Transcript Prenatal Care, Assessment and Screening

Prenatal Care,
Assessment and Screening
Maternal Newborn Orientation Learning Module
July 2012
Objectives
On completion of this module, learners will:
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Describe the basic elements of antenatal assessment
and screening as identified in the Nova Scotia Prenatal
Record 1 & 2
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Explain the relevance of this information to nursing
care of the antepartum woman and family

Identify key resources for care providers working with
the perinatal population
Introduction
To get the most out of this module, please
refer to the following documents:
– The Nova Scotia Prenatal Record (1, 2 & 3)
– Guidelines for Antenatal Screening & Testing (card)
These may be available on your unit or can be
downloaded from:
http://rcp.nshealth.ca/chart-prenatal-forms/nova-scotia-prenatal-record
http://rcp.nshealth.ca/clinical-practice-guidelines/antenatal-laboratory-screening-testing
Nova Scotia Prenatal Record 1
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Demographics
Pregnancy Dating
Obstetrical History
Problems/Comments/Referrals
– Present Pregnancy
– Past Illnesses
Demographics
Race/Ethnicity:
• Genetic Screening
• Culturally Competent Care
http://www.gov.ns.ca/health/primaryhealthcare/diversity.asp
Nova Scotia Prenatal Record 1
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Demographics
Pregnancy Dating
Obstetrical History
Problems/Comments/Referrals
– Present Pregnancy
– Past Illnesses
How do I
do this?
Why is this
so
important?
Pregnancy Dating
Dating:
• LMP (last menstrual period)
– Certainty of dates, regular cycle
– Naegle’s rule: June 8th, 2011 + 7 days = June 15th, - 3 months =
March 15th 2012 EDB
• Ultrasound (SOGC)
– 1st trimester ultrasound between 11 and 14 weeks
– Use 1st trimester U/S If > 5 days difference between U/S and LMP
– Use 2nd trimester U/S if > 10 days difference between U/S and
LMP
– Gestational age should be determined by the earliest ultrasound
http://www.sogc.org/guidelines/documents/gui214CPG0809.pdf
Nova Scotia Prenatal Record 1
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Demographics
Pregnancy Dating
Obstetrical History
Problems/Comments/Referrals
– Present Pregnancy
– Past Illnesses
Obstetrical History
• Pain preferences
• Confidence or fear
• Education, support, individualized care
Nova Scotia Prenatal Record 1
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Demographics
Pregnancy Dating
Obstetrical History
Problems/Comments/Referrals
– Present Pregnancy
– Past Illnesses
Present Pregnancy
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Depression/Anxiety
Bleeding – Rh
Smoking
Alcohol & substance use
Present Pregnancy
• Depression – Stage 1 & 2
http://www.phac-aspc.gc.ca/mh-sm/preg_dep-eng.php
• Bleeding – Rh
• Smoking
• Alcohol and substance use
Depression: Stage 1
• Asking
• Educating
• History of depression
• Substance use
Depression: Stage 2
• Screening for all women
using EPDS
http://www.fresno.ucsf.edu/pediatrics/downloads/
edinburghscale.pdf
• Education, emotional and
practical support
• Diagnostic assessment and
treatment
• Immediate intervention
Present Pregnancy
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Depression/Anxiety
Bleeding – Rh
Smoking
Alcohol & substance use
Bleeding
First Trimester
• Implantation
• Infection
• Miscarriage
Bleeding
Second Trimester
• Placental abruption
• Placenta previa
Rh Program of NS: http://rcp.nshealth.ca/rh
– Telehealth: http://videtis.ucis.dal.ca/MedIT/RHTeleH2010-05-10.wmv
Present Pregnancy
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Depression/Anxiety
Bleeding – Rh
Smoking
Alcohol & substance use
Smoking
• Motherisk:
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http://www.motherisk.org/prof/updatesDetail.jsp?content_id=975
• Public Health Agency of Canada:
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http://www.phac-aspc.gc.ca/hp-gs/guide/05_sp-tg-eng.php
Present Pregnancy
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Depression/Anxiety
Bleeding – Rh
Smoking
Alcohol & substance use
Substance Use
PRIMA (PregnancyRelated Issues in the
Management of Addictions)
www.addictionpregnancy.ca
Provincial Alcohol
Strategy - FASD
http://www.motherisk.org/women/alcohol.jsp
SOGC Guideline
http://sogc.org/guidelines/alcohol-use-andpregnancy-consensus-clinical-guidelines
TPTL –
Threatened Preterm Labour
Predicting Preterm Labour
• fFN
• Cervical length
• Digital examination
Audibert et al., JOGC April 2010
Nova Scotia Prenatal Record 1
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Demographics
Pregnancy Dating
Obstetrical History
Problems/Comments/Referrals
– Present Pregnancy
– Past Illnesses
Past Illnesses
• Acute and Chronic Illnesses
– Physiological and emotional components
• Experiences of hospitalizations
– Pain
– Fear
– Health care providers
Nova Scotia Prenatal Record 2
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Physical Assessment – BMI
Psychosocial/Environmental Factors
Prenatal Genetic Screening
Education/Discussion
Physical Assessment:
Body Mass Index
Maternal Pre-pregnancy BMI
NSAPD 2010
Maternal BMI and Weight Gain
• BMI<20:
28 to 40 lbs
• BMI 20-27:
25-35 lbs
• BMI 27-29:
15-25 lbs
• BMI > 29:
15 lbs
• Health Canada
– Gestational Weight Gain Recommendations:
http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/ewba-mbsa-eng.php
Nova Scotia Prenatal Record 2
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Physical Assessment – BMI
Psychosocial/Environmental Factors
Prenatal Genetic Screening
Education/Discussion
Abuse in Pregnancy
• Prevalence
• Assessing
• Intervention
• Resources:
http://www.cdc.gov/reproductivehealth/violence/IntimatePartnerViolence
http://sogc.org/guidelines/intimate-partner-violence-consensus-statement
Nova Scotia Prenatal Record 2
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Physical Assessment – BMI
Psychosocial/Environmental Factors
Prenatal Genetic Screening
Education/Discussion
Genetic Screening
Guidelines for Antenatal Laboratory
Screening and Testing - RCP July 2007
First Prenatal Visit
Guidelines for Genetic Screening
and Testing
• Screening:
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Maternal Serum Testing (MST)
Integrated Maternal Serum Testing (IMST)
Early Pregnancy Review (EPR)
Diagnostic Ultrasound
• Diagnostic Tests
• CVS and amniocentesis
• Ethical considerations
• RCP:
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http://rcp.nshealth.ca/clinical-practice-guidelines/antenatal-laboratory-screening-testing
Nova Scotia Prenatal Record 2
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Physical Assessment – BMI
Psychosocial/Environmental Factors
Prenatal Genetic Screening
Education/Discussion
Education/Discussion
• Prenatal education
– Physical and emotional well-being
• Breastfeeding
• Plans for Labour and Birth
• Newborn screening
• Cord blood banking
• RCP Prenatal Record Companion Document
http://rcp.nshealth.ca/publications/nova-scotia-prenatal-record-companion-document
Prenatal Record:
Relevance to Nursing care
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Individualized nursing care
Education and support
Referrals
Resources
Questions and Comments?
• We welcome your feedback. Please click on this
link to complete a short evaluation form:
http://rcp.nshealth.ca/education/learning-modules/evaluation
• Please contact one of the Perinatal Nurse
Consultants with RCP at:
[email protected]
THANK YOU!