OB Learning Outcome no, 4 activity of the thyroid gland; not to reach

• Perform prenatal care and give health teachings on 38°C. CR: Plus 10 to 15BPM
nutrition and use of vaccines.  RR: May tend to be rapid and deep (16/min,
•Remembering: 3 test items Understanding: 3 test items deeper) because of progesterone's
•Applying: 4 test items influence on the respiratory center.
Maximum increase under normal
conditions: 24/min at rest.
PRENATAL MANAGEMENT  BP-Tends to be hypotensive with supine
position: vena caval syndrome.
A. FIRST VISIT: as soon as the mother missed a menstrual  Prevention: LLR. BP lowest in the 2nd
period when pregnancy is suspected. trimester. Elevated BP reading, may
indicate pregnancy-induced hypertension
B. SCHEDULE OF VISITS (PIH).
1. Once a month up to first 32 weeks  The roll-over test can be done in the
2. Twice a month (every 2 weeks) from 32 to 36 first trimester for early detection of
weeks developing pregnancy-induced
3. Four times a month (every week) from 36 to 40 hypertension by 20 to 24 weeks.
weeks
In the presence of danger signals of pregnancy, the mother b. Weight is checked in every visit.
should be instructed to report promptly for evaluation.  Total weight gain: 20 to 25 lb., with average
of 24 lb.; upper limit: 25 to 35 lb.
C. CONDUCT OF INITIAL VISIT  First trimester: 1 lb. per month which is 3 to
4 lb, total
1. Baseline Data Collection  Second trimester: 0.9 to 1 l per week or
a. To serve as basis for comparison with information about 10 to 12 lb.
gathered on subsequent visits  Third trimester: 0.5 to 1 l. per week of
b. To screen for high-risk factors about 8 to 11 lb.
 The patterns of weight gain are important
ROLL-OVER TEST than the amount of weight gain.
 Normal weight gain patterns contribute to
I. PROCEDURE health of mother and fetus
A. Place mother on left-side lying position (left lateral  Failure to gain weight is an omino sign.
recumbent, LLR)  Weight is therefore a measure of health of
B. Check BP until stable, may take 10 to 15 minutes. a pregnant mother.
C. Roll to supine.
D. Check BP right away c. Urine testing for albumin and sugar
E. Wait for 5 minutes.  Sugar-ideally not more than 1+
F. Check BP again. Compare the first with the second  Albumin-negative
diastolic reading
d. Fetal growth and development assessment
Il. INTERPRETATION  Fundal height
A. Positive Result- An increase in the diastolic  Requites emptying of the bladder for
pressure of values greater than 20 mm of mercury, woman accurate results
at risk  Fetal heart tones/fetal heart rate
B. Negative Result- An increase in the dastobe  Abdominal palpitation - Leopold's
pressure of values less than 20 mm of mercury maneuver
 Quickening-first fetal movement, plus
2. Obstetrical History subsequent mobility
a. Menstrual history menarche (onset, regularity,
duration, frequency, character) 7. Obstetrical History
b. Last menstrual period (LMP), sexual history, a. Preceding pregnancies and perinatal outcomes:
methods of contraception Past menstrual period (PMP):  4-Point System: Past pregnancies and
menstrual period before the last perinatal outcomes (FPAL)
F: number of full term births
3. Medical and Surgical History- past illnesses and surgical P: number of premature births
procedures, current drugs used A: number of abortions
L: number of currently living
4. Family History to detect illnesses or conditions that are children
transmittable
 5-Point System: the total number of
5. Current Problems- activities of daily living, discomforts, pregnancies (G) is the first number (GFPAL)
danger signs G: total number of pregnancies
F: number of full term births
6. Initial and Subsequent Visits P: number of premature births
a. Vital signs A: number of a of abortions
 Temperature: slight rise because of L: number of currently living
increased progesterone and increased children
 b. Age of Gestation: clinicians use the gestational age
b. Gravida number of pregnancies regardless of or menstrual age calculated from the first day of the
duration and outcomes, inchaling the present pregnancy last menstrual period, to identify temporal events in
 Gravida 1 (G)-pregnant for the first time, a pregnancy. Reproductive biologists and embryologist
primigravida had one pregnancy. often use the terms ovulatory age or fertilization age
 Multigravida- pregnancies with two or more which are calculated from the time of ovulation or
 Nulligravida woman who is not pregnant fertilization, both are 2 weeks shorter (Cunningham,
now and has never been pregnant. er al., 1989).

c. Parity: number of pregnancies carried to period of  McDonald's Rule (used in second and third
viability whether born dead or alive at birth (twins trimesters)
considered as one parity)  First take the fundic height (FH) in
 Primipara: a woman who has once centimeter using a tape measure. Measure
delivered a fetus or fetuses who reached the distance from the top of the symphysis
the stage of viability. Therefore, the pubis over the curve of the abdomen to the
completion or pregnancy beyond the period top of the uterine fundus using a tape
of abortion means one parity. It also means, measure
therefore, that any abortion is not included  Formula for estimating age of gestation in
in the counting. lunar months
 Multipara: a woman who has completed
two or more pregnancies to the stage of FH x 2
viability. 7

8. Estimates in Pregnancy  Formula for estimating age of gestation in

a. EDC/EDD: expected data of confinement/expected lunar weeks:
date of delivery
 Naegele's Rule Formula: FH x 8
Add 7 days to the first day of the last 7
menstrual period (LMP), subtract 3 calendar months
then add 1 year  Fundic height correlates well with weeks of
gestation between 20 and 31 weeks. For
Give LMP: May 20, 2008 example, at 26weeks gestation, fundal
5 20 2008 height is probably 26 cm, at 20 weeks
- 3 + 7 gestation, the fundus is about 20cm and at
+1 the level of the umbilicus
2 27
2009 A. LMP: last menstrual period
B. Fundic height
EDD: February 27, 2009 C. McDonald's Rule: requires fundic height measurement
in cm
 Mittendorf's Rule Formula:  AOG in weeks: FH in cm * 8/7
First, identify the LMP woman's race  AOG in months: FH in n * 2 + 7
(Caucasian/white or non-Caucasian), and gravidity D. Ultrasonography: measures biparietal diameter
[primigravida (G1) or multigravida (G2) above  A biparietal diameter of 9.5 cm mature fetus;
usually attained at 36 weeks of gestation
 Formula for Caucasian/white women, E. X-ray after 15 weeks to be safe
first time pregnant (G):  Identification of distal femoral ossification = 36
EDD = weeks
[LMP+15 days]-3 months  Identification of proximotibial ossification =
mature
 Formula for non-Caucasian/non white, F. Date of Quickening: at 20 weeks
multigravida: EDD= G. Identification of FHT: at 12 weeks by Doppler
(LMP+10 days)-3 months ultrasound

 Date of Quickening  Bartholomew's Rule of Fours measures age of

Primigravida: Date of Q + 4 months and 20 days= gestation by determining the position of the fundus in
EDC the abdominal cavity.
Multigravida: Date of Q + 5 months and 4 days = EDC
c. EFW: estimated fetal weight
 Fundic height can also help estimate EDC. To get  Johnson's Rule: needs fundic height measure in cm
accurate results, instruct the mother to first  If unengaged:
VOID. EFW in g = [FH - 11] * 155
 At symphysis pabic:12 weeks  If engaged:
 At umbilicus: 20 to 22 weeks EFW in g = [FH - 12] * 155
 At xiphoid process: 36 weeks
d. EFL: estimated fetal length in cm; Haase's Rule
  First five months of pregnancy: square the  Danger sign: Homan's sign (Pain in the
month. To square the month is to multiply it by calf upon dorsiflexion of the toes; a
itself: sign of thrombophlebitis)
Example: How long is a three-month- old fetus?
3 * 3 = 9cm
3. Laboratory Tests Blood Studies
 For the second half of pregnancy: Multiply  Complete blood count
month by 5.  Hemoglobin (12 to 16g/dL) and hematocrit
Example: How long is a 7-month-old fetus? (37% to 47%); decreased in pregnancy
7 * 5 = 35cm  Leucocytosis is NOT a sign of infection in
pregnancy because the WBC count is
9. Complete Physical Examination: includes internal usually elevated: Pregnancy: 5,500 to
gynecologic examination and bimanual eximinations. 11,500/mm, labor: 20,000/mm², and
a. Internal Examination (IE): detects early signs of postpartum: 25,000/mm²
pregnancy: Chadwick's sign, Goodell's and Hegar's sign.  Blood typing and Rh determination. If If the
The following are the preparation for IE: mother is Rh negative, the first thing to be
 Explanation done is to determine paternal Rh; and if the
 Void before IE result is Rh positive, cord blood will be
 Proper positioning: Lithotomy obtained at birth to determine Rh of the
 Equal height of padded stirrups baby's blood.
 Simultaneous placing of legs on stirrups  According to institution protocol. If the serology
 No pressure on the popliteal region for:
 Syphilis (VDRL) if mother is found positive
 Draping for syphilis, she must be treated early.
 Instruction: position hands across the chest, There is placental barrier to syphilis in the
correct breathing, slow, chest breaths first 16 weeks.
 DON'TS:  Rubella antibody titer determination.
 Any activity that can increase intra- Results: If the ratio is 1:8 or less, there is a
abdominal pressure (i.e., squeezing of risk; the mother should be C. immunized in
nurse's hands, breath holding) the postpartum confinement. If the ratio is
 Distracting woman's attention from focused greater than 1:8, immunity is present and
breathing/relaxation techniques thus, there is; no need for immunization.
 Any impediment to communication  Human Immunodeficiency Virus (HIV)
 Hepatitis screening as indicated
b. Important concerns of physical examinations  Alpha-fetoprotein screening (AFP) at 16 to
 Breasts look for breast changes, adequacy 18 weeks' gestation to rule out neural
of breasts for breastfeeding, any abnormal defects. Screening for sickle cell trait (if of
signs. Black race)
 Abdomen
 Fundic height  Urine Testes: In addition to testing for sugar (Normal
 Leopold's maneuvers: systematic finding in pregnancy +1), urine may also be tested for
abdominal palpitation to estimate fetal bacteria for there is asymptomatic bacteriuria which
size, locate fetal back and parts and can result in abortion in early pregnancy, and
determine fetal position and premature labor in late pregnancy.
presentation. Preparation for Leopold's  Pelvic Lab Test: collection of pelvie cultures (Pap test,
Maneuvers are as follows: culture for gonorrhea and Chlamydia) and the
 Explain the procedure and the need for performance of bimanual examination, usually the
it. last part of the initial physical examination (Littleton
 Ensure proper position: dorsal & Engebretion, 2006).
recumbent with knees slightly flexed  to identify cervical and uterine changes in
to relax abdominal muscles. pregnancy
 Drape accordingly.  to detect uterine size
 Nurse's hands should be warm to  to assess for deviation in expected
prevent contracting mother's  size and shape
abdominal muscles resulting in difficult
palpation.  In all the necessary testing, prepare the client through
 Apply gentle, firm palpations using the the following steps:
palm of the hands.  providing an explanation of the procedure
 physical preparations specific to the procedure
 Pelvic measurements: done in the third trimester  provision of support to patient and spouse,
to determine CPD (cephalo pelvic encouraging verbalization of concerns
disproportions).  monitoring of patient and fetus
 after procedure documentation as necessary
 Extremities
 Discomforts: leg cramps, varicosities, VIII. MAJOR GOALS OF COMPREHENSIVE PRENATAL
pedal edema ASSESSMENT AND EVALUATION:
A. Define the health status of the mother and fetus.
B. Determine gestational age of the fetus estimate date of  Sources: liver (best source) and other red
confinement. meats, green leafy vegetables, egg yolk,
C. Initiate a nursing care plan for continuing maternity care cereals, dried fruits, and nuts
of both mother and fetus.  Needed to increase maternal RBC mass and
D. Detect early any high-risk condition. for fetal liver storage in the third trimester.
 Intake of iron-fortified multi- vitamins to
IX. HYGIENE OF PREGNANCY ensure essential levels.
A. NUTRITION  best absorbed in acidic medium: take
1. Always start with diet history when it comes to giving between meals and with vitamin C-rich
nutritional instruction to the mother. juice
2. Nutritional Profile should include the following:  may cause constipation; so there is
a. Pre-pregnant and current nutritional status also a need for increased fluid intake,
b. Dietary habits: junk, empty-caloric foods, fibers/roughage; regular ambulation
regularity of meals, peer pressure, adequacy of  will darken stools: explain this to the
food/available finances, cultural and religious restrictions patient; can be used in evaluating
c. Pica: persistent ingestion of inedible substances compliance
(eg, clay, dirt, starch, chalk), and/or substances of little
nutritional value; a psychobehavioral disorder  Calcium
(Rainville, 1998). Effects are displacement of nutritious  Needed for maternal calcium and
foods, interference with nutrient absorption, and anemia. phosphorous metabolism and fetal bone
d. Mother's knowledge of nutritional needs and the and skeletal growth
daily recommended allowances  1,200 mg/day, equivalent to 1 quart of milk
e. Physical findings indicative of poor nutritional a day (4 glasses)
status such as:  Sources: milk and milk products and
 anemia, underweight/overweight states broccoli (which carries the same amount of
 dull hair dry/scaly skin calcium as milk)
 pale/dull mucus membrane/conjunctiva
f. Factors/conditions requiring special attention such  Sodium: most abundant cation in extracellular
as: fluid
 young, adolescent mother  Needed in pregnancy for tissue growth and
 Primigravidity development
 low pre-pregnant weight  Contained in most kinds of foods
 Obesity  Should not be restricted withoutserious
 low socioeconomic status/economic indications
 Deprivation
 pre-pregnant debilitating conditions  Folic Acid
vegetarians-lack essential protein and  Needed to meet increased metabolic
minerals; may need vitamin B12 demands in pregnancy and for production
supplement of blood products
 successive pregnancies; short interval  Deficiency may cause fetal
between pregnancies anomalies/neural defect and bleeding
 education not so much what they know complications
(may receive nutritional teaching) but how  Sources: liver, dark green leafy vegetables
much they earn (spells adequate finances)
to buy essential foods.  Vitamins: water-soluble vitamins (C and B) and
fat-soluble vitamins (A, D,E, and K)
3. Nutrient Needs should include the following: Major Food Sources:
a. Calories  Vitamin C: citrus fruits and vegetables like
 Non-pregnant requirement: 1,800 to 2,200 broccoli, bell peppers, and tomatoes
Kcal/day  Vitamin B Group: legumes, beans, nuts,
 Additional caloric requirement per day: 300 whole grain, oatmeal, pork, beef, fish, liver,
Kcal/day organ meats, eggs, and green leafy
 Usual daily caloric need in 2,100-2,500, vegetables
never less than 1,800 Kcal/ day  Vitamin A: milk and dairy products; dark
 Avoid 'empty' calories like soft drinks green and dark yellow fruits and vegetables,
b. Protein: body-building food, additional 30 g/day eggs and liver
to ensure 74 to 76 g/day. Rich food Sources include: milk,  Vitamin D: milk and foods fortified with
meat, fish, poultry, and eggs. vitamin D; egg yolk, fish
e. Fats: high-energy foods for absorption of vitamins  Vitamin E: nuts, seeds, wheat germ, whole
A, D, E, and K. Avoid too much fat to prevent vomiting and grain products, green leafy vegetables,
heartburn. vegetable oils
f. Essential Minerals and Vitamins  Vitamin K: meats, liver, cheese, tomatoes,
 Iron: Most important mineral that must be taken peas, and egg yolk
in supplementary amount
 18 mg/day in non-pregnant state, 4. Daily Food Needs/Servings
supplementary in pregnancy: 30 to 60
mg/day FOOD NUMBER OF SERVINGS
 Milk and milk product 1 quart a day ( 4 glasses/ 1. Cleansing Breathing: deep relaxed breath, like a sigh.
day) Can be practiced in pregnancy; used in labor to signal the
Meat and meat products 3-4 servings beginning of uterine contractions.
Cereals/grain products 4-5 servings 2. Pelvic Rock: The most important exercise for comfort
Fruit/fruit juices 4-5 servings ( one serving during pregnancy. Purposes:
of vitamin C-rich fruit/ a. increases flexibility of the lower back
juice included b. strengthens the abdominal muscles
Vegetables/ vegetables 3-4 servings (included is 1 c. shifts center of gravity back to uterine spine
juices serving of dark green or d. relieves backache, improves posture and
yellow vegetable) appearance in late pregnancy
Fluids 4-6 glasses of water plus 3. Squatting/Tailor-sitting: strengthens perineal muscles,
other fluids to equal 8 (8- makes pelvic joints more pliable.
10) cups/ day 4. Abdominal Breathing: utilizes the diaphragm primarily
and not the chest muscles; helpful during the first half of
B. BATH labor, and, when used together with total relaxation, can
1. Daily bath if desired. carry women through most of the first stage.
2. Avoid soaps on nipples: with drying effect. 5. Kegel: improves the tone of pubococcygeal, perineal,
3. Towel-dry breasts: increases integrity/toughness of vaginal and pelvic floor muscles. In uterine prolapse,
nipples. cystocele and rectocele, this can be done every hour.
4. Tub bath: may cause injuries from accidental slipping as 6. Panting: best for crowning period and actual delivery of
pregnant women have difficulty maintaining balance the baby leaving the work to be accomplished by the
a. Usually contraindicated except when there is care uterus. Only by panting can the mother be kept from
in getting into and out of bathtubs nonskid rubber mat on pushing in the transition phase of labor, pushing should be
bathtub floor helps to prevent falls in the second stage of labor EXCEPT during CROWNING.
5. Douching: not needed to manage vaginal discharge
(Leucorrhea is estrogen-induced); daily bath will suffice 7. Nursing Considerations Related to Exercises in
Pregnancy
C. CLOTHING a. Regular exercises are needed.
1. Loose, comfortable clothes, of cotton material for more b. Not necessary to limit maternal exercises provided
comfort they are:
2. No constrictions around breasts, abdomen, legs, no  Usual, customary, no new exercises H.
round garters should be started in pregnancy.
3. Flat-heeled shoes for comfort and balance  Do not cause maternal fatigue. Evidences
4. Support panty hose for varicosities (avond kner length support that women who are used to
stockings.) aerobic exercises before pregnancy should
5. Supportive, cotton-lined brassiere continue them during pregnancy provided
6. Maternity girdle as necessary fatigue is avoided With no risk for maternal
and feral injury.
D. SLEEP AND REST c. Literature reports that regular exercise in pregnant
women results to lower CS rate and length of
1. Assess activities to identify need for rest and sleep hospitalization.
2. Average number of hours of sleep is 3 hours may need 1 d. Exercise in standing position (not supine to
to 2 hours of afternoon nap. In the second half of prevent pressure on the inferior vena and against the
pregnancy, advise to avoid the supine position in bed. diaphragm.
3. Plan rest time during the day. e. Avoid excessive and strenuous exercises.
4. At work, get to stand and walk about for few minutes at  Excessive exercises cause increased blood
last once in every 2 hours (If task requires prolong flow to muscles and bones, diminishing
standing, there should be time to walk about and sit at blood flow to uterus, placenta and
intervals therefore, fetus. This implies the possibility
of fetal distress in severe exercise.
E. TRAVELING  Excessive exercises can cause increased
1. Long distance travel by land needs stop-overs so body temperature; elevated temperature is
pregnant women can get out of the car and walk. theoretically teratogenic.
Seatbelts are needed.
2. Traveling by air requires pressurized planes; in late G. MARITAL RELATIONS/COITUS
pregnancy, airlines will require a medical certificate
indicating fitness to travel by air. 1. Changes in normal sexual response are related to the
3. Best time to travel is during the second trimester physiologic changes of pregnancy (Alteneder & Hartzell,
because: 1997):
a the pregnant woman is most comfortable. a. First Trimester: less interest in sex due to fatigue,
b. the danger of abortion is not great. nausea, or adaptation to pregnancy.
c. the threat of premature labor is at a minimum. b. Second Trimester: interest in sex may increase as
4. Journeys close to term are discouraged. this trimester is the most comfortable period.
c. Third Trimester, near term: less interest due to the
F. EXERCISES discomforts brought about by positional difficulty and
abdominal size.
2. Generally no contraindications except in the presence  Infant mortality
of:  Spontaneous abortion
a premature rupture of membranes  Placenta previa/abruption placenta
b. premature labor  Premature rupture of membranes
c. history of abortion, bleeding
d. deeply engaged head in late pregnancy b. Causes of adverse effects of smoking
e. incompetent cervix  Nicotine, a vasoconstrictor, causes reduced
placental perfusion.
3. In healthy, pregnant women, sexual intercourse usually  The increase of carbon monoxide causes
does no harm. functional inactivation of maternal and fetal
a. Like any other activity, avoid fatigue, exercise hemoglobin.
moderation and hygiene.  Smokers have decreased plasma volume
b. Couple may need counseling regarding more  Smokers have reduced appetite, resulting to
comfortable positions. The traditional man on-top position decreased caloric intake.
is uncomfortable for many couples.
c. Suggested positions: side lying and the woman-on- 2. Alcohol. Alcohol ingestion by pregnant women is likely
top position. to cause fetal abnormalities. Alcohol is the leading known
teratogen in the Western world.
H. EMPLOYMENT
The pregnant woman may continue working provided the a. Effects of chronic alcoholism: fetal alcohol syndrome
work, work area, and work conditions do not pose hazards (FAS). Heavy use of alcohol (2 or more drinks/day) has 10%
to the health of mother and ferus. risk of producing FAS, characterized by:
 retardation/delays: cognitive,
1. Safety and rest are the two most important motor,attention, and learning deficits
considerations in deciding whether or not the pregnant (streissguth, Barr, Sampson, & Bookstein,
woman should continue working 1997)
 mental retardation: associated with
2. Whether standing or sitting at work, the pregnant microcephaly, and seizure disorders
woman should be advised to stop and walk about every (Littleton & Engebretson, 2006). Prenatal
few hours to improve circulation of blood. alcohol is the leading cause if mental
retardation, surpassing down syndrome
3. Adequate periods of rest should be provided during the (Streissguth et al., 1997)
workday.  craniofacial defects (FAS facies): flat
midface, wide nasal bridge, thin upper lip
4. Women with previous complications that are likely to be  cardiovascular defects
repetitive like SGA, premature labor, or abortions,  limb defects
probably should minimize physical work.  impaired fine and gross motor function

I. CARE OF THE TEETH b. Since modern science has not determined what level of
alcohol is safe for pregnant women, it is best that
Regular examination of the teeth and gums should be part pregnant women abstain from alcohol ingestion, including
of the prenatal general physical examination. Dental the so-called "social drinking," as this can cause problems
carties require prompt management in pregnancy, but that persist into the child's teenage years and beyond
major dental surgeries should be postponed for the (Streissguth et al., 1997).
postpartal period.
3. Caffeine: reduce intake of coffee, tex, colas, and cocox
1. Because of estrogen effect on vascularity, the gums of to 300 mg of caffeine per day or no more than 2 to 3
pregnant women are painful and swollen. Instruct on the servings per day (US FDA).
use of soft-bristled toothbrush and gentle brushing.
4. Drugs should only be taken by pregnant women when
2. The concept that dental caries are aggravated by prescribed by their physicians. Drugs prescribed in
pregnancy is not supported by literature. There is no tooth pregnancy should have benefits or advantages
loss secondary to pregnancy. ourweighing the risks. The best recommendation: no
medication is taken during pregnancy unless absolutely
J. S-A-D HABITS OF PREGNANCY necessary and prescribed.
a. Intake of illicit drugs in the first trimester can cause the
1. Smoking. Pregnant women should not smoke. Women most adverse fetal malformations because:
who smoke in pregnancy have smaller infants (SGA) than  placental barrier is not yet fully developed,
those women who do not. The use of over five cigarettes placenta is mature by 10 to 12 weeks of
per day in pregnancy doubles a woman's risk of delivering gestation.
a low-birth infant (Lieberman et al., 1994). Prenatal  rapid organogenesis takes place during this
tobacco exposure causes learning and attention problems period and could therefore be altered.
in children but less consistently than does alcohol b. The so-called "hard" drugs may cause growth
exposure (Streissguth et al., 1997). retardation and drug withdrawal which is associated with
a. Effects of tobacco use (Lieberman et al., 1994): increased neonatal mortality. The most common harmful
 Increased risk of SGA effect of heroin on the neonates is withdrawal (Richardson
 Prematurity
et al., 1996), or neonatal abstinence syndrome giving rise First 3 childhood DTP/Pentavalent vaccines
to a group of signs that include: series at 6 weeks, 10 weeks and 14 weeks.
 sneezing →
 Irritability A booster with Td at 4-7 years
 vomiting and diarrhea →
 seizures A second booster with Td at 12-15 years
c. Illegal drugs carry the risk of acquiring HIV and other →
STDs because women may trade sex for drugs and may One dose during the first pregnancy
provide sexual favors for money needed to acquire drugs  WHO recommendation for women who
(Henderson et al., 1994). (See pages 43 το 45). were not previously vaccinated with TT-
containing vaccines before adolescence
d. Herbal Supplements. Herbs, being natural, are not
always safe because of lack of consistent potency in the →
active ingredient, For vomiting or morning sickness, a gram At first contact with woman of
of ginger is effective and safe, but 20 times the stomach- reproductive age or at first
settling dose can trigger menstruation (Littleton & antenatal care visit, as early as TT
Engebretson, 2006). possible. 1
 General rule for natural herbs: must be
approved and supervised by health care →
provider. At least 4 weeks after TT1 (at next TT
antenatal care visit). 2
→ TT
At least 6 months after TT2. 3
→ TT
At least 1 year after TT3. 4
Give tetanus toxoid → TT
 Immunize all women who are due for At least 1 year after TT4. 5
their TT vaccine dose
 Any woman who has completed any of
 Check the woman's tetanus toxoid (TT) the WHO recommended schedules
immunization status by card or history: above (6 or 5 doses) does not need any
additional dose of TT-containing
→ vaccines throughout their reproductive
When was TT last given? age.
→
Which dose of TT was this?  However, they still need to attend their
 If immunization status unknown, give antenatal care visits.
TT1.

 Plan to give TT2 in 4 weeks.

If due for a dose of TT vaccine:

 Explain to the woman that the vaccine is
safe to be given in pregnancy; it will not
harm the baby.

 The injection site may become a little

swollen, red and painful, but this will go
away in a few days.

 If she has heard that the injection has

contraceptive effects, assure her it does
not, that it only protects her from
disease.

 Give 0.5 ml TT IM, upper arm.

 Advise woman when next dose is due.

 Record on mother's card.

Tetanus toxoid schedule

 This is dependent on whether the
woman has previously received any
dose of TT-containing vaccines
(DTP/Pentavalent, DT, Td)

 Standard WHO recommendation