26 - week appointment Flashcards
what are the information sharing topics for a 26 week appointment?
- signs of premature labour and when to call the midwife
- signs of baby’s wellbeing - expectations re movements
- normal physiological changes
- discuss emotional and social situation - feelings re pregnancy, financials, employment, work en date, PPL, support needs.
what are the signs of preterm labour? and what is the rationale for sharing this with the woman?
- contractions - frequent strong painful contractions
- ruptured membranes - leaking or a gush of fluid from the vagina
- low back ache / menstrual like cramps
bleeding
Recognizing the signs of preterm labor is important because it allows for early medical intervention, which can help improve outcomes for both the mother and the baby.
when to call the midwife?
- reduced fetal movements - as this can be an indication that the fetus is unwell
- preterm labour - to initiate intervention and improve outcomes for mother and baby.
- preterm SROM - as antibiotics may be required to prevent infection to the fetus
- visual disturbances, swelling in the face/hands/feet, severe headache that doesn’t go away with panadol - signs of pre-eclampsia
what is the rationale for sharing with the woman the normal physiological changes in pregnancy?
- reduces maternal anxiety about body changes
- empowers women to take responsibility for their ow health and wellbeing
- helps them recognise the normal and the abnormal
- enhances prenatal bonding
what assessment and screening is done at this appointment?
- assess woman’s wellbeing re physiological changes
- urinalysis (glucose and protein) / blood pressure
- routine blood screen (CBC, blood group, rhesus antibodies)
- gestational diabetes (polycose or GTT)
- serum ferritin if at increased risk of IDA
- domestic violence (if appropriate)
- baby’s wellbeing - size (fundal height), growth, movements, heart rate)
why is protein and glucose screened for in the urine?
protein - >_ 1+ indicates abnormal proteinuria in pregnancy showing a decrease in kidney function and indication of pre-eclampsia if paired with high blood pressure and any pre-eclamptic symptoms.
glucose - glucose present in a urinalysis shows excess glucose in the urine and is indicative of increased risk of having gestational diabetes mellitus.
why is blood pressure measured in pregnancy
hypotension - while a decrease in blood pressure during pregnancy is normal due to lower peripheral resistance and vasodilation from progesterone, it is important to ensure that blood pressure remains within a safe range (100-139mmHg / 40-89mmHg - as per MEWS chart).
hypertension - high blood pressure is a key indication for gestation hypertension and pre-eclampsia - both conditions that can negatively affect mother and baby. Early detection is crucial for timely interventions to improve the the outcomes.
Why is a blood screen routinely carried out at 26-28 weeks?
haemoglobin is generally at it’s lowest point in the second trimester before a slight increase in the third trimester. At this screen, the normal Hb level is 105g/L or more and if lower the woman is anaemic and would require dietary supplementation and potentially an iron infusion.
white blood cells are an indication of infection markers
platelets play an important role in haemostasis - low levels of platelet place a woman at risk of bleeding, therefore if platelets are low at this stage, it would be important to continue monitoring this and discuss methods of reducing blood loss at birth.
is serum ferritin routinely checked at this stage?
According to NZ guidelines, serum ferritin is not required to be offered for routine screening, however, midwives may screen blood for SF if a woman is at risk of IDA such as vegetarians, history of anaemia or PPH, low socioeconomic status, poor diet and nutrition.
Additionally, due to haemoglobin reaching its low in the second trimester, this places a woman at risk of having lower iron at this stage too.
what is the rationale for domestic violence screening?
- as midwives we are well placed to screen for domestic violence as we see women on a regular basis and develop a trusting relationship with them and have contacts and connections with community agencies that can help them. (womens refuge, police, oranga tamariki).
- pregnancy is identified as a common time for domestic violence to commence.
- identifying DV and referring women for help can help to improve the safety, health and wellbeing of the woman as well as the unborn baby.
Why is abdominal palpation routinely carried out during antenatal appointments?
to ascertain the fetal position in order to locate the fetal heart and auscultate.
FHR auscultation is a way to be reassured about the fetal wellbeing at that moment in time. It can be measured with a pinnard or doppler or fetoscope.
fundal height - measures the uterus to assess 1. the growth of baby is tracking as it should be according to the customised growth chart an 2. the liquor volume.
Palpation of the uterus can often assess a normal or abnormal liquor volume.
Thus, if a woman was measuring above the 90th centile on her grow chart and the palpation indicated excess liquor - a referral could be made for a scan to measure AFV.
A small for gestational age or restricted growth in the uterus could indicate baby is not growing adequately due to insufficient nutrients or blood flow to the fetus.
what are the active decision making points at this appointment?
- routinely offer TDAP, and influenza vaccines - recommended in pregnancy to provide additional protection to the mum and passed through placenta to provide protection to the fetus and the new born baby against influenza and whooping cough.
- continue developing care plan - antenatal education to be commencing soon or alternative education.
- preparations for care of baby: carseat, cot / bassinet, clothing, support. - to ensure woman is thinking about these aspects and ascertain how she may be feeling emotionally about the coming change in her life.
health promotion and education at this appointment?
- postnatal sleeping arrangements - planning to bed share? safe sleep practices? (smoke free, breastfed, own space, face up and clear, natural fibres)
- safe sleep in pregnancy - from 26- 28 weeks, sleep on side to avoid uterine compression on inferior vena cava. (reduces venous return, reducing cardiac output and reducing oxygen to baby causing fetal hypoxia).
