Recommended Requirement that increases During Pregnancy

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Recommended Nutrient Requirement that increases During Pregnancy

Recommended Nutrient Requirement that increases During Pregnancy

Nutrients	Requirements	Food Source
Calories Essential to supply energy for -    increased metabolic rate -    utilization of nutrients -    protein sparing so it can be used for -    Growth of fetus -    Development of structures required for pregnancy including placenta, amniotic fluid, and tissue growth.	300 calories/day above the prepregnancy daily requirement to maintain ideal body weight and meet energy requirement to activity level -    Begin increase in second trimester -    Use weight – gain pattern as an indication of adequacy of calorie intake. -    Failure to meet caloric requirements can lead to ketosis as fat and protein are used for energy; ketosis has been associated with fetal damage.	Caloric increase should reflect -    Foods of high nutrient value such as protein, complex carbohydrates (whole grains, vegetables, fruits) -    Variety of foods representing foods sources for the nutrients requiring during pregnancy -    No more than 30% fat
Protein Essential for: -    Fetal tissue growth -    Maternal tissue growth including uterus and breasts -    Development of essential pregnancy structures -    Formation of red blood cells and plasma proteins * Inadequate protein intake has been associated with onset of pregnancy induces hypertension (PIH)	60 mg/day or an increase of 10% above daily requirements for age group Adolescents have a higher protein requirement than mature women since adolescents must supply protein for their own growth as well as protein t meet the pregnancy requirement	Protein increase should reflect -    Lean meat, poultry, fish -    Eggs, cheese, milk -    Dried beans, lentils, nuts -    Whole grains * vegetarians must take note of the amino acid content of CHON foods consumed to ensure ingestion of sufficient quantities of all amino acids
Calcium-Phosphorous Essential for -          Growth and development of fetal skeleton and tooth buds -          Maintenance of mineralization of maternal bones and teeth -          Current research is : Demonstrating an association  between adequate calcium intake and the prevention of pregnancy induce hypertension	Calcium increases of -    1200 mg/day representing an increase of 50% above prepregnancy daily requirement. -    1600 mg/day is recommended for the adolescent. 10 mcg/day of vitamin D is required since it enhances absorption of both calcium and phosphorous	Calcium increases should reflect: -    dairy products : milk, yogurt, ice cream, cheese, egg yolk -    whole grains, tofu -    green leafy vegetables -    canned salmon & sardines w/ bones -    Ca fortified foods such as orange juice -    Vitamin D sources: fortified milk, margarine, egg yolk, butter, liver, seafood
Iron Essential for -    Expansion of blood volume and red blood cells formation -    Establishment of fetal iron stores for first few months of life	30 mg/day representing a doubling of the pregnant daily requirement -         Begin supplementation at 30- mg/day in second trimester, since diet alone is unable to meet pregnancy requirement -         60 – 120 mg/day along with copper and zinc supplementation for women who have low hemoglobin values prior to pregnancy or who have iron deficiency anemia.  -         70 mg/day of vitamin C which enhances iron absorption -         inadequate iron intake results in maternal effects – anemia depletion of iron stores, decreased energy and appetite, cardiac stress especially labor and  birth -         fetal effects decreased availability of oxygen thereby affecting fetal growth * iron deficiency anemia is the most common nutritional disorder of pregnancy.	Iron increases should reflect -          liver, red meat, fish, poultry, eggs -          enriched, whole grain cereals and breads -          dark green leafy vegetables, legumes -          nuts, dried fruits -          vitamin C sources: citrus fruits & juices, strawberries, cantaloupe, broccoli or cabbage, potatoes -          iron from food sources is more readily absorbed when served with foods high in vit C
Zinc Essential for * the formation of enzymes * maybe important in the prevention of congenital malformation of the fetus.	15mcg/day representing an increase of 3 mg/day over prepreganant daily requirements.	Zinc increases should reflect -          liver, meats -          shell fish -          eggs, milk, cheese -          whole grains, legumes, nuts
Folic Acid, Folacin, Folate Essential for -          formation of red blood cells and prevention of anemia -          DNA synthesis and cell formation; may play a role in the prevention of neutral tube defects (spina bifida), abortion, abruption placenta	400 mcg/day representing an increase of more then 2 times the daily prepregnant requirement. 300mcg/day supplement for women with low folate levels or dietary deficiency 4 servings of grains/day	Increases should reflect -          liver, kidney, lean beef, veal -          dark green leafy vegetables, broccoli, legumes. -          Whole grains, peanuts
Additional Requirements Minerals -          iodine -          Magnesium -          Selenium	175 mcg/day 320 mg/day 65 mcg/day	Increased requirements of pregnancy can easily be met with a balanced diet that meets the requirement for calories and includes food sources high in the other nutrients needed during pregnancy.
Vitamins E Thiamine Riborlavin Pyridoxine ( B6) B12 Niacin	10 mg/day 1.5 mg/day 1.6 mg/day 2.2 mg/day 2.2 mg day 17 mg/day	Vit stored in body. Taking it not needed – fat soluble vitamins. Hard to excrete.

Assessment of Fetal Well-Being

Assessment of Fetal Well-Being-

1. Daily Fetal Movement Counting (DFMC) –begin 27 weeks

Mom- begin after meal - breakfast

a. Cardiff  count to 10 method – one method currently available

(1)  Begin at the same time each day (usually in the morning, after breakfast) and count each fetal movement, noting how long it takes to count 10 fetal movements (FMs)

(2) Expected findings – 10 movements in 1 hour or less

3) Warning signs

                a.) more then 1 hour to reach 10 movements

                b.) less then 10 movements in 12 hours(non-reactive- fetal distress)

                c.) longer time to reach 10 FMs than on previous days

                d.) movement are becoming weaker, less vigorous

                                Movement alarm signals - < 3 FMs in 12 hours

4.) warning signs should be reported to healthcare provider immediately; often require further testing. Examples: nonstress test (NST), biographical profile (BPP)

2. Nonstress test – to determine the response of the fetal heart rate to activity

Indication – pregnancies at risk for placental insufficiency

                Postmaturity

a.)     pregnancy induced hypertension (PIH), diabetes

b.)     warning signs noted during DFMC

c.)      maternal history of smoking, inadequate nutrition

Procedure:

Done within 30 minutes wherein the mother is in semi-fowler’s position (w/ fetal monitor); external monitor is applied to document fetal activity; mother activates the “mark button”  on the electronic monitor when she feels fetal movement.

Attach external noninvasive fetal monitors

1. tocotransducer over fundus to detect uterine contractions and fetal movements (FMs)
2. ultrasound transducer over abdominal site where most distinct fetal heart sounds are detected
3. monitor until at least 2 FMs are detected in 20 minutes
• if no FM after 40 minutes provide woman with a light snack or gently stimulate fetus through abdomen
• if no FM after 1 hour further testing may be indicated, such as a CST

Result:

Noncreative

Nonstress

Not Good

                                                Reactive

                                                Responsive is

                                                Real Good

Interpretation of results

i.                     reactive result

1.       Baseline FHR between 120 and 160 beats per minute

2.       At least  two accelerations of the FHR of at least 15 beats per minute, lasting at least 15 seconds in a 10 to 20 minute period as a result of FM

3.       Good variability – normal irregularity of cardiac rhythm representing  a balanced interaction between the parasympathetic (decreases FHR) and sympathetic (increase FHR) nervous system; noted as an uneven line on the rhythm strip.

4.       result indicates a healthy fetus with an intact nervous system

ii. Nonreactive result

1. Stated criteria for a reactive result are not met
2. Could be indicative of a compromised fetus.

       Requires further evaluation with another NST, biophysical profile, (BPP) or contraction stress test (CST)

9. Health teachings

        a. Nutrition – do nutritional assessment – daily food intake

High risk moms:

1. Pregnant teenagers – low compliance to heath regimen.
2. Extremes in wt – underweight, over wt – candidate for HPN, DM
3. Low socio – economic status
4. Vegetarian mom – decrease CHON – needs Vit B12 – cyanocobalamin – formation of folic acid – needed for cell DNA & RBC formation. (Decrease folic acid – spina bifida/open neural tube defect)

       How many Kcal CHO x4,CHON x4, fats x 9

Leopold’s Maneuver

Leopold’s Maneuver

                Purpose: is done to determine the attitude, fetal presentation lie, presenting part, degree of descent, an estimate of the size, and number of fetuses, position, fetal back & fetal heart tone

- use palm! Warm palm.

Prep mom:

1.       Empty bladder

2.       Position of mom-supine with knee flex (dorsal recumbent – to relax abdominal muscles)

Procedure:

1^st maneuver: place patient in supine position with knees slightly flexed; put towel under head and right hip; with both hands palpate upper abdomen and fundus. Assess size, shape, movement and firmness of the part to determine presentation

2^nd Maneuver: with both hands moving down, identify the back of the fetus ( to hear fetal heart sound) where the ball of the stethoscope is placed to determine FHT. Get V/S(before 2^nd maneuver) PR to diff fundic soufflé (FHR) & uterine soufflé.

Uterine soufflé – maternal H rate

3^rd Maneuver: using the  right hand, grasp the symphis pubis part using thumb and fingers.

To determine degree of engagement.

Assess whether the presenting part is engaged in the pelvis )Alert : if the head is engaged it will not be movable).

4^th Maneuver: the Examiner changes the position by facing the patient’s feet. With two hands, assess the descent of the presenting part by locating the cephalic prominence or brow. To determine attitude – relationship of fetus to 1 another.

When the brow is on the same side as the back, the head is extended. When the brow is on the same side as the small parts, the head will be flexed and vertex presenting.

Attitude – relationship of fetus to a part – or degree of flexion

Full flexion – when the chin touches the chest