ANTE--PARTUM. Lecture 2. Prenatal Nursing Care Flashcards
Part 1:Prenatal Care?
Prenatal care involves medical supervision and support for pregnant individuals to ensure the health and well-being of both the parent and the developing fetus. Here’s some more information on the topics you’ve mentioned:
First Visit by 12 Weeks (1st Trimester):
It’s recommended for pregnant individuals to have their first prenatal care visit within the first 12 weeks of pregnancy, which is considered the first trimester. This early visit allows healthcare providers to establish a baseline for the pregnancy, conduct initial assessments, and provide essential guidance for a healthy pregnancy.
Pre-existing Conditions and Preconception Care:
Individuals with pre-existing medical conditions, such as diabetes, hypertension, or other chronic illnesses, are encouraged to seek preconception care before becoming pregnant. Preconception care involves working with healthcare professionals to manage and optimize existing health conditions before conception, which can contribute to a healthier pregnancy.
Healthy People 2030:
“Healthy People 2030” is a set of national health objectives established by the U.S. Department of Health and Human Services. One of the goals outlined in this initiative is to increase the proportion of pregnant women who receive early and adequate prenatal care. This goal reflects the importance of early intervention and comprehensive care to improve maternal and fetal health outcomes.
Adequate prenatal care involves regular check-ups, screenings, tests, and guidance from healthcare providers. It’s essential for monitoring the health of both the pregnant individual and the developing baby, identifying and addressing any potential complications or risks, and providing education on healthy behaviors during pregnancy.
What is Prenatal Care?
Prenatal care (PNC) refers to the medical care and support provided to pregnant individuals throughout the course of their pregnancy. The primary goal of prenatal care is to monitor and promote the health of both the pregnant person and the developing fetus, while also identifying and addressing any potential complications or risks that may arise during pregnancy.
The key components of prenatal care include:
Routine Assessments and Screenings: During prenatal care visits, healthcare providers perform various assessments and screenings to monitor the health of the pregnant person and the fetus. This can include measuring blood pressure, checking weight gain, monitoring fetal growth, and conducting blood tests to check for conditions like gestational diabetes or anemia.
Individualized Counseling: Healthcare providers offer individualized counseling based on the pregnant person’s medical history, risk factors, and any specific conditions that may be present. This can involve discussing prenatal testing options, addressing concerns, and providing guidance on maintaining a healthy lifestyle during pregnancy.
Patient Education: Education is a crucial component of prenatal care. Pregnant individuals are provided with information about nutrition, exercise, managing discomfort, recognizing warning signs of complications, and preparing for labor and childbirth. This empowers them to make informed decisions and take an active role in their own prenatal health.
Diagnoses and Prenatal Testing: Prenatal care involves diagnosing and managing any medical conditions that the pregnant person may have, as well as monitoring the health of the fetus. This can involve ultrasounds, genetic testing, and other specialized tests to assess fetal development and detect any potential issues.
Reducing Risks: One of the main purposes of prenatal care is to identify and mitigate potential risks to both the pregnant person and the fetus. Regular check-ups and screenings help healthcare providers catch any complications early on and take appropriate actions to reduce the risks.
Individual vs. Group Setting: Prenatal care can be provided in individual or group settings, depending on the healthcare facility and the preferences of the pregnant individuals. Group prenatal care involves bringing together a small group of pregnant individuals with similar due dates for shared educational sessions, discussions, and support.
Accessing Prenatal Care
Financial Limitations: The cost of prenatal care, including doctor visits, tests, ultrasounds, and medications, can be a significant barrier for many individuals. Those without health insurance coverage or with high deductibles may struggle to afford these expenses.
Lack of Adequate Healthcare Resources: In certain areas, especially rural or underserved communities, there might be a shortage of healthcare facilities, clinics, and qualified healthcare providers who offer prenatal care services. Limited availability of healthcare resources can make it difficult for pregnant individuals to access the care they need.
Geographic Barriers: People living in remote or geographically isolated areas may face challenges in reaching healthcare facilities. Long distances, lack of transportation options, and difficult terrain can make it physically challenging to attend regular prenatal care appointments.
Personal/Social Barriers: Various personal and social factors can impact access to prenatal care. These include language barriers, cultural beliefs, stigma around seeking medical care, and fear of discrimination. For example, immigrants or individuals from marginalized communities may face language barriers that prevent them from fully understanding their care options.
Perception of Lack of Services/Coverage: Some individuals might not be aware of the available prenatal care services or believe that the services offered do not meet their needs. This perception can discourage them from seeking care, even if resources are available.
Inadequate Childcare: Pregnant individuals who have other children may face challenges in finding suitable childcare options while they attend prenatal appointments. This can be a practical barrier that prevents them from accessing care.
Perinatal Care Providers:
A) Physicians: MDs or DOs
-Provide care to low & high risk clients
-Can perform surgical birth (c/s)
-Usually attend deliveries in hospital settings
B) Midwives: Certified Nurse-Midwives (CNMs), Certified Midwives or Traditional Midwives
- Provide care to low risk clients
- May attend deliveries in hospital settings or outside of hospital settings
MEDICAL MODELofPRENATAL CARE
- Medical Model of Prenatal Care:
Initial Visit (Meet 1:1 with provider in an office setting): The prenatal care begins with an initial visit where the pregnant woman meets with their healthcare provider in an office or clinic setting. During this visit, medical history, current health status, and any pre-existing conditions are discussed. The healthcare provider gathers information to establish a baseline for the pregnancy and to identify any potential risks.
Setting Schedule of Visits: After the initial visit, a schedule of prenatal care visits is set. These visits are spaced out over the course of the pregnancy to monitor the health and development of both the pregnant individual and the fetus. The schedule typically involves more frequent visits in the later stages of pregnancy.
Physician or CNM: Prenatal care can be provided by different healthcare professionals, including physicians (Obstetricians) and Certified Nurse Midwives (CNMs). Both are trained to provide prenatal care, monitor the pregnancy, and manage any complications that may arise. The choice between a physician and a CNM depends on the pregnant person’s preferences, medical history, and the level of medical intervention required.
CENTERING PREGNANCY PRENATAL CARE
Evidence-based model:
Group visits w/ pregnant people w/ similar EDD
Improves health outcomes/reduces disparities
Greatest impact for Black childbearing people
Often CNM led
Here are some key features and benefits of the Centering Pregnancy model:
Group Visits: Centering Pregnancy replaces the traditional one-on-one prenatal care visits with group sessions. These sessions usually consist of about 8 to 12 individuals who are at similar stages of pregnancy. The group dynamic provides a supportive and interactive environment for sharing experiences, concerns, and information.
Structured Sessions: Each Centering Pregnancy session follows a structured format, covering various topics related to pregnancy, childbirth, and postpartum care. Sessions are facilitated by healthcare providers and may include discussions, educational activities, and hands-on learning.
Health Assessments: During group sessions, participants receive individual health assessments (e.g., blood pressure checks, weight measurements) as well as group activities that provide valuable information about their pregnancy progress.
Reduced Disparities: Centering Pregnancy has shown promise in reducing healthcare disparities, especially among Black childbearing individuals. These disparities are addressed through increased access to care, improved communication, and the group’s supportive environment.
Empowerment and Engagement: The group setting fosters empowerment and engagement among participants. Pregnant individuals have the opportunity to actively participate in their care, ask questions, and learn from both healthcare providers and their peers.
Extended Time: Unlike traditional prenatal visits, which are often brief, CenteringPregnancy sessions last longer (about 90 to 120 minutes) and provide ample time for education, discussions, and relationship-building.
Care Continuity: Participants get to know their healthcare providers and fellow group members more closely over the course of their pregnancy. This continuity of care can lead to stronger patient-provider relationships and improved overall care experience.
CNM (Certified Nurse-Midwife) Leadership: CenteringPregnancy groups are often led by certified nurse-midwives (CNMs), who have expertise in providing comprehensive prenatal care and promoting natural childbirth options. The leadership of CNMs aligns well with the model’s focus on holistic and patient-centered care.
Prenatal Visit Schedule
- First visit within the first trimester (12 weeks)
- Monthly visits weeks 16 through 28
- Every 2 weeks from weeks 29 to 36
- Weekly or bi-weekly visits week 36 to birth
First Prenatal Visit
Confirm pregnancy: Blood or urine pregnancy test
Determine Estimated Due Date The Estimated Due Date (EDD), also referred to as Estimated Date of Confinement (EDC, The Latin word “confinare” means “to limit” or “to bound.) or Estimated Date of Birth (EDB), is the approximate date on which a pregnant person is expected to give birth.
Screening exams: blood tests, weight/BMI, urine dip, STI tests, full physical assessment/pelvic exam
Health Baseline: Baseline VS, reproductive history, medications, substance use, nutritional status, comorbidities (including age) (Ricci p. 370, Fig12.2, Health History Summary)
Comprehensive history taking: Family structure, psychosocial risk factors (Ricci p. 366, Fig. 12.1: Preconception screening tool)
Pregnancy Dating
Nagele’s Rule:
- Nagele’s Rule is a basic method used to estimate a pregnant person’s due date based on their last menstrual period (LMP). It assumes a regular 28-day menstrual cycle and is a simple way to provide an approximate due date. However, it might not be accurate for everyone, especially those with irregular menstrual cycles.
Here’s how Nagele’s Rule works:
Start with the first day of your last menstrual period (LMP).
Add 7 days to that date.
Subtract 3 months from that result.
The estimated due date you get from this calculation is just an approximation and is often referred to as the “EDD” or estimated date of delivery. It’s important to note that the actual length of pregnancy can vary, and many healthcare providers use other methods and measurements, such as ultrasound, to more accurately determine the due date.
DIAGNOSIS OF PREGNANCY
POSITIVE SIGNS: Fetal Assessment
Ultrasound: Ultrasound imaging uses sound waves to create a visual representation of the fetus in the uterus. This is one of the most common and reliable methods for confirming pregnancy and assessing the development of the fetus. Ultrasound can provide information about the gestational age, growth (Ex 1cm arm means the fetus is 2 months old ), and overall health of the fetus.
Doppler: A Doppler ultrasound is a specific type of ultrasound that focuses on detecting and amplifying the sound of the fetal heartbeat. It uses the Doppler effect to detect the movement of blood and convert it into audible sound. This allows healthcare providers to listen to the fetal heart tones, which is reassuring evidence of fetal well-being.
Manual Exam (Palpation): A healthcare provider may perform a manual examination by gently feeling (palpating) the abdomen of the pregnant woman. This can help determine the position of the fetus, its size, and its overall presentation. However, this method is not as accurate as ultrasound for assessing fetal well-being.
Non-stress Test (NST): A non-stress test is a prenatal test that monitors the fetal heart rate in response to the baby’s movements. It’s a way to assess the well-being of the fetus by observing how the heart rate changes when the baby moves. The test involves attaching monitors to the pregnant person’s abdomen to record the fetal heart rate and uterine contractions. Heart rate goes up when the baby moves which is a normal response
Ultrasound
Standard procedure for determining gestational age
Considered low risk
High-frequency sound waves create image
Sonogram: “ a sonogram is a picture of a body structure taken using ultrasound.”
Fetal Assessment-Doppler
Fetal Heart Rate:
110-160 bpm
Why? Metabolic Rate:
Fetuses and babies have a higher metabolic rate compared to adults. They are rapidly growing and developing, which requires a greater demand for oxygen and nutrients. A higher heart rate helps ensure that an adequate supply of oxygen-rich blood is delivered to the developing tissues and organs.
Manual Pelvic Exam
Evaluate the size and contour of the uterus.
Speculum Exam
Speculum Exam: A speculum exam is a common gynecological procedure that involves using a speculum, which is a medical instrument, to examine the cervix and the vaginal walls. The speculum is gently inserted into the vagina to open it up, allowing the healthcare provider to visually inspect the cervix and collect samples for various tests, such as Pap smears and STI screenings.
Pap Test (Pap Smear): A Pap test, also known as a Pap smear, is a screening test used to detect abnormal cervical cells, including those that may lead to cervical cancer. During this test, a sample of cells is collected from the cervix using a swab or a brush. The collected cells are then examined under a microscope to identify any cellular changes or abnormalities. Regular Pap tests are essential for early detection and prevention of cervical cancer.
STI Screening: STI stands for sexually transmitted infection. STI screening involves testing for various infections that can be transmitted through sexual contact. Common STIs that are often screened for include chlamydia, gonorrhea, syphilis, HIV, and herpes. The screening process may involve collecting samples of blood, urine, or genital swabs, depending on the specific infection being tested for. Regular STI screenings are recommended for sexually active individuals to ensure early detection and appropriate treatment.
Screening Tests: Labs
CBC (Complete Blood Count): This test measures the various components of your blood, including red blood cells, white blood cells, and platelets. It helps to diagnose conditions like anemia, infections, and other blood-related disorders.
Blood Type: Determining blood type is crucial for blood transfusions and organ transplants. The four main blood types are A, B, AB, and O.
Serology Tests: These are blood tests that detect antibodies or antigens related to specific infections. The tests you mentioned are for rubella (German measles), rpr (syphilis), varicella (chickenpox), HIV (human immunodeficiency virus), and Hep B (hepatitis B).
A1C (Glycated Hemoglobin): This test is used to assess blood sugar control over the past 2-3 months, particularly for individuals with diabetes. An A1C level below 6.5% is generally considered within the normal range.
Renal Function Tests: These tests evaluate how well your kidneys are functioning. They typically include measurements of creatinine, blood urea nitrogen (BUN), and estimated glomerular filtration rate (eGFR).
Cervical Cultures for STIs: These cultures check for sexually transmitted infections (STIs) in the cervix. Common infections tested for include chlamydia and gonorrhea.
Pap Test (Pap Smear): This test involves collecting cells from the cervix to screen for cervical cancer and abnormalities that could lead to cancer. It’s an important part of women’s reproductive health.
Urine Test: A general urine test can provide information about kidney function, urinary tract infections, and other health conditions. It may also include a urinalysis to check for various markers in the urine.
Lab Tests: Urine
Dipstick Tests for Glucose, Protein, Signs of UTI: A dipstick is a quick and simple diagnostic tool that can provide preliminary information about certain components in urine. In the context of prenatal care, it’s common to use a dipstick to check for glucose (sugar) and protein in the urine. Elevated glucose levels might indicate gestational diabetes, while elevated protein levels could be a sign of potential kidney issues. Additionally, signs of urinary tract infections (UTIs) might be detected through the presence of abnormal levels of certain substances.
U/A (Urinalysis) and/or C&S (Culture and Sensitivity) Tests for UTI: If there are symptoms suggestive of a urinary tract infection (such as frequent urination, pain, or discomfort), a more detailed urinalysis might be performed. This involves examining urine under a microscope and can provide a more comprehensive assessment of factors like white blood cells, red blood cells, bacteria, and other components. If a urinary tract infection is suspected, a urine culture and sensitivity test might be performed to identify the specific bacteria causing the infection and determine which antibiotics are effective against it.
Holistic PNC Considerations
It looks like you’ve provided a list of considerations related to a holistic approach to perinatal care (PNC). These considerations encompass various aspects that can influence the health and well-being of individuals during the perinatal period, which includes the time during pregnancy and shortly after childbirth. Each of these factors plays a role in ensuring the best possible outcomes for both the parent and the newborn. I’ll briefly explain each consideration:
Health Status: The overall physical, psychological, and emotional health of the individual is crucial. This includes assessing any pre-existing medical conditions and addressing any concerns that may arise during pregnancy and postpartum.
Health Services: The availability, accessibility, acceptability, and affordability of health services are important factors. Adequate medical care should be within reach and culturally sensitive.
Socioeconomic Status: This refers to the person’s income, which should meet the needs for essentials like food, shelter, and clothing. Access to health insurance or Medicaid is also essential.
Nutrition: Proper dietary intake is crucial during pregnancy to ensure the health of both the parent and the developing fetus.
Food Supply: Access to good quality and affordable food is important for maintaining proper nutrition.
Self-care: Encouraging healthy habits and practices, including those related to pregnancy and postpartum care, is important for overall well-being.
Wanted Pregnancy: Ensuring that the pregnancy is planned and desired is a significant psychological and emotional consideration.
Program Adherence: Compliance with recommended prenatal care and medical advice is essential for a healthy pregnancy.
Personal Genetics: Understanding potential genetic predispositions can help guide medical care and risk assessments.
Culture, Race/Ethnicity, Language: Providing care that respects cultural backgrounds, race/ethnicity, and language preferences is important for effective communication and personalized care.
Family Size, Composition, Stability: The structure of the family and its stability can influence the support available to the individual during pregnancy and postpartum.
Support Available: Having a strong support network can positively impact mental and emotional well-being.
Education: Knowledge and skills related to pregnancy, childbirth, and parenting are important for making informed decisions.
Perinatal Education: Receiving education specifically focused on the perinatal period can empower individuals to navigate pregnancy and childbirth more effectively.
Environment: The home and community environments can affect overall health, especially exposure to substances that could be harmful to the developing fetus.
Follow-up Visits:
Pregnant Person
Weight Tracking: Monitoring weight gain during pregnancy is important for ensuring a healthy pregnancy and managing any potential complications.
Assessment of Physical and Emotional Well-being: Regularly assessing both the physical and emotional well-being of the pregnant person can help identify any concerns or issues that may arise.
Vital Signs (VS) and Blood Pressure (BP): Monitoring vital signs and blood pressure provides crucial information about the individual’s overall health and well-being.
Urine Testing: Checking urine for protein and glucose can help detect potential complications like preeclampsia or gestational diabetes.
Additional Blood Tests PRN: Administering additional blood tests as needed allows for the detection of any underlying health issues or complications.
Education: Providing education about prenatal care, childbirth, and postpartum care equips the pregnant person with the knowledge they need to make informed decisions.
Additional Tests in 2nd/3rd Trimester: Administering tests like Group B Streptococcus (GBS) screening and gestational diabetes screening during the later stages of pregnancy helps in identifying and managing potential risks.
Rhogam PRN: Rh(D) immune globulin (Rhogam) is administered to Rh-negative pregnant individuals to prevent Rh isoimmunization, a condition that can lead to complications in future pregnancies.
Planning for Birth/Preferences: Discussing birth plans and preferences allows healthcare providers to understand the individual’s desires for labor and delivery, helping to tailor the care accordingly.
Genetic Testing: Genetic testing provides information about potential genetic disorders or conditions that could affect the pregnancy or the baby.
Follow-up Visits:
Fetus
Fetal Growth: Fundal Height
Fundal height measurement is a common way to estimate fetal growth during pregnancy. This involves measuring the distance from the pubic bone to the top of the uterus (fundus). It’s usually done by the healthcare provider at prenatal check-ups. Fundal height can help assess if the baby’s growth is progressing as expected.
Fetal Well being Subjective: FHR via U/S or Doptones
Fetal Heart Rate (FHR) monitoring is essential to assess the baby’s well being. This can be done using ultrasound (U/S) or a handheld Doppler device (Doptones) to listen to the baby’s heartbeat. Changes in heart rate could indicate potential issues, so regular monitoring helps ensure the baby’s health.
Fetal Wellbeing Subjective: Fetal Movement
Fetal movement is a positive sign of the baby’s wellbeing. Feeling regular fetal movements is important, as a decrease in movements could be a sign of distress. Healthcare providers often recommend counting movements at certain times of the day and noting any significant changes.
Genetic Screening Exams/Results
Genetic screening during pregnancy involves tests that assess the risk of genetic disorders in the fetus. These tests can include non-invasive prenatal testing (NIPT), which analyzes cell-free fetal DNA in the mother’s blood, or ultrasound-based tests to check for markers of genetic conditions. Results from these tests can provide information about the risk of certain genetic disorders. Example : Non-Invasive Prenatal Testing (NIPT):
Sarah decides to go for NIPT, a non-invasive blood test that analyzes fetal DNA present in her bloodstream. This test can detect chromosomal abnormalities such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18), and Patau syndrome (trisomy 13), as well as assess the baby’s sex and screen for other genetic conditions. Sarah’s blood sample is taken, and the genetic material is analyzed in a lab.
Ultrasound-Based Test for Markers:
In addition to NIPT, Sarah’s healthcare provider recommends an ultrasound-based test. This involves a detailed ultrasound scan that assesses the baby’s anatomy and looks for physical markers associated with certain genetic conditions. This type of ultrasound can also provide insights into the development of the baby’s organs and body structures.
Potential Complications during pregnancies
Infection: Infections can occur at any trimester of pregnancy and may include various types of infections, such as urinary tract infections (UTIs), respiratory infections, or sexually transmitted infections. Infections during pregnancy need to be managed and treated promptly to prevent complications.
Spontaneous Abortion (SAB) / Miscarriage: Spontaneous abortion, commonly known as miscarriage, is the loss of a pregnancy before the 20th week. It most commonly occurs during the first trimester and can be caused by various factors, including genetic abnormalities or health conditions.
Hyperemesis: Hyperemesis gravidarum is severe nausea and vomiting during pregnancy, which can lead to dehydration and weight loss. It can occur throughout the entire pregnancy and may require medical intervention.
Pyelonephritis: Pyelonephritis is a kidney infection that can occur at any trimester. It is a serious condition that needs prompt medical attention to prevent complications for both the mother and the baby.
IUFD (Intrauterine Fetal Demise): IUFD refers to the death of a fetus after 20 weeks of pregnancy but before delivery. It’s most commonly associated with the second and third trimesters.
Kidney Stones: Kidney stones can potentially occur during any trimester of pregnancy. Management may involve pain relief and monitoring to prevent complications.
Gestational Diabetes: Gestational diabetes can develop during pregnancy, typically in the third trimester, due to increased insulin resistance. It’s important to manage gestational diabetes to prevent complications for both the mother and the baby.
PPROM (Preterm Premature Rupture of Membranes): PPROM refers to the rupture of the amniotic sac before 37 weeks of pregnancy. It’s most commonly associated with the second and third trimesters and requires medical attention to prevent infection and preterm labor.
Hypertensive Disorders: Hypertensive disorders, such as preeclampsia and gestational hypertension, can occur at any trimester and involve high blood pressure during pregnancy. These conditions can be serious and require careful monitoring and management.
- 50-70% of HTN related morbidities/mortalities due to delays in dx and treatment
- Most cases are preventable.
- Hypertensive Disorders of pregnancy 2nd leading cause of morbidity.
Hypertensive Disorders of Pregnancy: Hypertensive disorders that occur during pregnancy, such as preeclampsia and gestational hypertension, can pose significant risks to both the mother and the baby. If not properly managed, these conditions can lead to complications such as preterm birth, low birth weight, placental abruption, and maternal organ damage. Timely diagnosis and appropriate medical care are essential to minimize the risks associated with these disorders.
Morbidity and Mortality Rankings: The statement that hypertensive disorders of pregnancy are the second leading cause of morbidity (illness) highlights the significant impact these disorders have on maternal health. It’s important to note that these disorders can lead to serious complications that affect not only the mother but also the unborn child. Proper antenatal care, close monitoring, and timely interventions can help mitigate the risks associated with these disorders.
3rd Trimester Testing:
Group B Strep
Group B Streptococcus (GBS): GBS is a type of bacteria that can naturally inhabit the gastrointestinal and genital tracts of humans. While it is generally harmless in healthy adults, it can pose a risk to newborns if transmitted from the mother during childbirth.
Testing in the Third Trimester: Testing for GBS typically occurs during the third trimester of pregnancy, specifically between 35 and 37 weeks. This testing involves taking a vaginal and rectal swab to check for the presence of GBS bacteria.
Considered GBS+ if Urine Contains GBS in First Trimester: If a pregnant person has a urine test during the first trimester of pregnancy that shows the presence of GBS bacteria, they are considered GBS positive (GBS+). This indicates that they are carriers of the bacteria.
Prevalence of GBS: It’s mentioned that GBS affects about 50% of pregnant individuals. This statistic highlights that a significant portion of pregnant individuals may carry GBS in their vaginal and rectal areas.
GBS as Normal Vaginal Flora: GBS is considered a normal part of vaginal flora for many people. This means that the presence of GBS in the genital tract is not necessarily indicative of an infection or illness.
GBS+ and Antibiotic Prophylaxis in Labor: For individuals who are GBS+, meaning they carry the bacteria, antibiotic prophylaxis is recommended during labor. This involves administering antibiotics intravenously to the mother during labor to reduce the risk of transmitting GBS to the newborn. This preventive measure significantly reduces the likelihood of GBS-related infections in newborns.
Rhogam
Purpose of RhoGAM: RhoGAM is an immunoglobulin (specifically, anti-D immune globulin) used to prevent the development of antibodies in an Rh-negative mother’s immune system when she is exposed to Rh-positive fetal blood. This is crucial to prevent hemolytic disease of the newborn (HDN) or erythroblastosis fetalis, a condition in which maternal antibodies attack the red blood cells of the fetus.
Risk Reduction: Administering RhoGAM significantly reduces the risk of antibody formation against the Rh factor. This risk reduction is substantial, as you’ve noted, decreasing from 12-13% to 1-2%.
Administration Timing:
28-32 Weeks: RhoGAM is typically administered between the 28th and 32nd weeks of pregnancy. This timing helps prevent sensitization in case of any mixing of fetal and maternal blood during pregnancy.
Bleeding Occurs: RhoGAM is also administered any time there is bleeding during pregnancy, such as after trauma or during procedures. This helps prevent sensitization due to the potential mixing of fetal and maternal blood during bleeding events.
Within 72 Hours of Birth: RhoGAM is given within 72 hours after childbirth if the baby is Rh-positive. This helps prevent the sensitization of the mother’s immune system due to exposure to Rh-positive fetal blood during childbirth. (given to the mom after she delivers to protect her future babies )
Dosage and Administration:
RhoGAM is administered via intramuscular injection (IM), usually into the deltoid muscle.
The typical dosage is 300 micrograms (mcg) of RhoGAM.
The primary goal of RhoGAM administration is to prevent the development of Rh antibodies in the Rh-negative mother’s system, which could otherwise lead to serious complications in subsequent pregnancies with Rh-positive fetuses. By receiving RhoGAM at appropriate times, Rh-negative pregnant individuals can significantly reduce the risk of Rh sensitization and its potential consequences. It’s a critical aspect of prenatal care for Rh-negative individuals carrying Rh-positive fetuses.
Prenatal Patient Education
Nutrition: Educate about the importance of a balanced diet rich in nutrients necessary for the mother’s health and the baby’s development.
UTI Prevention: Explain ways to prevent urinary tract infections (UTIs), as pregnant individuals are more susceptible due to changes in the urinary system.
Kegel Exercises: Describe how Kegel exercises can strengthen pelvic floor muscles, helping with urinary control and supporting the birthing process.
Breastfeeding Preparation: Offer information about the benefits of breastfeeding, proper latch techniques, and resources for assistance.
Physical Activity: Discuss safe levels of physical activity during pregnancy to maintain fitness and reduce discomfort.
Posture/Body Mechanics: Teach about proper posture and body mechanics to minimize strain on the body as it undergoes changes.
Medications and Substance Use: Explain which medications are safe during pregnancy and the importance of avoiding harmful substances.
Immunizations: Educate about recommended vaccinations during pregnancy to protect both the mother and baby.
Sexual Changes: Address physical and emotional changes in sexual health during pregnancy and provide guidance for maintaining intimacy.
Childbirth Education: Offer information about the stages of labor, pain management options, and birth plan considerations.
Patient Education: 1st Trimester. Morning sickness
Morning Sickness:
Occurs primarily during the first trimester of pregnancy, but its effects may extend into the second trimester or even throughout pregnancy for some individuals.
The exact cause of morning sickness is not fully understood, but hormonal changes, particularly elevated levels of human chorionic gonadotropin (hCG) and estrogen, are thought to play a role.
Interventions:
Eat Dry Carbs in the Morning: Consuming dry carbohydrates like crackers before getting out of bed can help settle the stomach.
Frequent, Small Meals: Eating small, frequent meals throughout the day can help prevent an empty stomach and reduce the likelihood of nausea.
Avoid Strong Smelling and Fatty Foods: Strong-smelling foods and fatty or fried foods might trigger nausea. Avoiding them can be helpful.
Ginger: Ginger, in various forms like tea or ginger candies, is a natural remedy that some find effective in alleviating nausea.
Vitamin B6 and Doxylamine: Vitamin B6 supplements, either alone or in combination with doxylamine (an antihistamine), are often recommended and available over-the-counter to manage nausea.
Prescription Medications: In severe cases, healthcare providers might prescribe medications like Zofran to control nausea and vomiting.
Prenatal Vitamins (PNVs): Taking prenatal vitamins can help ensure the mother and baby receive essential nutrients even if dietary intake is limited due to nausea.
Patient Education: Physical Changes
Urinary Frequency:
Increased need to urinate due to the growing uterus pressing on the bladder.
Manage by staying hydrated but moderating fluid intake before bedtime.
Fatigue:
Common in early and late pregnancy due to hormonal changes and increased energy demands.
Get plenty of rest, maintain a balanced diet, and consider light exercise.
Nausea and Vomiting (N&V):
Often experienced in the early stages of pregnancy due to hormonal changes.
Eat small, frequent meals, and consider remedies like ginger or vitamin B6 under medical guidance.
Nasal Congestion and Nosebleeds:
Increased blood volume and hormonal changes can lead to nasal congestion and occasional nosebleeds.
Use a humidifier, stay hydrated, and avoid irritants. Gently blowing the nose can help prevent nosebleeds.
Mood Swings:
Hormonal fluctuations can lead to emotional changes.
Practice stress management techniques, communicate feelings, and seek support.
Pruritis (Itchy Skin):
Skin stretching and hormonal changes can cause itching.
Use fragrance-free moisturizers, wear loose clothing, and consult a healthcare provider if severe.
Palpitations:
Increased blood volume and heart rate are common.
Stay hydrated, avoid caffeine, and inform your doctor if palpitations are severe or concerning.
Constipation:
Hormonal changes and pressure on the intestines can cause constipation.
Stay hydrated, consume fiber-rich foods, and discuss safe constipation relief with your doctor.
Varicose Veins:
Increased pressure on blood vessels and hormonal changes can lead to varicose veins.
Elevate legs when possible, avoid prolonged standing or sitting, and wear supportive stockings.
Round Ligament Pain:
Sharp, shooting pains due to ligaments stretching to accommodate the growing uterus.
Change positions slowly and use pillows for support while sleeping.
Shortness of Breath:
Pressure from the growing uterus and increased oxygen demand can cause shortness of breath.
Practice good posture, sleep with extra pillows, and take breaks when needed.
Insomnia:
Hormonal changes, discomfort, and anxiety can affect sleep.
Establish a bedtime routine, create a comfortable sleep environment, and consider relaxation techniques.
Leg Cramps:
Muscle cramps are common due to increased pressure on blood vessels and nerves.
Stretch regularly, stay hydrated, and consider gentle exercises like walking.
Swelling:
Edema, or swelling, is common in the feet, ankles, and hands due to fluid retention.
Elevate feet when possible, avoid excessive salt, and consult a healthcare provider if swelling is severe or sudden.
Back Pain:
As the belly grows, the center of gravity shifts, potentially causing back pain.
Practice good posture, use proper body mechanics, and consider prenatal exercises to strengthen core muscles.
Sexual Changes in Pregnancy
Attitudes/Interest May Change:
Pregnancy can lead to changes in attitudes toward sex and fluctuations in sexual interest due to hormonal, physical, and emotional changes.
Contributing Factors:
Physical Changes: Discomfort, fatigue, and physical changes in the body can affect sexual desire and enjoyment.
Psychological Changes: Hormonal shifts, mood swings, and anxiety about pregnancy and childbirth can impact sexual well-being.
Social/Cultural Factors: Societal beliefs and cultural norms around pregnancy and sexuality can influence attitudes.
Possible Changes in Libido:
Sexual desire, or libido, varies greatly among pregnant individuals. Some may experience an increase in libido due to hormonal changes, while others may experience a decrease due to discomfort or fatigue.
Attitudes and Misconceptions: Pregnant Person & Partner:
Open communication between the pregnant person and their partner is essential to address any concerns, misconceptions, or fears related to sex during pregnancy.
Risk Assessment:
In most uncomplicated pregnancies, sexual activity is safe and unlikely to harm the baby. However, certain medical conditions may necessitate caution or abstinence. Consultation with a healthcare provider is recommended.
Sex is Safe Except for Certain High-Risk Patients:
For most pregnant individuals, engaging in sexual activity is safe. However, high-risk situations such as a history of preterm labor, cervical insufficiency, or placenta previa may require medical advice and temporary abstinence. (explanation : Placenta Previa: Placenta previa occurs when the placenta partially or completely covers the cervix. Sexual activity could cause bleeding in this scenario, potentially endangering the health of both the pregnant individual and the baby. Abstinence might be recommended until the condition is resolved.)
Patient Education: Immunizations
Flu (Influenza) Vaccine:
The flu vaccine is recommended during pregnancy to protect against seasonal influenza. Pregnant individuals are more susceptible to severe illness from the flu.
The flu vaccine is safe and can be received at any stage of pregnancy. It also provides some protection to the newborn after birth.
TDAP Vaccine (Tetanus, Diphtheria, and Pertussis):
The TDAP vaccine is recommended during every pregnancy, preferably between 27 and 36 weeks gestation.
It provides protection against pertussis (whooping cough) for both the pregnant person and the newborn, who cannot receive the vaccine until later.
Hepatitis B Vaccine:
The Hepatitis B vaccine is typically recommended for pregnant individuals who are at increased risk of infection or have not previously been vaccinated.
The vaccine is safe during pregnancy and helps prevent transmission of Hepatitis B to the baby.
COVID-19 Vaccine:
The COVID-19 vaccine has been recommended by health authorities for pregnant individuals, especially those at higher risk of severe illness from COVID-19.
Pregnant individuals should discuss the decision to get vaccinated with their healthcare provider and consider their individual risk factors.
No Live Vaccines:
Live vaccines, like the MMR (measles, mumps, rubella), varicella (chickenpox), and oral polio vaccines, are generally not recommended during pregnancy due to the potential risk to the developing fetus.
If a pregnant individual needs these vaccines, it’s recommended to get them before pregnancy.
Patient Education: Planning for the Birth
Birth Plans:
Purpose: A birth plan is a document that outlines the preferences and wishes of the birthing person for labor, delivery, and postpartum care. It helps healthcare providers understand their desires and needs.
Components: Birth plans can include preferences for pain management, labor positions, who will be present during birth, interventions, feeding choices, and more.
Flexibility: While birth plans are valuable communication tools, it’s important to remain open to adjustments based on the unfolding circumstances of labor and delivery.
Shared Decision Making:
Definition: Shared decision making is a collaborative process where healthcare providers and patients work together to make informed decisions about care.
Patient’s Authority: It recognizes the patient’s right to actively participate in their own healthcare decisions. Providers share information about options, benefits, and risks, allowing patients to choose what aligns with their values and preferences.
Informed Consent:
Definition: Informed consent is the process through which healthcare providers inform patients about the details of a proposed medical treatment, procedure, or intervention.
Purpose: It empowers patients with the necessary information to make educated decisions about their healthcare.
Components: Informed consent includes understanding the nature of the treatment, potential risks and benefits, available alternatives, and the right to ask questions before giving consent.
Birth Plans and Shared Decision Making
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Part 2: Genetic Screening
Screening Test VS Diagnostic Test:
Screening Test:
A screening test is a preliminary test that identifies individuals who might have a higher risk of a specific condition. It doesn’t provide a definitive diagnosis but helps identify those who may need further testing.
Diagnostic Test:
A diagnostic test confirms or rules out the presence of a specific condition. It’s usually more invasive and provides a conclusive result.
Screening for Neural Tube Defects, Trisomy 21, and Chromosomal Abnormalities:
Neural Tube Defects: These are structural abnormalities of the brain and spinal cord. Screening may involve a blood test and/or ultrasound to assess the risk of conditions like spina bifida (folic acid lack )
Trisomy 21: Also known as Down syndrome, trisomy 21 occurs when there’s an extra copy of chromosome 21. Screening may involve blood tests and/or ultrasound to estimate the risk.
Other Chromosomal Abnormalities: Screening may also include assessing the risk of other chromosomal abnormalities, such as trisomy 18 (Edwards syndrome) and trisomy 13 (Patau syndrome).
Follow-Up Diagnostic Tests:
If a screening test indicates a higher risk, further diagnostic tests like chorionic villus sampling (CVS) or amniocentesis may be recommended for a definitive diagnosis.
Individual Counseling for Decision-Making:
Genetic screening involves informed decision-making. Individual counseling takes into account factors like personal beliefs, preferences, and risk factors to guide whether to proceed with screening or diagnostic testing.
Screening Tests
Cell-Free Fetal DNA Testing:
Timing: Typically performed between 8 to 10 weeks of pregnancy.
Procedure: A blood sample is taken from the pregnant individual. This blood contains cell-free fetal DNA shed into the maternal bloodstream. The fetal DNA is then analyzed.
Detection: This test detects and analyzes the DNA fragments of the developing fetus that are present in the maternal circulation.
Sensitivity to Trisomy 21: Cell-free fetal DNA testing has a high sensitivity for detecting chromosomal abnormalities, particularly Trisomy 21 (Down syndrome), with a reported sensitivity of around 99.9%.
Nuchal-Fold Translucency (NT) Screening:
Timing: Typically performed between 11 to 13 weeks of pregnancy.
Procedure: An ultrasound is performed to measure the nuchal translucency, which is the fluid-filled space at the back of the fetal neck.
Purpose: Increased nuchal translucency can be associated with an increased risk of chromosomal abnormalities.
PAPP-A (Pregnancy-Associated Plasma Protein-A):
Timing: Measured during the same time frame as the nuchal-fold translucency, between 11 to 13 weeks of pregnancy.
Procedure: A blood sample is taken from the pregnant individual to measure PAPP-A levels.
Association: Lower levels of PAPP-A in maternal serum during this time frame can be associated with an increased risk of chromosomal abnormalities.
Screening Tests Cont’d
Triple Marker Screening:
Timing: Typically performed between 15 to 20 weeks of gestation.
Procedure: It involves a maternal serum test, meaning a blood sample is taken from the pregnant individual.
Measures: The test measures the levels of three proteins: Alpha-fetoprotein (AFP), human chorionic gonadotropin (hCG), and unconjugated estriol.
Purpose: The triple marker test screens for open neural tube defects and chromosomal abnormalities, such as Trisomy 21 (Down syndrome).
Trisomy 21 Indicators: In cases of Trisomy 21, the levels of unconjugated estriol are low and hCG is elevated. For Trisomy 18, all markers tend to be low.
Quad Marker Screening:
Same as Triple Marker Plus Inhibin A: The Quad Marker test includes the same three markers as the Triple Marker (AFP, hCG, and unconjugated estriol) plus the addition of inhibin A.
Purpose: Like the Triple Marker, the Quad Marker test assesses the risk of chromosomal abnormalities and neural tube defects.
Penta Marker Screening:
Components: The Penta Marker test includes the same markers as the Triple Marker (AFP, hCG, and unconjugated estriol), and the Quad Marker (AFP, hCG, unconjugated estradiol, inhibin A), plus two additional markers: dimeric inhibin A and hyperglycosylated hCG (h-hCG).
Availability: The Penta Marker test is not as widely available as the Triple and Quad Marker tests.
Diagnostic Tests
Chorionic Villus Sampling (CVS):
Timing: Typically performed between 10 to 13 weeks of gestation.
Specimen Collection: A sample of chorionic villi (tissue from the placenta) is obtained either through the abdominal wall (trans-abdominal) or through the vaginal canal (trans-vaginal).
Purpose: Genetic material from the obtained tissue is analyzed for common chromosomal abnormalities, such as Down syndrome.
Limitation: CVS does not detect neural tube defects, which are structural abnormalities affecting the development of the brain and spinal cord.
Risks: There is a risk of damage to surrounding structures during the procedure, and the procedure carries a 0.5-1.0% risk of miscarriage (spontaneous abortion, SAB).
Amniocentesis:
Timing: Typically performed between 15 to 20 weeks of gestation, though it can be done earlier (11-14 weeks) if there’s a higher risk of miscarriage.
Specimen Collection: A sample of amniotic fluid is withdrawn from the amniotic sac surrounding the fetus.
Purpose: The amniotic fluid is analyzed for chromosomal abnormalities, infections, and Rh sensitization (a condition where a mother’s immune system attacks the baby’s blood cells if they have an incompatible blood type). In the third trimester, amniocentesis can also be used to assess fetal lung maturity.
Risks: Similar to CVS, amniocentesis carries a risk of miscarriage. The risk is generally comparable to that of CVS.
Both CVS and amniocentesis are invasive procedures and carry a small risk of causing a miscarriage. The choice between these tests depends on factors such as the gestational age, the specific risks and benefits for the mother and fetus, and the specific information the healthcare provider needs to gather. It’s important for expectant parents to discuss these options with their healthcare provider to make an informed decision based on their individual circumstances.
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Part 3: Nutrition in Pregnancy
Goals of Nutrition in Pregnancy:
Optimal Weight Gain: Pregnant individuals need to gain an appropriate amount of weight to support the growth of the fetus and accommodate changes in the body. However, excessive weight gain can lead to complications, just as insufficient weight gain can impact fetal development.
Adequate Nutrients: Proper nutrition is essential to provide the necessary nutrients for the development of the fetus and to support the overall health of the pregnant person. Adequate intake of vitamins, minerals, protein, carbohydrates, and fats is vital during this time.
Identifying Risk Factors:
It’s important to identify any risk factors that could impact nutrition during pregnancy. These could include pre-existing health conditions, dietary restrictions, or lifestyle factors that might affect nutrient intake.
Inadequate Nutrition and Consequences:
Low Birth Weight: Inadequate maternal nutrition can lead to low birth weight in newborns, which is associated with an increased risk of health problems and developmental issues.
Preterm Birth: Poor nutrition during pregnancy can contribute to preterm birth, which increases the risk of health complications for the baby.
Congenital Anomalies: Insufficient intake of certain nutrients during critical periods of fetal development can increase the risk of congenital anomalies or birth defects.
Excessive Intake and Consequences:
Macrosomia: Excessive maternal weight gain and overconsumption of calories during pregnancy can result in a condition called macrosomia, where the baby is born weighing more than 4000 grams (about 8.8 pounds). This can lead to complications during childbirth and increase the risk of health problems for both the mother and the baby.
Identify Patients at Risk
Adolescence or less than 2 years post menarche: Teenage pregnancies or pregnancies that occur soon after the onset of menstruation can be associated with higher risks of complications due to the mother’s still-developing body and reduced access to prenatal care.
Frequent pregnancies: three within 2 years: Rapid and frequent pregnancies within a short span of time can lead to maternal nutrient depletion, inadequate recovery between pregnancies, and increased risk of maternal and fetal health problems.
Poor fetal outcome in a previous pregnancy: A history of poor fetal outcomes, such as miscarriages or stillbirths, could indicate underlying health issues or potential risks that may need to be managed in subsequent pregnancies.
Poverty/food insecurity: Limited access to nutritious food and proper healthcare due to poverty and food insecurity can lead to maternal malnutrition, which in turn can impact fetal development and increase the risk of complications.
Poor diet habits with resistance to change: Unhealthy eating habits can result in inadequate nutrition for both the mother and the developing fetus, contributing to a higher likelihood of pregnancy complications and poor birth outcomes.
Use of tobacco, alcohol, or substances: Smoking, alcohol consumption, and drug use during pregnancy can have serious negative effects on fetal development, leading to a range of health issues and developmental problems.
Weight at conception under or over normal weight: Being underweight or overweight at the beginning of pregnancy can lead to an increased risk of complications, including gestational diabetes, preeclampsia, and difficulties during labor.
Problems with weight gain: Inadequate or excessive weight gain during pregnancy can contribute to complications like preterm birth, low birth weight, and increased risk of maternal health issues.
Weight loss during pregnancy: Significant weight loss during pregnancy can be a sign of malnutrition or underlying health problems, which can pose risks to both the mother and the developing fetus.
Identify Patients at Risk Cont’d (“Cont’d” is short for “continued)
Weight gain of more than 3 kg (6.6 lb)/month after the first trimester: Gaining too much weight rapidly during pregnancy, particularly after the first trimester, can lead to complications. It might increase the risk of gestational diabetes, high blood pressure, and other issues.
Weight gain of less than 1 kg (2.2 lb)/month after the first trimester: Not gaining enough weight during pregnancy can also pose risks. Insufficient weight gain might lead to undernourishment for both the mother and the baby, potentially causing developmental problems.
Multi-fetal pregnancy: Carrying twins, triplets, or more can increase the risk of various complications due to the extra demands on the mother’s body and the potential for premature birth.
Low hemoglobin and/or hematocrit values: Low levels of hemoglobin (the protein in red blood cells that carries oxygen) and hematocrit (the volume of red blood cells in the blood by %) can indicate anemia, which can affect the mother’s and baby’s health by reducing oxygen supply.
Diabetes: Having diabetes, either pre-existing or gestational, can lead to various pregnancy complications, such as high blood pressure, birth defects, and difficulties during delivery.
Chronic illness, including an eating disorder: Pre-existing health conditions, including eating disorders, can impact the intake, absorption, or metabolism of nutrients, affecting both the mother’s and baby’s well-being during pregnancy.
Nursing Nutrition Assessment/Intervention
Anthropometric Measurements:
Weight/BMI: Regularly measure the pregnant individual’s weight and calculate their Body Mass Index (BMI) to monitor changes and ensure they are within a healthy range for their stage of pregnancy.
Diet Record:
Ask the individual to maintain a detailed record of their daily dietary intake. This will help you understand their eating habits, nutrient intake, and potential deficiencies.
Review Supplement Intake:
Check if the individual is taking any prescribed or over-the-counter prenatal supplements. Evaluate the type, dosage, and compliance to ensure they are getting the necessary vitamins and minerals for a healthy pregnancy.
Individualized Plan of Care:
Based on the collected data (weight, BMI, diet record, supplement intake), develop a personalized care plan. Address any identified nutritional deficiencies or concerns, and set goals for maintaining a healthy weight and providing adequate nutrients for both the pregnant individual and the developing fetus.
Education on Food Choice and Calorie Intake:
Educate the pregnant individual about making healthy food choices and ensuring adequate calorie intake. In the second and third trimesters, an additional 300 calories per day may be recommended to support the growing baby’s needs.
Physical Assessment:
Conduct a comprehensive physical assessment from head to toe, paying attention to any signs of malnutrition or other health issues. Look for signs of weight loss, hair and skin changes, and other indicators of nutrient deficiencies.
Signs of Malnutrition:
Keep an eye out for signs of malnutrition, such as fatigue, muscle wasting, poor wound healing, and changes in skin and hair health. Address any concerns promptly.
Special Considerations
Food Allergies/Intolerances:
Identify any known food allergies or intolerances and adjust the diet accordingly to avoid triggering adverse reactions. Ensure that the pregnant woman is getting appropriate alternatives to maintain a balanced diet.
Level of Nausea and Vomiting (N&V)/Food Aversion:
Address the impact of nausea, vomiting, and food aversions on dietary intake. Suggest ways to manage symptoms, such as eating smaller, more frequent meals and opting for bland, easily digestible foods.
Cultural and Food Preferences:
Respect cultural and personal food preferences when planning meals. Adapt the diet to incorporate familiar and preferred foods while ensuring nutritional adequacy.
Nutritional Deficits with Certain Diets (e.g., Vegan):
For pregnant individuals following specific diets like vegan or vegetarian, assess their intake of key nutrients such as protein, iron, vitamin B12, omega-3 fatty acids, and calcium. Provide guidance on how to obtain these nutrients from plant-based sources or consider supplementation if necessary.
Food Resources and Accessibility:
Determine if the pregnant individual has access to a variety of nutrient-rich foods. Address any challenges related to food affordability, availability, or transportation. Provide information about local food resources, such as food banks or assistance programs, if needed.
Gastrointestinal Issues:
Assess any gastrointestinal issues that might impact digestion and absorption of nutrients. Provide recommendations to manage these issues and ensure optimal nutrient absorption.
Prenatal Vitamins and Supplements:
Discuss the importance of prenatal vitamins and supplements, especially for nutrients like folic acid, iron, calcium, and vitamin D. Ensure that the individual is taking these supplements as recommended by their healthcare provider.
Hydration and Fluid Intake:
Emphasize the importance of staying hydrated during pregnancy. Address any concerns about fluid intake and provide guidance on adequate water consumption.
Weight Management:
Monitor weight gain and provide guidance on appropriate weight management during pregnancy. Ensure that the individual is gaining weight within the recommended range for their pre-pregnancy BMI.
Physical Activity:
Discuss the role of physical activity during pregnancy and its impact on nutritional needs. Encourage appropriate exercise and ensure that energy expenditure is balanced with nutritional intake.
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Target Nutrients
Tempeh: Tempeh is a fermented soybean product that originates from Indonesia
- Calcium
**Support bone/teeth growth
**Sources: dairy, almonds, canned fish, dried beans/lentils - Iron
**Animal meats, leafy greens, eggs, tofu, tempeh, fortified foods (but whole foods are better)
**Vit C aids absorption
**Low iron=anemia - Folic Acid
**Leafy greens, black-eyed peas and other legumes, citrus, peanuts, liver
**Deficiency: risk for NTD
FOLIC ACID
Red Blood Cell Formation: Folic acid is essential for the synthesis and maturation of red blood cells (erythrocytes) in the bone marrow. These cells are responsible for carrying oxygen throughout the body.
Reduced Risk of Neural Tube Defects (NTDs): Neural tube defects are serious birth defects that can occur early in pregnancy when the neural tube, which forms the baby’s brain and spinal cord, does not close properly. Adequate folic acid intake before and during pregnancy has been shown to significantly reduce the risk of NTDs, such as spina bifida and anencephaly, in newborns.
Supplementation for Pregnant Individuals: It’s recommended that individuals who may become pregnant take a folic acid supplement. This is because neural tube development happens very early in pregnancy, often before a person even realizes they are pregnant. By the time pregnancy is confirmed, it might be too late to prevent these defects. Therefore, taking folic acid before conception is crucial.
Fortification in Food: In many countries, certain staple foods like flour and grains are fortified with folic acid to help ensure that people are getting enough of this essential nutrient. This is especially important for individuals who might not have access to a well-balanced diet.
Other Benefits: Folic acid also plays a role in DNA synthesis, cell growth and division, and the metabolism of amino acids. It’s important for overall cell health and function.
Food Concerns in Pregnancy
-Alcohol: No safe amount in pregnancy
-Artificial Sweeteners
**Unknown effects: may be linked to higher birthweight/childhood obesity
**No nutritional value
- Mercury poisoning
**May lead to pregnancy complications & childhood developmental delays
**Limit fish to 2x/week & avoid fish higher in mercury (Ricci, p. 350) - Listeriosis:
**Unpasteurized & raw foods, deli meats, refrigerated smoked fish, deli salads, “old” food, poorly refrigerated
**May pass through placenta
**Risk of miscarriage, stillbirth, neonatal demise
Part 4:Psychological Adaptation to Pregnancy
Social and Cultural Context: Pregnancy is not just a physiological process but also a psychological and emotional one. How individuals adapt to pregnancy can be influenced by their cultural beliefs, societal norms, family structures, and personal experiences. Different cultures may have varying expectations and practices around pregnancy, childbirth, and parenting. Factors such as socioeconomic status, ethnicity, religion, and access to healthcare can also play a significant role in shaping the psychological experience of pregnancy.
Research on Family Dynamics: It’s important to recognize that research on family dynamics and psychological adaptation to pregnancy has historically focused on specific demographics, particularly white middle-class heterosexual nuclear families. This limited scope can overlook the diverse experiences of individuals from different backgrounds. Family structures vary widely, including single-parent families, LGBTQ+ families, extended families, and families from different cultural backgrounds. These variations can influence how individuals experience and adapt to pregnancy and parenthood.
Psychological Adaptation to Pregnancy: Stages
Ambivalence
Introversion
Acceptance
Psychological Adaptation to Pregnancy: 1st Trimester
The word “introversion” is derived from the Latin term “intro-“ which means “inward” or “within,” and “vertere” which means “to turn.” When combined, “introvertere” essentially means “to turn inward.” The term has been adapted into English to describe the process of focusing one’s attention, thoughts, or reflections on one’s own inner world, thoughts, and feelings rather than on external stimuli or interactions.
The word “ambivalence = التناقض” has its origins in the Latin language. It is a combination of two Latin words:
“Ambo” - which means “both.”
“Valentia” - which means “strength” or “power.”
When combined, “ambivalence” essentially conveys the idea of having conflicting feelings or attitudes toward something, where one experiences both positive and negative emotions with equal strength. In the context of psychological adaptation to pregnancy, ambivalence refers to the mixed feelings and contradictory emotions that individuals may experience as they grapple with the changes and challenges associated with impending parenthood.
Introversion: Focus on Self: During the early stages of pregnancy, individuals may find themselves turning inward to process the news and their feelings about it. This introverted phase involves self-reflection, self-discovery, and contemplation about the changes that lie ahead. It’s a time when individuals may begin to imagine how their lives will transform and what parenthood means to them.
The Baby Isn’t Real: In the first trimester, especially early on, some individuals might find it difficult to fully grasp the reality of the pregnancy. Since the physical changes are minimal and the baby isn’t yet visibly present, it can be challenging to connect emotionally with the idea of a growing life inside. This feeling often changes as the pregnancy progresses and physical changes become more noticeable.
Ambivalence: Examining Sacrifices: Ambivalence is a common experience during pregnancy. This stage involves considering what needs to be given up or adjusted to accommodate the impending arrival of the baby. Expectant parents may grapple with the changes in lifestyle, routines, and personal freedoms that come with parenthood. It’s normal to have mixed feelings about these sacrifices.
Emotional Lability: Hormonal changes that occur during pregnancy can lead to emotional lability, which means experiencing rapid and unpredictable shifts in mood. It’s not uncommon for pregnant individuals to feel a heightened range of emotions during the first trimester, from elation and joy to anxiety and frustration. This emotional roller coaster is partly due to the hormonal fluctuations taking place in the body.
Change in Body Image: Physical changes, such as breast tenderness, bloating, and morning sickness, can influence how individuals perceive their bodies during the first trimester. Some may struggle with body image concerns as they navigate these changes. The idea of one’s body transforming to accommodate a growing baby can be both exciting and challenging, particularly if it conflicts with societal beauty standards.
Psychological Adaptation to Pregnancy:2nd Trimester
Establishing a relationship with the fetus
Fetal movement/fetus as separate being
Pregnancy/fetus main focus
Attention to own mother and others who are pregnant (more outward focus)
Psychological Adaptation to Pregnancy: 3rd Trimester
Tired of being pregnant
Prepares realistically for the birth and parenting
May be unconfident about parenting
Identifying with the mother/parent role
Reordering of relationships
Mental Health Screening
Screening for risk factors at initial appointment, throughout trimesters and postpartum.
Referral for mental health services PRN.
Nurse education:
**Reassure client around normal changes.
**Provide education on reportable s/sx.
CNM
Certified Nurse Midwives
LMP
last menstrual period (LMP).
Nagele’s Rule Example
can you give a real life example ?
Of course! Let’s say a person’s last menstrual period (LMP) started on April 1st.
Start with the first day of your last menstrual period (LMP): April 1st.
Add 7 days to that date: April 8th.
Subtract 3 months from that result: January 8th.
So, according to Nagele’s Rule, the estimated due date would be January 8th for someone with an LMP that started on April 1st. However, remember that this is a simplified calculation and doesn’t account for variations in menstrual cycle length or other factors that could affect the due date. It’s always best to consult with a healthcare provider for a more accurate estimate.
