Eating during pregnancy is different from usual, especially if the expectant mother has previously allowed herself unnatural food of poor quality. The entire diet should now consist of environmentally friendly products, minimally heat-treated. It is advisable to eat only freshly prepared homemade meals.
The basic rules of good nutrition include regularity of meals, enrichment of the body with vitamins and microelements, and exclusion from the diet of anything that can harm the health of mothers and children.
The expectant mother should:
1. Observe the diet:
- take food in small doses, but often - every 2-4 hours;
- healthy breakfast. In the morning, the body will be grateful for dairy products, whole grain bread, muesli, fruits. It is best to avoid eating food immediately after waking up. A glass of fresh water without any additions will be most beneficial;
- lunch must be complete, and not in the form of a light snack with a sandwich;
- a light dinner 2-3 hours before bed, consisting of vegetable salad, kefir or fruit.
2. Eliminate harmful products:
- sweet (anything that contains white sugar);
- flour (avoid eating white flour);
- fatty (minimize the consumption of animal fats);
- fried (only occasionally you can lightly fry food in butter);
- smoked (sausage, fish, cheese);
- carbonated drinks.
3. Beware of extremes:
- you can not overeat. You should not even abuse healthy products, eating them in large quantities. Get up from the table with a slight feeling of hunger, avoiding heaviness in the stomach;
- you must not be malnourished. If you lose your appetite, you should not follow his lead. You need to include in your daily diet vegetables and fruits that will make you want to eat. Nutrient deficiencies can be irreversible.
4. Enrichment of the body:
- proteins are essential building blocks for the growth and full development of the embryo. It is very important to include in the daily diet such foods as eggs, chicken and turkey meat, fish, milk;
- A, E, C, D, B play an important role in the formation of the skeleton, bones, muscles of the baby. Stimulates and strengthens the mother's immunity, contributes to the normal functioning of the digestive, nervous and cardiovascular systems;
- trace elements are necessary for the formation of bones, cartilage and the normalization of hemoglobin levels, which contributes to the preservation of the fetus until the end of the term.
The consequences of malnutrition
1. The expectant mother:
- anemia;
- bleeding;
- infectious complications.
2. The child:
- intrauterine growth retardation;
- hyperactivity;
- decreased resistance to infections;
- prematurity.
If during gestation you gained a few extra pounds, you will certainly be interested, without harm to your health and the health of the baby!
You should know that already inside the mother, the child forms basic taste preferences that will guide him throughout his life. Therefore, by changing unhealthy eating habits, a woman will provide him not only with normal development and birth, but also with the correct course in relation to a healthy lifestyle.
Pregnancy is a very important, exciting, responsible and at the same time a wonderful period in a woman's life. Becoming a mother, a woman forever "enters the club of pregnant women" and will more than once remember how it was with her. Pregnancy, no matter what it is, is always a milestone. Life "before" the appearance of the baby and with him. Mom should take care of the baby at the first signs of pregnancy. And while she and the child are one, all her decisions and actions should be aimed at the good of both. Walk more in the fresh air, relax, think about pleasant things, avoid stressful situations and, of course, eat right. The development of the fetus, the course of childbirth and the further health of the baby depend on the nutrition of the expectant mother.
A few words about the most important
Hearing the cherished words "you will have a baby", a woman begins to replenish her knowledge base in the field of pregnancy and childbirth. Fortunately, now there is plenty of information and the main points are known to every girl.
If you do not take into account individual characteristics, the duration of pregnancy is 9 months. Doctors divide this period into three trimesters.
Of course, to argue that one of the trimesters is more important than the rest is foolish. For the full development of the fetus, for normal childbirth and the condition of the baby and mother, every moment of pregnancy is of enormous importance.
So, in the first trimester, the fetus is formed and by the end of the term it already begins to move (although the woman does not yet feel this clearly). In the second trimester, all internal organs are actively developing in the child. The child is already moving well, hears the mother's heart and the voices of the parents. In the last trimester, the baby is fully formed, all organs, including the brain, eyes and even marigolds. The baby's lungs develop the longest. In the third trimester, the baby turns head down.
During pregnancy, and preferably in advance, a woman needs to give up bad habits: smoking, alcohol and unhealthy diet. Adequate nutrition of a pregnant woman is a very important factor in the development of a baby.
Effects of nutrition on pregnancy
There are legends about the vagaries of taste and oddities of pregnant women. Indeed, a woman's gastronomic preferences change during pregnancy. Sometimes the taste preferences of expectant mothers are shocked, moreover, they are so fickle that future fathers have to be patient. This is due to hormonal disruption, a special "defense mechanism" of Mother Nature and "dots" in the head of a pregnant woman.
The fetus receives its food from the mother's blood, so it is very important to monitor how she feeds. You should not adhere to a specific diet without the appointment of a specialist. Each doctor schedules the nutrition of pregnant women by week and gives individual recommendations to the future woman in labor, guided by her analyzes.
General nutritional rules for expectant mothers
A diet for pregnant women in terms of trimesters has long been developed with its own dishes and cooking technologies.
But there are a number of principles that are recommended for all pregnant women:
- Most important is the elimination of alcohol.
- It is better to take food in small portions several times a day (at least 5). It is advisable to eat slowly, chewing thoroughly, enjoying the food.
- Before going to bed, do not overeat, it is best if dinner (whatever it may be) was a few hours before bedtime.
- Food should not be greasy, fried, or raw. Preference should be given to boiled or steamed dishes.
- The diet should contain all the necessary trace elements that can be found in meat, fish, cereals, dairy products, vegetables and fruits.
- Do not overuse sugar and caffeine.
Oxyphenylketonuria, listeriosis, and many other diseases can be avoided by eating a healthy diet. Many diseases are detected by test results, and they can be cured or prevented with the help of vitamins (both natural and pharmaceutical), but you also need to be careful with them. In such an important period of a woman's life as pregnancy, absolutely everything matters!
What should be the diet for pregnant women. 3 trimester
A pregnant woman's menu should be balanced, healthy, exclude allergenic foods and at the same time not be "overloaded". In the last stages, many women are advised to eat less or arrange because the weight of the mother, baby and the physical condition of the mother can complicate childbirth.
Pregnant women are shown green salads with vegetable oil (or without dressing). Vegetables and fruits are also very healthy, especially if they are seasonal. cucumbers, cabbage, eggplants, peppers - what mom and her baby need. Tomatoes should be eaten with care, they are allergens.
Dairy products should be selected without additives and with a short shelf life. Dairy and fermented milk products have a beneficial effect on the digestive system and provide calcium necessary for the fetus. The doctor may ask you to limit yogurt, kefir, cottage cheese, cheese and milk in the prenatal period, since these are high-calorie foods.
Cereals are very important in the diet, it is advisable to cook whole grains, and not in cereals. It is recommended to soak the cereals before cooking. By the way, there are restrictions on cereals; pregnant women are not recommended to eat semolina and white rice.
Mushrooms should not be consumed by pregnant women at all, especially in the last stages.
You need to drink whenever you want. If a woman does not have severe problems with puffiness, you should not limit yourself to liquid. You can drink water, tea, fresh juices, milk. Alcoholic drinks and carbonated drinks are unacceptable. Coffee is not unambiguously perceived by doctors, therefore it is recommended to limit it, if not exclude it.
Popular wisdom about the nutrition of a pregnant woman says: "You can eat everything, but a little bit." In the third trimester, this "slightly" is greatly reduced. Also, depending on the period, the nutrition of pregnant women by week will differ.
Nutrition for a pregnant woman by weeks of the 3rd trimester
It is important for a pregnant woman to consider several subtleties regarding her diet. The fact is that during this wonderful time a woman needs to get as many useful trace elements and vitamins as possible, while not all of them have the same benefits in different periods of pregnancy. Therefore, doctors have long drawn up a diet for pregnant women in the 3rd trimester. The menu of the expectant mother depends on the week of pregnancy and its individual indications.
Calcium is very important for the formation of various tissues of the unborn baby, therefore, it is recommended to consume foods containing calcium daily in the third trimester. But excess calcium can negatively affect the birth process. Starting from 34 weeks, the expectant mother needs to limit foods containing calcium and iodine.
Vitamin D is intended for the absorption of calcium and the prevention of childhood rickets. A pregnant woman needs to remember that it is not enough just to consume foods containing this vitamin; for its assimilation, it is necessary to walk in the fresh air under the “sparing” sun.
Adequate consumption of foods containing iron excludes possible fetal hypoxia, and also contributes to the early recovery of the woman in labor. Starting from the first weeks, the menu of a pregnant woman should include various, including meat. Starting from 34 weeks, it is preferable for a pregnant woman to eat young beef or chicken from meat products.
For normal blood clotting, as well as to improve kidney function, the expectant mother needs to eat foods containing vitamin K.
Vitamin C helps to improve the mental state and immunity of a pregnant woman. For a baby, foods with its content are important as strengthening blood vessels. But by the middle of the third trimester, you need to be extremely careful with this vitamin, since it contributes to the development of preeclampsia.
Vitamin E will help a woman's body better prepare for childbirth. From week 30 onwards, foods containing this vitamin should complement maternity nutrition. A woman's menu must necessarily include carrots, radishes, cucumbers and other foods rich in vitamin E.
Each woman individually, but from about 32 weeks, it is worth limiting fluid intake, or replacing water with a decoction or green tea. This will relieve the pregnant woman of puffiness. For the same reason, in the 3rd trimester, starting from the 35th week, it is worth limiting or completely eliminating salt intake.
Juices
Nutritionists all over the world argue about the benefits and dangers of juices, the scales are constantly changing their position. But nutritionists and doctors agree on one thing - juices in the diet of a pregnant woman should be present in reasonable quantities.
Important note: juices must be freshly squeezed. Not packaged, but fresh vegetable or fruit juices drunk within half an hour after preparation will be useful for mom and baby.
The most famous fruit juices: pomegranate, apricot, peach, apple, cranberry.
The most affordable vegetable juices: carrot, beetroot, tomato.
Not the most common, but one of the most useful is birch sap. A glass of fresh birch sap is a storehouse of vitamins. If a woman is not allergic to pollen, then birch sap during pregnancy will be her best medicine for many ailments.
Drinking several glasses of fresh birch sap a day, the expectant mother will forget about toxicosis, pressure surges and edema. Returning to the topic "Diet for pregnant women in the 3rd trimester", a woman's menu should be enriched with birch sap, as it will contribute to further lactation and weight loss of a young mother. For women, thoughts about often become intrusive. After giving birth, mom will need time and energy to restore her health and shape. Any woman wants to look beautiful, especially in a new status. Birch sap is an excellent assistant for women in solving these problems.
It is important to remember that birch sap during pregnancy should be consumed in reasonable quantities. The harvest time for this natural gift is early spring.
Fruits in the diet of the expectant mother
The beneficial properties of fruits have long been known; each of them contains various vitamins. Interestingly, the most beneficial for a person are those fruits and vegetables that grow in the region where he lives.
Fruits, berries and vegetables must include a diet for pregnant women "3 trimester". The menu of the expectant mother, however, should not be overloaded even with these healthy products, since in large quantities they can cause allergies. When the first signs of allergy appear, taking fruit should be stopped, since not only the mother suffers, but also the fetus. In the third trimester, doctors recommend completely abandoning exotic fruits. Domestic, and even better homemade apples, pears, plums, apricots, peaches, grapes, persimmons, pomegranates, grapefruit must be present in the diet of a pregnant woman.
The healthiest fruits for pregnancy are those in the harvest season. If the main gestation period was in winter and spring, it is better to use dried fruits or frozen fruits, vegetables and berries than purchased fresh ones.
Meat on the menu of a pregnant woman
Eating meat during pregnancy is not just important, but vital. Since only meat contains animal protein, which is involved in the formation of the skeletal system and muscle tissue of the baby. In addition, meat contains enough iron to maintain normal hemoglobin levels. It will not be possible to replace meat with other foods during the entire pregnancy.
But it should be remembered that it is necessary to give preference to lean varieties of meat: beef, chicken, turkey, rabbit or duck. The meat should be boiled, stewed or baked for a long time.
Lack of meat in the diet is the cause of a woman's fatigue. But in the last stages of pregnancy, it is recommended to reduce the amount of meat consumption.
Dishes for pregnant women in the 3rd trimester
The list of healthy foods and the number of calories are of concern to any expectant mother, even one who has not previously limited herself in food. Interestingly, this pregnancy diet is just the beginning. If after giving birth, mommy chooses to breastfeed, she will have a strict diet. But this is later, and before childbirth, the main question that a woman should be interested in is a diet for pregnant women in the 3rd trimester.
Pregnant woman's menu for every day of the week:
Lunch | Second supper |
||||||
Banana or dried fruit | Light soup, meat and mashed potatoes, vegetable salad and compote | Yogurt or fermented baked milk | Stew with mashed potatoes, bean salad and green tea | ||||
Muesli with dairy products | Sandwich with cheese and cucumber | Soup, vegetable stew, fruit drink | Cheesecakes and green tea | Steamed fish and vegetables, vinaigrette, juice or tea | |||
Cottage cheese, apple or carrot | Green tea, a glass of juice or yogurt, fermented baked milk | Soup, fish with vegetables and juice | Sandwich with jelly or cocoa | Boiled or baked meat, rice, salad with herbs, cottage cheese, kefir | Cheese or fruit |
||
Boiled egg, bread with butter or jam, and green tea | Yogurt or fruit | Fruit salad | Roast beef, vegetable stew, jelly | Lazy salad and tea | Kefir or yogurt |
||
Cottage cheese with berries or jam | Nuts, raisins, or dried fruits | Borsch, baked vegetables, cocoa or tea | Salmon sandwich | Tea or fruit |
|||
Cheesecakes with tea | Seaweed salad | Fish soup or fish cutlet with rice, vegetable salad, tea | Curd | Pumpkin puree soup, chicken baked with vegetables | Raisins or dried fruits |
Let the food bring pleasure and benefit to the woman and the baby.
Since these goals are normal physiological tasks of the human reproduction process, the changes in the woman's body during pregnancy should be considered as natural and physiological. According to this concept, pregnancy reveals weak links in a woman's body, which can lead to the development of pregnancy pathology. During pregnancy, a woman's body undergoes profound transformations. With the normal development of pregnancy, all changes that take place in a woman's body are aimed at creating harmonious ...
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State budgetary professional educational institution
Yamalo-Nenets Autonomous Okrug
"Yamal Multidisciplinary College"
Department of Natural Science Profile
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Approved for protection
APPROVED BY
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protocol No. from ".." ____ 201 .. g
Chairman _______________________
/ G.A. Preobrazhenskaya /
Deputy Director
for educational work
______________________ / V.N. Sarycheva /
Course work
in an interdisciplinary course, professional module
_______ __________________________________________
_________________________________________________
(topic of term paper (project)
Speciality ____________________
Student (s) group number _____ ________ (full name of the student)
Teacher - head _______ (full name of the teacher)
Introduction
Structural and functional changes in the body of a pregnant woman are aimed at achieving the following main goals: - ensuring an adequate supply of the growing body of the fetus with oxygen, nutrients and evacuation of the products of its vital functions from the body of the fetus; - preparation of the mother's body for the process of giving birth to a child and breastfeeding. Since these goals are normal physiological tasks of the human reproduction process, then changes in a woman's body during pregnancy should be considered as natural and physiological. On the other hand, since all the systems of a woman's body work during this period in a more intense mode, a point of view has recently appeared that considers pregnancy as a kind of "strength test" of the mother's body. According to this concept, pregnancy reveals "weak links" in a woman's body, which can lead to the development of pregnancy pathology. Consider these changes in body systems. At the same time, this will make it possible to formulate some preventive measures that prevent the development of pathology in the event that such a system is a "weak link". Pregnancy is a normal (physiological) process that takes place in a woman's body during the intrauterine development of the fetus. During pregnancy, a woman's body undergoes profound transformations. With the normal development of pregnancy, all changes that take place in a woman's body are aimed at creating a harmonious relationship between the mother's body and the developing fetus. Also, from the very first days of pregnancy, the preparation of a pregnant woman's body for future childbirth and breastfeeding begins.
The role of the nurse in the nutrition of the pregnant woman
Goals:
1. To improve the system of organizing nutrition of a pregnant woman.
2.Providing professional fulfillment of the obligations of the midwife for the nutrition of a pregnant woman.
Tasks:
1. Identify the main causes of malnutrition in pregnant women
2. To increase the role of the nurse in organizing the nutrition of a pregnant woman
Relevance:
1. The threat of miscarriage and especially the care of premature babies is very relevant today in connection with the unfavorable demographic and environmental situation in the Russian Federation and the adoption of the presidential program "Children of Russia"
2. The subject of the course work meets the objectives of the national project "Health", aimed at preventing the adverse consequences of this pathology in pregnant women
MAIN PART
Chapter I : Changes in a woman's body during pregnancy. Daily routine, nutrition and hygiene of a pregnant woman
- Body systems that undergo changes during pregnancy
From the very first days of pregnancy, the body of a pregnant woman undergoes profound transformations. These transformations are the result of the coordinated work of almost all body systems, as well as the result of the interaction of the mother's body with the child's body.
1.2 Changes in body weight
Undoubtedly, one of the most noticeable changes that manifests itself in a pregnant woman is a change in body weight. By the end of pregnancy, the woman's weight increases by about 10-12 kg. This value is distributed as follows: fetus, placenta, membranes and amniotic fluid - about 4.0 - 4.5 kg, uterus and mammary glands - 1.0 kg, blood - 1.5 kg, intercellular (tissue) fluid - 1 kg , an increase in the mass of adipose tissue of the mother's body - 4 kg. It is obvious that such an increase in the weight of the woman herself, as well as the process of development and growth of the fetal body, place increased demands on the nutrition of the pregnant woman. Along with an adequate intake of proteins, fats and carbohydrates, it is usually recommended to supplement a woman's diet with iron preparations (necessary for the synthesis of erythrocytes of the mother and fetus), vitamins and calcium preparations (construction of the fetal skeleton). The question often arises - which weight gain should be considered normal, and which is excessive? It all depends on the initial weight of the woman before pregnancy. And not so much on weight as on the ratio of weight and height, expressed by the so-called body mass index (BMI). BMI is calculated by the formula: BMI = Weight (kg) / Height2 (m 2) So, for example, for a woman weighing 60 kg and 1.6 m tall, this index will be 60 / 1.62 = 23.4 kg / m2. Women with an index from 20.0 to 26.0 are considered proportionally folded. If the index exceeds 26.0, then these are women with signs of obesity, and if the BMI is less than 20.0, then the woman. 5
there is a nutritional deficiency. Approach to weight gain in pregnant women
depending on BMI is next. In women with a reduced diet, significantly greater weight gain is allowed than for women with a normal diet (for example, a weight gain of 15-18 kg should not be considered pathological for them). The approximate approximate value of weight gain during pregnancy for women with a normal physique is 10-12 kg. And for women with signs of obesity, weight gain should be less than for women in the two previous groups and not exceed 10 kg. Women who smoke during pregnancy have less overall weight gain than non-smokers. This weight deficit is mainly due to less weight gain in the fetus, placenta, and amniotic fluid. Children born to mothers who smoke have a weight of 250 g less than that of nonsmoking women, which directly indicates the obvious negative effect of smoking on the intrauterine development of the fetus.
1.3 Respiratory system
An increase in the concentration of the pregnancy hormone progesterone in the blood leads to additional relaxation of the smooth muscles of the bronchial wall and an increase in the lumen of the airways. An increase in the oxygen supply requirements of a growing fetus is expressed in an increase in tidal volume (the amount of air inhaled per breath) and respiratory rate per minute. This leads to an increase in the so-called indicator of "minute ventilation" by 30-40%, which significantly exceeds the increased oxygen demand of a pregnant woman to 15-20%. The fetal requirement is approximately 30% of the total increase in oxygen consumption of the pregnant woman's body. An additional 10% falls on the needs of the placenta, and the rest goes to cover the increased, due to pregnancy, the work of the body systems of the woman herself.
1.4 A few words about the power supply
Considering the above-mentioned changes in motility and direct mechanical pressure on the digestive organs by the enlarging uterus, frequent fractional meals are considered the most rational for a pregnant woman. It is advisable to have about 6 meals a day. Considering that the fetus' body is formed mainly from proteins, these food components play a special role in the diet of a pregnant woman. In the gastrointestinal tract of a pregnant woman, proteins are broken down, digested and absorbed. It should be noted that amino acids are absorbed - the elementary components that make up proteins. The source of amino acids in the body of the mother and fetus can be proteins of a very different nature. These are primarily proteins of animal origin: lean meat (beef, pork), poultry. Fish is very useful, especially fatty varieties of sea fish containing omega-3 fatty acids, which play a positive role in the prevention of gestosis. Egg, milk and dairy products are important sources of protein. Proteins of plant origin (nuts, soy) are very useful for the mother and the unborn child. In addition to their significant nutritional value, proteins have another important property. It has been shown that proteins somewhat slow down the absorption of carbohydrates from food - the main energy substrate for a growing organism. Thanks to this property, proteins smooth out the sharp peaks in the increase in the concentration of glucose in the mother's blood after a meal and make the concentration of carbohydrates in the blood of the pregnant woman more stable,
1.5 Nutrition during pregnancy: by week and trimester
Happiness, anxious expectation, anticipation and even fear - all these feelings inevitably accompany pregnant women. And it is very important during this period not to surrender to emotions, but to remember that responsibility, which is also an integral part of it. It is at this time that the observance of the foundations of a healthy lifestyle is most important. Almost all of them apply to pregnancy, although some require minor modifications.
Pregnant: proper nutrition
Proper nutrition during pregnancy is most important, since it depends on what a woman eats, how her child will develop. For example, whether a pregnant woman gets enough protein depends on whether the child will have enough building material. Protein nutrition for pregnant women is very, very important.
In addition, many products have the most detrimental effect on the condition and development of the child, and on the well-being of the mother. Naturally, such products must be discarded. It makes sense to take into account one important feature: proper nutrition in the early stages of pregnancy will differ slightly from the diet of a pregnant woman in the last weeks.
Not everyone understands where such differences come from, but understanding the topic will be quite simple. Judge for yourself, in the early stages important body systems are laid, but the size of the fetus increases
insignificantly. Therefore, in the early stages, healthy nutrition of pregnant women
women is based on an adequate intake of minerals, vitamins and the like.
In the second trimester of pregnancy, nutrition should be guided by increased protein intake, since right now the active growth of the child and his internal organs begins. All this requires a building material, that is, protein.
Nutrition in the third trimester of pregnancy is, first of all, vitamins and minerals that are necessary for the development of the internal systems of the child's body, in particular calcium for the growth of bones and the development of the nervous system.
When planning a pregnancy, proper nutrition is also very important. The healthier, more enduring, strong the woman's body is at the moment of conception, the more chances of successful fixation of the ovum in the uterus. And a certain set of vitamins in the body contributes to the correct development of the embryo.
As you can see, the difference in recommendations for proper nutrition of pregnant women by months, and sometimes even by weeks, is quite justified. However, there are, of course, general rules for proper nutrition during pregnancy, so they will be discussed further.
General principles of proper nutrition during pregnancy
First of all, it is worth remembering one simple thing: it is better to get up from the table slightly hungry than with a heaviness in the stomach from overeating. In this regard, it is better to adhere to the principles of fractional nutrition altogether: eat less, but more often. The ideal option would be to eat 5-6 times a day. You need to eat the last time 3 hours before bedtime. It is highly discouraged to eat later, if the feeling of hunger is unbearable, you can drink a glass of milk or kefir, eat an apple or a pear. It is this diet for pregnant women that will be the most optimal.
A pregnant woman eats an apple: fruits are part of a healthy diet during pregnancy
Proper nutrition during pregnancy, as well as, in fact, any proper nutrition, involves the rejection of junk food.
Food for pregnant women should be as fresh as possible, should not contain preservatives, excess salt and the like.
Obviously, canned food, various sausages and other products of long storage, if they do not refuse under the prohibitions, then require strict control of their use.
Of course, it is recommended to give up fast food. However, it is worth noting that if you have a choice - to stay hungry or to eat something not very healthy, it is better to choose the latter. A pregnant woman should not starve. Another thing is, if you face such a choice suspiciously often, then you should think about carrying fruits or sandwiches with you.
The balance between essential nutrients such as proteins, fats, carbohydrates, and vitamins and minerals is essential. Of course, balanced nutrition for pregnant women at different periods presupposes a different balance of these components, the fact itself remains unchanged.
Meals by week
1-3 weeks of pregnancy
Gynecologists count pregnancy not from the day of conception, since it is almost impossible to calculate it, but from the first day of the last menstruation. Consequently, the first 2 weeks of obstetric pregnancy are before conception.
Pregnancy planning is an extremely crucial period, on which, whatever one may say, the health of the unborn child and the absence of any complications during pregnancy depend. So it turns out that
proper nutrition before pregnancy is of the utmost importance.
At this stage, it is very important to increase the amount of folate. Often doctors recommend drinking it in capsule form, but it is much better to get all vitamins from normal food. Folic acid is found in greens, lettuce, and grains.
Eating yellow fruits and vegetables is also beneficial. But it is better to refuse fatty and sweet foods. This will avoid problems with obesity, as well as reduce the risk of early toxicosis.
A pregnant woman prepares a fruit cocktail for proper nutrition
At about 10-14 days of the cycle, fertilization occurs and the ovum begins to move towards the uterus. From this time on, we can talk about the onset of pregnancy.
3 week
Nutrition at the beginning of pregnancy is a very complex topic, since literally every week new organs and systems appear in the embryo, which means that the need for vitamins and nutrients is constantly changing.
In the third week of pregnancy, the egg is implanted and the placenta begins to develop, as well as the fetal membrane. For their full development, calcium is needed, which is found in milk and dairy products, broccoli, green vegetables and fruit juices; and manganese, it can be obtained from turkey and pork, almonds, oatmeal, eggs, raisins, bananas, carrots and spinach.
4 week
For 4 weeks, the nutrition remains the same as for 3, but at this time it is especially important to give up coffee. However, drinking this, of course, tasty, but not very healthy drink during pregnancy should be done with extreme caution. Especially coffee is contraindicated in the evening. As you can see, proper nutrition in the first month of pregnancy is not too difficult. Further it will be a little more difficult.
5 week
As a rule, around this time, toxicosis of pregnant women begins. To alleviate this condition, you can slightly change your daily menu. So, meat and eggs, as well as other animal proteins, can be replaced with nuts, soy and other legumes. Instead of milk, you can eat yogurt and cheese. It will not be superfluous to introduce carrots, mango, apricot into the diet.
6 week
Toxicosis is in full swing, so the morning should start with crackers or savory crackers. It is better to eat them immediately after waking up, without getting out of bed. At this stage, it is better to drink plenty of fluids, at least 8 glasses a day. You can eat a handful of raisins at night.
7 week
At this time, bowel problems may occur. Therefore, avoid gas-forming foods, including cabbage. It will not be superfluous to refuse those products that are attached. It is better to introduce prunes, fresh kefir and the like into the diet.
Kefir: an element of proper nutrition during pregnancy
8 week
Ginger tea will help cope with toxicosis, and do not forget about nuts.
9-10 weeks
Choose whole grain cereals and whole grain breads. Brown rice is better than white rice. In general, the body of a pregnant woman at this stage requires quite a lot of fiber.
11-12 weeks
The first trimester of pregnancy is coming to an end, and nutrition at this time should be special. This is the most difficult time, and it is very important to listen to yourself, to your body. If you want to eat a specific dish, then it is precisely those substances that are contained in it that your baby lacks. Of course, you shouldn't go to extremes.
13-16 weeks
Nutrition in the 2nd trimester during pregnancy is characterized, as already mentioned, by an abundant intake of proteins. In addition, it is necessary to increase the total daily caloric intake of food. If in the first trimester it will be enough to eat 2400-2700 kcal, then from that time it is necessary to eat 2700-2900 kcal.
16-24 weeks
Nutrition at 6 months of pregnancy should promote the development of the baby's eyesight and hearing. That is, you need vitamin A and beta-carotene. At this time, it is better to eat cabbage, yellow peppers, carrots. Keep in mind that vitamin A is absorbed only with fats.
24-28 weeks
It is at this time that fractional nutrition becomes especially relevant. The uterus is actively growing, takes up more and more space in the abdominal cavity, and begins to put pressure on the stomach. Accordingly, the stomach becomes smaller and it is difficult for it to hold large amounts of food. Even with small meals, a pregnant woman may experience heartburn. It is better to give up carbonated drinks and coffee, they also provoke heartburn. In general, the nutrition of a pregnant woman in the third trimester should be as varied as possible, since the baby's needs are growing.
Food: nutrition during pregnancy by week
29-34 weeks
At the 8th month, bones are actively growing and teeth are forming, therefore, it is very important to eat as many foods containing calcium as possible. For the development of the brain, fatty acids are simply necessary, and it is they that contribute to the absorption of calcium. Lack of iron during this period can lead to the development of anemia, both in the mother and in the child. Fatty fish, nuts, red meat, dark green vegetables and seeds are some of the foods you should eat during this period of pregnancy.
35-40 weeks
Nutrition at 9, the last month of pregnancy, should contribute to the overall strengthening of the mother's body. After all, she has a very difficult and time-consuming job ahead of her - childbirth. The main source of energy in the body is carbohydrates, it is their consumption that should become the basis of a pregnant woman's nutrition before childbirth. Porridge and vegetables - these are the foods that you should eat during this period.
That's all there is to say about trimester nutrition. An example of a dinner, breakfast or lunch for pregnant women can also be useful.
An approximate menu for the day may look like this:
First meal: black bread toast, a small piece of butter, a chicken egg, a glass of kefir;
Second meal: Green salad, a glass of tea;
The third meal: Chicken fillet, boiled potatoes, one pear, a glass of kefir or drinking yogurt;
Meal 4: Toast with jam or butter, a glass of juice;
Meal 5: Brown rice, boiled fish, vegetable salad, tea;
Sixth meal: a glass of kefir or a small fruit.
Special nutrition for pregnant women
But this is not all the nutritional features of pregnant women. In some cases, women develop pathologies during pregnancy that require special nutrition. So, with anemia of pregnant women, special nutrition is simply necessary. In this condition, it is very important to increase the intake of foods containing iron.
In addition, it is important not only to know what foods to eat, but also in what combinations, as this affects the absorption of iron in the human body. A woman facing anemia during pregnancy should consult a doctor not only about drug treatment, but also about an appropriate diet.
1.6 Nutrition for pregnant women
What are the basic principles of a healthy diet for a pregnant woman?
Rational nutrition contributes to the normal development of pregnancy, the fetus, and is also the prevention of the development of large fetuses, which significantly complicate the course of pregnancy, childbirth, the postpartum period, neonatal and postnatal development of newborns.
In the first half of pregnancy, no special diet is required. The food should be varied, containing a sufficient amount of proteins, carbohydrates, fats, salts and vitamins. In the first months of pregnancy, spicy and salty dishes are not excluded, if necessary, in the second half, predominantly dairy-vegetable food is recommended. Meat and fish should be eaten 3-4 times a week. Spicy and spicy foods are prohibited, carbohydrates, flour products, starch and liquids are reasonably limited.
What amount of proteins, fats, carbohydrates and microelements should be in the daily diet of a pregnant woman?
The amount of proteins and fats is introduced into the daily diet at the rate of 1.5-2 g per 1 kg of a woman's body weight. Carbohydrates, as the main energy material and a source of fat formation, should be no more than 500 g per day (with obesity, the amount of carbohydrates decreases to 300-400 g per day). For the prevention of late toxicosis of pregnant women, table salt in the second half of pregnancy should be limited to 5 g per day, liquid up to 1-1.2 lava in the last weeks - up to 0.8 liters per day. The amount of trace elements, sources of which are milk, cottage cheese, eggs, liver, meat, bread, nuts, buckwheat and barley groats, beets, peas, in the second half of pregnancy should be: calcium - 1.5-2 g, phosphorus - 2 g, magnesium - 0.5 g, iron - 15-20 mg per day.
What is the importance of vitamins for a pregnant woman?
In the diet of a pregnant woman, vitamins are especially necessary, which are part of a number of enzymes and perform the function of catalysts for metabolic processes in the body. In case of a lack of vitamins entering the body of a pregnant woman with products of dairy and vegetable origin, ready-made dosage forms should be prescribed.
What is the value and daily requirement of vitamins A, PP, C, E for a pregnant woman?
Vitamin A (carotene) affects the uterine mucosa, promotes its regeneration, which is especially important in the postpartum period. The daily dose is 5000 IU, in the last months of pregnancy - 10000-20000 IU.
Vitamin PP (nicotinic acid) is involved in the metabolism of sex hormones, in small concentrations it has a depressing effect on the contractile function of the pregnant uterus. The daily dose is 18-25 mg.
Vitamin C (ascorbic acid) is a powerful catalyst for redox processes in the body, potentiates the action of estrogens, enhances the effect of pituitrin and mammophysin on uterine contraction. The daily dose is 100-200 mg.
Vitamin C is involved in the regulation of calcium and phosphorus metabolism, is used in obstetric practice for the prevention of rickets in the fetus. The daily dose is 1000 ME.
Vitamin E (tocopherol) plays an important role in the normal course of pregnancy (fertility vitamin), a lack of it leads to dysfunction of the genitals, sometimes to fetal death and miscarriage. The daily dose is 20-25 mg.
What is the value and daily requirement of B vitamins for a pregnant woman?
Vitamin Bj (thiamine) is involved in the regulation of estrogenic hormone metabolism, the synthesis of acetylcholine, promotes proper metabolism in the nervous system, liver, and regulates water-salt metabolism. The daily dose is 10-20 mg.
Vitamin B2 (riboflavin) contributes to the normal course of pregnancy and childbirth, is used to prevent threatening abortion, and enhances redox processes in the body. The daily dose is 2-3 mg.
Vitamin B6 (pyridoxine) is essential for the exchange of essential amino acids (histamine and tryptophan). The daily dose is 5 mg.
Vitamin B12 (cyanocobalamin) is effective in treating anemia caused by diseases of the gastrointestinal tract and liver, increases the release of growth hormone. It is used for fetal malnutrition. Daily dose - 0.003 mg
1.7Diet for pregnant women
Pregnancy is the most crucial period of a woman's life, and childbirth is a kind of test of the functional and physical state of her body. During pregnancy, a number of physiological functions change, due to the restructuring of the activity of the entire woman's body.
The body of the mother and fetus in the early stages of pregnancy is sensitive to the influence of various factors of the external and internal environment. There is a restructuring of metabolic processes, the body's need for plastic and energy material increases. This is due to the fact that the body of the expectant mother should provide the best conditions for the life of the fetus.
Early pregnancy (up to 12 weeks) can be accompanied by various disorders in the work of the digestive system (nausea, vomiting, salivation, dermatoses). These are toxicosis (gestosis) arising during pregnancy and associated with the development of the ovum.
There are also several forms of late toxicosis of pregnant women: dropsy, hypertension, hypotension, nephropathy of pregnant women, preeclampsia and eclampsia. Sometimes pregnancy proceeds against the background of concomitant diseases, i.e. those diseases that a woman had before
pregnancy. These are various diseases of the cardiovascular,
respiratory systems, liver, kidneys, etc. In addition, in the second half of pregnancy, when the uterus increases in size and raises the diaphragm, displacing the abdominal organs, there is an additional load on the cardiovascular, respiratory, digestive and other systems.
So, from the second half of pregnancy, the stomach turns around its axis and shifts up and back, its ability to stretch decreases, the muscles of the walls relax, which leads to a violation of the ability to move food into the intestine. The function of the digestive glands is often reduced; the amount of gastric juice and hydrochloric acid decreases, lethargy of the intestinal walls, weakness of peristalsis develop. Constipation, hemorrhoids, rectal swelling appear, gases can accumulate, which causes discomfort and disruption of the digestion process, mainly carbohydrates, and the exchange of individual vitamins.
All this requires careful monitoring of the course of pregnancy and the development of the intrauterine fetus, the appointment of a balanced diet to the woman and timely treatment of concomitant diseases and possible complications.
Rational nutrition is one of the main conditions for a favorable course and outcome of pregnancy and childbirth, ensuring the normal development of the fetus and newborn.
Rational nutrition is a properly organized and timely supply of the body with well-prepared and tasty food containing the optimal amount of various nutrients necessary for its development and functioning. Food products in the body of a pregnant woman perform both construction (plastic) and energy functions. In the process of digestion, the complex components of food are broken down and absorbed into the blood through the intestinal walls, the blood delivers nutrition to all cells of the mother and fetus. As the fetus grows, the need for
nutrients increases, at the same time the body of pregnant women
can assimilate far from all food, due to the above-mentioned features of the function of the digestive system. It has been proven that malnutrition at different stages of pregnancy affects the fetus in different ways. So, starvation and insufficient amount of protein and vitamins in the pre-implantation period causes the death of the embryo, during the period of organogenesis it can contribute to fetal malformations.
Violation of the qualitative composition of the diet, in particular, a change in the content of proteins, fats, carbohydrates in the direction of the predominance of carbohydrates and fats, can lead to overweight women. With an excess of body weight above 15 kg, in 15% of cases, there is weakness in labor, prolonged pregnancy and a large fetus, which complicates childbirth and the postpartum period, since there is a higher percentage of delivery operations, birth traumatism of the mother and fetus.
Eating good nutrition during pregnancy will also contribute to normal lactation and to ensure that there is sufficient quantity and quality of breast milk required for the baby.
One of the most important indicators of a healthy diet for a pregnant woman is the increase in body weight. By the 40th week of pregnancy, the increase in body weight consists of the weight of the fetus (approximately 3200 g), the weight of the placenta (650 g), amniotic fluid (800 g), and an enlarged uterus (900 g). Body weight increases during pregnancy by an average of 9-10 kg (with a tolerance of 3.0 kg). An increase in body weight over 2 kg per month is undesirable, since it indicates the possibility of edema or metabolic disorders.
During pregnancy, the expenditure of muscle energy is significantly reduced, women are transferred to lighter work, are on maternity leave, that is, they belong to groups I and II of labor intensity, in some cases to group III (moderate physical labor).
The general principles of drawing up a diet for pregnant women are that the nutrition of a pregnant woman should be differentiated in
depending on body weight, geographic conditions, season, period
pregnancy and household habits, as well as the nature of work. The diet for women of average height (155-165 cm) and average weight (55-65 kg) should be from 2700 to 2900 kcal per day. The calorie content of the required diet can be calculated individually. To maintain weight with an average labor activity, 50 kcal is required for each kilogram of body weight. So, with a height of 155 cm, a normal weight of 53 kg, 50 kcal x 53 kg = 2650 kcal per day is required. In the second half of pregnancy, the body's need for energy rises to 2900 kcal, and in working conditions - up to 3300 kcal.
In the first half of pregnancy, a woman's nutrition should not differ significantly from her usual diet, she can eat anything that meets her tastes, but products that irritate the kidneys (smoked meats, garlic, horseradish, pepper) should be avoided. It should be remembered that in the first trimester the fetal organs are laid, therefore during this period it is especially important to ensure a sufficient intake of high-grade proteins, vitamins and trace elements in the optimal amount and ratio.
Chemical composition of food
Proteins. It is the main plastic material for the construction of fetal tissues, the synthesis of hormones and enzymes in the mother's body. It is not only the quantity that matters, but also the quality of the proteins. The completeness of a protein is determined by the content of essential amino acids in it, that is, those that are not produced in the human body, but come only with food. All amino acids necessary for humans are part of the proteins contained mainly in animal products (meat, fish, eggs, milk, etc.). And these products should make up at least 60% of the diet of pregnant women. The main amount of protein is consumed in the form of milk protein - casein with the addition of meat and fish proteins.
From the 4th month of pregnancy, you need 1.3 g of protein per 1 kg of body weight per day (an average of 110-120 g). Especially recommended are cottage cheese, kefir, milk, boiled meat and fish, mild varieties of cheese. These products contain not only easily digestible proteins, but also essential amino acids and calcium salts.
Protein for pregnant women is also necessary for the growth of the uterus, placenta, increase in the mass of blood and mammary glands. Insufficient protein nutrition leads to a change in the biochemical composition of the blood and can contribute to a delay in fetal development, a decrease in the weight of its body, brain, liver and heart, spontaneous abortion, and premature birth.
Fats. Like proteins, they are involved in the structure of body cells, are a source of energy and carriers of a number of vitamins. They are necessary for the normal assimilation of certain vitamins (A, D, E) and mineral salts (calcium, magnesium) by the body. Part of the fat is deposited in the liver, placenta, and mammary glands. Fat consumption during pregnancy should be somewhat limited (no more than 90 g, or 1.5 g per 1 kg of body weight per day). The main type of animal fat during pregnancy is fresh butter, cream, sour cream, and cheeses. It is also necessary to consume 25-30 g of vegetable oils (sunflower, olive, corn) daily, which contain a number of vitamins. It must be remembered that overweight women also need fats, but in smaller quantities (70-80 g).
Carbohydrates. These are organic substances made up of carbon, hydrogen and oxygen. They are part of plant products - vegetables, cereals, fruits - in the form of sugars, starch, fiber. More than half of the energy necessary for the vital activity of the body, a person receives in the form of carbohydrates. Increased consumption of carbohydrates, especially sucrose, is one of the factors leading to obesity in women and increased fetal weight. With food, a woman should consume 350-400 g of carbohydrates per day, and with an excess of body weight - 250-300 g. The source of carbohydrates should be: wholemeal bread, potatoes, vegetables, fruits, buckwheat, oatmeal.
In winter, you can use apple, plum, tomato juices, frozen fruits. Juices prepared at home are not recommended, since if they are improperly prepared, alcohol is formed in them, which is categorically contraindicated for a pregnant woman. The total amount of sugar should not exceed 45 g per day, and in the second half of pregnancy, the consumption of confectionery, jams, sweets should be limited, since they cause increased fermentation in the intestines, peristalsis. This is especially important for women with habitual miscarriages, since they often have high blood sugar levels, and glucose easily penetrates the placental barrier and enters the fetus.
Liquid. Water, together with the minerals dissolved in it, constitutes the internal environment of the body, being the main part of plasma, lymph, tissue fluid. Water exchange pregnant women has a number of features.
The body's daily need for fluid is about 35 g per 1 kg of body weight, that is, about 2 liters. The amount of fluid consumed by pregnant women ranges from 2-3 liters per day. It must be remembered that a significant portion of the water is found in food. Therefore, with a rational diet, the liquid in the form of tea, milk, soups, etc. should be no more than 1.2 liters.
Excessive fluid intake leads to its delay (the average amount can be 8 liters, with about 6 liters accounted for by the fetus, placenta, uterus, increased amount of blood), and in the last months of pregnancy increases the load on the cardiovascular system, causes edema of pregnant women, therefore, it is advisable to limit its use to 0.8 liters, in combination with a slightly salted diet.
Vitamins. With a lack of vitamins, various complications of pregnancy occur (miscarriages, premature birth). Without vitamins, enzymes are not formed, and therefore, the normal metabolism is disrupted, hematopoiesis suffers, and the body's resistance to infections decreases.
During pregnancy, the need for vitamins almost doubles.
In winter, it is very important to use carrots (preferably raw with sour cream or butter).
Synthetic preparations can be used as an additional source of vitamins in the winter-spring period.
Vitamins are found more in plant foods: vegetables, fruits, roots, berries. Some vitamins (B, PP, K and D) are formed in the human body under the influence of intestinal microflora, D - in the skin under the influence of ultraviolet radiation.
Long-term use of antimicrobial drugs, as well as diseases of the gastrointestinal tract, can lead to hypovitaminosis, despite their rational administration with the diet.
Vitamin A (retinol) - promotes the growth of all cells and tissues of the body, ensures normal growth of skin, hair, skeleton, takes part in fat metabolism, in the act of night vision. Vitamin A is resistant to heat and absorbed better with fats. It is essential in the prevention of abnormal development of the placenta and postpartum infections. In the last 2 months of pregnancy, it should be included in the diet in an increased amount. The richest in vitamin A are fish and animal liver, eggs, butter, milk, carrots, pumpkin and other vegetables. But for better assimilation, vegetables should be eaten slightly stewed with vegetable oil. Its daily dose is 1.25 mg, and at the end of pregnancy - 1.5 mg.
B vitamins - take part in the processes of growth and metabolism, especially protein and carbohydrate, contribute to normal hematopoiesis. With a lack of one of the vitamins of this group or the entire complex, the activity of the nervous system and the gastrointestinal tract is disrupted. The main source of vitamins of this group are almost all plant and dairy products. There are many of them in brewer's and baker's yeast, meat, liver, especially in the embryos and shells of grains, in coarse flour, cereals (except for pearl barley and polished rice).
B1 (thiamine) - its deficiency is accompanied by increased fatigue, decreased appetite, damage to peripheral nerves, a sufficient amount improves the secretory and motor function of the stomach. Source - liver, meat, yeast, bread made from coarse flour.
B2 (riboflavin) - affects the function of the liver, vision, is involved in the metabolism of carbohydrates, fats, proteins. With its lack, it is possible that the function of capillaries and blood flow is impaired.
B5 (calcium pantothenate) - participates in the metabolism. Its rich source is yeast, bran, liver.
Bg (pyridoxine) - participates in the cellular metabolism of amino acids, carbohydrates, fats. Found in bread, beans, yeast, beef, egg yolk.
B12 (cyanocobalamin) - participates in the formation of a number of amino acids (methionine, etc.) and ribonucleic acids. Its source is the liver, kidneys, heart, egg yolk, buckwheat. Lack of vitamin B13 contributes to the development of anemia.
B15 (calcium pangamate) - increases the absorption of oxygen by tissues, the content of glycogen in the muscles and liver, reduces the phenomenon of hypoxia in the body. More of it is found in plant seeds, liver.
B (folic acid, folacin) is an antianemic vitamin. Its sources are beans, yeast, leafy vegetables, beef liver.
Vitamin C (ascorbic acid) - activates the activity of enzymes and hormones, the growth of bones, cartilage, increases blood clotting, prevents edema, increases the body's resistance to infections, strengthens the walls of capillaries. Vitamin C is found in black currants, rose hips, citrus fruits, herbs, fruits, potatoes, cabbage, tomatoes and other foods. In the winter-spring period, its dosage increases, and the amount in food by the end of their storage decreases, therefore, during this period it is advisable to additionally take vitamin C in tablet forms.
Vitamin P - has a lot in common with vitamin C.
In plant nature, a large number of substances with P-vitamin activity have been identified, all of which have received the general name of bioflavonoids. Their main role is in the capillary-strengthening effect and in reducing the permeability of the vascular wall. They enhance the effect of vitamin C. Vitamin P is found in chokeberry, rose hips, black currants, carrots, beets, salads, sweet peppers, etc.
Vitamin PP (nicotinic acid) - participates in the reactions of cellular respiration, improves the function of the pancreas and liver. Nicotinic acid is a participant in tissue metabolism of the brain, normalizes inhibitory-excitatory processes in the central nervous system. Partial deficiency of vitamin PP in the body can be in diseases of the gastrointestinal tract and with prolonged use of antibiotics, sulfonamide. This can be the cause of headaches, insomnia, impairment of attention, memory. Contains nicotinic acid in yeast, nuts, beans and grain products, veal, beef, potatoes.
Vitamin E (tocopherol) - vitamin of reproduction, affects the normal course of pregnancy, prevents miscarriages, premature birth. A close relationship of vitamin E with the function of the gonads, pituitary gland and other endocrine glands has been established. If there is no vitamin E in the body of a pregnant woman, the metabolism is disturbed and the resulting poisonous products can cause fetal death and spontaneous abortion. Contains tocopherol in butter and vegetable oils, egg yolk, wheat germ, corn, buckwheat and oatmeal. Its daily dose during pregnancy rises from 10 mg to 20 mg.
Vitamin D D2 (calciferol) is an antirachitic vitamin. Plays an important role in phosphorus-calcium metabolism, in the osteoplastic processes of the fetus, in the function of the reproductive system, promotes the maturation of full-fledged germ cells. Contains vitamin D in egg yolk, caviar, cod liver, fish oil, milk, butter. But, mainly, it is formed in the skin when exposed to sunlight. In the last months of pregnancy, especially with a lack of sunny days, the dose should be 600-800 units (IU).
An overdose of this vitamin is also harmful, since it has a toxic effect: body weight decreases, early ossification of the fetal skull sets in, calcium is deposited in a number of organs and vascular walls.
Vitamin K - promotes normal blood clotting, strengthens the walls of blood vessels, and prevents hemorrhages. Contained in lettuce, spinach, milk, eggs.
Table 14.1 The need of pregnant women for vitamins
Vitamins, units rev. Need
Thiamine, mg 1.7
Folacin, mcg 600
Riboflavin, mg 2.0
Niacin, mg 19
Pyridoxine, mg 2.0
Ascorbic acid, mg 70
Cyanocobalamin, mg 4.0
Tocopherol, ME 15
Retenol, mg 1.25
Calciferol, ME 500
Equally important is the provision of a woman's body with the necessary amount of macro- and microelements. Their excess and deficiency adversely affects the body of the mother and fetus. Salts are necessary for building the skeleton of the fetus, blood and other tissues. The most important are the salts of sodium, calcium, potassium, phosphorus, iron, magnesium, copper, cobalt, zinc.
Calcium is essential for the construction of bone-cartilaginous tissues of the fetus. The female body's need for calcium during pregnancy increases to 1100 mg per day.
If the increased need for calcium is not covered by its content in the diet, then the fetus provides itself at the expense of the maternal body, which leads to its deficiency in the pregnant woman and can cause osteoporosis of the pubic bones (during childbirth, the threat of simphitis and discrepancy of the pubic articulation), teeth are affected etc.
A valuable source of calcium is milk, cottage cheese, lactic acid products, egg yolk. The absorption of calcium salts depends on the supply of the body with vitamin D and phosphorus.
Phosphorus is involved in the formation of fetal bone tissue. During pregnancy, the need for phosphorus (1500 mg per day) increases by 50-60%, and the ratio of calcium and phosphorus in the diet should be 1: 1.5; 1: 2. A pregnant woman needs a daily intake of 1.5-2.0 g of phosphorus (in dairy, meat and fish products). There is a lot of phosphorus in nuts, beans, oatmeal and buckwheat.
Iron. The woman's need for iron increases and is 20 mg per day. Iron, copper, cobalt are involved in hematopoiesis and oxidative processes. Pregnant women tend to develop iron deficiency anemia. It is possible to prevent it or reduce its severity with the help of a balanced diet, including liver, kidney, tongue, apples, apricots, plums, salad in the diet.
Cobalt, which is included in vitamin B12, in combination with copper and iron, participates in oxidative processes and in hematopoiesis.
Copper, zinc. With their lack, protein deficiency occurs, the weight of the fetus may decrease, newborns are born with edema.
Magnesium is found in bone tissue, the metabolism of magnesium and phosphorus in the body is interrelated. A lack of magnesium salts in food violates the excitability of the nervous system, muscle contraction. The need for it is 450 mg.
The main source of these microelements are buckwheat, oatmeal, beans, peas, prunes, dried apricots, nuts, rye bread. Cobalt is also found in black and red currants, strawberries, and liver.
Potassium (and its salts) is especially important for the normal functioning of the cardiovascular system, takes part in plastic processes and energy metabolism. Apples, plums, apricots, raisins, peaches, mulberries, gooseberries, baked potatoes, oatmeal, etc. are rich in potassium salts. The need for potassium is at least 5 g per day.
Sodium salts (table salt) - are involved in the regulation of water metabolism. You should pay special attention to their content in the diet of a pregnant woman: in the second half of pregnancy, it should not exceed 6-8 g per day. In the last month, you can use dietary salt (sanasol) instead of table salt.
Thus, nutrition, containing the optimal amount of macro- and microelements, ensures the normal course of metabolic processes in the mother and the fetus and is an important remedy.
Diet of pregnant women
Nutritional regimen is of exceptional importance for the physiological course of pregnancy. Violations of it harm not only the mother's body, but also the normal development of the fetus. Nutrition should not only be rational, but largely individual. When compiling a diet for a pregnant woman, one should proceed from the fact that proteins constitute an average of 20-30%, fats - 20-25% and carbohydrates - 45-50% of the total energy value of the diet. All foods should be absorbed and used as much as possible. One of the prerequisites for this is to limit the amount of food taken at one time. Physiologically justified in the first half of pregnancy 4-5 meals a day: the first breakfast at 8-9 am, the second breakfast at 11-12 hours, lunch at 14-15 hours, dinner at 18-19 hours and at 21 hours - a glass of kefir.After eating, it is inappropriate to rest lying down, rest should be active.
In the second half of pregnancy, you first need five, and in the last two months - six meals a day.
Meat and fish dishes should be consumed mainly during breakfast and lunch.
It is advisable for pregnant women to eat meat of young animals and preferably in a boiled form in order to avoid harmful
the influence of extractive substances. In the last three months of pregnancy, it is advisable to exclude broths, meat borscht, soups from the diet. During this period, meat consumption should be limited to 3-4 times a week, and in the last month - 1-2 times a week (to facilitate kidney function). In the first half of pregnancy, fish should occupy no less place in the diet than meat. In the second half of pregnancy, it is advisable to eat dishes prepared from fresh fish. Milk and dairy products are recommended throughout pregnancy (if tolerated). On average, a pregnant woman needs to consume 0.5-0.6 liters of milk per day. Vegetables, fruits and berries are a must for a woman throughout her pregnancy. From cereals, preference should be given to buckwheat, oatmeal and rice. Bread should include more rye. At the end of pregnancy, exclude oatmeal and semolina, especially if you are overweight.
It is most favorable to combine animal and vegetable products in the diet so that the former make up 60-70%. It is recommended to compose the menu taking into account the time of the year and to diversify the food more.
The food you eat should be fresh, well cooked and not very hot. If food is stored for a long time and then reheated, it loses not only its taste, but also a large amount of vitamins.
Basic cooking principles
Food is prepared from fresh, good-quality products, well washed in running water and refined. The main task of food preparation is to preserve their nutritional value (proteins, fats, carbohydrates and vitamins) and promote better absorption of nutrients.
In culinary processing, cooking in water and steam, frying is used; vegetables are best stewed with water and fat over low heat in a sealed container.
Under the influence of culinary processing, physical and chemical changes occur in food substances and the food becomes suitable for digestion. For example, when meat is boiled at a temperature of 100 ° C, the insoluble protein collagen, which is part of the connective tissue, turns into soluble - glutin, suitable for assimilation.
During the cooking of meat, some of the nutrients and extractives are transferred to the water. If the meat is immersed in boiling water, then the broth will be low in concentration, but more extractives will remain in the meat, which is not advisable for pregnant women to take. It is better to cook meat for a diet during pregnancy in a different way: cut it into small pieces and immerse it in cold water, gradually bring to a boil and cook for 1.5-2 hours. fewer.
During the preparation of products of plant origin, significant structural changes in protein and carbohydrates also occur. The protein curls up, the starch gelatinizes. When preparing vegetables, in addition to heat treatment, mechanical (fine shredding) and chemical treatment (fermentation, treatment with acetic or citric acid) are used. Vegetables are then better digested and absorbed. Vegetables should not be soaked in water for a long time, as this destroys vitamins and other nutrients. From 50 to 75% of minerals pass into the water in which vegetables were cooked, so the vegetable broth can be used to prepare first courses. Vitamins of group B pass into water during cooking. For example, when stewing meat, only 40-60% of vitamin B1 is retained? up to 75% - vitamin B2, up to 70-90% niacin. The activity of vitamin A and carotene during heat treatment does not decrease. Vitamin C is highly degraded when peeling and storing vegetables in water. This also applies to dairy products. It is known that lactic acid products lose their nutritional value when heated above 60 °. Less destruction of vitamins and enzymes can be achieved by pasteurization of milk (heating it for 30-40 minutes at a temperature of 60 °) than by boiling it. It is better to take cottage cheese fresh or after heat treatment in the form of cottage cheese dishes (cheesecakes,
casseroles, cheesecakes). Kefir is stored in the refrigerator for no more than 48 hours. Butter is stored in a sealed container in the refrigerator for no more than 7 days.
Brief description of individual food products
Meat. This is a protein-rich food product, it also contains mineral salts, vitamins of group B. Lean meats (beef, veal) are introduced into the diet of pregnant women. Meat by-products are valuable; liver, brain, rich in phosphorus compounds, tongue.
A fish. Fish contains highly digestible proteins. Cod, hake, perch, pike perch, navaga, catfish are used to feed pregnant women. The fish should be fresh, boiled or in the form of steamed cutlets, you can cook fish soup.
Eggs, a valuable food product, contains proteins, fats and vitamins (A, B, D and E). Eggs are best eaten boiled, as raw eggs can provoke allergies or be infected. Women should only eat fresh eggs during pregnancy.
Butter. It is better to use butter in the diet of pregnant women. When preparing salads and vegetable dishes, vegetable oil is recommended. Lard can be used in small quantities and only fresh. It is better not to use beef and mutton fats for the nutrition of pregnant women, since they are refractory, contain almost no vitamins and are poorly digested.
Sour cream. It should only be fresh, add it to vegetables.
Milk and dairy products. The milk contains high quality proteins, fats, carbohydrates, minerals, vitamins. It is recommended to take up to 500-600 ml of dairy products per day (kefir, acidophilus milk), which improve digestion. Milk is best consumed in pasteurized form (or fresh only from healthy cows, in full observance of hygiene standards during milking). To preserve the value of milk, it must be boiled for no more than 1 - 2 minutes or pasteurized. Repeated boiling dramatically reduces the amount of vitamins and the value of proteins. In the diet of pregnant women, lactic acid products have an advantage, with a tendency to constipation
only one-day kefir is advisable.
Cottage cheese. A nutritious protein product essential for women during pregnancy. It is better to use freshly made cottage cheese at home. The recipe is as follows: mix 3 liters of fresh cold milk with 12 g of lactic acid calcium and heat slowly, bringing to a boil (1-2 minutes), then cool to room temperature and squeeze through a sterile gauze napkin. Transfer the curd to a glass jar. Output - 500 g. Store in the refrigerator for no more than 2 days. Recipe for making sour cottage cheese: 3 liters of sour pasteurized milk is placed in a water bath for 1 hour at a temperature of up to 75 ° (cannot be brought to a boil). When the transparent serum has separated, the jar is removed from the water bath, cooled, filtered and wrung out.
Cereals, flour. The most valuable in terms of chemical composition are buckwheat and oat groats. Cereals are used to prepare cereals of various consistencies and soups. It is used with butter, milk and other seasonings to taste.
Vegetables and fruits. Contains vitamins, carbohydrates, minerals and organic acids. The diet includes: carrots, cabbage, pumpkin, zucchini, tomatoes, cucumbers, beets, onions, dill, parsley, lettuce, etc. Greens are rich in vitamins and microelements, it is better to eat them fresh. Onions, radishes, garlic contain essential oils that irritate the mucous membrane of the gastrointestinal tract, so they are included in the diet to a limited extent. Vegetables, fruits and berries are consumed both raw and after appropriate cooking. Vegetables, especially potatoes, peeled before cooking, cannot be soaked and stored for a long time, since their nutritional value is lost (vitamins, starch and trace elements pass into the water). It is better to boil potatoes and other vegetables like this: the cooked vegetables are immediately placed in boiling water and boiled in a bowl with a closed lid over low heat. Vitamin C is better preserved in baked potatoes or boiled in "uniforms".
The variety of food is of great importance, which largely depends on the ability to correctly compose the menu. About correct
the selection of food products in the organization of rational nutrition can be
judged by the normal course of pregnancy
weight gain in the second half should not exceed 300-350 g per week. With a more intense increase, you should find out the reason and adjust the diet. Here is an example of a set of products for one day, their chemical composition and energy value.
Table 14.2. A set of products for one day for a woman in the second half of pregnancy
Quantity, g Chemical composition Energy
Products proteins, g fats, g carbohydrates, g gia, kcal
Meat products 120 16.2 9.12 -147.6
Fish products 100 16.0 0.4 -68.0
Cottage cheese (low-fat) 170 23.8 0.85 5.9 129.6
Kefir (fermented baked milk) 200 6.0 7.4 9.4 136.6
Milk 250 9.0 10.5 13.5 186.0
Sour cream 30 0.6 8.4 0.9 85.5
Butter 15 0.06 11.7 0.09 110.1
Vegetable oil 25 - 23, 2 - 215.7
Sugar 50 - - 48.0 196.0
Rye bread 100 7.0 1.0 45.0 223.0
Wheat bread 100 7.1 1.0 47.5 230.0
Eggs 1 pc. 9.2 5.4 0.5 100.5
Bun, biscuits 100 5.7 11.8 55.7 361.3
Groats, pasta 60.0 7.4 1.5 40.0 208.0
Potatoes 200 3.7 - 42.1 189.0
Cabbage 100 1.4 - 5.2 62.0
Beet 100 1D - 10.3 47.0
Carrots 100 1.3 - 7.6 36.0
Tomatoes 200 1.3 - 4.0 21.3 and other vegetables
Onions 35 1.0 - 3.1 16.1
Fruits, berries 200 1.2 - 46.0 193.4 or fruit juice
TOTAL 119.2 92.27 384.7 2962.7
If a pregnant woman for any reason is on bed rest, the calorie content of the diet is reduced by 20-30%.
Menu for one day for pregnant women in the second half of pregnancy
1st breakfast
Boiled meat - 120 g with mashed potatoes - 200 g, fresh cabbage salad - 100 g. Cottage cheese - 150 g, tea - 200 g, sugar - 25 g. Rye bread - 50 g.
2nd breakfast
Buckwheat porridge - 200 g, milk - 200 g. Wheat bread - 50 g.
Dinner
Ukrainian borsch with minced meat and sour cream - 300 g. Rye bread - 50 g. Vegetable stew - 80 g with boiled fish - 100 g. Fruits, berries - 300 g.
Afternoon snack
Egg - 1 pc. hard boiled, rosehip infusion or apple juice - 200 g, cookies - 50 g.
Dinner
Protein omelette - 60 g with sour cream - 15 g. Bun - 75 g. Tea - 200 g,
sugar - 25 g
Before bedtime
Fresh kefir - 200 g.
Food rations for pregnant women have been developed at the Kiev Institute of Pediatrics, Obstetrics and Gynecology. The effect of these diets on a large number of observed women has been studied. In women who were on such a diet, complications (anemia, toxicosis) developed less often, such nutrition has a beneficial effect on the course of pregnancy and childbirth, the development and condition of the fetus and newborn.
In addition to diet, an important therapeutic and prophylactic agent that contributes to the normal course of pregnancy and the development of the intrauterine fetus, for a pregnant woman is regular exercise in a special complex. On this issue, information can be obtained from the antenatal clinic.
Approximate weekly menu in the second half of pregnancy with its normal course
MONDAY
First breakfast (8-9 h)
Butter. Egg. Salad. Tea with lemon. Bun.
Second breakfast (11-12 hours)
Pancakes with rice and sour cream. Milk. Bun.
Lunch (14 - 15 h)
Vegetarian cabbage soup, with grows, butter. Meat meatballs with noodles. Baked apples. Black bread.
Afternoon snack (17 h) Berries with honey.
Dinner (19h)
Tea with a bun.
Cottage cheese with sour cream.
At night (21-22 h) Kefir.
TUESDAY
First breakfast (8-9 h)
Butter. Cottage cheese with sour cream. Tea with milk. White bread.
Second breakfast (11-12 hours)
Vinaigrette with vegetable oil. Pancakes with meat. Rosehip decoction.
Lunch (14-15 h)
Milk rice soup. Beef stroganoff made from boiled meat with boiled potatoes. Dried fruits compote. Black bread.
Afternoon snack (17 h) Fresh apples.
Dinner (19h)
Boiled fish. Tea. Bun.
At night (21-22 h) Ryazhenka.
WEDNESDAY
First breakfast (8-9 h) Butter, nom, biscuits. Boiled fish. Salad. Tea with lemon
Second breakfast (11-12 hours)
Boiled potatoes with salad. Protein omelet. Milk, cookies.
Lunch (13-14 h)
Ukrainian borsch. Stewed meat with salad with vegetable oil. Fruit or berries with honey. Black bread.
Afternoon snack (17 h) Apple juice.
Dinner (19h)
Vegetable stew. Milk tea, biscuits.
At night (21-22 h) Kefir.
THURSDAY
First breakfast (8-9 h)
Butter. Sour cream salad. Cheese. Tea with lemon. White bread.
Second breakfast (11-12 hours)
Rice porridge with milk. Cheese. Rosehip decoction.
Lunch (13-14 h)
Buckwheat soup with potatoes. Boiled pike perch. Vegetable oil salad. Compote. Black bread.
Afternoon snack (17 h) Fruit.
Dinner (19h)
Boiled meat with vegetable salad. Milk.
At night (21-22 h) Kefir.
FRIDAY
First breakfast (8-9 h)
Butter. Protein omelet. Tea with milk.
White bread. Second breakfast (11-12 hours)
Semolina pudding with raisins. Rosehip decoction. Lunch (13-14 h)
Vegetarian pickle. Boiled meat with rice
porridge. Dried fruits compote. Black bread.
Afternoon snack (17 h)
Stuffed pepper with carrots. Fruit juice. At night (21-22 h)
Ryazhenka.
SATURDAY
First breakfast (8-9 h)
Butter. Cottage cheese with sour cream. Tea with milk.
Bun. Second breakfast (11-12 hours)
Potato fritters. Milk, biscuits Lunch (13-14 h)
Vegetarian cabbage soup with vegetable oil. Hen
boiled with vegetable salad. Berry compote. Bread
black. Afternoon snack (17 h)
Rosehip infusion. Biscuits. Dinner (19h)
Boiled fish. Vegetable stew. Tea. At night (21-22 h)
Kefir.
SUNDAY
First breakfast (8-9 h)
Butter. Vinaigrette with vegetable oil.
Tea with lemon. Biscuits. Second breakfast (11-12 hours)
Buckwheat porridge with butter. Milk. Lunch (13-14 h)
Fish soup. Meat zrazy with buckwheat porridge. Fruits. Rosehip decoction. Black bread. Afternoon snack (17 h)
Low-fat cottage cheese. Milk. Dinner (19h)
Boiled meat or egg. Vegetable salad. Tea. At night (21-22 h)
Kefir.
The amount of products depends on their chemical composition.
It is necessary to monitor the amount of fluid taken, which should be no more than 1.2 liters per day (together with soups, milk, tea, etc.). With the appearance of edema and the last 2 months - no more than 0.8 liters.
Features of nutrition of women with toxicosis of pregnancy
Toxicosis of pregnant women is early - up to 3 months of pregnancy and late, which develop in the last 2-3 months of pregnancy.
The early ones are manifested in the form of nausea (especially in the morning), vomiting of pregnant women, salivation and allergic skin reactions (dermatoses). Early toxicosis occurs in 50-60% of women. According to the severity of the disease, mild, moderate and severe toxicosis are distinguished. With a mild form, vomiting of pregnant women occurs from 1 to 5 times a day, sometimes only on an empty stomach, but the woman's well-being remains satisfactory.
The nutrition of pregnant women with a mild degree of toxicosis corresponds to the chemical composition of the nutrition of a healthy woman. Food should be digestible and rich in vitamins. Vomiting may appear on an empty stomach, during meals or after meals, sometimes on occasional odors. If vomiting appears on an empty stomach, pregnant women are advised to take a small sandwich before getting out of bed - bread with butter or cheese, you can eat a few pieces of small brown bread rusks, slightly salted. All pregnant women with a mild form of toxicosis should eat food in small portions every 2-3 hours, warm, but not hot, and in case of reaction to odors - chilled. You should not take liquid and solid food at the same time, that is, 0.5-1 hour before meals and after it is not recommended to drink (water, milk, compote, etc.). It is useful to include cottage cheese, hard eggs, baked potatoes, vegetable puree, a small amount of pickles (cucumber, tomato) or a piece of herring in the diet. If possible, satisfy food whims that appear during pregnancy.
When drooling, a number of trace elements and fluid are lost. In these cases, a woman can recommend liver and herring pates, freshly pickled cucumbers, sauerkraut and an additional intake
liquids or juices.
In case of vomiting of pregnant women of the 2nd degree (up to 10 times a day) and 3rd degree (15-20 or more times), treatment should be carried out in a hospital, since it is necessary to replenish the lost trace elements, proteins and fluid by parenteral nutrition (through probe, intravenously).
With repeated vomiting, the body undergoes deep biochemical changes, the content of residual blood nitrogen increases, ketoacidosis and dehydration increase.
The period of fasting in pregnant women should not exceed 2-3 days, since after 12-18 hours of fasting, fats and proteins of the pregnant woman herself become the main source of nutrition. There is a drop in body weight, the woman's condition deteriorates sharply, dry skin and mucous membranes appear, the smell of acetone from the mouth, aversion to food, the pulse quickens, and there are violations of the central nervous system. All this negatively affects the state of the intrauterine fetus until its death.
In this regard, all pregnant women in whom vomiting reaches 10 times a day (and even less than 10 times) should consult a doctor within 1-2 days and begin treatment as early as possible. The task of parenteral (intravenous) nutrition is to replenish the loss of energy and plastic materials, as well as to normalize violations of the water-salt and vitamin balance.
Late toxicosis of pregnant women is accompanied by various metabolic disorders of proteins, fats, carbohydrates, vitamins and microelements. The functions of a number of organs and systems are impaired: liver, kidneys, cardiovascular and nervous. There are such forms of late toxicosis of pregnant women: dropsy, hypertension, nephropathy of pregnant women, preeclampsia and eclampsia.
The diet of pregnant women with late forms of toxicosis should include: vegetables, fruits, honey, wholemeal bread. Strawberries, strawberries, black currants, apples, pumpkin, watermelons, beets, carrots are especially useful. These foods provide adequate intake
vitamins and minerals and are a source of carbohydrates.
The amount of free fluid should not be sharply limited, since with late toxicosis, the volume of circulating blood and plasma decreases and the uteroplacental blood flow decreases. The amount of liquid should be at least 800 ml and it is advisable to include in the diet foods that increase urine output; rosehip broth, beet juice, parsley, blackberry, viburnum, chokeberry, cool milk, dried apricots.
With an excessive increase in body weight and the development of edema, women are transferred to a salt-free diet, in which the content of table salt should not exceed 3-4 g per day. The complete elimination of salt is impractical, since this can lead to a decrease in urine excretion and the retention of nitrogenous wastes in the body.
Pregnant women with severe forms of late toxicosis should have fasting days once a week, for example:
1) curd-kefir - 200 g of cottage cheese and 500 g of kefir per day (4-5 receptions);
2) apple-cottage cheese - 1 kg of apples and 250 g of cottage cheese per day;
3) apple - 1.5 kg of apples per day;
4) potato - 500 g of baked potatoes, 20 g of butter, 500 g of milk per day.
The chemical composition and energy value of the diet for toxicosis: proteins - 100-110 g, fats - 80 g, carbohydrates - 40 g, calories - 2600-3000 kcal. The most complete proteins are used - cottage cheese, milk, meat, fish. Exclude from the diet - meat, mushroom broths, spices, pickles, smoked meats, fried foods, sauces, seasonings, chocolate, coffee.
Cooking food. Cook the first courses only on vegetable broths (cabbage soup, beetroot soup, soups, milk soups). Second courses are boiled. Food intake - 5 times a day, before going to bed - kefir.
An approximate menu for one day for pregnant women with a late
toxicosis
1st breakfast
Boiled fish - 150 g or 120 g meat with potatoes - 180 g or stewed liver - 75 g with carrots - 200 g Vegetable salad with sour cream - 15 g or 1 boiled egg and salad with fresh cabbage - 200 g with vegetable oil - 15 d. Butter - 10 g. Tea or tea with milk - 200 g.
2nd breakfast
Cottage cheese - 150 g or millet milk porridge - 300 g. Apples - 300 g or fruit juice - 200 g.
Dinner
Beetroot - 300 g with sour cream - 15 g or rice soup with minced meat - 50 g. Boiled meat - 50 g with noodles - 200 g; or steam cutlet - 60 g with buckwheat porridge - 200 g; or vegetable stew - 100 g with boiled fish - 75 g. Compote or rosehip decoction - 200 g.
Afternoon snack
Fat-free cottage cheese - 50 g with milk - 200 g; or fruits and berries - up to 300 g; or cottage cheese - 50 g with honey - 40 g.
Dinner
Milk rice porridge - 300 g; or low-fat cottage cheese - 150 g with rosehip decoction - 100 g; or boiled fish - 100 g with vinaigrette - 200 g.
Before bedtime
Kefir - 200 g.
For a day
Rye bread - 200 g or wheat bread - 100 g.
Complex therapy of late toxicosis of pregnant women, including the nutritional therapy developed by the Kiev Research Institute of Pediatrics, Obstetrics and Gynecology, helps to reduce high blood pressure, normalize metabolic processes, increase urine output,
the normal development of the fetus, the course of pregnancy and childbirth.
Nutritional support for anemia in pregnant women
In recent years, there has been an increase in the number of anemias in pregnant women up to 20-37%. Iron deficiency anemia is most often noted, in most cases it is attributed to one of the types of toxicosis of pregnant women. Most often it appears after 18-22 weeks of pregnancy. A pregnant woman develops rapid fatigue, weakness, dizziness, headache, drowsiness. In the blood, a decrease in hemoglobin, color index, the number of erythrocytes and iron content in the blood serum is determined.
The main reasons for the development of iron deficiency anemia in pregnant women are an increase in the need for iron in the developing fetus, its insufficient intake into the body or its assimilation in the alimentary canal. If the balance of iron is disturbed, when the consumption exceeds the intake, anemia with iron deficiency of varying degrees develops. The biosynthesis of hemoglobin is disrupted by a lack of cobalt (the main component of vitamin B2) and vitamins B2, B6, E, C, D, as well as glutamic acid.
A decrease in the level of hemoglobin in the mother's blood causes changes in tissue metabolism in the fetus, leads to a violation of oxidative processes and the appearance of oxygen deficiency, and intrauterine fetal hypoxia develops. With anemia in pregnant women, there are a number of complications of pregnancy (miscarriage, late toxicosis, fetal death) and childbirth (untimely rupture of amniotic fluid, weakness of labor, high stillbirth). All pregnant women with iron deficiency anemia are at high risk and should be monitored and treated.
A balanced diet is of great importance in the prevention and treatment of anemia.
Purpose of the diet: replenishment of the deficiency of protein, iron, trace elements and vitamins.
The chemical composition and energy value of the diet: in the first half of pregnancy for women of average height (155-165 cm) and average body weight (55-65 kg) - proteins - 120 g; fat - 80 g; carbohydrates - 300-400 g; energy - 3200-3300 kcal.
It is necessary to consume more proteins of animal origin, as they contribute to the absorption of iron. The diet includes foods rich in amino acids (meat, fish, cottage cheese, chum roe), foods rich in iron (tongue, liver, eggs, fruits - peaches, apricots, apricots, Antonov apples, pumpkin, tomatoes, beets). Berries are also valuable - strawberries, strawberries, raspberries. Vitamins of group B are replenished with vegetables, fruits, buckwheat and oatmeal. In winter, with a lack of vitamins in the products, a complex of vitamins is prescribed in the form of medications. Vitamin C plays an important role, it activates the absorption of iron in the stomach and intestines and is involved in the metabolism of folic acid and vitamin B12. Women with anemia are also allowed to take extractives (meat broths), since they often have a violation of the secretory function of the stomach.
An approximate menu for one day for pregnant women with iron deficiency anemia
1st breakfast
Braised liver - 75 g with carrots - 200 g or liver pate - 100 g, butter - 15 g. Tea with lemon - 200 g, oatmeal cookies - 50 g.
2nd breakfast
Cottage cheese casserole - 150 g or boiled fish - 120 g with mashed potatoes - 100 g, vegetable salad - 100 g. Apple juice - 200 g.
Dinner
Ukrainian borsch with meat and sour cream - 300 g, meat - 80 g. Boiled tongue - 80 g with oatmeal - 200 g or sausages - 100 g with buckwheat porridge - 200 g. Rosehip infusion - 200 g.
Afternoon snack
Milk - 200 g, bun - 100 g.
Before bedtime
Kefir - 200 g, baked apples - 100 g.
Cooking. To preserve vitamins, it is necessary to dip the chopped vegetables in boiling water and cook until tender under a closed lid. Prepare raw vegetables before eating. Do not store cooked food for a long time, as reheating it reduces the content of trace elements.
Conclusion
Nursing staff plays a huge role in organizing the nutrition of a pregnant woman, performing a significant amount of care work, medical manipulations, and prevention of nosocomial infections.
The problem in the organization of nutrition for pregnant women, and the fight against it is relevant for the entire health care system of the country and St. Petersburg, in particular. The incidence of GSI is determined, along with violations of the rules of asepsis and antiseptics and anti-epidemic regime, by the presence of objective factors, such as: a significant technical complication of diagnostic and therapeutic manipulations, an increase in the number of operations, as well as their complication and often carried out against the background of immunosuppression and in the early period.
The introduction of modern, effective methods of infection control helps to improve the quality of medical care for pregnant women, and also reduces the cost of their treatment. In addition, the results of the work carried out allowed the administration of other departments to demonstrate their effectiveness of treatment.
The reserve for increasing the effectiveness of epidemiological surveillance is the active involvement of nursing specialists in the implementation of its individual areas. The proposed model of the nursing service for the supervision of nosocomial infections will improve it and will contribute to obtaining a more complete and timely
information on infectious diseases in the hospital and
the factors determining it.
Bibliography:
1. Grekov I.G. The attitude of nurses to their professional activities. // Nurse. - 2000. - No. 1.
2. Deev A.N. Socio-hygienic characteristics of health and living conditions of paramedical workers and their family members: Diss. Cand. honey. sciences. - M., 1987.
3. Dubrovina Z.V. et al. Health status of nurses
4. Kanishchev V.V. Disinfection in neonatology. Complex processing of incubators and instruments. // Nurse, 2007, no. 7.
5. Korchagin V.P., Naygovizina N.B. Organizational and economic aspects of the implementation of the concept of development of healthcare and medical science in the Russian Federation. // Health Economics. - 1998.
6. Marchuk N.P., E.N. Fomicheva Professional training of nurses and midwives of obstetric institutions and the formation of symptoms of "emotional" burnout // Nurse, 2007, No. 7.
7. Monisov A.A., Lazikova G.F., Frolochnikina T.N., Korshunova G.S. The state of the incidence of nosocomial infections in the Russian Federation. // Epidemiol. and infectious bol. - 2000. - No. 5.
8. Fundamentals of Infection Control: A Practical Guide. / Ed. E.A. Burganskaya. - 1997.
9. Perfilieva G.M. Nursing process. // Honey. sister. - 1999. - No. 3
10. Ponomareva G.A., Uspenskaya I.V., Voronkov D.V., Kineleva T.A. Planning the number of medical personnel around the clock posts. // Healthcare. - 1999. - No. 4.
11.Romashova T.I. Assessment by health workers of their work activity. // Sociology in medicine. Issue 3. - Tbilisi, 1990
12. Semina N.A. Scientific and organizational principles for the prevention of nosocomial infections. // Epidemiol. and infectious bol. - 2001. - No. 5.
13. Smirnova L.M., Saidova R.A., Braginskaya S.G. Obstetrics and Gynecology: Textbook. - M .: Medicine, 1999 .-- 368 p.
14. Ugarov V.A. Social and hygienic characteristics of nursing staff in rural areas and ways to improve work with medical personnel in the Tula region: Diss. Cand. honey. sciences. - M., 2000.
15. Cherkassky B.L. General Epidemiology Guide.- M .: Medicine, 2001.
16.Kratz C.R. The Nursing Process.- London: Bailliere Tindall, 1979.
17.McFarland G.K., McFarlane E.A. Nursing Diagnosis and Intervention: Planning for Patient Care.- 3-rd Ed. - St. Louis: Mosby-Year Book, 1997.
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It is difficult to overestimate the influence of nutrition on the well-being and health of children and adults - especially in modern conditions of massive use in industrially prepared food of quite toxic, and often just harmful, prohibited dietary supplements, flavoring and coloring substances, including many.
It should be understood that normal conception, gestation (the period of intrauterine gestation), the process of childbirth and breastfeeding are normal physiological processes that do not require any medical or other external assistance.
With normal childbirth (now in Russia in 40% of cases it is desirable, but not completely obligatory, only the help of a modern nurse-midwife, previously, according to popular definitions, a "midwife", that is, very trained and experienced in childbirth women). In reality, with modern childbirth in Russia, in 60% of cases, serious medical assistance is immediately required for both the newborn and his mother.
Rational nutrition is one of the main conditions for a favorable course and outcome of pregnancy and the normal development of the fetus. The body of a pregnant woman requires more than usual the amount of nutrients needed not only by the mother herself, but also by the growing child.
In the diet of a pregnant woman (both nursing and a child), the freshest products and freshly prepared food should be used. It is highly desirable to exclude sucrose from the diet (including in the composition of confectionery products), replacing it with glucose, fructose, honey and confectionery products made on their basis.
Energy intake should correspond to the costs of the body. Often, the expectant mother deliberately overeats, moreover, against the background of reduced physical activity.
An excess of nutrients leads to a change in the metabolism and functions of the endocrine glands of the fetus, which disrupts the harmonious development of all organs of the body's systems. As a result, a large baby is born with overweight, "loose" muscles and insufficient development of individual organs. On the other hand, insufficient and inadequate nutrition of women during pregnancy, especially a deficiency in the diet of any essential substances - amino acids, vitamins, polyunsaturated fatty acids, minerals - also negatively affects the body of women and the fetus, leading to metabolic disorders. This can contribute to miscarriages, impaired intrauterine development of the fetus, the birth of a child with a very low body weight, the development of a tendency for children to become ill, developmental delay, anomalies and deformities, etc.
One of the most important indicators of a healthy diet for pregnant women is the increase in their body weight, which normally amounts to 8-10 kg during pregnancy (300-350 g per week in the second half of pregnancy).
a woman's diet should not differ significantly from usual. But since the first 3 months are the period of the formation of organs in the fetus, it is especially important that the pregnant woman receives complete proteins, fats, carbohydrates, vitamins, minerals and trace elements in optimal physiological quantities. The daily diet should contain on average 110 g of protein, 75 g of fat and 350 g of carbohydrates with a total energy value of 2400-2700 kcal, this ratio fully covers the needs of the pregnant woman's body and ensures the normal functioning of the digestive system. With a change in taste and a feeling of need for sour or salty, it is allowed to use small quantities of herring, caviar, sauerkraut, pickled cucumbers. In general, you can satisfy whims in food, but not abuse anything. The only thing that should be completely excluded from the very beginning of pregnancy is alcoholic beverages. Smoking is unacceptable - each smoked cigarette inevitably brings its "contribution" to the development of fetal malnutrition (and the more cigarettes, the stronger the malnutrition). Should not be taken without a doctor's prescription and medication, especially in the first months of pregnancy. Mustard, pepper, horseradish, vinegar should also be excluded from the use. The food taken must, of course, be of good quality - the consequences of food poisoning are too serious for the fetus and for the pregnant woman herself. Also, during pregnancy and lactation, any canned food (due to the content of toxic preservatives in them) should be excluded, except for those with the inscription on the label: either "For baby food" or "The absence of preservatives is guaranteed."
the amount of protein in the diet should already be 120 g, fat 85 g, carbohydrates 400 g with a total energy value of the daily diet of 2800-3000 kcal. On prenatal leave, when the volume and working conditions change and the body's energy consumption decreases, the calorie content of food must be reduced. At this time, you should not use extractives (fish, meat, mushroom broths and gravies), various smoked meats and canned food. Vegetable, dairy and fruit soups, cottage cheese, sour cream, mild cheese are recommended, although the nutrition of pregnant women during this period should not be limited to dairy and vegetable food. A balanced diet of pregnant women provides for optimal quantitative and qualitative ratios in the daily diet of basic nutrients - proteins, fats, carbohydrates, vitamins, mineral salts and trace elements. For the growth of the uterus, placenta, mammary glands, to increase the amount of blood, the mother's body needs additional proteins. The need for them is satisfied mainly by high-grade animal proteins, the share of which in the daily diet of a pregnant woman should account for 50%, of which about 25% - due to meat (120-200 g) or fish (150-250 g), 20% - for milk account (500 g) and up to 5% - due to eggs (1 pc.). Milk, yogurt, kefir, low-fat cottage cheese, mild cheese, boiled lean meat, fish contain high-grade easily digestible proteins, essential amino acids, which are in optimal proportions.
The diet of pregnant women should include 75-85 g of fat per day, of which 15-30 g of vegetable (sunflower, corn, olive) oils containing unsaturated fatty acids and vitamin E; from animal fats, premium grade butter and ghee are recommended. Refractory lamb and beef lard, as well as some other types of animal fats and margarine are excluded from the diet. A direct relationship was established between the content of carbohydrates in the diet of a pregnant woman and the weight of the fetus. A pregnant woman should receive 350-400 g of carbohydrates per day, mainly due to foods rich in vegetable fiber - bread made from wholemeal flour (black bread enhances intestinal motility and is, therefore, one of the means to combat constipation, which often occurs during pregnancy ), vegetables, fruits, berries. In winter and spring, juices (apple, plum, tomato), dried fruit compotes and fresh frozen berry jelly are recommended. Starting from the second half of pregnancy, a woman should limit the consumption of confectionery, jams, sweets, as they contribute to an increase in the body weight of the pregnant woman and the fetus. The amount of sugar should not exceed 40-50 g per day. It can be replaced with bee honey (based on 1.25 g of honey instead of 1 g of sugar). For a favorable course of pregnancy, preparation of a woman's body for childbirth, normal development of the fetus and newborn, vitamins are of great importance, the need for which in pregnant women increases almost 2 times.
Vitamin A promotes the development of the placenta, its daily requirement is 2.5 mg. Vitamins B1 and B2 strengthen muscle fibers, the daily requirement for vitamin B1-3-5 mg, B2-3 mg. Vitamin C (ascorbic acid) contributes to the contraction of the muscles of the uterus and strengthens the body's immune system, the daily requirement for it is 100-200 mg. With a lack of vitamin D, the fetus does not develop bones properly, defects form in the laying of teeth, and the pregnant woman herself may develop anemia. The daily requirement for it is 500 IU. Lack of vitamin PP (nicotinic acid) is fraught with fetal abnormalities, abortion and premature birth, the daily requirement is 15-20 mg. Vitamin E favors the growth of the uterus of the pregnant woman and the intrauterine development of the fetus, the daily requirement is 15-20 mg. The use of a wide range of vegetable products (products made from wholemeal flour, buckwheat and barley cereals, legumes, potatoes, tomatoes, fruits, berries) and animal (liver, meat, eggs, cottage cheese, milk, butter) origin provides the basic need of a pregnant woman for vitamins. In the winter and early spring months, food should be fortified, including syrups containing vitamins A, B, C, D, E in the diet, or take multivitamin pills. To prevent rickets in a child in the last months of pregnancy, take fish oil or vitamin D (the latter only as prescribed by a doctor).
For detailed information about the needs of the pregnant woman's body in vitamins, the conditions for the use of vitamin preparations, as well as tables of the content of various vitamins in food, see the page "Vitamins".
The need for a pregnant woman in mineral salts increases in the second half of pregnancy. The diversity of the diet ensures that most of them are supplied to the body in sufficient quantities. A special problem in the nutrition of a pregnant woman is the provision of iron, which is necessary for normal hematopoiesis and tissue respiration. The daily requirement for it is 15-20 mg and is covered by the use of liver, egg yolk, herbs, fruits, buckwheat and oatmeal in food. Here you can see a table showing the iron content of staple foods.
Sometimes women at the beginning of pregnancy feel like eating lime, chalk, salt, etc. This condition indicates an insufficient supply of calcium salts to the body and requires a revision of the consumed food products, in extreme cases (if it is impossible to provide adequate nutrition), the appointment of vitamins (mainly vitamin D), calcium, iron and phosphorus preparations. The daily intake of calcium in a pregnant woman is 1500-2000 mg (while the usual rate for an adult is 800 mg per day). The most significant and complete sources of calcium are milk and dairy products. Only 100 ml of pasteurized milk adds 128 mg of calcium to the diet. Fatty cottage cheese contains 150 mg%, low-fat cottage cheese - 120. In terms of calcium content, cheeses surpass all other food products (up to 1000 mg per 100 g).
In the first half of pregnancy, a woman can consume table salt 10-12 g, in the second - up to 8 g, and in the last 2 months - up to 5 g per day.
Approximately the following amount of minerals should be consumed per day (for pregnant women):
Calcium - 1500-2000 mg
Magnesium - 300-500 mg
Phosphorus - 1-1.5 g
Potassium - 3-5 g
Sodium - 4-6 g
Chlorine - 4-6 g
Iron - 18 mg
The daily fluid requirement of a pregnant woman is about 2-2.5 liters. A significant part of this amount is found in consumed foods. Free liquid usually needs to be consumed 1-1.2 liters (water, tea, milk, jelly, compotes, first courses). In the last weeks of pregnancy, especially with a tendency to edema, the amount of free liquid in the daily diet is limited to 4 glasses (including tea, milk, compotes, fruit juices, soups).
Proper nutrition of a woman is in itself a prevention of pregnancy complications. For healthy women, no diet is required in the first half of pregnancy; it is important to follow a healthy diet.
In the first half of pregnancy the most physiological is 4 meals a day. The first breakfast should contain about 30% of the energy value of the daily diet, the second breakfast - 15%, lunch - 40%, dinner - 10%, at 21 o'clock a glass of kefir - 5%.
In the second half of pregnancy 5-6 meals a day are recommended. A woman should receive (approximately): wheat bread - 100-150 g, rye - 150-200 g, meat or fish - 200 g, butter - 40 g, vegetable oil - 30 g, 1 egg, milk - 500 g, cottage cheese - 150 g, kefir - 200 g, sour cream - 30 g, flour products (cookies, bun, etc.) - 100 g, pasta - 60 g, cereals - 50 g, potatoes - 400 g, cabbage -100 g, onions - 35 g, carrots - 100 g, tomatoes - 200 g, as well as tea, cocoa (coffee and hot spices should be discarded).
Of the same products, you can offer menu for a pregnant woman, which provides 4 meals a day:
- first breakfast at 7-8 am,
- lunch at 11-12 h,
- lunch at 14-15 h,
- dinner at 18-19 p.m.
- you can arrange an afternoon snack: a glass of milk with cookies or a glass of juice,
or a glass of rosehip broth, or fruits, berries,
- and before going to bed, a glass of kefir is recommended.
This meal schedule may vary depending on the pregnant woman's routine, her activities, etc. Food should be distributed in such a way that meat, fish, cereals are included in breakfast and lunch. For dinner, predominantly dairy-based foods are recommended. The last dose should be done 2-3 hours before bedtime.
Approximate menu for a week for women in the second half of pregnancy
Monday:
First breakfast: goulash with mashed potatoes, apple juice.
Lunch: milk.
Dinner: pea soup with minced meat, boiled fish with vegetable stew, compote.
Afternoon snack: fruits or berries.
Dinner: curd soufflé, cranberry mousse.
21h: kefir.
Tuesday:
First breakfast: curd soufflé, boiled egg, vinaigrette, rosehip infusion.
Lunch: milk, bun.
Dinner: Ukrainian borsch with minced meat and sour cream, boiled chicken with noodles, cranberry mousse.
Afternoon snack: a glass of rosehip infusion, a bun.
Dinner: low-fat cottage cheese.
21 h: kefir.
Wednesday:
First breakfast: boiled fish with mashed potatoes, low-fat cottage cheese, milk.
Lunch: protein omelet with sour cream, fruit juice.
Dinner: mashed vegetable soup with sour cream, boiled tongue with oatmeal, fruits, berries.
Afternoon snack: rosehip infusion, bun.
Dinner: low-fat cottage cheese.
21 h: kefir.
Thursday:
First breakfast: boiled fish with vegetable stew, low-fat cottage cheese, coffee with milk.
Lunch: milk, bun.
Dinner: rice soup with minced meat, boiled chicken with mashed potatoes, fruits.
Afternoon snack: low-fat cottage cheese, cranberry mousse.
Dinner:
21 h: kefir.
Friday:
First breakfast: protein omelet with sour cream, fresh cabbage salad, coffee with milk.
Lunch: milk, bun, low-fat cottage cheese.
Dinner: potato fish soup, sausages with buckwheat porridge and salad, fruit jelly.
Afternoon snack: fruits or berries, cookies.
Dinner: low-fat cottage cheese, rosehip infusion.
21 h: kefir.
Saturday:
First breakfast: boiled fish with mashed potatoes, milk.
Lunch: herring with onions, vinaigrette, cranberry mousse.
Dinner: pea soup with minced meat, boiled beef with carrot puree, compote.
Afternoon snack: biscuits, rosehip infusion.
Dinner: protein omelet with sour cream, tea.
21 h: kefir.
Sunday:
First breakfast: stewed liver with carrots, low-fat cottage cheese, fruit juice.
Lunch: wheat milk porridge.
Dinner: fish soup, goulash with buckwheat porridge and salad, compote.
Afternoon snack: cookies, cranberry mousse.
Dinner: low-fat cottage cheese, tea.
21 h: kefir.
During pregnancy with any complications, if the pregnant woman has diseases, obesity or other deviations from the norm, the diet and diet are agreed with the doctor of the antenatal clinic. It is not uncommon for pregnant women to intolerance to certain foods that cause allergic reactions. If it is impossible to exclude such products from the diet, you can try to use them in gradually increasing quantities after consulting a doctor. Milk, egg yolk or white, flour, fish and other products are diluted in boiled water in a ratio of 1: 1000, 1: 100, 1:10, 1: 2. First, they begin to take the maximum dilution of 1 teaspoon 1 time per day, then 2-3 times a day, then repeat daily up to 10 spoons 3 times a day, then proceed to a dilution of 1: 100, etc. The course of such food intake is 3-6 months. In the case of mild food allergies, for training, you can take a small amount of an intolerable product for 3-4 weeks (a quarter teaspoon of an egg, 20-30 ml of milk) 45-60 minutes before the main meal.
With complications of pregnancy, most often with late toxicosis, unloading diets may be recommended: apple (5 times a day, 300 g of ripe raw or baked apples, only 1.5 kg); watermelon (5 times a day, 300-400 g of watermelon pulp, only 1.5-2 kg); cottage cheese (5 times a day, 100 g of cottage cheese of 9% fat content, 2 glasses of tea, 1 glass of rosehip broth, 2 glasses of low-fat kefir, only 1 liter of liquid. Such diets are inferior in energy and chemical composition, therefore they are prescribed no more than 1 once a week.
Future mothers! Be sure to read p.
Department of Public Health of the Kemerovo Region
State budgetary professional educational institution
"KEMEROVSK REGIONAL MEDICAL COLLEGE"
Prokopyevsk branch
(PF GBPOU "KOMK")
Methodical development of a practical lesson
PM. 04. Participation in medical, diagnostic and rehabilitation processes
MDK. 02.01. Nursing care for various diseases and conditions / Nursing care in obstetrics and gynecology
for the specialty 34.02.01 nursing
Lesson number 1
Topic: "Planning nursing care for pregnant women, in childbirth and the postpartum period"
Compiled by the teacher: Prokhorenko M.V.
Learning goal: To form a system of knowledge about the normal course of pregnancy, physiological changes in organs and systems, hygiene of pregnant women.
Developing goal: Develop interest in the subject, promote the activation of students' thinking. To develop the cognitive activity of students, to master the programmatic educational material.
Educational purpose: To form a conscious attitude to the learning process, striving for independent work and comprehensive mastery of the specialty
The student should know:
methods for diagnosing pregnancy
signs of pregnancy
the role of the nurse in women's health and her responsibilities in the antenatal clinic;
anatomy of the pelvis and its main dimensions, the structure of the fetal head.
instruments for examination and examination of pregnant women.
scheme of examination of a pregnant woman in an antenatal clinic
registration of documentation for a pregnant woman
hygiene of the pregnant woman.
diet of a pregnant woman.
psychoprophylactic preparation of a pregnant woman for childbirth .
The student should be able to:
Conduct an external examination of the genitals,
Measure the outer dimensions of the pelvis.
Use the simplest pregnancy test.
Determine the duration of pregnancy and delivery by the date of the last menstruation and by the first movement of the fetus.
Be able to examine the cervix and vagina in the mirrors (on a phantom).
Take material for bacterioscopic examination (on a phantom)
Conduct an external obstetric examination (Leopold's reception)
Measure the circumference of the abdomen and the height, standing of the bottom of the uterus.
Listen to the fetal heartbeat.
Conduct a conversation on hygiene and nutrition of pregnant women.
Have practical experience:
Planning and Implementing a Nursing Examination
communication with patients
collection of anamnesis and examination of patients
documenting nursing documentation
Formed elements of competencies:
PC 1. Present information in a form understandable to the patient, explain to him the essence of the intervention.
PC 2. To carry out medical and diagnostic interventions, interacting with participants in the treatment process.
PC 5. Observe the rules for the use of apparatus, equipment and medical products during the treatment and diagnostic process.
PC 6. Maintain approved medical records.
PC 8. Provide palliative care.
OK 1: Understand the essence and social significance of your future profession, show a steady interest in it.
OK 2. Organize your own activities, choose standard methods and ways of performing professional tasks, evaluate their performance and quality.
OK 5. Use information and communication technologies in professional activities.
OK 7: Take responsibility for the work of team members (subordinates), for the result of completing tasks
Occupation type: development and consolidation of knowledge, skills
Activity type: practical lesson
Interdisciplinary connections: clinical pharmacology, nursing in pediatrics, nursing in surgery, the basics of resuscitation, human anatomy and physiology, the basics of pathology, psychology, a healthy person and his environment.
Equipment of the lesson:
obstetric phantoms
obstetric and gynecological instruments
gloves,
antiseptic solution
manipulation algorithms
projector
multimedia presentation
test forms, prescriptions, individual pregnancy card
methodical development of a practical lesson
Literature:
main: Slavyanova, I.T. Nursing in obstetrics and gynecology [Text]: textbook SPO / I.T. Slavyanova - Rostov-on-Don, "Phoenix", 2014. - 395 p .: ill.
additional:
1 Androsova, E. N, Ovrutskaya, Z. L, Novitsky, S. N, Marchenko, A. M Obstetrics and gynecology. Methodical recommendations for performing manipulations. - M .: "ANMI", 1995 - 64p .; 39 ill.
2. Slavyanova, I. T. Nursing in obstetrics and gynecology
[Text]: Workshop. SPO / I.T. Slavyanova - Rostov n / Don: Phoenix, 2002 .-- 352 p.
3 Krylova, EP Nursing in obstetrics and gynecology [Text]: textbook SPO / EP Krylova-Rostov n / Don: "Phoenix", 2000. - 384 p.
Electronic sources:
Internet sites.
Electronic supplement to the “National Guide. Obstetrics "- M .: GEOTAR-Media. - 2007.
Electronic supplement to the textbook “Obstetrics. Textbook for obstetric departments of secondary specialized medical institutions. " ed. V.E. Radzinsky - M .: GEOTAR-Media. - 2008.
Electronic supplement to the textbook "Women's consultation", ed. V.E. Radzinsky M .: GEOTAR - Media - 2009.
Electronic supplement to the practical guide "Infections in
Lesson structure
Organizing time
Setting the goals and objectives of the lesson
Motivation
Updating basic knowledge
Instructing students to work independently / demonstration of performing manipulations
Independent work of students
Summing up the results of the lesson, checking diaries, marking (diagnostics)
Homework
| № p / p | Session elements, study questions | (min) | Teaching Methods and Techniques |
| Organizing time | |||
| 1.1. Greeting students, checking for absentees | The teacher welcomes, notes the absent |
||
| 1.2. Lesson plan lighting | The teacher announces the topic, (written on the board) |
||
| Setting the goals and objectives of the lesson | The teacher sets the goals and objectives of the lesson |
||
| Motivation During pregnancy, from the moment of conception to childbirth, a pregnant woman should be under the supervision of a antenatal clinic. Early registration allows you to accurately determine the duration of pregnancy, timely resolve the issue of maintaining pregnancy in women suffering from any diseases, and most effectively prevent pregnancy complications. When examining women, problems arise: fear of manipulation, expectation of pain, anxiety. A nurse must learn how to conduct preventive examinations and conversations, observe ethical standards, reduce the feeling of fear, be able to calm the patient, explain the need for manipulation, prepare a pregnant woman for research | The teacher gives concepts and asks students about the role of a nurse in obstetrics, as they see it in the future profession |
||
| Updating basic knowledge | Situational tasks (presentation). Work at the blackboard. Pair work. Frontal poll |
||
| Instructing for independent practical work includes issues of labor protection and explanations to students of the course of the practical lesson. | Studying instructions - |
||
| Break (airing the audience, physical education) | Health preservation |
||
| Practical work. | Works in pairs. Group work. Individual work. Performing manipulations according to the instructions of the teacher. |
||
| Summing up the results of the lesson, setting marks (diagnostics) Reflection | The teacher assesses each type of student's work (oral frontal and individual surveys, IWS, filling out a workbook and practice diary), based on the assessments of each type of activity, an overall assessment for the practical lesson is set and communicates it to the student. Notes the best and weak answers of students, gives recommendations for improving students' knowledge and reports the topic and homework for the next practical lesson |
||
| Homework : | Slavyanova I.T. Nursing in obstetrics and gynecology [Text]: textbook of the SPO. / I.T. Slavyanova - Rostov-on-Don, Phoenix, 2014. - 395 p. : ill. |
Oral frontal survey
What does the obstetric and gynecological history include?
Pelviometry rules?
Characteristics of the size of the pelvis.
4. Changes in a woman's body during pregnancy
5. Determination of the gestational age.
6.Method of research of pregnant women
SRS: Preparation of abstract messages on the topic:
"Modern research methods in obstetrics"
"Pain relief of childbirth"
"Prevention of postpartum infectious and toxic diseases in an obstetric hospital"
"Modern diagnostic methods in gynecology"
Work of students in groups: "Diagnosis of pregnancy"
Exercise 1
There are three groups of signs and the signs themselves on your tables. Spread out the signs of pregnancy and list them.
probable: cessation of menstruation, enlargement of the mammary glands, cyanosis of the mucous membranes of the vagina and cervix, change in the size, shape and consistency of the uterus.
reliable: palpation of small parts of the fetus, listening to the fetal heartbeat, fetal movement
presumptive: nausea, vomiting, changes in appetite, pigmentation on the face, white line of the abdomen, changes in the central nervous system - irritability, drowsiness, fatigue.
Task 2. Solving situational tasks
Situational tasks:
PROBLEM 1. Patient J., 22 years old, first pregnancy. Last menstrual period August 22; the first stirring of the fetus on January 14.
by menstruation;
by the first movement of the fetus.
Questions. Estimated due date:
by menstruation;
by the first movement of the fetus.
Patient I., 24 years old, the second pregnancy, the first childbirth is normal. Last menstruation on February 16; the first stirring of the fetus on June 30.
Questions. Estimated due date:
by menstruation;
by the first movement of the fetus.
TASK 4 Patient N., 21 years old, pregnancy 1. Last menstruation on April 3; first fetal movement on August 27
Questions. Estimated due date:
by menstruation;
by the first movement of the fetus.
or slide presentation
Work at the blackboard. Drag the cards to the desired places in the picture.
anterior view, first position, cephalic presentation;
posterior view, first position, cephalic presentation;
anterior view, second position, cephalic presentation;
posterior view, second position, cephalic presentation;
anterior view, first position, breech presentation;
posterior view, first position, breech presentation,
anterior view, second position, breech presentation;
posterior view, second position, breech presentation.
Business game "Reception in the antenatal clinic"
goal: to teach the correct sequence of research of a pregnant woman, manipulations carried out in an antenatal clinic
selected from students: Senior nurse, Nurse working with documentation, "Patient".
Equipment: Individual pregnancy card, test forms, prescriptions.
task number 1 (students work in turn).
conduct (survey, collection of anamnesis, anthropometry, blood pressure measurement, pelviometry.)
write down the results obtained in the individual card of the pregnant woman.
task number 2 (second student)
Prepare the following instruments for external examination: obstetric stethoscope, measuring tape., Pelvimeter, tonometer with phonendoscope, disinfectant solution, cotton balls.
obstetric and gynecological examination: vaginal examination, bimanual examination, examination in the mirrors.
task number 3
set the table for examining the patient in the gynecological chair and for taking swabs.
gloves, korzang, tweezers, glasses, Cuzco mirrors, spoon-shaped mirrors, disinfectant solution, container with disinfectant solution, sterile balls, skin aseptic, Volkmann's spoons, Eyre's spatula.
task number 4
inspect in mirrors
take a smear on the degree of cleanliness of the vagina, pronouncing the algorithm of action
choose from the directions and forms I have suggested for the tests required when the pregnant woman is discharged.
Task number 6 (all subgroup)
Write a Prescription of Folic Acid Tablets No. 50 Oral
Reflection.
test control:
7 minutes to answer. One correct answer.
Menstrual cycle- this is
1.attachment of the egg to the wall of the uterus
2.cyclical changes in a woman's body
4.Capture of the egg from the abdominal cavity
2... Menstruation is
1.the release of the egg from the follicle
3.rejection of the functional layer of the endometrium
3. Internal genital organs
1.the pubis
4.labia
4... Are involved in the regulation of the menstrual cycle
1.parathyroid glands
2.hypothalamic-pituitary system
3.adrenal glands
4.pancreas
5 .. The ovaries form
1.estrogens
2.prolactin
3.form elements of blood
4.enzymes
6. A hormone is formed in the corpus luteum
1.estradiol
2.insulin
3.progesterone
4.oxytocin
7... Follicle rupture and release of the egg into the abdominal cavity
1.menstruation
2.ovulation
3. fertilization
4.implantation
8. Implantation of the ovum
1.accumulation of secretions in the uterine glands
2.attachment of the ovum to the wall of the uterus
3.the release of the egg from the follicle
4.fusion of nuclei of germ cells
9. The main component of the placenta
1.muscular tissue
2.epithelium
3.Villus
4.Uterine glands
10. The fetal membrane secreting amniotic fluid
1.chorion
3.decidua
4.myometrium
11. When vomiting pregnant women appoint
1.papaverine
3.heparin
4.cerucal
12. Complication of reproductive function due to induced abortion
1.infertility
2.the prolapse of the genitals
3. polyhydramnios
4.multiple pregnancies
Scheme of examination of a pregnant woman in an antenatal clinic:
ANSWER STANDARDS
Clarification of basic passport data:
The number of the passport and insurance certificate is recorded. The surname, name, patronymic of the woman is found out (it is necessary to find out how the woman wants to be called, the midwife herself must introduce herself to the woman, and also introduce the doctor who will guide her, or the doctor will do it). Age (risk factors include young age under 18, after 30 for nulliparous and over 35 for multiparous). Home address and telephone number (registration and residence, it is preferable that the woman be monitored at the place of residence, this is convenient for patronage, however, in modern conditions, given the availability of convenient means of communication, a registration option is also possible).
the housing conditions are specified, with whom the woman lives together, what are the amenities. Place of work and profession (working conditions, the presence of occupational hazards are immediately clarified, in this case exemption from harmful work is provided).
Husband data:
(Full name, age, place of work and profession, presence of occupational hazards). It is necessary to ask: which of the relatives can be contacted, whom the woman trusts most of all, if necessary. All this information should be on the first page. Also, the most important information on risk factors is placed on the first page in natural or encoded form.
Collection of complaints:
A healthy pregnant woman may not have complaints. Nevertheless, it is necessary to find out if she has any unpleasant sensations, pains. In the study of the following topics, those complaints that need to be identified will be studied.
Taking anamnesis:
Information about the conditions of labor and life. It is necessary to find out the nature of the work, what is the hazard in production, and also to clarify what kind of work a woman does at home, to warn about the exclusion of excessive workload, household hazards, and also to find out if there are animals at home (the likelihood of infection). Learn about the woman's education and interests, which will help improve contact with her.
Heredity:
To identify a hereditary predisposition in a pregnant woman: did the parents have diabetes, hypertension, other endocrine, genetic diseases. It is important to know the husband's heredity. It is necessary to obtain information about the bad habits of the pregnant woman and her husband, to give recommendations.
AND Information about past illnesses:
Children's infections, colds, diseases of the cardiovascular system, diseases of the urinary system, liver, baseline blood pressure, etc. First of all, ask about tuberculosis, rubella and infectious hepatitis.
Reveal: whether a woman has recently come into contact with tuberculosis and infectious patients, whether she has such patients at home, to find out about her trips to epidemiologically disadvantaged areas recently.
Ask separately about surgical interventions, whether there was a blood transfusion. Ask about the features of the menstrual function (from what age menstruation, duration, regularity, frequency, soreness of menstruation, abundance of discharge). From what age sex life outside of marriage, in marriage, by what means was it protected from pregnancy. List the transferred gynecological diseases, venereal diseases (the health of her sexual partner - the child's father).
In order of priority, list all pregnancies, their outcomes and complications. Separately tell about the course of this pregnancy before registration.
Further, a general inspection is carried out, in which attention is paid to height, weight, posture, physique, nutrition, condition of the skin, subcutaneous tissue, blood vessels, lymph nodes, the presence of edema. Pulse and blood pressure, heart sounds are examined. They measure the temperature and examine the nasopharynx, listen to the lungs. Palpation of the abdomen and liver is performed, the symptom of tapping on the lower back is checked, and they are interested in physiological functions.
Measurement of blood pressure in a pregnant woman
Purpose: to teach the student to measure blood pressure in a pregnant woman and record the data obtained in an individual card of the pregnant woman.
Equipment:
Tonometer;
Stethoscope;
Execution method:
Explain to the woman the need for the procedure;
To acquaint the woman with the progress of the procedure and the need for its implementation;
Sit the pregnant woman to the table, putting her forearm in a horizontal position on the table (clothes should not squeeze the hand above the forearm); you can measure blood pressure in the supine position;
Fasten the cuff tightly so that only a finger passes between it and the shoulder;
Put your hand with the palm up in an extended position, asking the pregnant woman to relax;
Connect the pressure gauge to the cuff;
In the area of the cubital fossa, grope for the pulse and put the phonendoscope in this place;
Close the valve on the pear and pump air with it until the pressure in the cuff exceeds 20 mm Hg. Art. (or units) the level on the scale at which the pulse ceases to be determined;
Open the valve and slowly release the air from their cuffs, listening to the tones on the brachial artery with a phonendoscope, while simultaneously monitoring the scale readings;
When a sound appears on the brachial artery, note the level of systolic pressure;
The moment of disappearance of tones on the brachial artery corresponds to the level of diastolic pressure;
Release air from the cuff completely and repeat the procedure on the other hand;
Record the data obtained when measuring blood pressure on both hands in the individual card of the pregnant woman;
Wash and dry your hands.
Pulse study
Equipment:
Stopwatch;
Execution method:
Explain to the woman the purpose, necessity and course of the procedure;
Can be carried out in a sitting and lying position;
Place the second, third and fourth fingers of the right cancer on the radial artery area: the first finger - from the back of the hand, the second and third - on the radial artery;
Press the artery against the bone, feeling its pulsation;
Mark and characterize the rhythm of the beats and their clarity (pulse tension);
Record the received data in the individual card of the pregnant woman;
Wash and dry your hands.
MEASURING THE EXTERNAL PELVIS SIZE
Purpose: to teach the student to measure the main dimensions of the pelvis using a pelvis meter and fix it in an individual chart of a pregnant woman.
Equipment:
Couch;
Tazometer;
Cotton balls or gauze;
70% ethyl alcohol;
Individual card of a pregnant woman;
Oilcloth.
Execution method:
Explain to the woman the purpose, necessity and course of the procedure;
Lay the pregnant woman on the couch, spreading oilcloth under her (under the buttocks and under the legs), in the “on the back” position with straightened legs;
Sit or stand to the right of the couch, facing the woman;
Pick up the pelvis meter so that the scale is facing up, and the first and second fingers lie on the pelvis meter buttons;
Wipe the buttons of the pelvis meter with a ball of alcohol;
Palpate the anterior-upper spines of the iliac bones with the index fingers, attach the buttons of the pelvis meter to them - the distance of the spinarum (normally the size corresponds to 25-26 cm);
Move the buttons of the pelvis meter to the most distant points of the iliac crests (the distance of the cristarums is normally 28-29 cm);
Find the thigh bones with the index fingers;
Press the buttons of the pelvis to the large trochanters of the femurs;
Determine the distance between the large trochanters of the femur on the scale of the pelvis (the trachateric distance normally corresponds to 30-31 cm);
Offer the woman to lie on her side with her back to the midwife, lower leg bent, upper straight;
Put one button of the pelvis meter on the upper edge of the pubic articulation, and the second - in the upper corner of the Michaelis rhombus, determine the distance on the pelvis meter scale (the outer conjugate is normally 20-21 cm);
To obtain the value of the true conjugate, you need to subtract 8-9 cm from this figure, which will correspond to 12-13 cm;
Enter the received data into the individual card of the pregnant woman in the columns:
a) dist. spinarum:
b) dist. cristarum
c) dist. trachanterika
d) con. externa
Treat the pelvis meter with a ball of alcohol;
Wash and dry your hands.
All subsequent studies are carried out in the second half of pregnancy.
Measuring the circumference of the abdomen
Purpose: to teach the student to measure the abdominal circumference of a pregnant woman using a measuring tape and record the result in the individual chart of the pregnant woman.
Equipment:
Couch;
Tape measure;
Oilcloth;
70% ethyl alcohol;
Individual card of a pregnant woman.
Execution method:
If it is difficult for a woman to stand, lay her on a couch with her legs straightened, placing an oilcloth under her buttocks;
Stand or sit to the right of the pregnant woman, facing her;
Wipe the measuring tape with a ball moistened with alcohol;
Bring the measuring tape under the back so that in front it is at the level of the navel, and in the back - at the level of the lumbar region;
Mark on the scale of a centimeter tape the volume of the abdomen at the investigated level;
Help the pregnant woman get up from the couch, first turning on her side, and then sitting on the couch;
Throw the oilcloth into a basin;
Wash and dry your hands;
Enter the result obtained during the measurement into the individual card of the pregnant woman.
Leopold's first move: Determination of the height of the fundus of the uterus
Purpose: To teach the student to measure the height of the fundus of the uterus using a measuring tape and record the data in an individual card of the pregnant woman.
Equipment:
Couch;
Cotton balls;
70% ethyl alcohol;
Oilcloth;
Tape measure;
Individual card of a pregnant woman.
Execution method:
Explain to the woman the purpose, necessity and course of the procedure;
Warn about the need to empty the bladder;
Lay the pregnant woman on a couch with straightened legs, spreading an oilcloth under the buttocks;
Sit to the right of the woman, facing her;
Wipe the measuring tape with a ball of alcohol;
Apply a measuring tape vertically along the midline of the abdomen; from below, the measuring tape should touch the upper edge of the symphysis, from above - the highest point of the fundus of the uterus;
Mark the result obtained on the scale of a centimeter tape;
Help the pregnant woman to get up from the couch by turning on her side and then sitting on the couch;
Throw the oilcloth into a basin;
Assessment of the received data
Leopold's second move: Determination of position, presentation, position, type of fetus using four methods of external obstetric examination of a pregnant woman.
Purpose: to teach the student to conduct an external obstetric examination of a pregnant woman using four obstetric techniques and record the result in an individual pregnant woman's card.
Equipment:
Couch;
Oilcloth;
Individual card of a pregnant woman.
Execution method:
Explain to the woman the need, purpose and course of the procedure;
Lay the pregnant woman on the couch in the "supine" position with straightened legs, spreading an oilcloth under the buttocks;
Sit to the right of the pregnant woman, facing her;
I Reception - determination of VSDM by palpation. The palms of both hands are located at the bottom of the uterus and determine the level of standing of the fundus in relation to the upper edge of the pubic articulation, the navel and the xiphoid process.
II Reception - determination of the position, position and type of the fetus.
Hands are transferred to the lateral walls of the uterus, palpation of parts of the fetus is performed alternately with the right and left hand. With the longitudinal position of the fetus, on the one hand, the back is determined, on the other, small parts.
Fetal position is the ratio of the longitudinal axis of the fetus to the longitudinal axis of the uterus.
The position of the fetus is longitudinal, transverse and oblique.
Longitudinal position - the longitudinal axis of the fetus coincides with the longitudinal axis of the uterus.
Transverse position of the fetus - the longitudinal axis of the fetus is at right angles to the longitudinal axis of the uterus.
Oblique position - the longitudinal axis of the fetus is at an acute angle to the longitudinal axis of the uterus.
Fetal position is the ratio of the fetal back to the lateral wall of the uterus.
I position - the back is facing to the left,
II position - the back is facing to the right.
View - the ratio of the fetal back to the anterior or posterior wall of the uterus. The back is facing more anteriorly - anterior view, more posteriorly - a posterior view.
III Leopold's Reception
Identifies the presenting part of the fetus that is closest to the entrance to the small pelvis (head, pelvic end)
The nurse stands on the right, face to face with the patient, pulls the thumb of the right hand as far as possible and gently plunge the fingers into the depths above the pubic joint and cover the presenting part. If it is the head, then it is dense, round and ballot, and if the pelvic end, then it is soft, not rounded and does not ballot.
IV Leopold's Reception
determination of the ratio of the presenting part of the fetus to the entrance to the small pelvis (mobile, pressed, in the small pelvis).
Listening to and evaluating the fetal heartbeat
Purpose: to teach the student with the help of an obstetric stethoscope to find the best place for listening to the fetal heartbeat, listen, count and evaluate the fetal heartbeat.
A fetal heartbeat can be heard with an obstetric stethoscope after 20 weeks (preferably 24 weeks) of pregnancy.
Equipment:
Couch;
Oilcloth;
Obstetric stethoscope;
Stopwatch;
70% ethyl alcohol;
Individual card of a pregnant woman.
Execution method:
Explain to the woman the purpose, necessity and course of the procedure;
Lay the pregnant woman on the couch in the "supine" position with straightened legs, spreading oilcloth under the buttocks;
Sit to the right of the pregnant woman;
Wipe the obstetric stethoscope with a ball of alcohol and take it in your right hand;
Take a stopwatch in your left hand;
with the help of an obstetric stethoscope, moving it along the abdomen, find a place for clear listening to the fetal heartbeat (with a cephalic presentation below the navel, and with a gluteal presentation - above the navel);
Using a stopwatch, count the time and count the number of beats per minute (to exclude an error with the pregnant woman's pulse, which in rhythm should not coincide with the fetal heartbeat);
Note the rhythm and clarity of the beats;
Help the pregnant woman to get up from the couch, first turning on her side, and then sitting on the couch;
Wipe the stethoscope again with a ball of alcohol;
Throw the oilcloth into a basin;
Wash and dry your hands;
Enter the obtained data into the individual card of the pregnant woman.
With twins, the fetal heartbeat is heard at two points clearly, independently of each other, while a "zone of silence" is marked between these points.
Normal fetal heartbeat is 120-140 beats per minute, rhythmic, clear.
Deviations in the frequency, rhythm and clarity of beats may indicate threatening intrauterine asphyxia of the fetus.
Work at the blackboard. Set correspondence
The technique of taking a smear for the degree of cleanliness of the vagina and preparation for a doctor's examination
Purpose: to teach the student to properly lay a woman on a gynecological chair and take a smear from the vagina for the degree of cleanliness.
Equipment:
Gynecological chair;
Sterile table with tools (mirrors, tweezers) and soft equipment (balls, napkins);
Crane lighting lamp;
Slide glasses;
Volkmann spoon;
Rubber gloves;
Referral to the laboratory;
Disinfectant solution.
Execution method:
Explain to the woman the need for and the course of the procedure;
Inform about the need to empty the bladder;
Lay oilcloth and liner on the chair;
Help a woman lie on a gynecological chair in a supine position, legs bent at the hip joints, divorced, popliteal fossa rest against supports;
Explain that breathing should be free during the examination;
Prepare the external genitals for examination by lubricating them on the outside and the inner surface of the thighs with a disinfectant solution using a forcepsang and a ball;
Wash your hands and put on gloves;
With the first and second fingers of the left hand, separate the large and small labia;
With your right hand, carefully insert the Cuzco mirror into the vagina: first in a longitudinal position, then translate it into a transverse position and open it into the vagina, without reaching the cervix;
Fasten the open mirror with a screw;
Insert a Volkman spoon into the vagina (tweezers can be used) and carefully take a smear, touching slightly the upper-lateral wall of the vagina;
Apply a smear on a glass slide in a thin layer without crushing the cells;
If there is abundant discharge in the vagina, then before taking a smear, it is recommended to gently blot the vagina with a cotton swab on tweezers (for better visibility);
Open the screw on the mirror;
Carefully remove the speculum from the vagina, gradually closing it;
Place the mirror in a 3% chloramine solution for one hour;
Take off gloves and wash your hands;
Apply for a referral to the laboratory:
answers to problems :
1. Patient J., 22 years old, first pregnancy. Last menstrual period August 22; the first stirring of the fetus on January 14.
Patient A., 28 years old, pregnancy 3, labor 2. Last menstruation December 25; first fetal movement on May 19.
Patient I., 24 years old, the second pregnancy, the first childbirth is normal. Last menstruation on February 16; first fetal movement on June 30
Patient N., 21 years old, pregnancy 1. Last menstruation on April 3; first stirring of the fetus on 27 August.
Work at the blackboard.
1 - front view, first position, cephalic presentation;
2 - posterior view, first position, cephalic presentation;
3 - front view, second position, cephalic presentation;
4 - posterior view, second position, cephalic presentation;
5 - front view, first position, breech presentation;
6 - posterior view, first position, breech presentation,
7 - front view, second position, breech presentation;
8 - posterior view, second position, breech presentation.
test poll: (answers)
1.2 ; 2.3; 3.2; 4.2; 5.1; 6.3; 7.2; 8.2; 9.3; 10.2; 11.4; 12.1.
Fizminutka
| DIRECTION ANALYSIS OF THE SIP ON THE DEGREE OF VAGINA CLEANLINESS FULL NAME……………………………………………………………….. G.R …………………………………………………………… .. |