Nursing diet for pregnant women for a week. Diet for pregnant women: menu, recommendations
Since these goals are normal physiological tasks of the human reproduction process, changes in a 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 pathologies. 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 Sciences
_______________________
Admitted to defense
APPROVED
at a meeting of the scientific and methodological council
protocol No. dated ".."____201.. g
Chairman _______________________
/ G.A. Preobrazhenskaya /
Deputy Director
By educational work
______________________/V.N. Sarycheva/
Course work
on an interdisciplinary course, professional module
_______ __________________________________________
_________________________________________________
(subject course work(project)
Speciality ____________________
Student group No. _____ ________ (student's full name)
Teacher head _______ (Full name of teacher)
Introduction
Structural and functional changes in the body of a pregnant woman are aimed at achieving the following main goals: - ensuring adequate supply of the growing fetus with oxygen, nutrients and evacuation of waste products from the fetus’ body; - preparing the mother’s body for the process of childbirth and breastfeeding. Since these goals are normal physiological tasks of the human reproduction process, changes in a woman’s body during pregnancy should be considered as natural and physiological. On the other hand, since all systems of a woman’s body work in a more intense mode during this period, recently a point of view has emerged 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 pathologies. Let's look at these changes by body system. 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 occurs in a woman’s body during the intrauterine development of the fetus. During pregnancy, a woman's body undergoes profound transformations. During 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 body of the developing fetus. Also, from the very first days of pregnancy, the pregnant woman’s body begins to prepare for future childbirth and breastfeeding.
The role of the nurse in organizing the nutrition of a pregnant woman
Goals:
1. Improve the system of organizing nutrition for a pregnant woman.
2. Providing professional fulfillment of the midwife’s obligations regarding the nutrition of a pregnant woman.
Tasks:
1. Identify the main causes of malnutrition in pregnant women
2. Increase the role of the nurse in organizing the nutrition of a pregnant woman
Relevance:
1. The threat of miscarriage and the peculiarities of caring for premature babies is very relevant for the present time due to 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 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
There is no doubt that one of the most noticeable changes that occurs in a pregnant woman is a change in body weight. By the end of pregnancy, a woman's weight increases by about 10-12 kg. This value is distributed as follows: fetus, placenta, membranes and amniotic fluid approximately 4.0 4.5 kg, uterus and mammary glands 1.0 kg, blood 1.5 kg, intercellular (tissue) fluid 1 kg , increase in maternal body fat mass 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, places increased demands on the nutrition of the pregnant woman. Along with adequate consumption of proteins, fats and carbohydrates, it is usually recommended to supplement a woman’s diet with iron supplements (necessary for the synthesis of red blood cells of the mother and fetus), vitamins and calcium supplements (construction bone skeleton fetus). The question often arises: what weight gain should be considered normal and what is excessive? It all depends on the woman’s initial weight before pregnancy. And not so much from weight, but from the ratio of weight and height, expressed by the so-called body mass index (BMI). BMI is calculated using the formula: BMI = Weight (kg)/Height2(m2) So, for example, for a woman weighing 60 kg and height 1.6 m, this index will be 60/ 1.62 = 23.4 kg/m2. Women with an index from 20.0 to 26.0 are considered proportionally built. If the index exceeds 26.0, then these are women with signs of obesity, and if the BMI is less than 20.0, then they are women. 5
there is a nutritional deficiency. Approach to weight gain in pregnant women
Depending on BMI the following. Women with low nutrition are allowed to gain significantly more weight than women with normal nutrition (for example, weight gain of 15-18 kg should not be considered pathological in them). The approximate estimated 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 of 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 formed due to a smaller increase in the weight of the fetus, placenta and amniotic fluid. Children born to smoking mothers weigh 250 g less than those of non-smoking 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. Increasing demands for oxygen supply to the growing fetus is expressed in an increase in tidal volume (the amount of air inhaled in one breathing movement) and the frequency of respirations per minute. This leads to an increase in the so-called “minute ventilation” rate by 30-40%, which significantly covers the oxygen requirement of the pregnant woman’s body, increased to 15-20%. The fetus's need accounts for 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 work of the woman’s body systems due to pregnancy.
1.4 A few words about the diet
Taking into account the above-mentioned changes in motility and direct mechanical pressure on the digestive organs by the enlarging uterus, frequent split meals are considered the most rational for a pregnant woman. It is advisable to have approximately 6 meals per day. Considering that the fetal body is formed mainly from proteins, these food components have a special role in the diet of a pregnant woman. In the gastrointestinal tract of a pregnant woman, protein is 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 various natures. These are primarily animal proteins: lean meat (beef, pork), poultry. Fish is very healthy, especially fatty varieties of sea fish, containing omega-3 fatty acids, which play a positive role in the prevention of gestosis. Important sources of protein are eggs, milk and dairy products. 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 sharp peaks in the increase in glucose concentration in the mother’s blood after meals and make the concentration of carbohydrates in the pregnant woman’s blood more stable,
1.5 Nutrition during pregnancy: by week and trimester
Happiness, anxious waiting, anticipation and even fear - all these feelings inevitably accompany pregnant women. And it is very important during this period not to give in to emotions, but to remember the responsibility that is also an integral part of it. It is at this time that adherence to the basics of healthy lifestyle. Almost all of them apply to pregnancy, although some require slight modifications.
Pregnant: proper nutrition
Proper nutrition during pregnancy, this is most relevant, since it is what a woman eats that largely determines how her child will develop. For example, whether a pregnant woman gets enough protein determines 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 abandoned. It makes sense to take into account one important feature: proper nutrition in the early stages of pregnancy will be somewhat different 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 formed, but the size of the fetus increases
insignificant. Therefore, in the early stages, a healthy diet for pregnant women
women is based on sufficient receipt of minerals, vitamins and the like.
In the second trimester of pregnancy, nutrition should focus on increased protein consumption, since this is when the active growth of the child and its internal organs begins. For all this, building material is needed, 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, especially calcium for bone growth and development of the nervous system.
When planning a pregnancy, proper nutrition is also very important. The healthier, more resilient, and stronger a woman’s body is at the time of conception, the greater the chance of successful implantation of the fertilized egg in the uterus. And a certain set of vitamins in the body contributes to the proper development of the embryo.
As you can see, the difference in recommendations for proper nutrition for pregnant women by month, and sometimes even by week, is quite justified. However, there are, naturally, general rules proper nutrition during pregnancy, these will be discussed further.
General principles proper nutrition during pregnancy
First of all, it's worth remembering one thing simple thing: It’s better to get up from the table slightly hungry than with a heaviness in your stomach from overeating. In this regard, it is better to adhere to the principles of fractional nutrition: eat less, but more often. The ideal option would be to eat 5-6 times a day. You should eat your last meal 3 hours before bedtime. Eating later is highly discouraged; if the feeling of hunger is unbearable, you can drink a glass of milk or kefir, eat an apple or a pear. This is the most optimal diet for pregnant women.
A pregnant woman eats an apple: fruit part of proper nutrition during pregnancy
Proper nutrition during pregnancy, like, in fact, any proper nutrition, involves avoiding junk food.
Food products for pregnant women should be as fresh as possible and should not contain preservatives, excess salt, etc.
It is obvious that canned foods, various sausages and other shelf-stable products, if not prohibited, require strict control over their consumption.
Of course, it is recommended to give up fast food. However, it is worth noting that if you have a choice between staying hungry or eating something that is not very healthy, it is better to choose the second. A pregnant woman should not starve. Another thing is that if you are faced with such a choice suspiciously often, then you should think about carrying fruit or sandwiches with you.
The balance between such essential nutritional components as proteins, fats, carbohydrates, as well as vitamins and minerals is of great importance. Of course, a balanced diet for pregnant women at different stages requires 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, but from the first day of the last menstruation. Consequently, the first 2 weeks of obstetric pregnancy occur before conception.
Planning a pregnancy is an extremely important 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 utmost importance.
At this stage it is very important to increase the amount of folic acid. Doctors often recommend drinking it in capsule form, but it is much better to get all the vitamins from normal food. Folic acid is found in greens, lettuce and grains.
No less useful to use yellow fruits and vegetables. But it’s better to avoid fatty and sweet foods. This will avoid problems with obesity, as well as reduce the risk of developing early toxicosis.
A pregnant woman prepares a fruit smoothie for proper nutrition
Around day 10-14 of the cycle, fertilization occurs and the fertilized egg begins to move towards the uterus. From this time on, we can talk about 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 fetus, which means the need for vitamins and nutrients is constantly changing.
During the third week of pregnancy, the egg implants and the placenta and membranes begin to develop. 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 diet remains the same as for 3, but at this time it is especially important to give up coffee. However, drinking this undoubtedly tasty, but not very healthy drink during pregnancy should be done with extreme caution. Coffee is especially 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, toxicosis of pregnant women begins around this period. To alleviate this condition, you can slightly change your daily menu. Thus, 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 wouldn’t hurt to include carrots, mangoes, and apricots in your diet.
week 6
Toxicosis is in full swing, so the morning should start with crackers or unsweetened crackers. It is better to eat them immediately after waking up, without getting out of bed. At this stage, it is better to drink more liquid, at least 8 glasses per day. At night you can eat a handful of raisins.
week 7
At this time, problems with the intestines may arise. Therefore, you should avoid foods that cause gas, including cabbage. It would not be a bad idea to give up those products that strengthen. It is better to introduce prunes, fresh kefir and the like into your diet.
Kefir: an element of proper nutrition during pregnancy
8 week
Ginger tea will help cope with toxicosis, and don't forget about nuts.
9-10 weeks
Give preference to whole grain cereals and grain bread coarse. Brown rice is better than white rice. In general, a pregnant woman’s body requires quite a lot of fiber at this stage.
11-12 weeks
The first trimester of pregnancy is ending, 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, it means that it is precisely the substances 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 abundant protein consumption. In addition, it is necessary to increase the total daily caloric intake of food. If in the first trimester it is enough to eat 2400-2700 kcal, then from now on you need to eat 2700-2900 kcal.
16-24 weeks
Nutrition during the 6th month of pregnancy should contribute to the development of the baby’s vision and hearing. That is, you need vitamin A and beta-carotene. It is better to eat cabbage, yellow peppers, and carrots at this time. Keep in mind that vitamin A is absorbed only with fats.
24-28 weeks
It is at this time that fractional meals become 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 accommodate large amounts of food. Even when eating small portions, a pregnant woman may experience heartburn. It is better to avoid carbonated drinks and coffee, they also cause heartburn. In general, a pregnant woman’s diet in the third trimester should be as varied as possible, as the baby’s needs grow.
Food: nutrition during pregnancy by week
29-34 weeks
During the 8th month, bones are actively growing and teeth are being formed, therefore, it is very important to eat as many foods containing calcium as possible. Fatty acids are simply necessary for brain development, and they contribute to the absorption of calcium. Lack of iron at this stage can lead to the development of anemia in both mother and child. Fatty fish, nuts, red meat, dark green vegetables and seeds are the foods you should eat during this period of pregnancy.
35-40 week
Nutrition in the 9th, 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, and it is their consumption that should become the basis of a pregnant woman’s nutrition before childbirth. Porridge and vegetables are the foods you should eat during this period.
That's all that can be said about nutrition by trimester. An example of dinner, breakfast or lunch for pregnant women may also be useful.
A sample menu for the day might look like this:
First meal: black bread toast, a small piece butter, egg, a glass of kefir;
Second meal: Green salad, a glass of tea;
Third meal: Chicken fillet, boiled potatoes, one pear, a glass of kefir or drinking yogurt;
Fourth meal: Toast with jam or butter, a glass of juice;
Fifth meal: Brown rice, boiled fish, vegetable salad, tea;
Sixth meal: a glass of kefir or a small piece of 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 in pregnant women, special nutrition is simply necessary. With this disease, it is very important to increase the consumption of foods containing iron.
In addition, it is important not only to know what foods to consume, but also in what combinations, as this affects the absorption of iron in the human body. A woman experiencing pregnancy anemia 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 rational nutrition for a pregnant woman?
Rational nutrition promotes the normal development of pregnancy and the fetus, and also prevents 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, a special diet is not required. Food should be varied, containing sufficient amounts 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 and vegetable foods are recommended. Meat and fish should be consumed 3x4 times a week. Hot and spicy foods are prohibited; carbohydrates, flour products, starch and liquid are limited within reasonable limits.
What amount of proteins, fats, carbohydrates and microelements should be in a pregnant woman’s daily diet?
The amount of proteins and fats is introduced into the daily diet at the rate of 1.5 x 2 g per 1 kg of a woman’s body weight. Carbohydrates, as the main energy material and source of fat formation, should be no more than 500 g per day (in case of obesity, the amount of carbohydrates is reduced to 300-400 g per day). To prevent late toxicosis in pregnant women, table salt in the second half of pregnancy should be limited to 5 g per day, liquid to 1 1.2 liters in the last weeks to 0.8 liters per day. The amount of microelements, the sources of which are milk, cottage cheese, eggs, liver, meat, bread, nuts, buckwheat and barley, beets, peas, in the second half of pregnancy should be: calcium 1.5 x 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?
Vitamins, which are part of a number of enzymes and perform the function of catalysts for metabolic processes in the body, are especially necessary in the diet of a pregnant woman. If there is a lack of vitamins entering the body of a pregnant woman with products of dairy and plant origin, ready-made dosage forms should be prescribed.
What is the importance and daily requirement of vitamins A, PP, C, E for a pregnant woman?
Vitamin A (carotene) has an effect on the uterine mucosa and promotes its regeneration, which is especially important in the postpartum period. Daily dose 5000 ME, in the last months of pregnancy 10000 x 20000 ME.
Vitamin PP (nicotinic acid) is involved in the metabolism of sex hormones, and in small concentrations has an inhibitory effect on the contractile function of the pregnant uterus. Daily dose 18 x 25 mg.
Vitamin C (ascorbic acid) is a powerful catalyst for redox processes in the body, potentiates the effect of estrogens, enhances the effect of pituitrin and mammophysin on uterine contractions. Daily dose 100 x 200 mg.
Vitamin C is involved in the regulation of calcium and phosphorus metabolism and is used in obstetric practice to prevent rickets in the fetus. Daily dose 1000 ME.
Vitamin E (tocopherol) plays an important role in the normal course of pregnancy (fertility vitamin), its deficiency leads to dysfunction of the genital organs, sometimes to fetal death and miscarriage. Daily dose 20 x 25 mg.
What is the importance and daily requirement of B vitamins for a pregnant woman?
Vitamin Bj (thiamine) is involved in the regulation of estrogen hormone metabolism, acetylcholine synthesis, promotes proper metabolism in the nervous system, liver, and regulates water-salt metabolism. Daily dose 1020 mg.
Vitamin B2 (riboflavin) promotes the normal course of pregnancy and childbirth, is used to prevent threatened miscarriage, and enhances redox processes in the body. Daily dose 2 3 mg.
Vitamin B6 (pyridoxine) is necessary for the metabolism of essential amino acids (histamine and tryptophan). Daily dose 5 mg.
Vitamin B12 (cyanocobalamin) is effective for anemia caused by diseases gastrointestinal tract and liver, enhances the release of growth hormone. Used for fetal malnutrition. Daily dose 0.003 mg
1.7 Rational nutrition of 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 a restructuring of the activity of the woman’s entire body.
The body of mother and fetus early dates pregnancy is sensitive to the influence of various external and internal environmental factors. A restructuring of metabolic processes occurs, the body's need for plastic and energy material increases. This is due to the fact that the body of the expectant mother must provide the best conditions for the life of the fetus.
Early pregnancy (up to 12 weeks) may be accompanied by various disturbances in the functioning of the digestive system (nausea, vomiting, salivation, dermatoses). These are toxicoses (gestosis) that occur during pregnancy and are associated with the development of the fertilized egg.
There are also several forms of late toxicosis in pregnant women: dropsy, hypertension, hypotension, nephropathy of pregnancy, preeclampsia and eclampsia. Sometimes pregnancy occurs against the background concomitant diseases, i.e. those diseases that the woman had before
pregnancy. These are various cardiovascular diseases,
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, additional stress occurs on the cardiovascular, respiratory, digestive and other systems.
So, from the second half of pregnancy, the stomach turns around its axis and moves upward and backward, its ability to stretch decreases, the muscles of the walls relax, which leads to a disruption in the ability to move food into the intestines. The function of the digestive glands often decreases; the amount of gastric juice and hydrochloric acid decreases, lethargy of the intestinal walls and weakness of peristalsis develop. Constipation, hemorrhoids, swelling of the rectum appear, gases can accumulate, which causes discomfort and disruption of the digestion process, mainly of carbohydrates, and the exchange of certain vitamins.
All this requires careful monitoring of the course of pregnancy and the development of the intrauterine fetus, prescribing the woman a balanced diet 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. During the digestion process, 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 body of the mother and fetus. As the intrauterine fetus grows, the need for
nutrients increases, at the same time the body of pregnant women
cannot digest all food, due to the above-mentioned features of the digestive system. It has been proven that malnutrition at different stages of pregnancy has different effects on the condition of the fetus. Thus, starvation and insufficient amounts of protein and vitamins during the preimplantation period cause the death of the embryo; during the period of organogenesis it can contribute to malformations of the fetus.
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 of a woman. With excess body weight above 15 kg, in 15% of cases there is weakness in labor, post-term pregnancy and a large fetus, which complicates childbirth and the postpartum period, since more high percent delivery operations, birth trauma of mother and fetus.
A balanced diet during pregnancy will also contribute to normal lactation and ensure sufficient quantity and good quality of breast milk necessary for the child.
One of the most important indicators of a pregnant woman’s rational nutrition is an 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 permissible deviations + 3.0 kg). A weight gain of more than 2 kg per month is undesirable, as it indicates the possibility of edema or metabolic disorders.
During pregnancy, the expenditure of muscle energy is significantly reduced, women are transferred to easier work, are on maternity leave, i.e. they belong to groups I and II of labor intensity, in some cases to group III (moderate physical labor).
The general principles of creating a diet for pregnant women are that the nutrition of a pregnant woman should be differentiated according to
depending on body weight, geographical conditions, time of year, period
pregnancy and everyday habits, as well as character labor activity. The diet for women of average height (155 x 165 cm) and average weight (55 x 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 during average work activity, 50 kcal is required for every kilogram of body weight. So, with a height of 155 cm, a normal weight of 53 kg, 50 kcal x 53 kg = 2650 kcal are required per day. In the second half of pregnancy, the woman’s body’s need for energy increases to 2900 kcal, and in working conditions – to 3300 kcal.
In the first half of pregnancy, a woman’s diet should not differ significantly from her usual diet; she can eat everything that suits her tastes, but foods that irritate the kidneys (smoked meats, garlic, horseradish, pepper) must be avoided. It should be remembered that in the first trimester the formation of fetal organs occurs, so during this period it is especially important to ensure sufficient intake of complete proteins, vitamins and microelements in the optimal quantity and ratio.
Chemical composition food
Squirrels. This is the main plastic material for the construction of fetal tissue, the synthesis of hormones and enzymes in the mother’s body. Not only the quantity, but also the quality of proteins matters. The completeness of a protein is determined by its content of essential amino acids, i.e. those that are not produced in the human body, but come only with food. All amino acids necessary for humans are part of proteins, found mainly in products of animal origin (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, 1.3 g of protein per 1 kg of body weight per day is required (on average 110 x 120 g). Cottage cheese, kefir, milk, boiled meat and fish, and mild varieties of cheese are especially recommended. 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 blood mass and mammary glands. Insufficient protein nutrition leads to changes in the biochemical composition of the blood and can contribute to delayed development of the fetus, reduction in the weight of its body, brain, liver and heart, spontaneous abortions, and premature birth.
Fats. Like proteins, they participate in the structure of body cells, are a source of energy and carriers of a number of vitamins. They are necessary for the normal absorption of certain vitamins (A, D, E) and mineral salts (calcium, magnesium) by the body. Some fats are 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 x 30 g of vegetable oils (sunflower, olive, corn) daily, which contain a number of vitamins. It must be remembered that fat women also need fats, but in smaller quantities (70 x 80 g).
Carbohydrates. These are organic substances consisting of carbon, hydrogen and oxygen. They are included in products of plant origin - vegetables, cereals, fruits - in the form of sugars, starch, and fiber. A person receives over half of the energy necessary for the functioning of the body in the form of carbohydrates. Increased consumption of carbohydrates, especially sucrose, is one of the factors leading to female obesity and increased fetal weight. With food, a woman should consume 350 x 400 g of carbohydrates per day, and if she is overweight, 250 x 300 g. The source of carbohydrates should be: wholemeal bread, potatoes, vegetables, fruits, buckwheat, oatmeal.
In winter, you can use apple, plum, tomato juices, and frozen fruit. Juices prepared at home are not recommended, because if they are prepared incorrectly, they produce alcohol, which is strictly 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, jam, and sweets should be limited, as they cause increased fermentation in the intestines and peristalsis. This is especially important for women with recurrent miscarriages, since they often have elevated blood sugar levels, and glucose easily penetrates the placental barrier and enters the fetus.
Liquid. Water, together with the minerals dissolved in it, makes up the internal environment of the body, being the main part of plasma, lymph, and 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, i.e. about 2 liters. The amount of fluid consumed by pregnant women ranges from 2 to 3 liters per day. We must remember that a significant portion of water is contained in food products. Therefore, with a balanced diet, liquid in the form of tea, milk, soups, etc. should be no more than 1.2 liters.
Excessive fluid consumption leads to fluid retention (the average amount can be 8 liters, with about 6 liters accounting for the fetus, placenta, uterus, increased amount of blood), and in the last months of pregnancy increases the load on the cardiovascular system, causing edema of pregnant women, therefore, it is advisable to limit its consumption to 0.8 liters, in combination with a low-salt diet.
Vitamins. With a lack of vitamins, various pregnancy complications arise (miscarriages, premature births). Without vitamins, enzymes are not formed, and therefore, normal metabolism is disrupted, hematopoiesis suffers, and the body's resistance to infections decreases.
During pregnancy, the need for vitamins almost doubles.
IN winter time 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 and spring.
Vitamins are found more in foods of plant origin: vegetables, fruits, root vegetables, 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 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, and in night vision. Vitamin A is heat resistant and is better absorbed with fats. It is important 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 increased quantities. The richest foods in vitamin A are fish and animal livers, eggs, butter, milk, carrots, pumpkin and other vegetables. But for better absorption, vegetables should be consumed lightly 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 metabolism, and contribute to normal hematopoiesis. If there is a deficiency of one of the vitamins of this group or the entire complex, the activity of the nervous system and gastrointestinal tract is disrupted. The main source of vitamins in this group are almost all plant and dairy products. There are a lot of them in brewer's and baker's yeast, meat, liver, especially in the germ and shells of grains, in wholemeal flour, cereals (except pearl barley and polished rice).
B1 (thiamine) its deficiency is accompanied by increased fatigue, loss of appetite, damage to peripheral nerves, a sufficient amount improves the secretory and motor function of the stomach. Source: liver, meat, yeast, wholemeal bread.
B2 (riboflavin) affects liver function, vision, and is involved in the metabolism of carbohydrates, fats, and proteins. With its deficiency, capillary function and blood flow may be impaired.
B5 (calcium pantothenate) participates in metabolism. Its rich sources are yeast, bran, and liver.
Bg (pyridoxine) participates in the cellular metabolism of amino acids, carbohydrates, fats. Contained in bread, beans, yeast, beef, egg yolk.
B12 (cyanocobalamin) is involved in the formation of a number of amino acids (methionine, etc.) and ribonucleic acids. Its sources are liver, kidneys, heart, egg yolk, buckwheat. A lack of vitamin B13 contributes to the development of anemia.
B15 (calcium pangamate) increases the absorption of oxygen by tissues, glycogen content in muscles and liver, and reduces hypoxia in the body. More of it is found in plant seeds and liver.
IN ( folic acid, folacin) antianemic vitamin. Its sources are beans, yeast, leafy vegetables, and beef liver.
Vitamin C (ascorbic acid) activates the activity of enzymes and hormones, the growth of bones, cartilage, increases blood clotting, prevents swelling, increases the body's resistance to infections, strengthens capillary walls. Vitamin C is found in black currants, rose hips, citrus fruits, greens, fruits, potatoes, cabbage, tomatoes and other foods. In the winter-spring period, its dosage increases, and the amount in food products decreases towards the end of their storage, so during this period it is advisable to take additional vitamin C in tablet forms.
Vitamin P has many similarities with vitamin C.
A large number of substances with P-vitamin activity have been identified in plant nature; all of them are collectively called bioflavonoids. Their main role is to strengthen the capillaries and reduce the permeability of the vascular wall. They enhance the effect of vitamin C. Vitamin P is found in chokeberries, rose hips, black currants, carrots, beets, salads, sweet peppers, etc.
Vitamin PP (nicotinic acid) participates in cellular respiration reactions, improves the function of the pancreas and liver. Nicotinic acid is a participant in brain tissue metabolism and normalizes inhibitory-excitatory processes in the central nervous system. Partial deficiency of vitamin PP in the body can occur due to diseases of the gastrointestinal tract and long-term use antibiotics, sulfonamide. This can cause headaches, insomnia, deterioration of attention and memory. Nicotinic acid is found in yeast, nuts, beans and grain products, veal, beef, and potatoes.
Vitamin E (tocopherol) reproduction vitamin, affects the normal course of pregnancy, prevents miscarriages and premature birth. A close connection has been established between vitamin E and the function of the gonads, pituitary gland and other glands. internal secretion. If there is no vitamin E in the body of a pregnant woman, metabolism is disrupted and the resulting toxic products can cause fetal death and spontaneous abortion. Tocopherol is contained in butter and vegetable oils, egg yolk, wheat germ, corn, buckwheat and oatmeal. Its daily dose during pregnancy increases from 10 mg to 20 mg.
Vitamin D D2 (calciferol) antirachitic vitamin. Plays an important role in phosphorus-calcium metabolism, in osteoplastic processes of the fetus, in the function of the reproductive system, and promotes the maturation of full-fledged germ cells. Vitamin D is found in egg yolk, caviar, cod liver, fish oil, milk, and butter. But, mainly, it is formed in the skin when exposed to solar radiation. In the last months of pregnancy, especially with a lack of sunny days, the dose should be 600 x 800 units (IU).
An overdose of this vitamin is also harmful, because it has a toxic effect: body weight falls, early ossification of the fetal skull occurs, and 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 Vitamin requirements of pregnant women
Vitamins, units change Need
Thiamine, mg 1.7
Folacin, mcg 600
Riboflav in, 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 providing the 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 fetal skeleton, blood and other tissues. The most important are sodium, calcium, potassium, phosphorus, iron, magnesium, copper, cobalt, and zinc salts.
Calcium is important 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 mother’s body, which leads to its deficiency in the pregnant woman and can cause osteoporosis of the pubic bones (during childbirth, there is a threat of symphysitis and divergence of the symphysis pubis), teeth are affected etc.
Valuable sources of calcium are milk, cottage cheese, lactic acid products, and egg yolk. The absorption of calcium salts depends on the body's supply of 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 x 2.0 g of phosphorus (in dairy, meat and fish products). There is a lot of phosphorus in nuts, beans, oatmeal and buckwheat.
Iron. A woman’s need for iron increases and amounts to 20 mg per day. Iron, copper, cobalt take part in hematopoiesis and oxidative processes. Pregnant women are prone to developing iron deficiency anemia. You can prevent it or reduce its severity with the help of a balanced diet, including liver, kidneys, tongue, apples, apricots, plums, and lettuce in your diet.
Cobalt, which is included in vitamin B12, in combination with copper and iron, is involved in oxidative processes and in hematopoiesis.
Copper, zinc. With their deficiency, protein deficiency occurs, fetal weight may decrease, and newborns are born with edema.
Magnesium is contained in bone tissue; the exchange of magnesium and phosphorus in the body is interconnected. A lack of magnesium salts in food impairs the excitability of the nervous system and muscle contraction. The need for it is 450 mg.
The main sources 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 normal functioning of cardio-vascular 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. Should be paid Special attention on their content in the diet of a pregnant woman: in the 2nd half of pregnancy it should not exceed 6 x 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 fetus and is an important therapeutic agent.
Diet of pregnant women
The diet 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 must proceed from the fact that proteins account for an average of 2030%, fats 2025% and carbohydrates 45 50% of the total energy value of the diet. All products must be absorbed and used to the maximum extent possible. One of the prerequisites for this is limiting the amount of food taken at one time. It is physiologically justified in the first half of pregnancy to eat 4-5 meals a day: first breakfast at 8-9 o'clock, second breakfast at 11-12 o'clock, lunch at 14-15 o'clock, dinner at 18-19 o'clock and at 21 o'clock glass of kefir. After eating, it is not advisable 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 consume meat from young animals, preferably boiled, to avoid harmful
influence of extractives. In the last three months of pregnancy, it is advisable to exclude broths, meat borscht, and soups from the diet. During this period, meat consumption should be limited to 3 x 4 times a week, and in the last month - 1 x 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 x 0.6 liters of milk per day. Vegetables, fruits and berries are mandatory for a woman throughout pregnancy. Among cereals, preference should be given to buckwheat, oatmeal and rice. Bread includes more rye bread. At the end of pregnancy, exclude oatmeal and semolina, especially if you are overweight.
It is most favorable to combine products of animal origin and plant origin in the diet so that the former make up 6070%. It is recommended to create a menu taking into account the time of year and provide more variety in food.
The food consumed should be fresh, well cooked and not very hot. If food is stored for a long time and then heated, 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 peeled. The main task of culinary processing of products is to preserve their nutritional value (proteins, fats, carbohydrates and vitamins) and promote better absorption of nutrients.
In culinary processing, boiling in water, steaming, and frying are used; It is better to stew vegetables with the addition of water and fat over low heat in a sealed container.
Under the influence of culinary processing, physicochemical changes occur in food substances and food becomes suitable for digestion. For example, when cooking meat at a temperature of 100°, the insoluble protein collagen, which is part of the connective tissue, is converted into soluble glutin, suitable for absorption.
During cooking of meat, some of the nutrients and extractive substances pass into the water. If the meat is immersed in boiling water, the broth will be of low concentration, but the meat will retain more extractive substances, which are not advisable for pregnant women to take. It is better to prepare meat for the 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. During the steaming of meat, extractive substances are also released, but in smaller quantities.
During the preparation of products of plant origin, significant structural changes in protein and carbohydrates also occur. The protein coagulates and the starch gelatinizes. When preparing vegetables, in addition to heat treatment, mechanical (fine chopping) and chemical treatment(fermentation, treatment with acetic or citric acid). Vegetables are then better digested and absorbed. You should not soak vegetables in water for a long time, as this destroys vitamins and other nutrients. From 50 to 75% of minerals are transferred into the water in which vegetables were boiled, so the vegetable broth can be used to prepare first courses. B vitamins pass into the 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% nicotinic acid. The activity of vitamin A and carotene does not decrease during heat treatment. Vitamin C is greatly destroyed 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 pasteurizing 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 (syrniki,
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.
a brief description of individual food products
Meat. This is a protein-rich food product that also contains mineral salts and B vitamins. Low-fat varieties of meat (beef, veal) are introduced into the diet of pregnant women. Meat by-products are valuable; liver, brain, rich in phosphorus compounds, tongue.
Fish. Fish contains easily digestible proteins. Cod, hake, perch, pike perch, navaga, and catfish are used to feed pregnant women. The fish should be fresh, preferably boiled or in the form of steam cutlets; you can prepare fish soup.
Eggs, a valuable food product, contain proteins, fats and vitamins (A, B, D and E). It is better to eat eggs boiled, as raw eggs can cause allergies or become infected. Women during pregnancy should only eat fresh eggs.
Oil. 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 lamb fats for feeding pregnant women, because they are refractory, contain almost no vitamins and are poorly digested.
Sour cream. It should only be fresh; you should add it to vegetables.
Milk and dairy products. Milk contains high-quality proteins, fats, carbohydrates, minerals, and vitamins. It is recommended to take up to 500 x 600 ml of dairy products (kefir, acidophilus milk) per day, which improve digestion processes. It is better to consume milk in pasteurized form (or fresh only from healthy cows, in full compliance with hygienic standards when milking). To preserve the value of milk, it should be boiled for no more than 1 2 minutes or pasteurized. Repeated boiling sharply reduces the amount of vitamins in it and the value of proteins. In the diet of pregnant women, lactic acid products have an advantage if they are prone to constipation.
Only one-day kefir is advisable.
Cottage cheese. A nutritious protein product necessary for women during pregnancy. It is better to use cottage cheese freshly prepared at home. The recipe is as follows: mix 3 liters of fresh cold milk with 12 g of calcium lactic acid and heat slowly, bringing to a boil (12 minutes), then cool to room temperature and squeeze through a sterile gauze cloth. Transfer the cottage cheese into a glass jar. Yield 500 g. Store in the refrigerator for no more than 2 days. Recipe for making sour cottage cheese: 3 liters of sour pasteurized milk are placed in a water bath for 1 hour at a temperature of up to 75° (do not bring to a boil). When the clear whey has separated, the jar is removed from the water bath, cooled, filtered and squeezed.
Cereals, flour. The most valuable in terms of chemical composition are buckwheat and oatmeal. Cereals are used to prepare porridges of different consistencies and soups. Use 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, and 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, as their nutritional value is lost (vitamins, starch and microelements pass into water). It is better to boil potatoes and other vegetables this way: place the cooked vegetables immediately in boiling water and cook in a container with a closed lid over low heat. Vitamin C is better preserved in baked potatoes or boiled potatoes in their skins.
Great importance has a variety of food, which largely depends on the ability to correctly create a menu. About the right
selection of food products in the organization of rational nutrition can be
judged by the normal course of pregnancy
body weight gain in the second half should not exceed 300 x 350 g per week. If the increase is more intense, the cause should be found out and the diet adjusted. We give 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 (ryazhenka) 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
Oil 25 23, 2 215.7 vegetable
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, cookies 100 5.7 11.8 55.7 361.3
Cereals, 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
Beetroot 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 is on bed rest for any reason, the calorie intake is reduced by 2030%.
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 borscht 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
White omelette 60 g with sour cream 15 g. Bun 75 g. Tea 200 g,
sugar 25 g.
Before bedtime
Fresh kefir 200 g.
Diets for pregnant women were developed at the Kiev Institute of Pediatrics, Obstetrics and Gynecology. The effect of these diets was studied on a large number of observed women. Women on such a diet were less likely to develop complications (anemia, toxicosis); 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 preventive measure that promotes the normal course of pregnancy and the development of the intrauterine fetus for a pregnant woman is regular physical exercise according to a special complex. Information on this issue can be obtained from antenatal clinic.
Approximate weekly menu in the second half of pregnancy during its normal course
MONDAY
First breakfast (8 9 h)
Butter. Egg. Salad. Tea with lemon. Bun.
Second breakfast (11 12 h)
Pancakes with rice and sour cream. Milk. Bun.
Lunch (14 15 h)
Vegetarian cabbage soup, with vegetable oil. Meatballs with vermicelli. Baked apples. Black bread.
Afternoon snack (17 h) Berries with honey.
Dinner (19 h)
Tea with a bun.
Cottage cheese with sour cream.
At night (21-22 hours) Kefir.
TUESDAY
First breakfast (8 9 h)
Butter. Cottage cheese with sour cream. Tea with milk. White bread.
Second breakfast (11 12 h)
Vinaigrette with vegetable oil. Pancakes with meat. Rose hip decoction.
Lunch (1415 h)
Rice milk soup. Beef stroganoff made from boiled meat with boiled potatoes. Dried fruits compote. Black bread.
Afternoon snack (5 p.m.) Fresh apples.
Dinner (19 h)
Boiled fish. Tea. Bun.
For the night (21:22 hours) Ryazhenka.
WEDNESDAY
First breakfast (8-9 hours) Butter, nom, cookies. Boiled fish. Salad. Tea with lemon
Second breakfast (11 12 h)
Boiled potatoes with salad. Protein omelet. Milk, cookies.
Lunch (1314 h)
Ukrainian borscht. Stewed meat with salad and vegetable oil. Fruits or berries with honey. Black bread.
Afternoon snack (17 h) Apple juice.
Dinner (19 h)
Vegetable stew. Tea with milk, cookies.
At night (21-22 hours) Kefir.
THURSDAY
First breakfast (8 9 h)
Butter. Salad with sour cream. Cheese. Tea with lemon. White bread.
Second breakfast (11 12 h)
Rice porridge with milk. Cheese. Rose hip decoction.
Lunch (1314 h)
Buckwheat soup with potatoes. Boiled pike perch. Salad with vegetable oil. Compote. Black bread.
Afternoon snack (17 h) Fruits.
Dinner (19 h)
Boiled meat with vegetable salad. Milk.
At night (21-22 hours) Kefir.
FRIDAY
First breakfast (8 9 h)
Butter. White omelette. Tea with milk.
White bread. Second breakfast (11 12 h)
Semolina pudding with raisins. Rose hip decoction. Lunch (1314 h)
Vegetarian rassolnik. Boiled meat with rice
porridge. Dried fruits compote. Black bread.
Afternoon snack (5 p.m.)
Peppers stuffed 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 h)
Potato fritters. Milk, cookies Lunch (1314 h)
Vegetarian cabbage soup with vegetable oil. Chicken
boiled with vegetable salad. Berry compote. Bread
black. Afternoon snack (5 p.m.)
Rosehip infusion. Cookie. Dinner (19 h)
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. Cookie. Second breakfast (11 12 h)
Buckwheat porridge with butter. Milk. Lunch (1314 h)
Fish soup. Meat zrazy with buckwheat porridge. Fruits. Rose hip decoction. Black bread. Afternoon snack (5 p.m.)
Cottage cheese is low-fat. Milk. Dinner (19 h)
Boiled meat or egg. Vegetable salad. Tea. At night (21×22 h)
Kefir.
The quantity of products depends on their chemical composition.
It is necessary to monitor the amount of liquid taken, which should be no more than 1.2 liters per day (together with soups, milk, tea, etc.). When edema appears and in the last 2 months, no more than 0.8 l.
Features of nutrition of women with toxicosis of pregnancy
Toxicosis in pregnant women can be early, up to 3 months of pregnancy, and late, which develops in the last 2 to 3 months of pregnancy.
Early ones manifest themselves in the form of nausea (especially in the morning), vomiting of pregnant women, drooling and allergic skin reactions (dermatoses). Early toxicosis occurs in 5060% of women. Based on the severity of the disease, there are mild, moderate and severe degrees of toxicosis. In mild forms, vomiting during pregnancy occurs from 1 to 5 times a day, sometimes only on an empty stomach, but the woman’s health remains satisfactory.
The nutrition of pregnant women with mild toxicosis corresponds in chemical composition to the diet of a healthy woman. Food should be easily digestible and rich in vitamins. Vomiting can occur on an empty stomach, during a meal or after a meal, sometimes in response to specific smells. If vomiting occurs 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 black bread crackers, lightly salted. All pregnant women with a mild form of toxicosis should take food in small portions every 2 to 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, i.e. it is not recommended to drink 0.5 x 1 hour before and after meals (water, milk, compote, etc.). It is useful to include cottage cheese, hard-boiled eggs, baked potatoes, vegetable puree, a small amount of pickles (cucumber, tomato) or a piece of herring in your diet. If possible, satisfy food cravings that arise during pregnancy.
When salivating, a number of microelements and fluid are lost. In these cases, the woman should be recommended liver and herring pates, freshly pickled cucumbers, sauerkraut and additional intake
liquids or juices.
For vomiting in pregnant women of the 2nd degree (up to 10 times a day) and 3rd degree (15 x 20 or more times), treatment should be carried out in a hospital, since it is necessary to replenish lost microelements, proteins and fluid through parenteral nutrition (through tube, intravenous).
With repeated vomiting, the body undergoes profound biochemical changes, the content of residual blood nitrogen increases, ketoacidosis and dehydration increase.
The period of fasting in pregnant women should not exceed 2 x 3 days, because after 12 x 18 hours of fasting, the main source of nutrition becomes the fats and proteins of the pregnant woman herself. A drop in body weight occurs, the woman’s condition sharply worsens, dry skin and mucous membranes appear, the smell of acetone from the mouth, aversion to food, the pulse quickens, and disorders of the central nervous system are observed. All this negatively affects the condition of the intrauterine fetus until its death.
In this regard, all pregnant women who vomit up to 10 times a day (or 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 losses of energy and plastic materials, as well as normalize disturbances in 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, pumpkins, watermelons, beets, and carrots are especially useful. These products provide sufficient intake into the body
vitamins and microelements 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 help increase diuresis; rose hip decoction, beet juice, parsley, blackberry, viburnum, chokeberry, cool milk, dried apricots.
With 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. Complete exclusion of salt is not advisable, as this can lead to a decrease in urine output and retention of nitrogenous waste 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 x 5 doses);
2) apple-curd 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 baked potatoes, 20 g butter, 500 g milk per day.
Chemical composition and energy value of the diet for toxicosis: proteins 100 x 110 g, fats 80 g, carbohydrates 40 g, calorie content 2600 x 3000 kcal. The most complete proteins are used: cottage cheese, milk, meat, fish. Exclude from the diet: meat, mushroom broths, spices, pickles, smoked foods, fried foods, sauces, seasonings, chocolate, coffee.
Culinary food processing. Prepare first courses only with vegetable broths (cabbage soup, beetroot soup, soups, milk soups). Main courses boiled. Meals 5 times a day, before bedtime kefir.
Sample menu for one day for pregnant women with 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 fresh cabbage salad 200 g with vegetable oil 15 g. 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 soup 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 rose hip decoction 200 g.
Afternoon snack
Low-fat 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
Rice milk 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 in pregnant women, including nutritional therapy developed by the Kyiv Research Institute of Pediatrics, Obstetrics and Gynecology, helps reduce high blood pressure, normalize metabolic processes, increase diuresis,
normal fetal development, pregnancy and childbirth.
Therapeutic nutrition for anemia in pregnant women
IN last years There is an increase in the number of anemia in pregnant women to 2037%. Iron deficiency anemia is most often noted; in most cases it is classified as one of the types of toxicosis of pregnant women. More often it appears after 18–22 weeks of pregnancy. A pregnant woman experiences fatigue, weakness, dizziness, headache, and drowsiness. In the blood, a decrease in hemoglobin, color index, number of red blood cells 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, insufficient intake of it into the body or its absorption in the alimentary canal. When the iron balance is disturbed, when consumption exceeds intake, anemia develops with varying degrees of iron deficiency. Hemoglobin biosynthesis 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 disruption of oxidative processes and the appearance of oxygen deficiency, and intrauterine fetal hypoxia develops. With anemia, pregnant women experience a number of complications of pregnancy (miscarriage, late toxicosis, fetal death) and childbirth (untimely rupture of amniotic fluid, weak labor, high stillbirth rates). All pregnant women with iron deficiency anemia are at high risk and should be monitored and treated.
Of great importance in the prevention and treatment of anemia is balanced diet.
The purpose of the diet is to compensate for the deficiency of protein, iron, microelements and vitamins.
Chemical composition and energy value of the diet: in the 1st half of pregnancy for women of average height (155 x 165 cm) and average body weight (55 x 65 kg) proteins 120 g; fat 80 g; carbohydrates 300 400 g; energy 3200 3300 kcal.
It is necessary to consume more animal proteins, as they promote the absorption of iron. The diet includes foods rich in amino acids (meat, fish, cottage cheese, chum salmon caviar), foods rich in iron (tongue, liver, eggs, fruits - peaches, apricots, apricots, Antonov apples, pumpkin, tomatoes, beets). Berries are also valuable - strawberries, strawberries, raspberries. B vitamins are replenished with vegetables, fruits, buckwheat and oatmeal. In winter, if there is a lack of vitamins in foods, 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 extractive substances (meat broths), since their stomach secretory function is often impaired.
Sample menu for one day for pregnant women with iron deficiency anemia
1st breakfast
Stewed 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 borscht 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.
Culinary processing. To preserve vitamins, you need to place chopped vegetables in boiling water and cook until tender under a closed lid. Prepare dishes made from raw vegetables before eating. Do not store cooked food for a long time, as reheating it reduces the content of microelements.
Conclusion
Nursing staff playing huge role in organizing the nutrition of a pregnant woman, performing a significant amount of care work, medical procedures, and the prevention of nosocomial infections.
The problem of organizing nutrition for pregnant women and combating it is relevant for the entire healthcare system of the country and St. Petersburg, in particular. The incidence of GSI is determined, along with violations of the rules of asepsis and antisepsis and the anti-epidemic regime, by the presence of objective factors, such as: a significant technical complication of diagnostic and therapeutic procedures, 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 improve the quality of medical care for pregnant women, and also reduces the costs of their treatment. In addition, the results of the work made it possible to demonstrate the effectiveness of treatment to the administration of other departments.
A 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 activities of the nursing service for the supervision of nosocomial infections will improve it and will contribute to obtaining a more complete and timely
information about infectious diseases in hospital and
factors determining it.
Bibliography:
1. Grekov I.G. Nurses' attitude towards their professional activity. // Nurse. 2000. No. 1.
2. Deev A.N. Social and hygienic characteristics of health and living conditions of paramedical workers and members of their families: Diss. Ph.D. honey. Sci. 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 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. State of 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. Perfilyeva G.M. Nursing process. // Med. sister. 1999. No. 3
10. Ponomareva G.A., Uspenskaya I.V., Voronkov D.V., Kineleva T.A. Planning the number of medical personnel at 24-hour posts. // Healthcare. 1999. No. 4.
11.Romashova T.I. Health workers' assessment of their work activity. // Sociology in medicine. Vol. 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 paramedical workers in rural areas and ways to improve work with medical personnel in the Tula region: Diss. Ph.D. honey. Sci. M., 2000.
15.Cherkassky B.L. Manual of general epidemiology. 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.3rd Ed. St. Louis: Mosby-Year Book, 1997.
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During pregnancy, in a healthy body, all organs function normally, but with increased load. If the rules of nutrition, hygiene, or overwork are not followed, the body’s functions are disrupted and various complications arise. Therefore, pregnant women must carefully follow all hygiene rules aimed at preserving and strengthening the woman’s health, the proper development of the fetus, the normal course of childbirth and the postpartum period, and preparing the woman’s body for breastfeeding.
All this information is explained to pregnant women during classes on psychoprophylactic preparation for childbirth. Their main goal is to eliminate fear and unpleasant emotions during pregnancy and childbirth, to prepare the body for childbirth and breastfeeding. Usually these are 5-6-8 classes, which consistently cover the regime, diet, hygiene of the pregnant woman, the physiology of pregnancy, possible complications, the course of labor and methods of pain relief, the course of the postpartum period and child care.
Prenatal care.
Body care is a necessary condition for the functioning of the whole organism. During pregnancy, the skin works under increased load - it performs an excretory function in conjunction with the kidneys. Showers, rubbing, washing, gymnastics, and air baths are of great importance.
Pregnant women are recommended to take a shower at least once a week and wipe their body daily with water at room temperature. When showering daily, use pH-neutral soap. Toilet of the oral cavity and teeth, sanitation of carious teeth is very important. Mandatory hygiene procedures include shaving the hair in the armpits and washing them daily with warm water. Thrush fungi can grow there.
Toilet the external genitalia 1-2 times a day with warm water and pH-neutral soap. Vaginal douching is not recommended.
Air baths should be carried out from 5-10 minutes to 15-20 minutes. at T 22-24 deg. Undosed sunbathing is contraindicated; it is better to use ultraviolet radiation as prescribed by a doctor, especially for residents of the North. Swimming in the sea and river is allowed, but limited in the last 2 months of pregnancy - there is a danger of ascending infection.
Sleep at least 8-9 hours at night and rest for 2 hours during the day, walks in the air before bed are required. Air flights and long-distance travel are not recommended.
Therapeutic exercises and 15-minute morning exercises are required. During pregnancy, exercises such as “bicycle”, “scissors”, bending forward, squats, and standing for a long time with your arms raised up are prohibited. Limit exercises to strengthen the abdominals; the main load should be on the shoulder girdle, chest, hips and perineum. “Movement is life!” Move every 2 hours to prevent congestion in the lower extremities.
Preparing the mammary glands for lactation, see above.
Clothing – comfortable and loose, preferably not made of synthetics, avoid elastic knitted fabrics, center of gravity on the shoulders, avoid tightness of the stomach and chest. The bandage prevents overstretching of the abdominal wall and skin and supports the fetus in the correct position in the womb. Comfortable shoes with wide heels no more than 5 cm high.
For varicose veins:
Avoid staying in one position for a long time;
· during sleep and prolonged stay in one position, the legs should be at a higher level than the body;
· Wear elastic stockings or wrap your legs with an elastic bandage, but they should be removed during sleep;
Avoid wearing knitwear with elastic bands;
· avoid heat sources near the feet, sunbathing, hair removal with hot wax;
With an increase in vaginal leucorrhoea:
· do a test to detect a vaginal or fungal infection;
· in case of detection of bacterial vaginosis or infection, carry out pathogenetic treatment.
For cramps in the calf muscles perform muscle massage; recommend magnesium and calcium preparations during pregnancy and lactation (Magne B 6, Additiva calcium, Upsavit calcium, Calcium-B 3 Nycomed); Remember that the bioavailability of calcium gluconate is very low.
Sexual life at risk of miscarriage is limited, individually - abstinence or a condom in the last 4 weeks of pregnancy - the danger of ascending infection.
Do not take medications without the advice of your doctor or midwife. Avoid diagnostic or therapeutic x-ray exposure. Avoid contact with infectious patients with rubella, cytomegalovirus and herpes infections, chickenpox
Diet.
Nutrition should be rational and, to a certain extent, individualized in accordance with family and living conditions and the characteristics of the woman’s body. In the first half, 4 meals a day are recommended: 1 breakfast - 25-30% of the diet, 2 breakfast - 10-15%, lunch - 40-50%, dinner - 15-20%. In the second half of pregnancy, 5-6 meals a day, serving size – 200g. Nutrition in the first half of pregnancy under the motto: “Eat whatever you want, and remember the adverse effects of alcohol, smoking, drugs, medications.” A varied and deliciously prepared diet rich in protein and vitamins is recommended.
ü from the moment of a positive hCG test:
Iodine - 200 mcg;
ü 8 weeks after the last menstrual period:
Iron - 50 mg;
Calcium - 1000 mg.
Proteins should account for an average of 20-25% of the total calorie intake (in the 2nd half - 30-35%), fats - 25-30%, carbohydrates - 40-45%. Daily requirements for normal weight:
· calories - 1800-2500 kcal;
· proteins - 60-90 g;
· carbohydrates - 325-450 g;
Limit fat to 50-70 g.
In the 2nd half of pregnancy, you should follow a predominantly dairy-vegetable diet, alternating meat, fish and vegetable days. Raw fruits, berries and vegetables are very useful. Meat - 2-3 times a week, fish more often. Supplement the amount of animal proteins with cottage cheese, eggs, cheeses, and dairy products. Liquid - up to 1200 ml per day. We recommend natural juices without preservatives, non-carbonated mineral water, tea with milk, whey. Spicy, salty foods and marinades, alcohol, spices, and coffee are prohibited.
In the North-West region it is recommended food pyramid: first floor– grains. They contain a lot of vitamin B. Coarse bread with bran, porridge - oatmeal, rice, buckwheat, it is better to cook them from whole grains due to the high iron content, pasta. Fibromed and flake (germ grains) are also useful, which contain all the microelements, vitamins and iron. Second floor- vegetables and fruits, walnuts. Green ones contain a lot of vitamin C, red ones have a lot of vitamin A. Strawberries and citrus fruits in moderation due to the possibility of allergies. Third floor- meat, fish and seafood, and milk and dairy products. Lamb and pork are difficult to digest and are difficult foods for pregnant women. Eggs no more than 3 times a week. Fourth floor– sweets and baked goods. There are very few of them.
Fasting days are useful for pregnant women: it is easiest to abstain from food from 18.00 one day to 18.00 the next. On this day, eat only one type of fruit - most often it is apples in the amount of 1-1.5 kg or drink one type of natural juice. After a fasting day, it is advisable to eat only light food - porridge with water, boiled vegetables.
On average, a woman gains 9-12 kg during pregnancy. Average weekly weight gain is 300-350 grams.
If you are prone to constipation:
· dairy products
Avoid a sedentary lifestyle
· overnight yogurt or kefir, dried fruits, 100-150 gr. prunes, apples, raw carrots, give preference in the diet to green vegetables, bran supplements and fruits;
· after waking up, drink a glass of still water;
Avoid eating foods containing starch, with the exception of rice;
· you can use laxatives (duphalac, mucofalk, forlax);
· use with caution during pregnancy and lactation senosides A+B (regulax, bekunis, tisasen), bisacodyl, guttalax;
· It is not recommended to use oils as laxatives: they promote the absorption of fat-soluble vitamins.
For heartburn:
- recommend eating small meals more frequently;
- try not to take carbonated drinks, coffee, hot sauces;
- prevent sudden bends;
- do not take antacids containing sodium bicarbonate (causes constipation);
- does not cause constipation when taking antacid medications containing aluminum hydroxide in combination with magnesium (Gastal, Alumag, Coalgel 60): they have a protective effect for the gastrointestinal mucosa; do not cause constipation;
- It is advisable to use drugs only with aluminum hydroxide (phosphalugel, tisacid, alumag).
For hemorrhoids: prevent constipation, regulate stool; prescribe topically aurobin and/or ointments rectal suppositories(procto-glivenol, proctosedyl).
For hypersalivation carry out oral hygiene; try to swallow or spit out saliva; stop smoking; if necessary, to reduce salivation, use metacin 0.002 g 2-3 times a day.
Approximate daily diet in the first half of pregnancy:
- up to 200 g of milk or its derivatives (preferably dairy products); eggs -1-2 pcs.;
- vegetables - 500 g;
- fruits - 200-500 g;
- 2 pieces of meat, cutlets, replaced during the week with sea fish, liver (120-150 g);
- bread and its products - 200 g;
- cereals or pasta - 50 g;
- limiting strong coffee and tea;
Approximate daily diet in the second half of pregnancy:
· up to one liter of milk or its derivatives (preferably fermented milk products);
· eggs - 1-2 pcs.;
· vegetables - 500 g;
· fruits - 200-500 g;
· 2 pieces of meat, cutlets, replaced during the week with sea fish, liver (200 g);
· bread and its products - 200 g;
· cereals or pasta - 50 g;
Limiting strong coffee and tea;
The idea that pregnant women first need to restructure their diet has firmly entered the consciousness of every woman, especially mothers and mothers-in-law: there are now two of you, you need to eat for two. The first thing I want to start discussing the topic of “menu for pregnant women” is a strict and categorical statement: no need to eat for two.
And in general, changing a woman’s diet during pregnancy is an important matter, but it must be done, like everything else during this period, with caution. In fact, if a woman has previously adhered to the principles healthy eating, then she won’t have to seriously change her diet.
Separately, I would like to say about those women who, before pregnancy, were actively involved in their figure: they went to fitness, went on a diet, and took various dietary supplements. They will need to turn to a nutritionist to draw up a menu for pregnant women, since it is simply impossible to predict the reaction of the body, accustomed to stress and dietary restrictions, to a sudden change in diet.
When creating a sample menu for a pregnant woman, you need to take it into account calorie content, as well as the content of proteins, fats and carbohydrates. The relationship between these three components is the basis of proper nutrition in normal times, but during pregnancy you cannot turn a blind eye to it.
Squirrels, as is known, are the main material for the construction of cells, tissues and organs. Therefore, they are especially necessary during pregnancy: it is from proteins that the baby’s body will be “built.”
Carbohydrates- this is the main source of human energy, and without them any activity is simply unthinkable. A lack of carbohydrates leads to increased fatigue. In addition, it is carbohydrates that give a person a feeling of fullness.
Fats They are also used as a source of energy; in addition, they promote the absorption of certain vitamins and microelements. Fats are the most high-calorie component of food, so they must be consumed with caution.
The menu for a pregnant woman should consist of 30% fats, 20% proteins and 50% carbohydrates. Separately, you need to remember that carbohydrates can be simple (sugars) and complex. Simple carbohydrates are very quickly broken down into components, including glucose, which immediately enters the blood. Moreover, during pregnancy, sugars are broken down faster than usual, which provokes sudden changes in blood glucose levels.
An increase in glucose levels in turn provokes the release of insulin, which is produced in the pancreas. Frequent and sudden surges in glucose seriously increase the load on the pancreas.
Please note that everything said above applies to both the mother and her unborn child. As a result of such stress, the expectant mother may develop, and the baby may become overweight. Both will seriously complicate the process of delivery. Diabetes, in most cases, goes away after childbirth, but complications caused by it can remain with you forever.
Thus, it is necessary to avoid sweets and flour - the main source of sugars - almost completely. Their place should be taken by whole grain cereals and vegetables. The calorie content of pregnant women's diet and their menu should be 2000-2500 kcal.
Nutritional features of a pregnant woman
What rules must be followed when creating a menu for a pregnant woman? Almost all of them, as already mentioned, are comparable to those that we know from a balanced diet.
First of all, you should adhere to the principle of fractional meals: that is, eat not the standard 3 times a day, as we were taught before, but at least 5-6 times a day. Of course, the portions should be smaller than in the case of three meals a day. This approach will eliminate the feeling of hunger, which means gaining excess weight.
All vegetables are better to eat fresh. Heat treatment, of course, is not excluded, but in this case most of the beneficial substances are lost. You should also be aware that freshly prepared food is always healthier and tastier than food that has been in the refrigerator and reheated.
The last rule is difficult to implement given the modern rhythm of life: a woman can hardly prepare fresh food for herself while at work. But at least on weekends and holidays, it makes sense to allow yourself to eat fresh food.
For pregnant women, more than for anyone else, the need to eat with feeling, sense and order, and not on the go, as is now customary, is relevant. Food must be thoroughly chewed.
What should a pregnant woman eat? First of all, vegetables and fruits, almost any kind. Salads, slices, vegetable stew, vegetable soups - all this will be appropriate in your “pregnant menu”.
You can’t give up animal food either. They are simply vital for the unborn child. animal squirrels. So meat, fish, and dairy products should also be present in your diet. Of course, they shouldn't be too greasy.
Of course, you can’t do without a variety of cereals. Especially those made from whole grains. They are unusually rich in carbohydrates and microelements. Unfortunately, they take much longer to cook than flakes or crushed porridges. To speed up the cooking process, you can soak the grains overnight before cooking.
Fasting days for pregnant women
The menu for pregnant women with excess weight and those who gain it during pregnancy is a separate topic. In the generally accepted sense, you cannot lose weight or go on diets during pregnancy. But I want to stay in shape, and being overweight won’t be a plus for pregnancy. How to solve this problem without harm to your health and the health of your baby?
The ideal option would be to introduce fasting days for pregnant women into your diet. The menu on such days, of course, is not very varied and nutritious, but it does not cause harm to the health of the mother and baby. Of course, if they are carried out wisely and without excesses.
Experts recommend conducting such fasting days once every 10 days. Please note that we have fasting days and contraindications. Therefore, you should definitely consult with your doctor about whether you need to perform “unloading” and how useful it will be.
There are three different options for fasting days for pregnant women:
- kefir – 1.5 liters of kefir per day;
- apple – 1.5 apples per day;
- cottage cheese – 600 low-fat cottage cheese and tea without sugar: 2 glasses.
Absolutely no!
It's time to talk about what pregnant women should absolutely not eat. When planning your diet during pregnancy, keep in mind that the daily menu should be completely free of coffee, chocolate, smoked foods, fatty foods, pickles, and so on. Ideally, a woman’s diet should not contain food containing chemical preservatives and dyes, flavor enhancers, and the like. The latter, unfortunately, is difficult to achieve, but it is still worth striving for.
Is under the strictest prohibition alcohol. And not only because of the harmful effects of directly containing alcohol. Wine increases blood pressure, and beer increases the load on the kidneys.
It is worth talking separately about allergens. These traditionally include chocolate, citrus fruits, strawberries, nuts, seafood, and various exotic products. These foods should be avoided by all pregnant women. If a woman or her relatives have an identified allergy, then those allergens that cause a reaction in them should also be avoided.
Reading such lists, women often become despondent: it turns out that pregnant women are not allowed to do anything. But, firstly, this is not at all true, women can do very, very much, all of this is listed above. And secondly, remember one little trick: everything listed above, except, perhaps, alcohol, should absolutely not be consumed systematically, and a one-time use of any product simply physically cannot have a detrimental effect on the development of the fetus. So sometimes, rarely and very little, but favorite dish you can still afford it.
It also happens that a pregnant woman, especially in the early stages, is drawn to various strange dishes, including those that are not recommended. So the question arises: what to do?
It makes sense to listen to the wishes of your body, but they are not always fulfilled literally. It’s better to think about why a woman is drawn to this particular product. As an example, we can understand the craving for pickled cucumbers, since she has long been included in all the jokes. Salt retains water in the body, so maybe that’s what your body needs?
How to prepare food for pregnant women?
The menu and nutrition for pregnant women should not only consist of the right products, but also properly prepared. It is best to steam food or bake it in the oven. These two cooking methods ensure the preservation of the greatest amount of nutrients.
In second place is cooking and stewing. This is a more aggressive treatment, but still quite acceptable for pregnant women. Moreover, both methods allow you to prepare a lot of delicious dishes.
Subject to certain rules, a pregnant woman can afford to consume and fried foods. In order to preserve as many useful substances as possible, and at the same time not receive harmful ones, it is necessary to follow certain rules. In particular, the products need to be cut as finely as possible and fried quickly - for 3-4 minutes.
Example of a daily menu for pregnant women
If you wish, you can create a menu for pregnant women for a week or for every day. This is relevant if you doubt that you can immediately get used to the new diet. But, as a rule, this is only necessary for the first month, maximum two. Then the woman will probably get used to the menu for pregnant women.
But it makes sense to separate the menu for a pregnant woman by trimester. After all, at different stages a woman needs different amounts of nutrients. As an example, we present one menu per day for different trimesters. Based on these menus and their explanations, you can create a menu for yourself.
Chapter 10. Care for pregnant women, women in labor, postpartum women and gynecological patients (A. L. Kaplan, V. I. Kulakov)
Pregnancy
Pregnancy- the period during which a fertilized egg develops. This process is accompanied by various changes throughout the woman’s body. The main condition for the normal course of pregnancy and the prevention of possible complications is adherence to a rational regimen. During pregnancy, all hygiene measures that are mandatory for a woman are carried out, but with some changes and additions in each individual case.
Bandage used from the VI-VII months of pregnancy to support the abdomen, prevent the divergence of the fibers of the deep layers of the skin and the appearance of pregnancy scars, significant divergence of the rectus abdominis muscles. The bandage must be put on and laced while lying on your back; it should not put too much pressure on your stomach. As the volume of the abdomen increases, it is necessary to adjust the lacing. A bandage selected according to the size and volume of the waist is recommended to be worn after childbirth to prevent sagging of the abdominal wall; it helps maintain the correct position of internal organs and prevent their prolapse. Elastic bands are attached to the bandage to hold the stockings in place.
Varicose veins peripheral veins are observed in pregnant women mainly on the legs, less often on the external genitalia and in the vagina. The reasons are pathological changes in the walls of the veins, damage to the venous valves, and sometimes their disappearance. For varicose veins on the legs, it is necessary to bandage the leg with an elastic bandage in the direction from the foot up the shin, and if necessary, further along the thigh, or use a special elastic stocking.
Weighing allows you to promptly notice fluid retention in the body of a pregnant woman; weighing is carried out at each visit to a pregnant antenatal clinic or a feldsher-midwife station, at least once a month in the first half and every 2 weeks (at least) in the second half of pregnancy. The woman should be weighed undressed, leaving only her shirt on; a pre-pregnant woman must urinate; on the day of weighing, the pregnant woman should have stool (either on its own or after an enema). In the first weeks of a normal pregnancy, body weight does not increase, and sometimes even decreases slightly, especially with nausea and vomiting. From the 16th week of pregnancy, an increase in body weight is noted; from the 23-24th week the weekly increase reaches 200 g, and from the 29th week it does not exceed 300-350 g; a week before giving birth, body weight usually decreases by 1 kg, which is associated with tissue fluid loss. Throughout pregnancy, a woman’s body weight increases by 10 kg (mainly due to the weight of the fetus, amniotic fluid and placenta).
Listening to the fetal heartbeat(auscultation) is performed with an obstetric stethoscope. The heartbeat can be heard starting from the end of the 5th lunar month of pregnancy (20 weeks), but with increasing pregnancy, the heartbeat can be heard more and more clearly. It is best heard closer to the head and on the side where the back of the fetus is facing: with a cephalic presentation - below the navel, with a pelvic presentation - above the navel, with a transverse position of the fetus - at the level of the navel on the right or left, closer to the head. The frequency of audible fetal heartbeats at the end of pregnancy usually corresponds to 120-140 per minute. The fetal heartbeat is determined more accurately and earlier using electrocardiography and fetal electrophonocardiography.
Miscarriage- termination of early pregnancy (up to 28 weeks). Predisposing factors: general diseases of the pregnant woman, diseases and abnormalities of the development of the ovum, insufficient function of the ovaries (corpus luteum) and other disorders of a nervous and endocrine nature; The possibility of early pregnancy termination as a result of injury (fall, bruises) cannot be ruled out. However, injuries usually lead to miscarriage in those women who have predisposing conditions. Ordinary household injuries themselves are extremely rarely accompanied by pregnancy disorders. A miscarriage without any intervention is called spontaneous, spontaneous, in contrast to an artificial miscarriage caused by various interventions; produced outside a medical institution - out-of-hospital miscarriage. When spontaneous threatened miscarriage a pregnant woman complains of slight, sometimes cramping pain in the lower abdomen; there is no bleeding. Particular attention should be paid to such complaints from women who already have a history of spontaneous miscarriages. Rest, hospitalization, complete abstinence from sexual activity for a more or less long period, and the use of progesterone sometimes allow pregnancy to be maintained. As an anti-plasma agent, suppositories with papaverine are prescribed, 0.02-0.03 g twice a day; no-shpu, vitamin E 1 teaspoon 2 times a day. At beginning miscarriage Along with cramping pain in the lower abdomen, there is also slight bleeding, which indicates the beginning of detachment of the fertilized egg. At this stage, miscarriage is limited to bed rest (hospital, maternity hospital); sometimes further detachment is prevented and the pregnancy continues. To reduce the excitability of the uterine muscles, no-shpu, progesterone, and suppositories with papaverine are prescribed. Do not apply ice to the lower abdomen - this increases uterine contractions.
If the detachment of the ovum continues, the bleeding intensifies, blood clots are released, i.e. there is a progressive miscarriage, then in most cases it proceeds as incomplete miscarriage: part of the fertilized egg comes out, and part of it is retained in the uterus. As a rule, such a patient is immediately sent to the hospital, where she has the remains of the fertilized egg removed (scraping); Remnants of the fertilized egg lingering in the uterus prevent uterine contractions and support further bleeding.
It is worth mentioning the so-called complete miscarriage. At the same time, the fertilized egg came out of the uterus, the bleeding stopped and the uterus contracted. However, small pieces of the placenta may remain in the uterine cavity, which will subsequently lead to prolonged bleeding and the formation of so-called placental polyps. In such a case, a test curettage of the walls of the uterine cavity is necessary, and the patient must be urgently hospitalized; in all cases of miscarriage, the patient should be urgently sent to the hospital.
Ectopic pregnancy, in most cases tubal, almost does not manifest itself in the first weeks characteristic symptoms. A woman with suspected ectopic pregnancy must be urgently hospitalized. Tubal pregnancy is diagnosed using ultrasound. Termination of a tubal pregnancy can proceed as a tubal abortion: a pregnant woman complains of cramping pain in the lower abdomen, pain on palpation of the abdomen, especially on the side of the pregnant tube due to irritation of the peritoneum; dark, bloody, spotting discharge from the genitals appears. When the pregnant tube ruptures, a different picture is observed: the rupture of the tube in most cases is accompanied by shock and internal bleeding - the patient suddenly develops acute pain in the lower abdomen, and a short-term fainting state occurs; there is a sharp pallor of the skin, pale, slightly cyanotic lips; pupils dilated; the stomach is slightly swollen and painful when touched; pulse is frequent, very weak filling; body temperature is normal, the patient complains of tinnitus, flickering in the eyes; in some cases there is pain radiating to the shoulder and scapula. On palpation of the abdomen - sharp pain in the lower part, Shchetkin's symptom is pronounced; with percussion of the abdomen - muffling of the percussion sound in the iliac regions and above the womb. The spilled blood accumulated in the pouch of Douglas protrudes the posterior vaginal vault - a uterine blood tumor. The presence of blood in the rectouterine cavity (pouch of Douglas) is determined by puncture through the posterior fornix. Only timely transsection - removal of a ruptured tube or tube with a fertilized egg with simultaneous blood transfusion (during and after surgery) - saves the patient’s life.
Prenatal care should be understood in a broad sense - as women’s hygiene and at the same time as prenatal, so-called antenatal, infant health care. It is wrong to talk about the hygiene of a pregnant woman in isolation from the hygiene of a woman before pregnancy, starting from her early childhood. The most favorable age for the first pregnancy in terms of the health of both the mother and her unborn child is considered to be 20-25 years old. Starting sexual activity too early and especially early pregnancy unfavorable for both the mother and her unborn child. During the first sexual intercourse, the hymen breaks and bleeds. Sometimes this bleeding is significant and in very rare cases may require medical attention. After the first sexual intercourse, you should take a break for 2-3 days. Sexual excesses adversely affect the state of the nervous system of both spouses. Sexual intercourse during pregnancy should be limited in the first 2 months and, if possible, excluded in the last month of pregnancy. Frequent sexual intercourse in the first months of pregnancy can lead to miscarriage, and in the last month it is possible to introduce pathogenic microbes into the vagina, which threatens the risk of infection during childbirth. A woman's body during pregnancy is the environment in which the fetus develops from the embryo. From this environment the fetus extracts the nutrients necessary for its growth and development, and here it gives the final metabolic products it produces. The body of a pregnant woman provides the growing fetus with the necessary nutritional materials and at the same time neutralizes and removes the end products of fetal metabolism.
Sanitary work carried out in antenatal clinics, in production, in the agro-industrial complex, nurse strives to ensure that every pregnant woman attends a consultation, a paramedic and midwifery station from the first weeks of pregnancy, which allows for the timely identification of possible pathology. Pregnancy represents a new qualitative state of the body, which during this period requires some changes and additions in the implementation of hygiene measures. A healthy woman who follows a rational regimen, combining work and rest (see. Occupational safety for pregnant women), eating normally (see. Nutrition for pregnant women), who takes sufficient advantage of fresh air, copes well with pregnancy. If the proper regimen is not followed, a physiological pregnancy can unnoticeably acquire a pathological course. By carefully monitoring a woman from the first month of pregnancy, it is possible to timely identify certain deviations in the state of her health, anticipate possible pathology during pregnancy and timely implementation of preventive and therapeutic measures to prevent pathology. This is what our doctors, midwives and nurses do, working in maternity hospitals and antenatal clinics in cities, and in rural areas - midwives and nurses at feldsher-obstetric stations with periodic consultation with a doctor.
Gymnastics for pregnant women and physiopsychoprophylaxis improve the general condition of a woman, strengthen the nervous system, help prevent toxicosis, improve and facilitate the course of labor, contribute to the favorable course of childbirth and the postpartum period. Gymnastics strengthens the abdominal muscles and increases the elasticity of the pelvic floor muscles, which improves pushing during childbirth and prevents prolapse and prolapse of the internal genital organs. With the help of physical education, a woman learns to control her breathing during childbirth; Gymnastics enhances oxidative processes in the body, which contributes to the normal development of the fetus. The combination of systematic physical education and psychoprophylactic preparation of a pregnant woman for childbirth ensures a painless course of labor. Systematic monitoring of the implementation of physiopsychoprophylaxis begins in the antenatal clinic, and, once mastered, is further carried out at home by the pregnant woman herself. The method of psychoprophylaxis is based on the elimination of labor pain through a positive effect on the higher parts of the central nervous system. The purpose of physical and psychoprophylactic preparation for childbirth is to remove the psychogenic component of labor pain, eliminate the idea of the inevitability of labor pain, and the oppressive feeling of fear. A woman is taught calm and active behavior during childbirth. Physical exercises and physiopsychoprophylactic preparation for childbirth are recommended for all women. Healthy pregnant women can practice physiopsychoprophylaxis on their own at home, and pregnant women with various diseases in the stage of compensation are under the supervision of a doctor and a visiting nurse, who monitors the well-being of the pregnant woman at each visit and brings this to the attention of the doctor.
Worm infestation negatively affects the condition of the pregnant woman (anemia, general malaise) and the fetus; can lead to pathological changes in the placenta, which, along with anemia, causes oxygen starvation fetus, termination of pregnancy. At the first consultation visit, the stool is examined for worm eggs and, if necessary, treatment is carried out.
Clinical examination- a method by which preventive medical examinations of the population are carried out to identify patients, register them, systematically monitor and improve their health.
Medical examination of pregnant women is carried out by antenatal clinics at the place of residence, and in rural areas - by district and local hospitals and clinics. Consultations register all pregnant women in their area and provide systematic dispensary monitoring of them. The most important task of the antenatal clinic is the early registration of all pregnant women and the identification of pregnancy complications (toxicosis, narrow pelvis, abnormal fetal position, bleeding, etc.), as well as diseases of internal organs (cardiovascular system, respiratory system, liver, kidneys, etc.) .d.). During pregnancy, a woman should attend a consultation 10-14 times (in the first half of pregnancy, once every 3 weeks, from the 20th to the 32nd week of pregnancy - 2 times a month, after the 32nd week - every 10 days, and when more often if necessary).
Basic antenatal clinic provides not only advisory and therapeutic assistance, but also methodological assistance to all outpatient institutions, including medical units.
Shop obstetrics and gynecology areas are organized in territorial basic antenatal clinics. A shop doctor-obstetrician-gynecologist gets the opportunity to systematically go to industrial enterprises, state farms, study the working conditions of women, and work closely with the administration, party and trade union activists.
On-site antenatal clinics- a modern form of service for women agricultural workers. The tasks of these consultations include qualified examination by specialists of pregnant and gynecological patients, carrying out the necessary laboratory tests of preventive examinations, dispensary observation of certain groups of gynecological patients, identification and timely hospitalization of women with complicated pregnancy.
Teeth, oral cavity. Timely treatment of diseased teeth and oral cavity in a pregnant woman is especially important, since foci of infection in the oral cavity are a source of constant infection and intoxication of the body and can cause infectious complications during childbirth and the postpartum period. During pregnancy, some women experience a significant depletion of calcium salts in the body, which also affects the condition of the teeth and leads to their rapid destruction. At the antenatal clinic, all pregnant women must be examined by a dentist and given the necessary treatment.
Maternity file carried out for the early and systematic identification of pregnant and postpartum women who do not appear for consultation at the appointed time. The card file is available in the office of each local doctor and consists of the main medical document - individual cards of pregnant women (registration form No. 96). Pregnant women's cards are located in a special box according to the dates of the next scheduled visit. The charts of pregnant women with any diseases or complications are marked with a colored flag, since these women need to be given special attention and examined more often. Cards remaining in the file cabinet at the end of the working day indicate that pregnant women did not show up for appointments; the latter are subject to urgent patronage. The file for gynecological patients is compiled from control cards of patients undergoing dispensary observation (registration form No. 30). The cards are arranged by disease, and within groups - by the date of scheduled appearance, which allows you to immediately identify a patient who did not appear on time and carry out the necessary patronage. The file is kept by a nurse and systematically checked by a doctor.
Blood. A clinical blood test is performed several times during pregnancy, especially in the second half of pregnancy; Repeated blood tests make it possible to promptly identify diseases that require special treatment. For all pregnant women, blood is taken from the ulnar vein twice (in the first and second half of pregnancy) for serological testing (Wassermann, Sachs-Georgi reaction). Treatment of patients identified in this way is carried out at a venereology clinic with the obligatory involvement of the father of the unborn child in treatment.
All patients must have their blood type and Rh status determined; With Rh-negative blood, the mother often experiences hemolytic disease of the newborn. If Rh-negative blood is detected in a pregnant woman, it is necessary to examine the blood of her husband as well. If the father has Rh-positive blood and the fetus inherits the father’s Rh-ness, then during such a pregnancy a Rh conflict arises between the mother and the fetus: the fetus may die in utero, be born prematurely or with signs of hemolytic disease. To increase the fetus's resistance to the harmful effects of Rh antibodies and improve placental blood circulation, all pregnant women with Rh-negative blood undergo desensitizing treatment (at 12-14, 22-24, 32-34 weeks of pregnancy). Therapeutic and preventive measures are designed to create the most favorable conditions for the development of the fetus: food should be rich in proteins and vitamin C (up to 1 g per day during pregnancy with short breaks).
The Coombs test is used to detect antibodies in the mother's blood. When antibodies appear in the mother's blood long before birth, the most severe forms of fetal disease occur. In approximately 30% of newborns from such mothers, hemolytic disease begins in the prenatal period.
Bleeding in early pregnancy cm. Miscarriage.
Bleeding in late pregnancy may be associated with abruption of the placenta at the beginning of labor, with its low location in the uterus, or with placenta previa, if the placenta is located above the internal os of the uterus (in this case, bleeding usually appears without any noticeable labor, without contractions), or associated with premature abruption normally placenta located in the uterus (usually there are contractions). All women in labor with bleeding should be urgently hospitalized in the nearest hospital, accompanied by a nurse, or a doctor or midwife should be urgently called to see them.
Mammary gland. During pregnancy, the mammary glands are prepared for the upcoming feeding of the child so that the mammary glands develop correctly, the nipples become stronger and cracks do not form on them. Every day, with cleanly washed hands, it is necessary to wash the mammary glands with water at room temperature and soap (preferably baby soap) and wipe with a shaggy towel. If the skin of the nipples is dry, they should be lubricated with sterile petroleum jelly. With flat or inverted nipples, a kind of gymnastics is performed on the latter. To do this, the nurse thoroughly washes her hands (nails should be cut short), lightly sprinkles her fingers and nipples with sterile talcum powder, grabs the nipple at its base with two fingers and pulls it in the direction from the areola to the top of the nipple with a simultaneous light massage; This is done daily once or twice a day for 5 minutes. If the massage does not achieve the goal, it should be stopped and subsequently used when feeding the child, if necessary, with a special pad. Air baths for the mammary glands for 15-20 minutes are very useful. This strengthens the nipple and skin; It is advisable to carry out air baths in the morning and evening.
Urine. The kidneys function under great strain during pregnancy, as they remove waste products from the body of both the pregnant woman and the growing fetus. Therefore, a pregnant woman’s urine must be examined every time she visits a antenatal clinic. If protein appears in the urine, the pregnant woman is taken into special registration, and if the protein increases, she must be hospitalized.
Maternity clothes should be comfortable, light and free. You should not wear tight belts, round garters, or tight bras. Stockings should be held in place with long elastic bands that are attached to a belt or bandage. It is better for a pregnant woman to wear loose dresses or a sundress with straps so that the weight of the clothes falls on the shoulders. Cleanliness of clothing during pregnancy is especially important. Shoes should be comfortable, with low heels.
A maternity bra should be made of rough material or lined with canvas and should not put too much pressure on the mammary glands. This contributes to the roughening of the skin of the nipples, which to a certain extent prepares them for feeding. The bottom edge of the bra should be at least 5-6 cm wide. The mammary glands in the bra should be slightly raised and moderately pressed. A bra of the same cut is recommended for postpartum women. A bra with straps should be fastened in the front so that it is convenient to expose the mammary glands when washing them and feeding the baby. Bras need to be clean, so you should have several and change them often.
Maternity and child care leave is provided for a duration of 56 calendar days before childbirth and 56 calendar days after childbirth with payment of state social insurance benefits for this period. In case of complicated pregnancy and childbirth or the birth of two or more children, leave after childbirth is granted for 70 calendar days. Since the duration of maternity leave is calculated in calendar days, this leave counts not only working days, but also weekends and holidays.
Postpartum leave is calculated from the day of birth, including the day of birth. After childbirth, at the request of a woman with a total work experience of at least one year, partially paid leave to care for a child is granted until the child reaches the age of one year, with payment of state social insurance benefits for these periods. For mothers studying in vocational schools educational institutions, in courses and schools for advanced training and training, partially paid leave is provided regardless of length of service. In addition to the specified leaves, a woman, upon her application, is granted additional leave without pay to care for a child until the child reaches the age of one and a half years. Additional leave without pay is counted towards the total and continuous work experience, as well as into the length of service in the specialty and, in particular, the length of service giving the right to annual leave. Before maternity leave or immediately after it, a woman, upon her application, is granted annual leave, regardless of length of service at the enterprise, as well as, if desired, leave without pay.
Occupational safety for pregnant and breastfeeding women. Pregnant women from the fifth month of pregnancy and breastfeeding women are allowed only to do light work (excluding overtime and night work). Women cannot be sent on business trips without their consent. When transferred to an easier job, the pregnant woman retains her average salary based on the last 6 months. It is prohibited to dismiss a pregnant or breastfeeding woman from work. Breastfeeding mothers and women with children under 1 year of age are provided, in addition to a general break for rest and nutrition, additional breaks for feeding the child - at least every 3 hours, lasting at least 30 minutes each. If there are two or more children under the age of 1 year, the duration of the break is set at least 1 hour. Breaks for feeding the child are included in working hours and are paid according to average earnings. The timing and procedure for providing breaks are established by the administration together with the factory, factory, and local trade union committee, taking into account the wishes of the mother. It is prohibited to refuse to hire women and reduce their wages for reasons related to pregnancy or breastfeeding. The dismissal of pregnant women, breastfeeding mothers, and women with children under the age of 1 year is not allowed at the initiative of the administration.
Patronage for pregnant women aims to monitor them at home. The tasks of patronage include: clarifying the general condition and complaints of a pregnant woman, a postpartum woman or a patient with gynecological diseases; familiarization with the life of a pregnant and postpartum woman, teaching her the rules of hygiene and caring for a newborn; education of sanitary and hygienic skills and assistance in improving the hygienic environment, based on specific living conditions; checking the implementation of the assigned mode; sanitary educational work. When caring for pregnant and postpartum women, it is necessary to pay special attention to balanced nutrition and compliance with all doctor’s recommendations. The sister records the data received during the first visit in detail on the visitation sheet, which she pastes into the pregnant woman’s individual card. During repeated visits, the nurse notes on the visitation sheet everything that has been done to eliminate the noticed shortcomings, and reports her observations to the doctor.
Nutrition for pregnant women . Proper nutrition during pregnancy is extremely important for maintaining the health of the mother and the normal development of the fetus. In the first half of a normal pregnancy, a special diet is not necessary. Food should be varied and tasty prepared. Nutrition in the second half of pregnancy should take into account the physiological characteristics of the body. The diet must include proteins up to 100-120 g per day. Among products containing complete proteins, we should recommend kefir, yogurt, milk, cottage cheese, eggs, cheese, lean meat (100-120 g per day), fish (150-250 g per day). The amount of carbohydrates in the diet should not exceed 500 g per day, and if a pregnant woman is overweight - 300 g. It is necessary to include fruits, berries, vegetables, and bread in the diet. Fats are recommended in the amount of 100-110 g per day, mainly in the form of butter, sour cream and vegetable oils. The amount of liquid is limited to 1-1.2 liters, and the amount of table salt, especially in the second half of pregnancy, to 8-5 g per day. During pregnancy, food should contain vitamins A, B, C, D, E. Vitamin A increases the body's resistance to infection. It is found in the liver of fish. Carrots contain carotene, which is converted into vitamin A in the body; You can also use a ready-made synthetic preparation in the form of pills or liquid. Vitamin B 1 prevents the development of vomiting in a pregnant woman. A lack of vitamin B 1 in the body leads to rapid fatigue, the development of neuromuscular weakness, and weakness of labor. Vitamin B1 is found in black bread, yeast and beans; You can also use ready-made preparations in the form of dragees. Vitamin C (ascorbic acid) helps maintain pregnancy; If there is a deficiency of this vitamin in a pregnant woman’s body, pregnancy termination often occurs. Vitamin C is found in large quantities in rose hips, black currants, cabbage and other vegetables, berries and fruits, which a pregnant woman should consume widely. If this is not possible (in winter, spring), it is recommended to take vitamin C in the form of ascorbic acid with glucose or in the form of proprietary tablets. Vitamin D, otherwise called antirachitic, prevents the development of rickets in the fetus and plays an important role in the regulation of calcium and phosphorus metabolism in a pregnant woman. Contained in fish oil (use 1 tablespoon 2 times a day before meals). Vitamin E helps maintain pregnancy, especially indicated for women with a history of premature pregnancies; promotes normal development of the embryo and fetus. Vitamin E is found in sprouted wheat grains and salad. There is a ready-made complex of vitamins specifically for pregnant women - gendevit; it is taken 2-3 tablets per day. Food should be taken in small portions, in the first half of pregnancy 4 times with three-hour breaks: first breakfast - 25-30% of the diet, second breakfast - 10-15%, lunch - 40-45%, dinner - 10-15%. In the last months of pregnancy, food is taken 5-6 times a day, dinner - 1-1.5 hours before bedtime (tea with milk, a glass of milk or curdled milk with a roll or cookies). Night break - 8-9 hours.
Treatment-protective regime in the care of pregnant women, women in labor and postpartum, in addition to observing the strictest asepsis and antisepsis, includes the creation of a favorable, calm, benevolent environment, timely, accurate, painless execution of all appointments, attentive and helpful attitude to the patient’s requests, a calm tone in conversation, concern for cleanliness around the patient , in the room, clean linen, delicious food, etc.; vanity and bustle in the work of medical personnel are eliminated. All of these are the most important tasks of a nurse working in an obstetric hospital, in a antenatal clinic and a clinic. Positive emotions contribute to increased reactivity of the body and faster recovery. And, conversely, negative emotions lower the overall tone and reduce the body’s resistance to infection. There are known cases of miscarriage, premature birth due to severe nervous experiences. Pregnant women, especially with a pathological pregnancy, and postpartum women, after undergoing great physical and mental stress, such as childbirth, need favorable conditions for rest and sleep. Sleep restores the performance of a tired, exhausted body. It is necessary to eliminate noise in the department; the clicking of heels, creaking doors, etc. is unacceptable; it is necessary to maintain the appropriate temperature in the room. The postpartum woman should be provided with at least 8-9 hours of good sleep during the day, with mandatory continuous night sleep of at least 6 hours. All manipulations, diagnostic and therapeutic procedures should be carried out by a nurse painlessly. It is necessary to try to ensure that every pregnant woman is promptly prepared at the antenatal clinic, at the feldsher-midwife station for a painless course of labor by conducting special classes - conversations using the method of psychoprophylactic training. To assimilate ourselves and systematically introduce junior medical staff to the principles of the medical and protective regime - these are the tasks of nurses at the antenatal clinic, maternity hospital and feldsher-obstetric station.
Gestational age. The average duration of pregnancy for a woman is 280 days, i.e. 40 weeks, or 10 obstetric (lunar) months. The gestational age in the first months is determined by simply counting the time that has passed since the last menstruation. To calculate the due date from the first day of the last menstruation, count 3 months ago and add 7 days. For example, the first day of the last menstruation is December 10, 1987: count 3 months ago (November, October, September), it turns out - September 10; add 7 days - it turns out September 17, 1988. This will be the expected due date, which in some cases may vary between September 10 and 20. To more accurately calculate the gestational age, along with anamnesis data, they use the determination of the size of the pregnant uterus, the height of its fundus above the symphysis, the position of the head, its size, the length of the fetus and the circumference of the pregnant woman's abdomen.
Until 3 months, the uterus is still in the pelvic cavity - pregnancy is determined by vaginal examination. Starting from the fourth month of pregnancy, the fundus of the uterus leaves the small pelvis and at the end of the fourth month obstetric month pregnancy (16 weeks) stands three transverse fingers (5 cm) above the symphysis pubis; at the end of the fifth obstetric month of pregnancy (20 weeks), the fundus of the uterus is in the middle between the womb and the navel (11 cm above the womb); at the end of the VI obstetric month of pregnancy (24 weeks) - at the level of the navel (22 cm above the womb); at the end of the VII obstetric month of pregnancy (28th week) - 26 cm above the womb; at the end of the 8th obstetric month of pregnancy (32 weeks) - 30 cm above the womb; at the end of the 9th obstetric month of pregnancy (36 weeks) - 36 cm above the womb. By the end of the X obstetric month of pregnancy (40 weeks), the fundus of the uterus drops approximately to the level at which it stood at the end of the VIII obstetric month, i.e., 30 cm above the womb.
Toxicoses of pregnant women- a multi-symptomatic disease manifested by dysfunction of metabolism, the cardiovascular system, kidneys, liver, central and peripheral nervous system; often occur against the background of existing chronic diseases of internal organs.
Early toxicoses may appear from the first days and weeks of pregnancy and disappear in the second half. Some early toxicoses of pregnant women do not completely disappear and persist until the end of pregnancy. Early toxicosis of pregnant women can manifest as dermatoses, a rash similar to urticaria, itching of the external genitalia, eczema, and herpes. Early toxicoses include vomiting and salivation. Many women, from the first days and weeks of pregnancy, develop intolerance to certain smells and tastes (an aversion to some foods and a need for others). Vomiting of pregnancy- the most common form of toxicosis; in most cases does not require special treatment. More severe forms are accompanied by rapid loss of body weight, dry skin, rapid pulse, and low-grade fever. Uncontrollable vomiting- severe form of early toxicosis of pregnant women; vomiting is repeated 20 or more times a day and leads to exhaustion of the body, and in some cases, especially if untreated, can lead to death. As a result of fasting, pregnant women with indomitable vomiting develop severe dystrophy, diuresis sharply decreases, protein, hyaline and granular casts, and acetone appear in the urine. The patient’s mouth smells of acetone (smells like apples), and the general condition deteriorates greatly. A pregnant woman with excessive vomiting should definitely be hospitalized. If treatment is not started immediately, the patient is at risk of death due to profound (irreversible) changes in the organs (kidneys, liver). Sometimes the only salvation can be a timely termination of pregnancy.
Drooling (ptialism) manifested by almost continuous secretion of saliva, often causing irritation and maceration of the skin of the chin, and significant weight loss. To measure the daily amount of saliva secreted (and vomit), use a graduated glass mug with a lid. The nurse records the amount of saliva (and vomit) collected in the medical record; large loss of fluid is compensated by drip infusion of fluid (glucose, vitamins, isotonic solutions).
Late toxicosis of pregnant women. At dropsy of pregnancy fluid accumulates mainly in the subcutaneous fat layer. Fluid accumulation depends on disruption of water-salt metabolism and increased capillary permeability. The disease begins in the second half of pregnancy. First, pastiness occurs, and then swelling of the feet and legs. With edema, body weight increases by 500-700 g or more per week. For a mild form of dropsy in pregnancy, bed rest and a diet with limited fluid and salt, the inclusion of complete proteins (boiled lean meat, boiled fresh fish, cottage cheese, kefir), vitamins, light dairy and vegetable foods, and control of diuresis are recommended. If the pregnant woman's treatment is incorrect, dropsy can progress to a more severe stage of toxicosis - nephropathy.
Nephropathy of pregnancy (kidney of pregnant women)- a disease accompanied by edema, the appearance of protein in the urine, and increased blood pressure. Treatment for nephropathy is aimed at increasing diuresis, reducing and completely eliminating edema, lowering blood pressure, improving cardiac activity, and preventing seizures. Intravenous infusions of glucose are used, calcium chloride is administered orally, and magnesium sulfate is administered intramuscularly. Treatment is carried out with intermittent sleep.
The diet for nephropathy consists of excluding table salt, limiting fluids (up to 500 ml per day until swelling disappears); in food - at least 100 g of proteins (cottage cheese or lean meat, boiled or steamed, or boiled fish), animal fats or vegetable oil in the amount of 50 g per day; sufficient amount of sugar and vitamins. The use of soda is prohibited, which is replaced if necessary with magnesium compounds. The nurse monitors very closely general condition patient with symptoms of nephropathy (blood pressure, albuminuria, edema, condition of the fundus vessels according to the ophthalmologist). Timely recognized nephropathy with proper care the nurse's care for the patient (diet, treatment, medical and protective regime) may be suspended.
Preeclampsia. If treatment and preventive measures do not stop nephropathy, then the amount of protein in the urine increases, swelling increases, blood pressure rises, and complaints of pain in the epigastric region, headache, and “veil” before the eyes often occur; at this stage, hemorrhage into vital organs, premature placental abruption and other complications dangerous for the pregnant woman and fetus are possible. Treatment of preeclampsia comes down to an appropriate regimen - the patient is placed in a separate room, providing her with peace and individual, constant care from a nurse. The windows in the ward are covered to avoid harsh light irritation. Magnesium sulfate is administered, the diet is strictly followed (see above), treatment is carried out with long sleep, and the necessary care is provided; This prevents the transition of preeclampsia to the convulsive stage of eclampsia. The nurse must perform all manipulations and injections under general anesthesia.
Eclampsia- the most severe stage of late toxicosis. The growing symptoms of preeclampsia as a result of increased intracranial pressure are accompanied by severe headache, sometimes vomiting, blurred vision, and agitation. Convulsions in eclampsia begin with twitching of the facial muscles; First, blinking of the eyelids appears, then fibrillar twitching of the facial muscles occurs, then the spasms spread to the muscles of the trunk and limbs, turning into tonic spasms of the muscles of the whole body. The neck muscles are tense, the veins in the neck are dilated, a sharp cyanosis of the face and upper extremities appears (due to respiratory distress); consciousness is lost; pupils are dilated. A convulsive attack can last from 30 seconds to 1 minute, then the convulsions gradually stop, the patient exhales deeply, foam is released from the mouth, sometimes stained with blood due to biting the tongue, then breathing is gradually restored, the cyanosis disappears, and after a while consciousness returns. The amount of protein in the urine increases sharply. Sometimes, with frequently recurring seizures, the blood supply to the central nervous system progressively deteriorates and the patient, without regaining consciousness, may die from asphyxia, cerebral hemorrhage or pulmonary edema. Eclampsia can occur in pregnant women, women in labor and postpartum women in the first days of the postpartum period.
The nurse must constantly remain with the patient. Before the onset of a seizure, the patient experiences increased agitation, slight twitching of the eyelids, the pulse becomes more intense, and blood pressure rises. At this moment, you need to insert the handle of a spoon wrapped in gauze into the patient’s mouth from the side between the molars (to avoid biting the tongue), and keep the spoon in the mouth until the seizure ends. If possible, the patient is immediately given anesthesia. Before the doctor or midwife arrives, in order to prevent the next seizure, the nurse injects the patient intramuscularly with 20 ml of a 25% solution of magnesium sulfate (this can be repeated every 4 hours, but not more than 4 times a day). If this drug is not available, you can inject 1 ml of a 1% morphine solution under the skin. A patient with eclampsia cannot be transported. The nurse, while staying with the patient, is obliged to provide everything possible to create a therapeutic and protective regime (see. Treatment-protective regime).
Prevention of toxicosis in pregnant women includes correct and qualified management of a pregnant woman from the first weeks of pregnancy; rational nutrition, abstaining from large amounts of fluids and food, limiting salt, regulating physical and mental labor, staying in the fresh air, getting a good night's sleep, following all the recommendations of the antenatal clinic. Those who have suffered toxicosis must be under medical supervision after childbirth.
Toilet external genitalia during pregnancy, it is done with warm water and soap (preferably baby soap). You must first wash your hands thoroughly. They wash themselves over the basin, pouring water from a jug or a kettle with their left hand, or in the bath with warm water from a hose; movements of the washing hand are made from the womb to the anus (but not in the opposite direction).
A nurse washes a bedridden pregnant woman: an oilcloth is laid under the woman and an individual bedpan is placed; use sterile cotton swabs on a forceps. In the second half of pregnancy, a woman washes herself while lying down from Esmarch's mug with a not very strong stream. When washing, water should not pour into the vagina; only the external genitalia are washed.
Folic acid (vitamin B9) is considered one of the main vitamins for a pregnant woman. Folic acid deficiency can cause early labor or mental retardation of the fetus. On the other hand, B9 prevents anemia in the expectant mother and her child, and is responsible for the normal condition of the skin and mucous membranes.
Therefore, the diet of pregnant women, especially in the first half of pregnancy, must include fish, meat, raw vegetables and fruits, and dairy products.
NB! Folic acid is destroyed during heat treatment, but is preserved better in meat products and milk.
It is very difficult to maintain a healthy diet when the body refuses to accept even the most ordinary foods - it is not up to it now, it is struggling with nausea and dizziness.
In these first weeks of pregnancy, the need for salty, spicy, etc. can be satisfied (of course, within reasonable limits) without harm to health.
In the fight against toxicosis, only natural, natural remedies are good. No drugs! Only properly selected products and diet. It is recommended to consume the most easily digestible foods. In the morning, while still lying in bed, you can eat light yogurt or an apple.
Man is in full swing. He really expects his mother to help him with building material! Among the most important substances now are calcium and phosphorus. They are found in the most optimal ratio in milk and dairy products.
7-8 weeks.
Pregnant women cannot live without milk, because milk in its pure form contains calcium, phosphorus, folic acid and other B vitamins, vitamin E, fluoride, complete protein, and animal fats.
Moreover, it is in milk that calcium and phosphorus are contained in that ideal proportion of 2:1, in which both elements are best absorbed. Unfortunately, not all people can drink milk due to the fact that their body lacks the enzyme responsible for the absorption of milk and dairy products. Kefir and live yogurt combine all the best properties of milk, multiplied by the ease of absorption by the body.
Week 10
Iron is part of hemoglobin and ensures the normal process of hematopoiesis. What both mother and child need now! Iron is best absorbed from animal products. There is especially a lot of iron in cottage cheese. Calcium and fluoride will help your baby's teeth develop. Fluorine is found in meat, fish, milk, greens, and fruits.
Week 11
Zinc is responsible for the development of the organs of smell and taste, the reproductive system and hematopoiesis. The most zinc is found in cheese, seafood, meat, legumes and nuts. Vitamin E strengthens the immune system, helps the process of hematopoiesis in the mother’s body and the work of her heart muscle. Vegetable oils, wheat germ, soybeans, broccoli, Brussels sprouts, leafy greens, spinach, whole grains, eggs.
Week 12.
The risk of premature rupture of the placenta is significantly reduced with increased dietary intake of vitamins C and E. Iodine is necessary for the normal functioning of the thyroid gland. With hypofunction of the thyroid gland, growth retardation is observed due to metabolic inhibition. The main source of iodine is seafood.
Week 13.
During the first trimester, the expectant mother is unlikely to gain more than 1-3 kg in weight. But from this week you will have to closely monitor your weight and, of course, your diet. “To over-recruit” or “to under-recruit” are equally harmful. And this is the main problem of the next three trimesters.
If in the first trimester when compiling your daily diet to the expectant mother I constantly had to take into account the hormonal vagaries of my body and fight toxicosis with all my might, then starting from the second trimester the situation will change somewhat.
The two main reasons for poor digestion during pregnancy are dysbacteriosis and compression of the abdominal organs due to an increase in the volume of the uterus. If constipation occurs, laxatives should never be used. This problem should only be solved with diet.
Fresh, stewed, baked vegetables and fruits, herbs will become especially relevant. Eating 30 grams (2 teaspoons) of bran daily will help the intestines get rid of all the excess.
We should start switching to new mode nutrition. If in the first trimester it was possible to maintain four meals a day, then from the second trimester until the end of pregnancy you need to eat more often, but in smaller portions.
