she suddenly craves oysters, where she didn’t like oysters before. She might experience colostrum from the breasts, which is discharge. Her abdomen might become enlarged. Montgomery’s tubercules is another sign – these are the tiny bumps which are on a woman’s aureolas, that become more pronounced during pregnancy. Braxton Hicks contractions are another possible sign of pregnancy - around six weeks of pregnancy, the uterus starts to contract periodically, although this is almost imperceptible to most women. Probable Signs of Pregnancy Probable signs are more diagnostic of pregnancy than are the presumptive signs, although even these signs are not definitive, in that these signs can occur without the woman being pregnant. One of the signs is that the vagina and the uterus change. The cervix becomes softer. There is also a dark violet coloration of the vagina, vulva and the cervix, and there is a softening of the lower part of the uterus between the cervix and the body. There is also increased circulation to the vagina/vulva/cervix area, caused by circulating estrogen. This is evident around 6 to 8 weeks of gestation. The uterus gets progressively larger, an if the uterus is getting progressively larger, and the woman has experienced amenorrhea, then this is a probable sign of pregnancy. The enlargement of the uterus is more pronounced in multigravidas, which means a woman who has been pregnant at least once before. This is because the abdominal musculature of the multigravida woman has lost some of its tone because of the previous pregnancy. Definite Sign of Pregnancy A positive pregnancy test is usually a definite sign of pregnancy, although there are false positives that might occur – this is when a pregnancy test states that it is positive, but it is really negative. However, an ultrasound may be used to detect the fetal dheartbeat. Also, an x-ray might be used to detect the fetus as well. Discomforts of Pregnancy and Maternal Adaptive Changes During Pregnancy There are definitive discomforts during early pregnancy, including nausea and vomiting, breast tenderness and lack of libido. Breast tenderness is another discomfort associated with early pregnancy. The breasts increase in size, because the milk glands become enlarged and the fat tissue also enlarges, and this causes breast firmness and tenderness during the pregnancy’s first months and last few months. The thick fluid called colostrum may leak from the breasts. The adaptive changes for breast tenderness might include wearing a bra that provides a firm support, especially bras which are made of cotton or natural fibers. Women might have to buy larger bras, or they might try to buy a pregnancy or a nursing bra. These bras provide more support to the woman, and they can also be used after pregnancy if the woman chooses to breastfeed. Some women might find comfort by wearing their bra at night. Another adaptive change might be that the woman may use a cotton handkerchief or gauze pad in each of the breast cups to absorb the leaking fluid, or might use nursing pads, which can be found in a drugstore, and put these pads into her bra. The breasts should not be washed with soap, only warm water, because soap might cause breast dryness. Fatigue is a common pregnancy discomfort. The woman should get as much sleep as possible, and the fatigue might be caused by anemia, which is low iron, and this is a common sign of pregnancy, and a common problem with pregnant women. Women should take naps whenever she can, and should keep a regular schedule, if at all possible. The woman should pace herself, and make sure that she has time to rest, even when she is busy with activity – so she needs to be able to have some downtime and naps, even when she is working, if at all possible. Moderate exercise is also recommended to combat fatigue. As for anemia, the woman should consult her doctor, and consider taking iron pills if she is anemic. However, the doctor should first check her out and make sure that she is anemic before she starts on a regime of iron pills. Pregnant nausea and vomiting is common, mainly because of hormonal changes. The body is adjusting to the changes in the hormones, so the woman experiences nausea and vomiting. This usually goes away by the fourth month of pregnancy, and it is worse in the morning because the stomach is empty, and it also might become worse if the woman is not eating enough. Some adaptive changes might include eating dry foods like cereal, toast and crackers before getting out of bed – the woman should keep a stash by her bed, and eat them before she gets out of bed. She might also try to eat a high protein snack, such as lean meat or cheese before she gets out of bed, because protein takes longer to digest. Women may also try the BRAT diet - bananas, rice and tea. Some women might try seabands, because this offers some women some degree of comfort. Ginger is another thing that a woman might try, as ginger combats nausea. The woman might also try to eat small meals or snacks every two to three hours, as opposed to eating three large meals. The woman might also try to sip on fluids throughout the day, including clear fruit juices, such as apple or grape juice. She might try to dietary changes – for instance, she might want to stay away from foods which are greasy, spicy or fried. She might want to eat foods which are cold or at room temperature, as these foods might minimize odors which might affect the woman. She also might investigate natural treatments, such as B6 vitamins or other kinds of natural cures, and she might even try to use prescription medicine, if her doctor can prescribe her the medicine. If the woman is dehydrated because she is unable to keep food down, than she should see her physician, because this is a condition that needs to be treated right away. For pregnancy frequency, which is caused by the growing uterus, there are certain adaptive change that the mother might make to minimize this. One of these changes is to make sure that she does not wear tight-fitting underwear, pants or pantyhose. Also, if it stings when the woman tries to urinate, she needs to see her doctor, as this is a sign of a urinary tract infection, which could cause pregnancy complications. Pregnancy headaches is something that women often experience. This might because the woman is tense, she has congestion, she is constipated, or she might be experiencing preemclampsia. Some maternal adaptive changes might be putting an ice pack on her forehead and on the back of her neck; resting, sitting quietly or lying down in a low-lit room; or taking over the counter medication, such as acetaminophen (such as Tylenol). However, the woman needs to see a doctor if the headaches are severe, they do not go away, or cause vision problems. Pregnancy constipation might be caused by hormonal changes. Other things that might cause constipation include taking over the counter iron supplements and other vitamins. The uterus might be placing pressure on the rectum, which is another problem. Adaptive changes might include adding more fiber into one’s diet, such as whole grains, fruits and vegetables; drinking plenty of fluids; drinking warm liquids; daily exercise; avoiding straining when having a bowel movement; or a laxative, but a laxative should only be used upon the advice of a physician. Nutritional Needs During Pregnancy The woman has different needs during her pregnancy, with regards to her nutrition. She should consume an additional 300 calories over and above her daily nutritional requirements, so if her daily nutritional requirements is 2,000 calories a day, she needs to consume 2300 calories per day. If she does not gain enough weight, which is optimally 25-35 pounds, then the baby might have low birth weight. If she gains too much weight, then the baby might have higher birth weight. Both low birth weight and high birth weight are associated with outcomes which are more poor than babies who are born at a normal weight. Moreover, if a woman gains too much weight during pregnancy, she is at a greater risk of needing to deliver the baby by cesarean section. A woman’s protein needs increase, and the woman should consume an extra 1,000 grams of protein over the course of her pregnancy. This is because protein is essential for certain functions, such as growth and repair of the fetal tissue, as well as the fact that there is extra blood volume. The fetus demands about 500 of the protein grams, and the other 500 of the protein grams are necessary for the repair and maintenance of the uterus, mammary gland and maternal blood. She should shoot for 2 cups a day of fruits, 2 ? cups a day of vegetables, 6 oz a day of grains, 5 ? oz of meat and beans, and 3 cups of milk. This would mean that, for instance, a serving of grains might be a slice of whole grain bread, ? cup of cooked pasta, rice or cereal; her 1 oz of meat or beans might be one egg, ? cup of cooked dried beans; or a tablespoon of peanut butter. Her milk serving might be 8 oz of yogurt or 1 1/8 oz of cheese. This works out to 9-11 servings a day of bread, cereal, rice and pasta; 4-5 servings a day of vegetables; 3-4 servings a day of fruit; 3 servings a day of milk, yogurt and cheese; and 3 serving a day of meat, poultry, fish, beans, eggs and nuts. The woman should use fats, oils and sweets sparingly. Her protein, grains and vegetable needs increase as the woman progresses in her pregnancy. In her second and third trimesters, she needs 3 cups of vegetables, 8 oz of grains, 6 ? oz of meat and beans, and 3 cups of milk. While she is breastfeeding, she needs 2 cups of fruits, 3 cups of vegetables, 8 oz of grains, and 6 ? oz of meat/beans, and 3 cups of milk. Pregnant women also need an extra 300 calories per day, every day. She needs protein for proper development of fetus and the placenta; calcium, for healthy fetal development; iron for the developing blood supply of the fetus and to prevent anemia in the mother; and folic acid, which reduces the risk of spina bifida, anencephaly and related birth defects. Vegetarians might need to make an extra effort to ensure that she is getting enough amino acids in her diet, because these are essential for the health of the fetus. There are special cases where women need to be extra vigilant about her diet. One of those instances is with vegan women. Women who are vegetarians, but eat dairy products and eggs do not have a problem with consuming adequate protein, as eggs and dairy products provide plenty of protein, which is what a woman needs during her pregnancy. She therefore needs to practice food combining so that she gets complete proteins – for instance, she should combine beans with brown rice, and this will provide better amino acids than if she just ate beans alone. She also should investigate the possibility that she can drink soy milk or other kinds of milk which provide calcium and protein. Even the vegetarian woman has issues, too, even if she is getting enough protein. The problems that the vegetarian woman might have is that she might experience iron deficiency or have a zinc deficiency. This can be remedied by taking proper supplementation. Another issue might be that the woman is lactose intolerant, which means that she has issues with consuming dairy products. There are a variety of ways that these women can still consume dairy products, however. They can sometimes eat cooked dairy, such as custard, or they might be able to tolerate some kinds of fermented dairy, such as yogurt and some kinds of cheeses. Alternatively, she might investigate products over the counter which help with dairy absorption, such as Lactaid or lactose free milk. Pica is a special concern for some women. This is where a woman might have a craving for items which are non-food and are generally harmful. She might want to eat dirt, clay, laundry starch or freezer frost. This is sometimes caused by an iron deficiency, and is resolved when the woman is no longer pregnant. This can be serious, so if the woman is experiencing pica, she needs to tell her doctor, so that the doctor can prescribe special a special diet which will help resolve the deficiencies that she might have which is causing the pica. Source: http://www.pregnancybymonths.com/articles-on-pregnancy/during-pregnancy/diet-during-pregnancy/ Assessment of maternal and fetal well-being Women who visit their doctors are assessed by a variety of measures. One of the measures that is typically used is that of weighing the woman to ensure that she is gaining the proper amount of weight for her trimester. This is in addition to taking a urine sample, looking for the proper amount of urine protein and a blood sample for glucose. Also, the fetal heartrate is also used. The woman should also be asked questions regarding contractions, fetal movement, membrane rupture and bleeding. The doctor should also measure the fundal height in centimeters. This would provide an accurate assessment of fetal growth, and the fundal height should match the pregnancy week. There are a number of ways to assess fetal well-being. One of these ways is antenatal fetal monitoring. This guides future care, and gives reassurances to the mother that the baby is developing at a normal rate. The way to conduct antepartum fetal monitoring includes Fetal movement counting Assessment of uterine growth Non stress test Fetal Movement Counting The woman needs to report how often she has felt the fetus move. If there is a decrease in fetal movement, this could be a sign of impending fetal death. If a woman notices 10 fetal movements or more during a span of 2 hours or less, than the fetus is most likely in good health. Assessment of Uterine Growth The uterus should have symphyofundal height in centimeters after 24 weeks until 36 weeks, which will equal the weeks of gestation. Which means that at 24 weeks, the symphyofundal height in centimeters is 24 centimeters, at 25 weeks it is 25 centimeters, etc. If there are abnormalities of this height, then this should be investigated. If the woman is obese, if there are multiple gestations or if there is fetal growth restriction, then the symphyofundal height might be abnormal. Non Stress Test When assessing fetal heart rate, the one thing to keep in mind is that the healthy fetus will display normal variations and fluctuations in the baseline fetal heart rate. There should be an acceleration of the heart rate when there is stress testing, and if there is an acceleration, this most likely means that the fetus is healthy. The fetal heart rate also increase with fetal movement, uterine contractions or in response to external stimuli. When the heart rate increases, this is a good sign of central nervous system alertness and activity. If the heart rate does not increase during a stress test, uterine contractions, movement and stimuli, then this might mean that the fetus is suffering central nervous system depression. This CNS depression might be cause by hypoxia, drugs, fetal sleep or congenital abnormalities. The doctor might perform a non-stress test as well. A fetus is reactive if there is 2 or more accelerations in 20 minutes. Acceleration means that there is an increase of at least 15 bpm above the baseline testing, and the acceleration should last at least 15 seconds. Responses may be elicited by fetal stimulation by sound. Non-reactive would be less than 2 accelerations in a 20 minute period, and the testing period may be extended to 40 minutes. The baseline for the fetal heartbeat is 110-160 bpm after 37 weeks. The way that the baseline is determined is that the heart rate is evaluated between contractions. The normal baseline is 110-160 bpm. If the heartbeats are around 160-180 bpm, then than this is a sign of tachycardia. Severe tachycardia is over 180 bpm. Bradycardia is 100-110 bpm. Severe bradycardia is less than 100 beats per minute. Baseline FHR Normal – 110-160 bpm Tachycardia – Moderate 160-180 BPM; Severe more than 180 BPM Bradycardia – Moderate 100-110 BPM; Severe less than 100 BPM Biophysical Profile The non stress test is a part of the biophysical profile. Also included in the biophysical profile are breathing, amniotic fluid, body movements and tone – these are detected through an ultrasound, which is conducted by an ultrasound machine that is put on the woman’s abdomen, and this machine shows the fetus and detects the fetal heartbeat. The ultrasound takes a picture of the fetus, and this picture can be given to the parents if the parents so desire. The fetus is then scored on scale of 1-10. 8-10 means that the fetus is well. A score of 6 means possible fetus asphyxia, and score of 4 means probable fetus asphyxia. A score lower than that means that the baby must be delivered immediately. Labor and Delivery Preparation One of the most important ways to prepare for labor and delivery is to make sure that the woman goes to her prenatal appointments. This is because the doctor or the midwife needs to monitor the pregnancy as the pregnancy progresses. Moreover, if there are any complications that need to be addressed, this can be noted in the prenatal appointments as well. The caregiver should be assessed for his or her statistics regarding episiotomie and C-sections, and the rate that the caregiver has for these procedures should be compared with others in the area. It is also important to attend child birth classes. These are classes that might have different focuses from other classes, so the mother should assess each of the classes to decide if a particular class might be right for her. The classes might be classes for natural childbirth, or they might be classes which are taught in the hospital. The classes should be completed before the 36th week. These techniques learned during classes should be practiced before labor. The woman should be familiar with the 3 stages of labor. She also should have a birth plan, which is a list of her wishes and expectations. The doctor or the caregiver should have access to this birth plan and should advise the mother if the birth plan is reasonable. The woman should have a talk with her doctor about the possibility of having a scheduled C-Section. She also should make sure that she knows the exact route to the hospital, including how long it would take to get there. She also needs to make sure that she has a labor bag with personal items and supplies for the baby. Adaptation to Parenthood There are a number of issues that parents might consider after the baby is born. One of these is support mechanisms – this might be especially true if the mother is a single mother. She has to make sure that she has proper support from family and friends. There are also massive changes to the lifestyle of both parents, and they need to be able to adapt to this as well. There should be attention paid to the anxieties that the parents have about being parents, and there is also a consideration about working outside the home. The mother, especially, has to consider whether she wants to continue working outside the home, and if she does, what kind of care she needs to provide for her infant and in what capacity she can be there to nurse the baby, etc. Much of what goes into adaptation to parenthood focuses around the socioeconomic background of the parent(s). If the parents have a low socioeconomic background, then they naturally would have different concerns than parents who come from a higher socioeconomic background. This might mean that the family might have to find out about public assistance, or they might have to consider strict budgeting. They also might have to look into day care for the baby. Parents who have more money also have concerns, which might have to do with the woman working. At any rate, any parents might have similar stressors – how to have a social life after the baby is born; sexual issues that might arise because of fatigue or hormonal changes; and the psychological stressors of having a new infant in the house. Pain Management Techniques There are a number of different techniques which may be used to manage pain during labor. These might include: Breathing exercises – taking deep breaths may help the woman get through her contractions. The woman should focus upon her breathing, and do the exercises which are taught to her during her class that she takes to prepare for labor, whether that class is a Lamaze class or another kind of class. Position changes – the woman may try to change her position, which might mean that she gets on an exercise ball or just moves around. Moving around helps to progress labor, as well as ease the pain. Rocking – a woman might try a rocking motion to help her get through her pain. Massage – this helps a woman try to get through her pain by relaxing her, as well as helping with any kind of muscle soreness. Walking – this helps because it helps the blood circulate, and also helps to speed labor along. Visualizing - this might mean that the woman meditates or learns visualization techniques in her prenatal class. She can use this technique to see herself on a warm beach or in some other kind of scene that is relaxing for her. Music – listening to music relaxes the woman and helps take her mind off of the pain. Water therapy – taking a warm bath may often lessen the pain that a woman feels. Acupuncture and acupressure – these are techniques where a practitioner either puts needles in certain pressure points, or puts pressure on certain points, and this has been shown to ease pain. Source Used Klossner, J. (2006) Introduction to Maternity and Pediatric Nursing. New York: Klossner and Hatfield. Read More