Supporting Women Exam prep Flashcards
List the 4 key components of care recommended by WHO (2007) that should be included in each Antenatal Visit
∗ information-sharing
∗ assessment and screening
∗ active decision-making
∗ health promotion and education
Name two evidence based guidelines that midwives use to inform the Antenatal care provided
Australian Health Ministers Advisory Council AHMAC (2012) Clinical Practice Guidelines : Antenatal Care - Module One
National Institute for Clinical Excellence (NICE) 2008 Antenatal care: routine care for the healthy pregnant woman.
What are the two National statistical measures that are collected annually that can be used as an indicator of the effectiveness of Antenatal Care?
Perinatal Mortality and Morbidity rate
Maternal Mortality and Morbidity rate
Name the key Government health initiative implemented in each state to reduce the gap in inequalities that exist between Aboriginal and Torres Strait Islander and non-Aboriginal and Torres Strait Islander Australians
Closing the Gap in Queensland
Key Action is on improving Maternal and child health
Queensland Closing the Gap report (2009)
http://www.health.qld.gov.au/atsihealth/close_gap.asp
Why is the initial contact with the pregnant woman and her family so important?
∗ Important as sets the scene for the woman & the midwife.
∗ Vital woman feels comfortable enough with you to disclose the information required to assess her health.
∗ Very important to begin to gather & share appropriate information so that the woman can start to make decisions about her care.
∗ This is the time when you work with the woman to establish the length of gestation & assess what extra care or referrals may be required.
∗ Early pregnancy advice re folic acid, diet, drugs, smoking
∗ Options available to consider prior to booking
Presumptive signs of pregnancy
∗ Amenorrhoea / Tingling and sensitive breasts
∗ Nausea and vomiting/changes in taste
∗ Frequency of micturition 1st and 3rd trimesters
∗ Bleeding gums / Fatigue/Tiredness
∗ Increased appetite and thirst/ craving
Probable signs of pregnancy
∗ Softening of the cervix and vagina (Hegars sign)
∗ Increased blood flow to vagina and cervix causing bluish discolouration (Jacquemiers sign)
∗ Enlarged abdomen
∗ HcG in urine
∗ Tingling & sensitive breasts
∗ Increased appetite & tiredness
Positive signs of pregnancy
∗ Fetal heart heard
∗ Fetal parts felt
∗ Confirmed ultrasound scan
Why is dating of the pregnancy so important to the woman and her carers? Social & Cultural significance?
Having a "due date" allows the woman to: ∗ plan place of birth, ∗ arrange ongoing support, ∗ organise maternity leave, ∗ apply for maternity benefit ∗ prove paternity for issues of legitimacy and inheritance.
Why is dating of the pregnancy so important to the woman and her carers? Obstetric reasons?
∗ allows monitoring of the health of the baby,
∗ allows planning for induction of labour,
∗ provides markers for tests and interventions such as elective cesarean section or even termination of pregnancy.
∗ supports record keeping for example rates of premature labour and birth.
What information should you obtain from the woman to enable you to date the pregnancy and estimate date of birth?
∗ Identify & record first day of LMP if known as early as possible LMP sure/unsure
∗ ask if it was a normal period in timing, length and volume
∗ ask about the normal mesntrual cycle—length and regularity
∗ ask about contraceptive use prior to conception
∗ check woman’s own self-awareness of body
∗ when was pregnancy test positive, when did the woman start showing other signs ie breast tenderness, when could uterus be palpated or FHH / FMF ?
∗ Careful use of language to reinforce view of ‘incorrect’ dates or ‘overdue’
∗ Careful documentation make note of how sure woman is re LNMP, conception
∗ Discuss estimate, variability & expectations regarding the actual timing of the birth
∗ Review pregnancy signs, symptoms & experiences compare with expected dating
∗ Palpate the woman’s abdomen to compare uterine size with dates
∗ Use Modified Naegele’s rule to estimate EDB (consider using LMP
plus 283 days for a 28-day cycle)
∗ consider the option of a scan, if the woman has no idea of LMP or timing of
conception, and date-specific screening is to be undertaken; or if her uterine size is
significantly mismatched with EDB on palpation.
Identify 4 different methods of dating the pregnancy
A. Conception / Ovulation date – add 266 -268 days
B.LNMP – add 283 days
C. Signs of Pregnancy – HcG urine, frequency micturition, breast changes, fetal movements,
D. Physical exam – Hegars sign 10wks, fetal parts, fetal heart, abdo palpation
E. Scan –heart visible at 5-6 weeks, early scan more accurate between 8 – 13wks 6 days.
Describe 5 methods used to calculate a woman’s estimated date of birth (EDB)
- MATERNAL HISTORY - LNMP . Ovulation, Conception
- NAGELES RULE - Add 9 mths & 7 days to the first day LMP
- Modified NAGELES RULE – add 9mths & 7days +/- ovulation phase
- WOODS METHOD
– Primips add 1yr & subtract 2mths + 14days
– Multips Add 1yr & subtract 2mths + 18days - U/S SCAN -unsure of their conception date an ultrasound scan between 8 weeks 0 days and 13 weeks 6 days to determine gestational age
Explain Nagele’s rule and how the modified version is different
Nageles rule - All women ovulate at the same time day 14 within a 28 day cycle and taking same length of time 266days to gestate ie add 280days.
NB recent studies ie Olesen (2006) suggest LNMP +283 days
∗ Modified Nageles rule - Takes into account variations in length of time between menstruation and ovulation
Example
∗ Annie has a regular 34 day cycle her last period started 10th Aug
Add 9 months + 7 days + 6 days (34 - 28= 6) EDB: 23 May
∗ Emily has a regular 23 day cycle 1st day of her LNMP 10th August.
Add 9 months + 7 days – 5 days (28 - 23=5) EDB: 12 May
What is the current evidence based recommendations regarding the use of ultrasound scans for the purpose of dating pregnancy and estimating date of birth?
Provide information and offer pregnant women who are unsure of their conception date an ultrasound scan between 8 weeks 0 days and 13 weeks 6 days to determine gestational age, detect multiple pregnancies and accurately time fetal anomaly screening. (NICE 2007)
Olesen & Thomsen (2006) found a median gestational age at birth estimated by LMP to be 283 days, but that the 18–22 week scan was ‘the most valid method of predicting the date of birth’
What are the aims of Antenatal history taking?
∗ Review the past – reproductive, medical & social history
∗ Assess woman’s current health status – physical, emotional, social and spiritual
∗ Information sharing – basis for ongoing relationship
∗ Identify and discuss Alerting factors or risk markers
∗ Opportunity to discuss woman’s needs and wishes, culture
∗ Establish - EDB, Model of care, Place of birth, relationship, partnership
Identify the key categories of information required as part of the Antenatal history
DEMOGRAPHICS PREVIOUS PREGNANCY & REPRODUCTIVE HISTORY OBSTETRIC HISTORY PRESENT PREGNANCY FAMILY HISTORY MEDICAL HISTORY PHYSICAL HEALTH ASSESSMENT RISK MARKERS SCREENING & ASSESSMENT HEALTH PROMOTION SOCIAL & MENTAL WELL BEING PLANS FOR CARE
What is included within the initial physical assessment of the woman?
∗ Blood pressure - provide base line measurement
∗ Urinalysis & mid stream urine underlying infection/ASB
∗ Weight & Height - calculate BMI
∗ Respiratory - listen to lungs sounds
∗ Heart - checking for anomalies such as heart murmur
∗ Skeletal - checking for signs of back injury, pelvis or spine injury
∗ Teeth - gums can swell & become infected during pregnancy
∗ Breasts – check lumps, breast pigmentation
∗ Abdominal palpation - palpate the uterus
∗ Lifestyle – diet, smoking, alcohol
What antenatal screening is routinely offered to woman during the Antenatal history taking?
∗ blood group and rhesus factor ∗ rhesus and ABO antibodies ∗ full blood count ∗ syphilis ∗ hepatitis B ∗ rubella antibodies ∗ human immunodeficiency virus (HIV) ∗ gestational diabetes mellitus (GDM) ∗ asymptomatic bacteriuria early in pregnancy MSU ∗ Downs syndrome and other conditions (first-trimester maternal serum screening in combination with nuchal translucency scan, or second-trimester maternal serum screening).
Identify the four key aspects of care provided at each Antenatal visit
∗ 1. information-sharing
∗ 2. assessment and screening
∗ 3. active decision-making
∗ 4. health promotion and education
What lifestyle advice do you provide as a midwife to women in early pregnancy regarding drugs?
∗ Advise women who are pregnant or planning a pregnancy that not drinking alcohol is the safest especially in first 3 months if possible.
∗ If women choose to drink alcohol advice drink no more than 1 to 2 units 1 or 2 times pw (1 small glass wine = 1.5)
∗ Emphasise benefits of quitting smoking as early as possible in pregnancy
∗ Assess woman’s smoking status & exposure to passive smoking
∗ Offer woman & her partner information about the risks to the unborn baby associated with maternal and passive smoking
∗ Offer women who smoke referral for smoking cessation interventions such as cognitive behavioural therapy
Each AN visit offer women personalised advice on how to stop smoking & provide information about available services to support quitting, including details on when, where and how to access them
What supplements are recommended to women during early pregnancy & why?
∗ Folic acid 400mcg supplements recommended from 12 weeks before conception until end of 1st trimester
∗ Evidence supports reduced risk of neural tube defects
∗ Advise women not to take iron routinely and not before end of 1st trimester
∗ Advise women importance vitamin D intake during pregnancy & breastfeeding. Women at risk of deficiency Vid D 10 mcg per day
∗ No evidence benefit Vitamin A, C & E supplements, advise Vitamin A not to exceed 700mcg daily also liver products
∗ Iodine supplements 150mcg in certain areas
∗ Emphasise importance of well balanced diet
What information can you provide to women during pregnancy regarding the importance of diet to reduce the risk of developing anaemia?
∗ Best sources of iron are meat, fish & chicken 2 serves per day
∗ Sources of iron in foods derived from plants: legumes ie dried beans, lentil, baked beans, nuts, sunflower, sesame seeds, wholegrain breads, green leafy vegetables, dried fruit iron enriched breakfast cereals (check label), Milo & Ovaltine
∗ To increase iron absorption eat Vit C rich foods at same time ie oranges, berries, kiwifruit, broccoli, tomato, cauli, cabbage
∗ Limit Liver to 50g per day (high levels vit A harmful to fetus)
∗ Iron & calcium compete for absorption in the body
∗ Tea & Coffee affect absorption iron
∗ Cooking in iron post increases amount of iron available in food
Identify two types of psychosocial assessment and why these are undertaken.
∗ Safe Start and EPDS Assessment
∗ Complete Safe Start and Edinburgh Postnatal Depression Score (EPDS)
What are the aims of Antenatal screening during pregnancy?
∗ Enable pregnant women to make informed decisions re:care
∗ Inform, support & educate pregnant women to make healthy living choices for own wellbeing & that of their unborn baby
∗ Confirm & monitor maternal & fetal wellbeing throughout pregnancy & the postpartum period
∗ Identify risk markers for possible complications ie pre-eclampsia, GDM & intrauterine fetal growth restriction
∗ Referral for appropriate specialist consultation where necessary
Identify the main difference between routine and risk based antenatal screening?
A. Universal / Population based screening organised and evaluated on a national or state basis to meet specific criteria and is supported by government funding ie Rubella screening
B. Risk Based / Opportunistic screening arise from consultation between a health practitioner and client. The health practitioner determines that the individual may benefit from the screening activity and offers it on the basis of that assessment ie Chlamydia
What are the current recommendations regarding assessment of fetal growth and well being undertaken at each antenatal examination?
∗ Symphysis–fundal height should be measured and recorded at each antenatal appointment from 24 weeks.
∗ Ultrasound estimation of fetal size for suspected LGA unborn babies should not be undertaken in a low risk population.
∗ Routine Doppler ultrasound should not be used in low risk pregnancies
∗ Fetal presentation should be assessed by abdominal palpation at 36 weeks or later, when presentation is likely to influence the plans for the birth.
∗ Routine assessment of presentation by abdominal palpation should not be offered before 36 weeks because it is not always accurate & may be uncomfortable.
∗ Evidence does not support the routine use of antenatal electronic fetal heart rate monitoring (cardiotocography) for fetal assessment in women with an uncomplicated pregnancy and should not be offered.
∗ The evidence does not support the routine use of ultrasound scanning after 24 weeks of gestation and therefore it should not be offered
Describe the information provided to a woman during pregnancy regarding:
A. Fetal movements and how these change during pregnancy
∗ Fetal movements are usually absent during fetal “sleep” cycles. These quiet cycles occur regularly throughout the day and night and usually last 20 – 40 minutes.
∗ They rarely exceed 90 minutes in the normal, healthy fetus.
∗ Fetal movements change during pregnancy and especially in last month – important to remain aware and notice patterns
∗ As a rule when the baby is awake if there are less than 10 movements felt in 2 hours woman contact health care provider.
∗ Maternal concern of DFM overrides any definition of DFM based on numbers of fetal movements.
