Module two Flashcards
Why do you need to have good nutrition when pregnant?
Associated with good perinatal outcomes and decreased the incidence of
1. Low birth weight (LBW)
2. Preterm delivery (PTD)
3. Congenital anomalies (think NTD/folic acid)
What do LBW, PTD, and congenital abnormalities all have in common?
All are leading causes of perinatal morbidity & mortality
How many calories should a pregnant women have per day?
2000 calories or extra 300/day
How many grams of protein should a pregnant women have per day?
60 grams
How much fat should a pregnant women have per day?
unchanged
How much iron should a pregnant women have per day? Ca and PO4? Vitamin C? Folic acid? B6? Vit D?
Iron: 27mg
Ca and PO4: 1,000-1,200mg
Vitamin C: 80-85mg
Folic acid: min 400 mcg
B6: 1.9mg
Vitamin D: 5 mcg
What should be included in a nutritional assessment?
3-Day Dietary Recall including food, drink, non-food
Nutritional Questionnaire
What foods should be avoided during pregnancy
Non-nutritive foods (Diet Coke and Skittles, etc.)
Alcohol
Illegal substances: Cocaine, Meth, etc.
Many prescription or over the counter drugs, herbs, supplements
Pica (craving and consuming of non-food substances)
Food made with unsafe preparation techniques
What would cause pica cravings? What contains pica?
Clay, Dust, Ice, Starch, Laundry soap, etc
May be caused by iron deficiency anemia
What would be considered unsafe preparation techniques?
Raw or undercooked meats and fish, unpasteurized dairy, excessive large mercury containing fish, etc.
What could cause too little weight gain in pregnancy? (5)
Anorexia/body image disorders
Nausea, “morning sickness”
Substance abuse, smoking
Insufficient means: poverty, homelessness, etc.
Pica (filling up on non-nutritive foods)
What could cause too much weight gain in pregnancy?
hidden calories
“stress” eating, depression
Poor dietary knowledge
What are the consequences of inadequate weight gain during pregnancy? What does this put the infant at risk for?
More likely to have low birth weight babies
Respiratory Distress Syndrome, Intraventricular Hemmorrhage, Patent Ductus Arteriosis, Necrotizing Eneterocolitis, and Retinopathy of Prematurity as newborns and at increased lifelong risk for hypertension, diabetes mellitus and heart disease.
What are the complications of obesity during pregnancy?
Birth Defects (Neural Tube Defects)
Chronic Hypertension
Pre-gestational diabetes
Gestational diabetes
Sleep disordered breathing
What are the complications of obesity during labor and birth?
Primary and repeat cesarean section
Medical induction/augmentation
Prolonged first stage
Excessive blood loss and longer operative time
What are the complications of obesity postpartum?
Wound infection
Urinary incontinence
Postpartum hemorrhage (70% higher in obese women)
Retained weight
Failure to successfully initiate breastfeeding
Due to maternal obesity, newborn is at increased risk for
Large infants-macrosomia
Intrauterine growth restriction (IUGR)
Stillbirth
Preterm birth
What is recommended weight gain during pregnancy based on? If patient has normal BMI what is the recommendation?
Based on BMI
Total gain : 25-35 puunds
1st Trimester: .5-3 pounds total
2nd/3rd Trimester: 1 pound/week
OR
5-10 pounds by 20 weeks, then 1 pound/week
What are nursing intervention surrounding nutrition/weight gain?
Thorough assessment of what she is taking in (food, beverages, non-food)
Find out what her expectations are and address any misconceptions/myths
Make individualized plans, including her and anyone else that is feeding her/supplying groceries/providing support in the formation of the plans
Make specific, manageable recommendations
Give patients the tools to allow them to participate in their own care (food diaries, referral to WIC, etc.)
Are antenatal testing required?
No the are all optional
What birth defects can antenatal testing detect?
Heart defects, abdominal wall, or neural tube defects
What chromosomal problems can antenatal testing detect?
Down Syndrome (Trisomy 21)
Edwards Syndrome (Trisomy 18)
Patau Syndrome (Trisomy 13)
Turner’s Syndrome (X)
What genetic diseases can antenatal testing detect?
Cystic fibrosis
Sickle Cell Disease
Fragile X Syndrome
Tay Sachs Disease
What is a screening test for antenatal testing? (5)
only determines RISK
Maternal serum Quad Screen
Sequential Screen/First Trimester Screen
Cell-Free DNA
Carrier Screening (CF, Ashkenazi Jewish Panel, Fragile X, etc.)
Review of systems sonogram
What do maternal carrier screening tests test for?
Screens for recessive linked disorders where the parents are carriers and NOT disease affected
What does maternal quad serum test for? When should It be collected?
Screens for trisomy 18 and 21
Collected between 15 and 23 weeks from maternal serum but ideal timing between 16-18 weeks
What can maternal quad serum test be influenced by?
Influenced by maternal weight, gestational age, and ethnicity
Alpha-fetoprotein
hCG
Estriol
Inhibin-A
What does sequential screen/First trimester screen screen for?
Screens for trisomy 13, 18, 21, cardiac and neural tube defects
What does the sequential screen/First trimester screen look for at 11-13 weeks? 15-21 weeks?
11-13 weeks– nuchal translucency (by ultrasound) and maternal serum
15-21 weeks– 2nd draw of maternal serum alpha-fetoprotein to screen for neural tube and abdominal wall defects such as spinal bifida and gastroschisis
What is the most accurate screening option?
Free Fetal DNA (ffDNA)
What does an ffDNA screen for? When should it be preformed? When are the results less accurate? Most accurate?
Screens for trisomy 13, 18, 16, 20, 21, as well as sex chromosome aneuploidies and micro-deletions
After 10 weeks
Results not as accurate in low-risk women
Most accurate in high-risk women and women of advanced maternal age (35 years or older)
What can a standard ultrasound in 2nd or 3rd trimester be used to identify? (7)
Fetal presentation and number
Amniotic fluid index (how much fluid is around the fetus)
Placental location
Presence of cardiac activity
Fetal biometry (to confirm dating or measure interval growth)
Anatomy
Uterine/Pelvic anatomy including cervical length, ovaries, etc.
What anatomy can be seen on an ultrasound in 2nd or 3rd trimester?
Major organs (brain, heart, stomach, kidneys, etc.)
Spine
Extremities
What are the two types of ultrasounds and when are they used?
Transvaginally - used in early pregnancy
Transabdominal - Usually used after 12-week gestational age depending on maternal body habitus
When using an ultrasound, what defects can it help detect?
Crania-spinal defects
Gastrointestinal malformations
Cardiac defects
Renal malformations
Skeletal malformations
What is the standard US used? When is a 3D/4D US used?
Standard: 2D
3D/4D is used commercially and not usually used to evaluate a fetus
What is diagnostic testing used for?
Diagnostic tests are used to definitively confirm a chromosomal abnormality or inherited disorder
What are the 3 types of diagnostic testing?
Chorionic villus sampling (CVS)
Amniocentesis
Percutaneous umbilical cord blood sampling
When is a CVS used? What does it detect? What does it not detect?
at 10-12 weeks
Detects genetic, metabolic, and DNA abnormalities
Does not detect neural tube defects
What tests for neural tube defects?
Alpha fetoprotein (AFP) which is drawn between 15-20 weeks
How is a CVS done? What are two ways?
Catheter biopsy of chorionic villi obtained from edge of developing placenta
Transabdominal or transcervical
What is done earlier, amniocentesis or CVS?
CVS is done earlier which allows for termination before fetal movement is felt
How is a percutaneous umbilical blood sampling (PUBS) preformed? What does it test for?
Procedure performed to obtain fetal blood from the base of the umbilical cord
Used to aid in diagnosis of hemophilia, hemolytic disorders, fetal infections, chromosomal abnormalities, fetal hydrops, and assessment of fetal H&H
What are the risks of CVS?
Increased risk of spontaneous abortion (twice the chance of loss when compared with amniocentesis)
Risk of fetal limb defects (finger or toe missing)
Bleeding
Infection
Failure to obtain tissue
Leaking of amniotic fluid
When is an amniocentesis done? What does it detect? How is it preformed?
Done at 15-18 weeks
Detects genetic, metabolic, and DNA abnormalities
Needle guided aspiration of amniotic fluid
What are the risks/side effects for amniocentesis?
Spontaneous abortion (0.5%)
Infection
Vaginal spotting
Cramping
Damage to fetus
What would an amniocentesis be used for later in pregnancy?
assess for infection, determine extent of fetal anemia, or assess fetal lung maturity
What are the ethical, legal, and social benefits for antenatal testing?
More customized treatment (such as birth location and special Dr.)
Earlier diagnosis with potential for higher survival rates
Increased social support - more time to plan
Preparation for grieving/palliative care after birth if anomaly is incompatible with life
Option to terminate affected pregnancy
What are the ethical, legal, and social risks for antenatal testing?
Increased anxiety for pregnant women with both true and false positive results.
Increased exposure to maternal levels of stress for fetus
Delayed bonding with the pregnancy
Family stress if opinions on testing/interventions differs between partners
Elective termination
What is the difference between positive, probable and presumptive s/s of pregnacy?
Positive: Can’t be anything else
Probable: Objective and things the provider can observe/measure
Presumptive: Subjective and things the woman experiences and reports
What are positive signs of pregnancy?
Fetal heartbeat per Doppler or fetoscope
Fetal movement with palpated (per trained provider) or visualized (per trained provider)
Visualization of fetus on ultrasound
Delivery
What are presumptive s/s of pregnancy? (8)
Amenorrhea
N/V
Urinary frequency
Breast tenderness
Darkened areola
Quickening
Weight gain
Fatigue
What are probable s/s of pregnancy? (10)
Goodell’s, Hegar’s sign
Chadwick’s sign
Braxton Hicks
Uterine souffle
Linea nigra
Abdominal striae
Ballottement
Palpation of fetal outline
Abdominal enlargement
Positive pregnancy test
What is partner couvade? How does this resent?
Unintentional taking on the physical symptoms of the pregnant partner
Low back pain
Nausea
Weight gain
What are hormonal causes for common pregnancy discomforts?
Estrogen
Progesterone
Relaxin
Human placental lactogen
Prolactin
Oxytocin
Human chorionic gonadotropin
What are mechanical issues r/t common pregnancy discomforts?
Enlarging uterus
Weight gain
Postural changes
Emotional stress (nausea, HA, difficulty sleeping, etc.)
What are the vaginal changes in pregnancy?
Estrogen influence
Hypertrophy
Hyperplasia of lining
Increased thick white secretions
What are the nutritional changes in pregnancy?
Normal weight gain fo 20-30 pounds
Balanced diet and increased folic acid and caloric intake
Increased need for water
What are the uterus changes in pregnancy?
Increase in size and weight
Increase fibrous CT
Braxton hicks
Cervical softening
Mucus plug
What are 3 signs caused by estrogen and progesterone?
Chadwick’s sign (blue tinge to cervix/vagina)
Goodell’s sign (cervical softening)
Hegar’s sign (softening lower segment)