Week 3: Maternal adaptations, minor conditions during pregnancy and antenatal care. The Growing fetus & screening in pregnancy Flashcards
What are the key principles/rights for a women in a health assessment?
▪ Right to privacy & respect (of information and the setting she is in)
▪ Right to accurate explanations, informed decisions and the option of alternative treatments
▪ Right to decline (not refuse)
▪ Taking great history forms initial part of overall assessment
▪ Systematic (to ensure we don’t miss anything)
▪ Evidenced based
▪ Culturally safe
These underpin every action in midwifery
Briefly overview what a midwifes role is in antenatal care?
▪ Find out what is important to the woman
▪ Take an antenatal history and perform a physical assessment
▪ Education
▪ Health promotion
▪ Develop professional partnership with woman
▪ Assist with informed choices with evidence
based information
▪ Recognise complications & consult or refer
appropriately
▪ Document
What are the objectives for an initial or booking an appointment?
Prior to this they have only likley had a GP app
▪ Health assessment
▪ Baseline vital signs
▪ Identify risk-factors (medical/obstetric/social)
▪ Identify education needs
▪ Establishment of professional relationship
▪ Provide opportunities for questions
Why is communication so important in midwifery?
It is key in women centered care.
Birth verbal and non verbal communication can change how the women and her support people feel.
Do do this, midwifes;
▪ Language (use, non judgmental and women centred without any tone or bais)
▪ Privacy & Confidentiality
▪ Listening skills
– attentive
– non verbal responses & body language
– reflecting back key words
▪ Style
– conversational or a checklist approach
– Open-ended statements
▪ Accurate documentation & appropriate storage of notes
How can privacy be upheld?
▪ Privacy, avoid interruptions & distractions
(woman-centred care)
▪ Comfort (temp, seating, bed is at the right height)
▪ Noise levels
▪ safety- is someone near by for you and for the woman (you sit closer to the door)
▪ Equipment necessary
▪ Paperwork necessary
Explain the principles of disclosure during pregnancy care
Midwifery care is based on information sharing we as are experts in midwifery and the women is expert in her body and life.
▪ Partnership is about equality
▪ Sometimes it’s appropriate for the midwife to share
something of herself, others it is not as information
should be evidence based
▪ The midwife should not:
– hold themselves up as a role model
– impose values and cultural practices
– generalise her experiences to all women
– be judgmental
What is carried out in the initial assessment?
▪ Discuss pregnancy care options – models of care
▪ Assess comorbidities - referral
▪ Ultrasounds
▪ Previous pregnancy care – attended GP, pathology attended
▪ Identify pathology required
▪ Discuss mental health
▪ Discuss symptoms and common disorders of pregnancy
▪ Discuss other issues that may affect health and wellbeing during pregnancy
▪ e.g. smoking, alcohol, prescription and over-the-counter medicines,
nutritional supplements, domestic violence and oral health
▪ Ask about concerns
In the initial visit, what history and physical examinations should be undertaken?
Review history
▪ Health and maternity history and current wellbeing.
▪ Estimate due date (EDD)
▪ Review early ultrasound if available.
▪ Review results if screening tests have been performed
Perform examination – Full assessment including: ▪ Vital signs ▪ Body mass index (BMI) ▪ Weight ▪ Urine ▪ Psycho-social
What are the models of care? (Victoria)
A women can choose any model of care they are eligible for;
▪ Midwifery-led care (public hospital)
▪ Continuity of midwifery care program
– Team
– Caseload (allocated to 1 specific midwife and is on call when she has her baby)
– MGP (midwifery group practice)
▪ Private midwife (some do home birth, some not)
▪ Private midwife shared care
▪ Home-birth
▪ GP shared-care
▪ Obstetric-led care (public hospital)
▪ Private Obstetrician in a private hospital
What are some base line investigations that should be done early in pregnancy/at booking in?
Guides vitamin and other recommendation
▪ Blood group and antibody screen
▪ Full blood examination (FBE)
▪ Screening for haemoglobinopathies
– Hb electrophoresis, ferritin and DNA analysis (if indicated)
▪ Vitamin D screening (above 75)- sups and sunshine
▪ Diabetes testing
– All women have a random blood glucose (RBG) as a minimum
– Oral Glucose Tolerance Test (OGTT) is recommended at 26 – 28 weeks or earlier for women
with previous GDM or other risk factors (such as an elevated RBG.
▪ Screening for infections in pregnancy
– Rubella immunity
– Syphilis (TPHA)
– Hepatitis B surface antigen
– Hepatitis C antibodies
– HIV (Human Immunodeficiency Virus)
– Asymptomatic bacteruria - mid-stream urine for microscopy, culture and sensitivity
– ? Chlamydia
▪ Aneuploidy screening
▪ Early ultrasound for dating and to detect multiple pregnancies
What are some lifestyle consideration related information should be provided?
▪ Nutrition, diet, and discussion of a healthy weight gain according to initial BMI. (baby, BMI and stores intentionally put on by body is normal)
▪ Pregnancy multivitamin including folic acid and iodine supplementation.
▪ Smoking behaviour / cessation (offer contacts and information as appropriate).
▪ Low dose aspirin if moderate or high risk for pre-eclampsia and under 16 weeks gestation.
▪ Oral and dental health.
▪ Implications of recreational drug use and alcohol consumption.
▪ Vaccinations (pertussis/influenza/Covid19)
▪ Psychosocial assessment.
▪ Breastfeeding information.
What categories of information is involved in an antenatal history?
General ▪ Social ▪ Medical/surgical history ▪ Menstrual ▪ Obstetric history ▪ Family History ▪ Pregnancy progress
what general information is gathered in an antenatal history?
▪ Demographics- where r u having the baby and can u get there? ▪ Next of kin ▪ Model of care ▪ G.P. ▪ Exercise ▪ Diet ▪ Allergies
What medical information is gathered in an antenatal history?
Medical disorders – Diabetes, hypertension, asthma, epilepsy.. ▪ Operations / anesthetic complications ▪ Mental illness – Depression, anxiety ▪ Medications (GA) ▪ Gynecological – incontinence / bleeding / pap smear ▪ Allergies ▪ Blood Group
What social information is gathered in an antenatal history?
▪ Family supports / issues
▪ Special needs – young woman, illicit drug use
▪ Financial issues – unemployment, young woman
▪ Cultural background – specific needs
▪ Environmental factors – living conditions
▪ Teratogens – alcohol, smoking, illicit drugs
What family history is gathered in an antenatal history?
Those directly related to her or the baby father ▪ Previous fetal abnormalities – Down syndrome, hip dysplasia… ▪ Familial diseases on paternal side ▪ Familial diseases on maternal side
What obstetric history is gathered in an antenatal history?
Estimated date of birth ▪ Number of pregnancies (Gravidity/Gravida) ▪ Number of births (Parity/Para) ▪ Previous pregnancies - details ▪ Menstrual history ▪ Estimate date of birth ▪ Regular cycle ▪ Use of contraceptives ▪ IVF
Previous pregnancies
▪ Number of pregnancies = gravida
▪ Number of (viable) babies = para
▪ Date / gestation / place of birth
▪ Was the pregnancy normal?
▪ Was the labour spontaneous / induced / normal
▪ Interventions?
▪ Complications such as high blood pressure / bleeding /
tears / infection etc
▪ Was the baby born in good condition
▪ Baby details sex / weight / method of feeding / A&W now
▪ Miscarriages / Terminations of Pregnancy (TOP)
What does LUSC stand for?
Lower Uterine Section Caesarean Section
What does LNMP stand for?
Last Normal Menstrual Period
Para=
Para ~ number of viable births (>20 weeks)
What is a grand multi
someone who has had more than 5 babys.
What is occurred out at every antenatal app?
▪ Blood Pressure
– normal range 100/60 - 140/90mmHg
Expected to drop in early pregnancy as progesterone causes BP to drop- BP= really good way tp measure placental blood pressure. If womens BP is high their is likleyhood that placenta has high BP and therefore baby isn’t getting what it needs.
▪ FH and /or movements (once they start= they should not stop! if they arent getting enough blood they will stop extra expendature= stop moving limbs)
▪ normal FH range 110 – 160 bpm
▪ Abdominal examination
– normal growth – after 20 weeks 1cm per wk
– presentation
▪ Urine dipstick – if indicated
▪ ? Weight
▪ Assessment of emotional wellbeing
▪ Provide relevant appointment information depending on gestation
▪ Allow time for questions/discussion
What are some normal discomforts during pregnancy?
▪ Reassurance of normal physiological changes
▪ Identify and offer strategies to manage normal discomforts
associated with healthy pregnancy
Discomforts: – Nausea & vomiting – Backache – Tiredness – Leg cramps – Heartburn – Headache – Constipation – Hemorrhoids – Varicose veins – Vaginal discharge – Emotional instability
