prenatal-care of maternal and child nursing

Maternal and Child Nursing

1. PRENATAL CARE

2. PRENATAL CARE
•Pre-conceptionalcare
•Prompt diagnosis of pregnancy
•Initial Prenatal Evaluation
•Subsequent Visits

3. DIAGNOSIS ofPREGNANCY
Presumptive. Probable. Positive Signs.

4. PRESUMPTIVE SIGNS
•Amenorrhea
•Nausea and vomiting
–Up to 1
st
trimester
•Breast changes
–Enlargement and tenderness
•Chadwick’s sign
•Quickening
–20 weeks AOG

5. PROBABLE SIGNS
•Positive pregnancy test
•Changes in uterine size and shape
•Palpation of the fetus
•Palpation of fetal movement
•Piscacek’ssign
•Hegar’ssign
•Goodell’ssign

6. POSITIVE SIGNS
•Detection of fetal heart tones
–Ultrasound: 5-6 weeks AOG
–Doppler: 10 weeks AOG
–Stethoscope: 17-19 weeks AOG
•Imaging of the fetus
–Ultrasound
–Radiograph
•Birth

7. INITIAL PRENATAL EVALUATION
Medical History. Physical Examination. Laboratory Tests. Patient Education.

8. MEDICAL HISTORY
•Past Medical Illness
•Diseases in the Family
•Psychosocial background
–Vices (smoking, alcohol, illicit drug use)
–Lifestyle (nutrition, exercise)
•Obstetric and gynecologic history
–Menstrual cycle
–Gynecologic conditions
–Previous pregnancies
–Obstetric score GP (F-P-A-L)
•GravidaPara (Full-term, Pre-term, Abortion, Live)

9. PHYSICAL EXAMINATION
•General physical examination
•Obstetric and gynecologic examination
Speculum exam. Digital pelvic exam.

10. ASSESSMENT ofGESTATIONAL AGE
•Using patient’s last
menstrual period
(LMP)
•Fundal height
–18-30 weeks AOG
–Pubis symphisisto
uterine fundus
•Ultrasound
Determination of fundal height.

11. ROUTINE LABORATORY TESTS
•Complete blood count (CBC)
–Hematocrit and hemoglobin
•Urinalysis and urine culture
–Protein and sugar levels
•Blood typing (ABO and Rh)
•Rubella status
•Syphilis screen
•Pap smear
•HbsAgtesting
•Antibody screen (at 28 weeks AOG)

12. PATIENT EDUCATION
•Medical/surgical
complications
•Cessation of vices
–Smoking, drinking, drug use
•Danger signs of pregnancy
Vaginal bleeding Pain/burningsensation on urination
Pelvicand/or abdominal painSudden onset of blurry vision
Edema (hands and face) Severe headaches
Persistent nausea and vomitingRegular contractions (<37 weeks AOG)
Chillsand/or fever Decreased fetal movement

13. PATIENT EDUCATION
•Nutrition
Nutrient Non-pregnant Pregnant
Kilocalories 2200 2500
Protein 55 60
Fat soluble vitamins
A (ugRE)
D (ug)
E (mg TE)
K (ug)
800
10
8
55
800
10
10
65
Water solublevitamins
C (mg)
Folate (ug)
Niacin (mg)
60
180
15
70
400
17

14. PATIENT EDUCATION
•Nutrition
Nutrient Non-pregnant Pregnant
Water soluble vitamins
Riboflavin (mg)
Thiamine (mg)
Pyridoxine (mg)
Cobalamin (ug)
1.3
1.1
1.6
2.0
1.6
1.5
2.2
2.2
Minerals
Calcium (mg)
Phosporus (mg)
Iodine (ug)
Iron (ferrous) (mg)
Magnesium (mg)
Zinc (mg)
1200
1200
150
15
280
12
1200
1200
175
30
320
15

15. PATIENT EDUCATION
•Nutrition
Pre-pregnancyBMI
(kg/m
2
)
Recommended total gain
Pounds Kilograms
Low (BMI < 19.8) 28-40 12.5-18
Normal (BMI 19.8-26) 25-35 11.5-16
High (BMI > 26-29) 15-25 7-11.5
Obese (BMI > 29) <15 <7

16. PATIENT EDUCATION
•Other Common Maternal Concerns
–Exercise
–Employment
–Travel
–Bowel Habits
–Sex
–Nausea and Vomiting
–Immunization
–Varicosities
–Heartburn
–Medicinal Drug Intake

17. PATIENT EDUCATION
•Schedule of subsequent visits
–Depends on whether pregnancy is low-risk or
high-risk
Factorsfor High-Risk Pregnancy
Extremesof reproductive age (<17 y.o. and >35 y.o.)
With medical complications
Poor obstetricand gynecologic history
With fetalproblems (aging, structure, size)
Polyhydramnios or oligohydramnios

18. PATIENT EDUCATION
•Schedule of subsequent visits
NormalPregnancy High-risk Pregnancy
Until 28 weeks AOG:
Every 4 weeks
Until36 weeks AOG:
Every 2 weeks
Until delivery:
Weekly
Until 32 weeks AOG:
Every 2 weeks
Until delivery:
Every week

19. SUBSEQUENT VISITS
Medical History. Physical Examination. Laboratory Tests. Patient Education.

20. MEDICAL HISTORY
•Danger signs of
pregnancy
•Nutritional intake
•Vitamin
supplementation

21. PHYSICAL EXAMINATION
•Maternal Health
–Blood pressure
–Weight increase
–Pelvic examination

22. PHYSICAL EXAMINATION
•Fetal Health
–Leopold’s maneuvers
•Presentation
•Lie
•Engagement
–Fetal heart rate and
rhythm
–Estimated fetal size and
weight
–Fundic height
–Fetal movement

23. SPECIAL LABORATORY TESTS
•Recommended for repeat (28-32 weeks AOG)
–Hematocrit (or hemoglobin) determination
–Syphilis serology
•Optional tests that should be offered
–Screening tests for genetic diseases
–HIV screening
•Required later in pregnancy
–Oral glucose tolerance test (OGTT) (24-28 weeks AOG)
–Rectovaginal culture of Group B Streptococcus(35-37
weeks AOG)

24. SPECIAL DIAGNOSTICS
•Electronic fetal surveillance
–Non-stress test (NST)
–Contraction stress test (CST)
•Ultrasound examination
–Fetal biometry
•Crown-rump length, femur length
•Biparietal diameter, head circumference
–Congenital anomaly scan
–Biophysical profile (BPP)
•5 variables: fetal tone, movement, breathing, amniotic
fluid levels and NST

25. SUMMARY
•Prenatal care encompasses maternal and fetal
health from pre-conception to delivery.
•History, physical examination, diagnostics and
patient education form the tetrad of every
prenatal care visit.

26. THANK YOU!
Prenatal Care.