Lesson One: Before Conception

Student Objectives

1. Explain cultural considerations and provide culturally competent care.
2. Determine how a client's preconception age, health history, and health status affect pregnancy and birth.
3. Document components of OB/GYN health history including GTpal, GP, and calculate estimated dates of delivery using Nagel's rule.
4. Explain the function of key female reproductive hormones in the phases of the reproductive cycle.
5. Examine different ways of confirming pregnancy and distinguish between presumptive, probable, and positive signs of pregnancy.

Cultural Competence

• Culture includes: Religion, language, profession, age, gender identity, disabilities, sexual orientation, beliefs, and traditions.
• Examples: Jehovah’s Witnesses (no blood donations), Jewish (kosher diet), Catholics, Muslims (female doctors preferred), Hispanic (matriarch decision-maker), Chinese (extended family care), Vietnamese (herbal remedies).
• Avoid Stereotyping: Respect individual preferences and avoid assumptions.
• Communication: Key to cultural competence; involves good communication and open-mindedness.
• Resources: Utilize dietitians, pharmacists, female doctors, etc., to respect and incorporate cultural practices.

Preconception Age and Pregnancy

• Critical Period: First few weeks for organogenesis (3-10 weeks gestation).
• Maternal Age: Ideal age for pregnancy is 20-34 years; pregnancies over 35 are high risk.
• Adolescents: Often lack healthcare, partner support, and may struggle with education.
• Health History: Obtain comprehensive history, including gynecological and obstetric details.

Documenting OB/GYN History

• Holistic Interview: Sexual history, self-care behaviors, system reviews, biographic data, immunizations, workplace, environmental habits.
• Medications: Some can be teratogens affecting pregnancy.
• GTpal and GP: Understanding gravida, term births, preterm births, abortions, and living children.

Key Reproductive Hormones

• FSH (Follicle-Stimulating Hormone): Maturation of the ovarian follicle.
• LH (Luteinizing Hormone): Egg release from the follicle.
• Estrogen: Growth of the endometrial lining post-menstruation.
• Progesterone: Maintains uterine lining, supports pregnancy, and rises body temperature during ovulation.

Phases of the Reproductive Cycle

1. Proliferative Phase: Endometrium thickens due to estrogen.
2. Secretory Phase: Endometrium maintained by progesterone.
3. Ischemic Phase: Corpus luteum disintegrates, leading to menstruation.

Confirming Pregnancy

• Presumptive Signs: Amenorrhea, breast tenderness, nausea (could be caused by other factors).
• Probable Signs: Braxton Hicks contractions, positive urine test, Goodell's and Chadwick's signs.
• Positive Signs: Visualization via ultrasound, fetal movement, fetal heart tones (auscultation as early as 9-12 weeks).

Health History Components

• Term Pregnancies: Early term (37-38 weeks), Full term (39-40 weeks), Late term (41 weeks), Post-term (42 weeks and beyond).
• GTpal Calculation: Gravida (total pregnancies), Term births, Preterm births, Abortions, Living children.
• Nagel's Rule: Calculating expected due date based on the last menstrual period (LMP).

Common Questions and Clarifications

• Cultural Competence in Nursing: Always keep an open mind and communicate effectively.
• Pregnancy Confirmation: Repeat pregnancy tests if unsure and consider further tests if necessary.
• Menstrual Cycle and Fertilization: Understanding hormone roles and phases for better reproductive health management.