LEC 1: Healthy Pregnancy Flashcards
(45 cards)
1
Q
Why is preinatal health important?
A
- Perinatal mortality (maternal/infant) is an important indivator of the health communities and countries
- Impacted on by many variables: social, economic, environment, health system
- Health women → healthy pregnancies → healthy infants → healthy families → healthy communities → an investment in the future
2
Q
Family Centered Maternity and Newborn Care (FCMNC) National Guidelines
A
- Dedicated to imporving and creating consistency in mental and newborn health and to inform evidence-based practice across Canada
- Privudes a standard of care to meet needs of mothers, babies, and families
- Aim to positively impact health from preconception to postpartum, and throughout the life course of children, women, and families
- Complex, multidimensional dynamic process of providing safe, skilled and individualized care
- Recignizes significance of family support, participation, and choice
3
Q
Guiding Principles of Family Centered MAternity and Newborn Care (FCMC)
A
- Family-centred
- Pregnancy and birth are normal, healthy processes
- Encourages early parent-infant attachment
- Infromed by research evidence, requires a holistic approach and involves collaboration among care providers
- Culturally-appropriate care is important in amulticultural society
- Indegenous people have distinctive needs during pregnancy and birth
- Ideal of care as close to home as possible
- Individualized maternal and newborn care
- Women and families play an integral role in decision making
- Attiudes and language have an impact on a family’s experience
- Respects reproductive rights
4
Q
Interprofessional Team with Obstetrics
A
- Physicians, advanced practice nurses, nurse practitioners, midwives
- Counsultant specialists
- Physiotherapists
- Community health nurses
- Respiratory therapists
- RN’s in rural, remote, outpost areas
- Nutritionists/ dieticians
- Prenatal educators
- Social workers
- Mental health workers
- Family home visitors
- Outreach service providers, especially for high risk women/ families
- Doulas/ labour companions
5
Q
Perinatal Care
A
- Values pregnancy as a state of health
- Diveristy of needs recognized; a variety of personal and cultural meanings are brought by families to pregancy and birht and parenthood
- Accessing care in pregnancy and postpartum can provide opportunites for health teaching and positive contributions to overall health status of the woman and her family
6
Q
When does obstetrical care start?
A
Before conception = pre-conception
7
Q
Pre-Conception
A
- Before conception
- 3 months is when preconception starts
- Preconception counselling for the couple
- Women of childbearing age 15 to 44
- Average age of women giving birth is 29.5
- 50 to 75% of pregnancies are unplanned- Many sexually active women preconceptural at any given time
- Thinking about becoming pregants? See a doctor 3 months before to sort out health, go on pre-natal vitamins
8
Q
Pre-Conception Care
A
- Positively impact health of woman and deccrease risk factors impacting on the pregnancy and the fetus
- Optimizing weight and nutrition, exercise
- Modifiable risk factors: smoking, alcohol, drugs
- Folic acid (400mcg/day, espcially first 8 weeks) and multivitamin with iron
- Prevent neural tube defects
-
Pre-existing conditions: diabetes, cardiac problems, HTN, depression, STIs
- Need to be under control
- Genetic counselling: Offered to woman >35, previous delivery of child with anomalies, family history
-
Dental care: Pregnant women wither periodantal disease may have a higher risk of devlivering a pre-term or low birth weight baby
- Increased bascularity bleeding gums, calcium, vomiting of morning sikness can cause dacay, X-rays avoided in pregnancy so get done prior
-
Family spacing/ planning: 2 to 3 normal periods after d/c of hormonal BC
- WHO recommends 2 years between pregnancies
- Screening for social risk factors, reducing stress, optimizing mental health
- Slcka, risk factors: social economic status, education, where they work, perinatal menternal health
9
Q
How are trimesters divided?
A
- 40 week of gestation divided into 3 trimesters
- About 280 days
- 1st trimester: 1 to 13 weeks
- 2nd trimester: 14 to 26 weeks
- 3rd trimester: 27 to 40 weeks
- About 280 days
10
Q
How much weight is reasonable to gain during pregnancy?
A
- It depends, there is not one magical number.
- Depends on the persons BMI.
- Want to add around 300 calories a day = 2 to 3 additional servings from Canada’s Food Guide
- 11 to 15lbs weight gain for obese BMI
- 11 to 20lbs for normal BMI
- Metabolism increases BMR 20 to 25%
11
Q
How should weight gain during pregnancy be divided?
A
- For women with a normal BMI (18.5 to 24.5)
- 1st trimester: 6 lbs
- 2nd trimester: 12 lbs
- 3rd trimester: 12 lbs
12
Q
Why is it important to monitor weight gain during pregnancy?
A
- To know the growth of the fetus
- If there is fluid balance
- Weight can indicate that something is wrong or if pregnancy is developing healthily
13
Q
Teaching to Promote Optimal Nutrition During Pregnancy
A
- Follow Canada’s Food guide, selecting a variety of foods from each group
- Gain weight in a gradual and steady manner as follows:
- Normal weight woman: 11.5 to 16kg (25 to 35 pounds)
- Underweight woman: 12.5 to 18kg (28 to 40 pounds)
- Overweight women: 7 to 11.5kg (15 to 25 pounds)
- Obese women: 5 to 9kg (11 to 15 pounds)
- Take your prenatal vitamin/ mineral supplementation daily
- Avoid weight-reduction diets
- Do not skip meals; eat three meals with one or two snacks daily
- Limit your intake of soda and caffeine-rich drinks
- Avoid the use of diuretics
- Do not restric the use of salt unless instructed to do so by you healthcare provider
- Engage in reasonable phyisical activity daily
14
Q
How much weight should a woman gain during her pregnancy based on her BMI?
A
- Gain weight in a gradual and steady manner as follows:
- Normal weight woman: 11.5 to 16kg (25 to 35 pounds)
- Underweight woman: 12.5 to 18kg (28 to 40 pounds)
- Overweight women: 7 to 11.5kg (15 to 25 pounds)
- Obese women: 5 to 9kg (11 to 15 pounds)
15
Q
Healthy Teaching in Pregnancy
A
- Prenatal nutrition
- Folic acid
- Alcohol
- Physical activity
- Smoking
- Oral health
- Emotional health
- Not everyone is going to be happy about being pregnant
- Birth preparation
16
Q
What are common discomforts of pregnancy?
A
- Urinary frequency or incontinence
- Fatigue
- Nausea and vomiting
- Backache
- Leg cramps
- Varicosities
- Constipation
- Hemorrhoids
- Heartburn/ indigestion
- Braxton hicks or prelabour contractions
17
Q
Discomforts of Pregnancy: Urinary Frequency or Incontinence
A
- Try kegel exercises to increse control over leakage
- Empty bladder when you first feel a fill sensation
- Avoid caffeinated drinks, which stimulate voiding
- Reduce your fluid intake after dinner to reduce nightime urination
18
Q
Discomforts of Pregnancy: Fatigue
A
- Attempt to get a full nights sleep, without interruptions
- Eat a healthy balanced diet
- Schedule a nap in the early afternoon daily
- When you are feeling tired, rest
19
Q
Discomforts of Pregnancy: Nausea and Vomiting
A
- Eat whenever and whatever you like. Avoid an empty stomach
- Munch on dry crackers/ toast in bed before arising
- Eat several small meals throughout the day
- Drink fluids between meals rather than with meals
- Avoid greasy, fried food or ones with a strong odour
- Try ginger supplements or acupressure (sea Bands)
- If symptoms persists, discuss taking a doxylamine/ pyridoxine supplement (Diclectin)
20
Q
Discomforts of Pregnancy: Backache
A
- Avoid standing or sitting in one position for long periods
- Apply a heating pad (low setting) to the samll of your back
- Support your lower back with pillows when sitting
- Stand with shoulders back to maintain correct posture
21
Q
Discomforts of Pregnancy: Leg Cramps
A
- Elevate legs above heart level frequently throughout the day
- If you get a cramp, straighten both legs and flex your feet toward your body
- Ask your healthcare provider about taking clacium supplements, which may reduce leg spasms
22
Q
Discomforts of Pregnancy: Varicosities
A
- Walk daily to improve circulation to extremities
- Elevate both legs at heart level while resting
- Avoid standing in one position for long period of time
- Don’t wear constrictive stockings and socks
- Don’t cross the legs when sitting for long periods
- Wear support stockings to promote better circulation
23
Q
Discomforts of Pregnancy: Constipation
A
- Increase your intake of foods high in fiber and drink at least 8-ounce glasses of fluid daily
- Exercise each day (brisk walking) to promote movement though the intestine
- Reduce the amount of cheese consumed
24
Q
Discomforts of Pregnancy: Hemorrhoids
A
- Establish a regular time for daily bowel elimination
- Prevent straining by drinking plenty of fluids and eating fiber-rich foods and exercising daily
- Use warm sitz bath and cool witch hazel compresses for comfort
25
Discomforts of Pregnancy: **Hearburn/ Indigestion**
* Avoid spicy or greasy foods and eat small, frequent meals
* Sleep in several pillows so that your head is elevated
* Stop smoking and avoid caffeinated drinks to reduce stimulation
* Avoid laying down for at least 2 hours after meals
* Try drinking sips of water to reduce the burning sensation
* Take antacids sparingly if the burning sensation is severe (tums are a good choice)
26
Discomforts of Pregnancy: **Braxton Hicks or Prelabour Contractions**
* Before 37 weeks it is important to identify preterm labour and seek early treatment
* Try changing your position or engaging in mild exercise to help reduce the sensation
* Drink more fluids is possible
27
What are sings of concern during pregnancy?
* Bleeding
* Decreased FM
* Sudden gush of fluid
* Severe cramps
* Urinary tract infection
* Severe headache
* Dizziness
* Edema
28
29
Screening in Pregnancy: **Mother**
* Blood group and Rh type, hemoglobin
* If mom is negative and baby is positive, there is mixing of blood, moms body will start making antibodies putting the fetus at risk
* Infectious disease
* STI, HIV, Hepatitis B and C, Rubella
* Gestational diabetes
* Glucose tolerance test
* 24 to 28 week
* Perinatal serum screening
* 15 to 20 week
* Group B streptococcus
* 35 to 37 weeks
* Asymptomatic Bacteruria
30
Screening in Pregnancy: **Fetus**
* Fetal movment
* 6 times every 2 hours
* Fetal heart rate
* Ultrasound
31
Screening in Pregnancy: **Non-Routine Tests in High Risk**
* Biophysical profile
* Amniocentisis
* Chorionic villus testing
* Doppler
32
Prenatal Serum Screening (Formerly MSS)
* Blood test offered to women to determin the risk of carrying an infant with Down Syndrome (Trisomy 21), Edward Syndrome (Trisomy 18), or ONTD (Open Neural Tube Defect)
* Does not diagnose just determines the risk
* **1st trimester serum screen**
* ****Between 11 to 14 weeks
Determines risk fo Trisomy only
* **2nd trimester serum screen**
* Between 15 to 20 weeks
* Quade screen (AFP, E2, Inhibin, and BhCG)
* Counselling should include considerations of further testing:
* Amiocentesis
* Detalied ultrasound-exclude anomalies
* Nuchal translucency
33
Nuchal Scan for Translucency
* Nuchal translucency is a collection of fluid under the skin at the back of a fetus' neck
* Ultrasound examination offered between 11 to 14 weeks gestation
* From the measured thickness of the nuchal translucenccy combined with maternal age, the risk of chromosomal abnormality can be calculated
34
Aminocentesis
* In the **2nd trimester** for **GENETICS**
* ****Generally done around 15 to 16 weeks and takes 2 to 3 weeks for results
* Decisions about bregnancy around 18 weeks
* Down syndrome (trisomy 21) and other fetal anomalies in women \>35 or high risk women
* Triple test: (1) Neural tube defects (AFP-alpha-fetoprotein), (2) human chorionic gonadotrophin (hCG), (3) unconjugated estriol (UE3)
* In the **3rd trimester** for **FETAL MATURITY**
* L/S ratio (Lecithin/ Sphingomyelin) 2:1 = \>35 weeks
* 2 components of surfactant which line alveoli of lungs and reduces surface tensionw hen the infant exhales
* Phosphatidylglycerol (PG)
* Appears around 35 weeks
35
Non-Invasive Prenatal Testing (NIPT) or Cell Free DNA Testing (efDNA)
* NIPT works by taking a sample of a pregnant woman's blood and isolating freely circulating placental DNA which is nalyzed for abnormalities of specific chromosomes (13, 18, 21, X, Y) associated with conditions like Down Syndrome and Turner Syndrome
* NIPT carries no risk of miscarriage, because there is no need to pierce the aminotic sac. NIPT can be performed from 9 to 10 weeks in pregnancy, versus 16 weeks for aminocentesis
36
Group B Streptococcus (GBS)
* Screenign done in 3rd trimester
* Group B strep (GBS) are common bateria which are often found in the vagina, rectum, or urinary bladder in 15 to 40% of women
* Screening by vaginal/ rectal cluture 35 to 37 weeks
* Treated with antibiotics in labour
* At least 1 dose of antibiotics 4 hours before delivery
* 2 Approaches
* Screen and treat all women who are GBS +
* Treat based on risk factors
37
Risk Factors for Group B Streptococcus (GBS)
* Preterm labour before 37 weeks gestation (with or without ruptured membranes)
* Term rupture of membranes \>18 hours
* Unexplained, mild fever during labour
* Previous baby with a GBS labour
* Previous baby with a GBS infection
* Previous or present GBS bacteruria caused by the GBS bacteria
38
Fetal Fibronectin fFN
* Only doen between 24 and 34 weeks
* Risk for pre-term delivery, absence is a better prodictor
* Glycoprotein released in response to inflamamtion or separation of amniotic mambranes
* Normally found in cervico vaginal secretion until 22 weeks gestation and agian near the time of labour
* Negative = lack of fFN = pregnancy is likely to continue for at least another two weeks
* Positive fFN = present 24 through 34 weeks gestation indicates increased risk of preterm delivery
39
When should an ultrasound be done?
* Experts in Canada **recommend that all women** have an ultrasound when they are pregnant
* The best time to do this is between 18 and 22 weeks of pregnancy
40
Why is it important to get an ultrasound?
* Confirms pregnancy and EDC dates
* Number of fetuses
* Size for gestational age
* How the baby's internal rogans are growing
* Placental position and size
* Woman's uterus, fallopian tubes, ovaries
* Check for sings of a possible genetic problem- detailed ultrasound (if problems with fetus, will recommend another ultrasound in the 3rd trimester)
41
When else might an ultrasound be beneficial?
* Previous history of early feta losses
* Bleeding or other complications
* Measure fetal growth and identify Intrauterin Growth Restriction (IUGR)
* Measure amniotic fluid
* Biophysical Profile (BPP) to determine fetal wellbeing
* Confirm position of fetus
42
What is a simple, easy way to assess fetal well being?
* Fetal movement
* Reduction in fetal movment = potential for distress/ fetus
* Want 6 movments in 2 hours at least
43
How many fetal movements is required during pregnancy?
Want **6 movments in 2 hours at least**
44
What should the nurse recommend the patient to do it they have not felt fetal movment in 2 hours?
* Cintact primary care provider
* Go to the hospital
45
Prenatal Classes
* Varying length, times
* Different groups
* Single, high-risk, adolescent, culture and languages, methods
* Tour of hospital
* Preparation for birth
* Education
* Breathing, relaxation, and pain control
* Operative deliveries
* Postpartum adjustment
* Infant care
* Breastfeeding classes
