Designation of a pregnancy as low risk or high risk creates specific expectations and requirements for prenatal management.

Low risk implies expectation of a favorable outcome, placing more prenatal care focus on health maintenance and social issues than on specific medical management.

High risk implies a need for increased surveillance, special care, and appropriate referrals.

Categories of increased risk:•Pre-existing medical illness•Previous pregnancy complications, such

as perinatal mortality, prematurity, fetal growth retardation, malformations, placental accidents, and maternal hemorrhage

Categories of increased risk:

• Evidence of poor maternal nutrition

• Onset of complicating events that may transform a low-risk pregnancy into a high-risk pregnancy.

• Maternal age >35 years at the time of the EDC• Family history of congenital anomalies or

inherited disorders• Abnormal development or mental retardation of

a previous child• Ethnic background associated with inheritable

diseases• Substance use or exposure to teratogens- Three or more consecutive spontaneous

abortions.

For low-risk pregnancies, the recommended frequency of prenatal visits is monthly up to 32 weeks, every 2 weeks up to 36 weeks, and then weekly until delivery.

Standard assessment at each prenatal visit includes maternal weight, blood pressure, uterine size, auscultation of fetal heart tones, and evaluation for edema, proteinuria, and glucosuria.

After 18 to 20 weeks, the patient should be questioned about fetal movements.

Late in pregnancy, the presenting fetal part should be determined.

Ongoing patient education appropriate to the gestational age of the fetus is incorporated into these visits.

All prenatal care information should be recorded on a standardized form.

BASIC PATIENT TEACHING CONSIDERATIONS FOR THE EXPECTANT MOTHER ON THE FIRST PRENATAL VISIT

WITH REINFORCEMENT ON EACH SUBSEQUENT VISIT

(1) Once a month until the seventh month.

(2) Every two weeks during the seventh and eighth month.

(3) Weekly during the ninth month until delivery.

(4) Patient teaching must continue on each visit.

(1) A well-nourished mother and baby are thought to be far less the victims of obstetric and prenatal complications, such as:

(a) Preeclampsia.(b) Prematurity.(c) Growth retardation.(d) Significant residual neurologic damage

(that is, cerebral palsy, mental deficiency, or behavior disorders in the child).

(a) Milk, yogurt, and cheese group-2 to 3 servings per day.

(b) Meat, poultry, fish, beans, eggs, and nuts group-2 to 3 servings per day.

(c) Vegetable and fruits-3 to 5 servings of vegetables and 2 to 4 servings of fruits per day.

(d) Breads, cereals, rice and pasta- 6 to 11 servings per day.

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BMI= weight in kilograms (Height in meters) 2 BMI category Less than 18.5 under weight

18.5- 24.9 normal

25-29.9 over weight 30-34.9 moderetly obese 35-39.9 obese 40 or greater severly obese

Mrs.Mahdia Samaha Kony

(1) Pregnancy will cause the patient to tire more easily.

(2) Prevention of fatigue through short rest periods is vital to good health.

(3) The amount of rest or sleep required will vary with the individual and stage of her pregnancy.

(1) The degree will vary according to her condition and stage of pregnancy.

(2) Walking is usually the exercise of choice.

(3) Swimming is an excellent overall exercise program.

(1) Decrease smoking or stop altogether if possible.

(2) Restrict or limit alcohol intake.(3) Avoid children with measles or

other contagious diseases.(4) Do not change kitty litter boxes or

eat raw meats to prevent toxoplasmosis.

Harmful effects of cigarette smoking during pregnancy include:

Low birth weight Premature labor Spontaneous abortion Stillbirth Crib death Birth defects Increased respiratory problems in newborns.

There are no restrictions for the patient without complications:

undiagnosed bleeding preterm labor placenta previa rupture of the membranes

• A flexible approach must be taken because pregnant women may have less tolerance to heat, humidity, environmental pollutants, prolonged standing, and heavy lifting.

• Pregnant women who should probably not work include those with a history of two premature deliveries, incompetent cervix, fetal loss secondary to uterine abnormalities, cardiac disease, hemoglobinopathies, diabetes with retinopathy or renal involvement, third-trimester bleeding, premature rupture of the membranes, or multiple gestation after 28 weeks.

(1) Any vaginal bleeding, regardless of how small, may indicate possible miscarriage or abortion, placenta previa, or placenta abruptio

Symptoms that may indicate preeclampsia. The symptoms are:

Severe continuous headache. Dimness or blurring of vision. Swelling of the face or hands, especially when

present after resting all night. Persistent vomiting.

Sharp pain in the abdomen. Epigastric pain. Weight gain greater than 4 pounds in one week. Chills and fever. Burning upon urination. Sudden escape of fluid from the vagina. The

patient should report immediately to the physician or the hospital. She should not wait for uterine contractions to start.

Lack of fetal movement over a 24-hour period once "quickening" has been established.

Regular uterine contractions less than 5 minutes apart for an hour for anyone less than 37 weeks pregnancy.

A feeling that the baby is balling up that lasts more than 30 seconds and occurs more than four times per hour

Contractions or intermittent pains lasting more than 30 seconds and recurring four or more times per hour

Menstrual-like sensations, occurring intermittently

Change in vaginal discharge, including bleeding Indigestion or diarrhea

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Common complaints

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o Acetaminophen (Tylenol), 325 to 650 mg every 3 to 4 hours, is usually sufficient.

oMild narcotics such as codeine should be reserved for refractory severe headaches or migraines.

o Aspirin should be avoided during pregnancy.

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First-trimester morning sickness may be treated symptomatically and relieved by eating frequent, small meals and avoiding spicy or greasy foods.

Severe, persistent, symptoms may require hospitalization and intravenous fluids. The antiemetics, promethazine (Phenergan), diphenhydramine (Benadryl), and several other antihistamines are considered safe.

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A high-fiber diet, increased fluid intake, and regular exercise are recommended. Stool softeners such as docusate sodium (Colace) or psyllium hydrophilic mucilloid (Metamucil) may help.

Mild laxatives should be used sparingly and only if the prior measures fail.

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When and where to call if they have questions or problems

Availability of childbirth classes Signs of the onset of labor Obstetric analgesic options Indications for cesarean delivery Home safety Infant care and feeding, including breast-feeding Access to consumer education (e.g., infant

safety products, furniture, car seats) Birth control counseling.

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Effective prenatal care requires patient education.

One of the primary goals of prenatal care is to encourage patient responsibility through active participation in their prenatal care plan.

In order for women to make effective choices, they need information about pregnancy and prenatal care before becoming pregnant.

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Women desire more control of the birthing process. To achieve this control, they need specific information and interactive discussion with their health care providers.

Each woman's personal socioeconomic situation and support system must be explored and taken into account as part of her prenatal plan of care.