MODULE 2:

1ST, 2ND, AND 3RD TRIMESTER

NURSING CARE

By Professor A. Portzline 8/2010

IN THIS MODULE WE WILL :

Discuss things that occur during prenatal appointments, up until labor begins

Introduce you to electronic fetal monitoring

Please note- this Module only covers the normal course of pregnancy. We will discuss abnormal aspects in Module 4.

A woman calls her OB’s office and says she took a pregnancy test, and it was positive. She’s very excited!

SO WHAT HAPPENS NOW?

Usually the first prenatal appointment occurs between

8-10 weeks gestation.

The earliest a woman can discover she’s pregnant is 5

days before her menses is due. This is different for

each woman, but typical menstrual cycles are

considered 28 days.

THE 1ST TRIMESTER= WEEKS 1 TO 13

During the first OB appointment, the woman

is interviewed by the nurse, who completes a

health history called the Hollister form

(named after the man who created the form).

Prenatal labs are drawn at this time.

A med check is done

to ensure the woman is

taking a prenatal

vitamin and that none

of her meds are

contraindicated in

pregnancy.

A transvaginal

ultrasound may be

done to measure

length and auscultate

the fetal heartbeat.

Notice the gestational age= 13weeks 5 days

THE 2ND TRIMESTER=

WEEKS 14-27

Many things occur during the 2nd

trimester:

1. If her blood is Rh negative, she receives

Rhogam between 24- 28 weeks.

2. Optional amniocentesis and/or genetic

testing to determine the risk of syndromes.

3. 1 hour glucola test ~28 weeks.

4. Fetal monitoring occurs at OB appointments,

starting ~24 weeks.

AM

NIO

CE

NT

ES

IS

Under the

guidance of

ultrasound, a

needle enters

the amniotic

sack through the

woman’s

abdomen and

draws a sample

of amniotic fluid.

This is tested

for various

genetic

syndromes, like

Downs (aka

Trisomy 21).

THE GLUCOLA TEST

Checks for gestational diabetes mellitus.

A fasting blood glucose level is drawn, then the patient

drinks a glucose solution.

A 1 hour blood glucose level is drawn to check her

metabolism of the glucose solution. Any value

> 130mg/dL is considered abnormal.

This will be discussed at length in Module 4.

Explore this website for details if you’re curious:

Gestational Diabetes

INTRODUCTION TO FETAL MONITORING

View this patient educational video first: http://www.youtube.com/watch?v=DvcDXvlCXAE

Fetal monitoring can be:

external, using a tocodynamometer or toco and an electronic fetal monitor disc or EFM.

internal, using an intrauterine pressure catheter or IUPC and a fetal scalp electrode or FSE. These can only be used once the amniotic sack is ruptured.

or a combination of the above.

Please read this fetal monitoring article

Internal fetal monitors

Main types of fetal heart rate

decelerations

Variable Early Late

Intro to fetal heart rate monitoring

Please read an overview about fetal heart rate monitoring here: http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_heart_monitoring.htm#Variable%20decelerations

You are responsible to know: tachycardia, bradycardia, baseline heart rate, accelerations, variability (long-term only), contraction pattern, early, late and variable decels.

Please contact me with any questions. I’m here to help you!

Don’t be overwhelmed by all this new info. You will come to understand it.

Module 3 will continue with info about electronic fetal monitoring.

Thank you for viewing this presentation.

REFERENCES

Edwards Hospital. (2010). Fetal monitoring. Retrieved from http://www.youtube.com/watch?v=DvcDXvlCXAE

Medline Plus. (2010). Fetal heart monitoring. Retrieved from http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_heart_monitoring.htm#Variable%20decelerations

Norman, J. (2010). Diagnosing diabetes. Retrieved from http://www.endocrineweb.com/diabetes/diagnosis.html

The Brookside Associates Medical Education Division. (2009). Electronic fetal heart monitoring. Retrieved from http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/electronic_fetal_heart_monitoring.htm#Variable%20decelerations