L2 Antenatal Care

Suggest the advantages of early care (4)

Reduce risk factors that might affect future pregnancies

1. Rule out heredity problems

2. Better birth outcomes

3. Better adaption to new roles

4. Population control, economical impact

Suggest the preconception state preparation (7)

1. Premarital counselling

2. disease screening and treatment

3. Vaccination (e.g. Rubella, aka german measles)

4. Restrict use of harmful substances (e.g. formaldehyde, asbestos)

5. Plan regular health checkups

6. Ensure a healthy lifestyle

7. Take prescribed supplements e.g. FeSO4, folic acid

Suggest the early signs for pregnancy (6)

1. Amenorrhea

2. Nausea & vomiting

3. Increased vaginal discharge

4. Bloating in abdomen

5. Frequent urination

6. Swelling breasts, tingling in nipples, visible veins in breasts

Suggest the late signs for pregnancy (3)

1. Pigmentation —> linea nigra, striae

2. Quickening, palpation of fetal parts

3. Enlargement of abdomen

Evidence / how to check pregnancy (4)

• HCG in morning urine

  • Be careful of the sensitivity of test kits, and e.g. Cancer —> may have high HCG level too

  • Most accurate when taken a week after missed period

• Visible fetal sac by ultrasound

• Fetal heart sound

• Fetal movement

Suggest the nutritional needs during pregnancy from 1st to 3rd trimester

• Cheese, orange, tomato, salmon, rice, vegetables…

What is the calorie intake recommended for Pregnancy ?

• Calorie intake (no need double, but more than normal)

What is the reference weight gain during pregnancy in different trimester ?

• 1st trimester: 1.6-2.3 kg gain [0.13-0.19/week]

• 2nd & trimester: 5.5-6.8 kg gain [0.46-0.57/week]

What is the purpose and benefits of rest & exercise in pregnancy ? (7)

1. Reduce discomfort during pregnancy

2. Improve blood circulation

3. Improve tone & elasticity of muscles

4. Improve flexibility of legs & spine

5. Reduce and prevent back pain

6. Reduce tension and anxiety in labour

7. Provide higher O2 level in blood for the fetus

Suggest the hygiene practice in pregnancy (3)

• Prevent public tub-bath

• Risk of fall

• Vulnerable to vaginal infection

Precaution of sex during pregnancy.

• Change in positions

  • Avoid putting pressure on the belly

  • Avoid lying flat on the back

• Ensure safe, get clearance from doctor

Aims of antenatal care (9)

• To educate pregnant woman for birth preparedness and complication readiness

1. To promote, protect & maintain health of the mother during pregnancy

2. To detect ‘high risk cases & provide special attention

3. To foresee complication & advocate prevention

4. To detect and treat existing medical & obstestrics problems

5. To reduce maternal & infant mortality & morbidity

6. To prepare pregnant women & their families for the changes

7. To reduce fear & anxiety associated with pregnancy & delivery

8. To educate the mother on childcare, nutrition, personal hygiene & environmental sanitation

9. To sensitize the mother to the need for family planning

What are the components of antenatal care ? (6)

1. Antenatal visits

2. Specific health protection

3. Mental preparation

4. Prenatal and postnatal advice

5. Newborn care

6. Family planning

What will be done during the 1st antenatal check-up as soon as pregnancy is suspected ? (7)

1. Confirmation of pregnancy (e.g. urine examination, test kit)

2. Blood tests, urine test

3. Know the expected date of confinement

4. History taking

5. Physical examination (general, reproductive system)

6. Antenatal education

7. Book visits

List the details history taking as investigations for maternal health. (5)

1. Menstrual history (PMP)

2. Medical history

3. Family history (e.g. Job of both mum dad)

4. Sociobiological background

5. Obstetric history

How to calculate the expected date of confinement ?

Nagele’s rule

= LMP -3 months + 7 days = EDC

---

First day of LMP = July 20

Subtract 3 months = April 20

Add 7 days EDC = April 27 (next year)

What are the abbreviations means in gestational history ?

• G = Gravidity 懷孕,

• P = Parity 生過,

• A = Abortion

How to conduct vaginal examination ?

• Use speculum to visualize cervix for discharge or bleeding and os status

• Cervical cytology

  • Rule out pre-exit treatable gynaecological problem

When will conduct CBC Blood tests in antenatal visit ?

CBC is a routine test in first visit and repeated in the 26th week and 34th week of gestation

The normal range of Hb levels during pregnancy is ?

10.5 - 15.0

• Nursing response: evaluate women for problems due to decreased O2 carrying capacity cuased by anemia

Non-pregnant —> 11.5-16.0

Describe the change of CBC (plasma volume, Hb, Hematocrit) during pregnancy.

• Falling hemoglobin & hematocrit (PCV) due to haemodilution

• Rising blood volume & RBC mass

What is Coomb’s test ? Explain it’s significant for pregnant women.

a blood test that detects antibodies against red blood cells (RBCs), which can cause their destruction.

• It is use to test on Rh-ve women to detect any previous Rh+ve exposure, for example Rh-ve mom used to carry a Rh+ve fetus.

• The (Rh-ve) women does not have Rh antigen but may develop Anti-Rh antibody upon exposure to Rh antigen (in her 1st pregnancy), which may severely affect her future pregnancies if fetus is Rh+ve

How to prevent hemolytic reaction of newborn ?

• Inject Rh immunoglobulin into mother and it conceal fetal Rh+ factor (ie. Inactivate fetal Rh antigen), so it does not stimulate immune response (ie. Mum’s anti-Rh antibody not contact to Fetal Rh+ve)

Suggest and explain two venereal (sex) diseases that might pose significant health risks to unborn infants

• Syphilis

• Gonorrhea

Explain why need to test for rubella antibodies ?

For those who are pregnant and rubella non-immune:

• Need to test for rubella titre (how many antibody) —> advise to avoid contact with rubella

• If contacted in early pregnancy, fetal abnormalities may occur

Explain the purpose of testing hepatitis for pregnancy women.

• If hep B surface antigen positive in mother, woman’s baby have to receive Hepatitis immunoglobulin injection within 24 hours after birth

What is the problem of HIV in pregnancy and how to solve it ?

• AIDS may transfer to fetus through breast milk, or perinatal transmission

  • Voluntary screening & preventive measures

List the blood tests for pregnancy (7)

1. CBC

   • Hb, Mean cell volume

2. Blood group, Rh factor

3. Venereal disease (Syphilis, Gonorrea)

4. Rubella antibodies

   • ** MMR vaccine not recommended during pregnancy, so only monitoring

5. Hepatitis B

6. AIDS (aka HIV antibodies)

7. Glucose

   • Or urinalysis for protein & glucose

What is Bimanual pelvic examination ? How often to be done ?

Insert the finger into the vagina + press on the uterus:

To be done in early pregnancy:

• To estimate the size of uterus

• Detect pelvic abnormality

In late pregnancy

• Pelvic assessment NO longer routinely

Done at 36 weeks

• To rule out cephalo-pelvic disproportion only

  • Baby’s head too big / vagina too small —> childbirth complication

State the different stage of USG checkups.

• ~6-10 weeks: Estimated date of delivery

• ~11-14 weeks: Genetic abnormality screening

• ~18-20 weeks: Morphology

What will be assess to check fetal health ?

• Fetal movement (FM)

• Fetal heart rate (FHR)

• Fetal growth

• Prenatal diagnostic test

Suggest the gestational routine other examination.

• 10-24 weeks

  • Antenatal blood investigation

  • (11-19) Prenatal screening for Down syndrome

• 24-28 weeks

  • Oral glucose test

• 26-34 weeks

  • Pertussis 百日咳 vaccination

• 35-37 weeks

  • Group B streptococcus screening test