2. Prenatal Care, Assessment and Screening Maternal Newborn Orientation Learning Module July 2012

3. Objectives On completion of this module, learners will: Describe the basic elements of antenatal assessment and screening as identified in the Nova Scotia Prenatal Record 1 & 2 Explain the relevance of this information to nursing care of the antepartum woman and family Identify key resources for care providers working with the perinatal population

4. Introduction To get the most out of this module, please refer to the following documents: –The Nova Scotia Prenatal Record (1 & 2) –Guidelines for Antenatal Screening & Testing (card) These may be available on your unit or can be downloaded from: http://rcp.nshealth.ca/resources-reports/nova-scotia-prenatal-record

6. Nova Scotia Prenatal Record 1 Demographics Pregnancy Dating Obstetrical History Problems/Comments/Referrals –Present Pregnancy –Past Illnesses

8. Demographics Race/Ethnicity: Genetic Screening Culturally Competent Care http://www.gov.ns.ca/health/primaryhealthcare/diversity.asp

9. Nova Scotia Prenatal Record 1 Demographics Pregnancy Dating Obstetrical History Problems/Comments/Referrals –Present Pregnancy –Past Illnesses

10. Why is this so important? How do I do this?

11. Pregnancy Dating Dating: LMP (last menstrual period) –Certainty of dates, regular cycle –Naegles rule: June 8 th, 2011 + 7 days = June 15 th, - 3 months = March 15 th 2012 EDB Ultrasound (SOGC) –1 st trimester ultrasound between 11 and 14 weeks –Use 1 st trimester U/S If > 5 days difference between U/S and LMP –Use 2 nd trimester U/S if > 10 days difference between U/S and LMP –Gestational age should be determined by the earliest ultrasound http://www.sogc.org/guidelines/documents/gui214CPG0809.pdf

12. Nova Scotia Prenatal Record 1 Demographics Pregnancy Dating Obstetrical History Problems/Comments/Referrals –Present Pregnancy –Past Illnesses

13. Obstetrical History Pain preferences Confidence or fear Education, support, individualized care

14. Nova Scotia Prenatal Record 1 Demographics Pregnancy Dating Obstetrical History Problems/Comments/Referrals –Present Pregnancy –Past Illnesses

15. Present Pregnancy Depression/Anxiety Bleeding – Rh Smoking Alcohol & substance use

16. Present Pregnancy Depression – Stage 1 & 2 http://www.bcwomens.ca/NR/rdonlyres/483927DE-698E-42A7-89E5- 6E7080D6ABA9/18624/Perinatal_Brochure1.pdf Bleeding – Rh Smoking Alcohol and substance use

17. Depression: Stage 1 Asking Educating History of depression Substance use

18. Depression: Stage 2 Screening for all women using EPDS http://www.fresno.ucsf.edu/pediatrics/downloads/ edinburghscale.pdf http://www.fresno.ucsf.edu/pediatrics/downloads/ edinburghscale.pdf Education, emotional and practical support Diagnostic assessment and treatment Immediate intervention

19. Present Pregnancy Depression/Anxiety Bleeding – Rh Smoking Alcohol & substance use

20. Bleeding First Trimester Implantation Infection Miscarriage

21. Bleeding Second Trimester Placental abruption Placenta previa

22. Rh Program of NS: http://rcp.nshealth.ca/rh http://rcp.nshealth.ca/rh –Telehealth: http://videtis.ucis.dal.ca/MedIT/RHTeleH2010-05-10.wmvhttp://videtis.ucis.dal.ca/MedIT/RHTeleH2010-05-10.wmv

23. Present Pregnancy Depression/Anxiety Bleeding – Rh Smoking Alcohol & substance use

24. Smoking Motherisk : – http://www.motherisk.org/prof/updatesDetail.jsp?content_id=975 http://www.motherisk.org/prof/updatesDetail.jsp?content_id=975 Public Health Agency of Canada : – http://www.phac-aspc.gc.ca/hp-gs/guide/05_sp-tg-eng.phphttp://www.phac-aspc.gc.ca/hp-gs/guide/05_sp-tg-eng.php

25. Present Pregnancy Depression/Anxiety Bleeding – Rh Smoking Alcohol & substance use

26. Substance Use PRIMA (Pregnancy- Related Issues in the Management of Addictions) www.addictionpregnancy.ca www.addictionpregnancy.ca Provincial Alcohol Strategy - FASD http://www.motherisk.org/women/alcohol.jsp

27. TPTL – Threatened Preterm Labour Predicting Preterm Labour fFN Cervical length Digital examination Audibert et al., JOGC April 2010

28. Nova Scotia Prenatal Record 1 Demographics Pregnancy Dating Obstetrical History Problems/Comments/Referrals –Present Pregnancy –Past Illnesses

29. Past Illnesses Acute and Chronic Illnesses –Physiological and emotional components Experiences of hospitalizations –Pain –Fear –Health care providers

30. Nova Scotia Prenatal Record 2 Physical Assessment – BMI Psychosocial/Environmental Factors Prenatal Genetic Screening Education/Discussion

31. Physical Assessment: Body Mass Index

32. Maternal Pre-pregnancy BMI NSAPD 2010

33. Maternal BMI and Weight Gain BMI<20: 28 to 40 lbs BMI 20-27:25-35 lbs BMI 27-29:15-25 lbs BMI > 29:15 lbs Health Canada –Gestational Weight Gain Recommendations: http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/qa-gest-gros-qr-eng.php http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/qa-gest-gros-qr-eng.php

34. Nova Scotia Prenatal Record 2 Physical Assessment – BMI Psychosocial/Environmental Factors Prenatal Genetic Screening Education/Discussion

35. Abuse in Pregnancy Prevalence Assessing Intervention Resources: http://www.cdc.gov/reproductivehealth/violence/IntimatePartnerViolence/sld011.htm#12 http://www.sogc.org/health/health-ipv_e.asp

36. Nova Scotia Prenatal Record 2 Physical Assessment – BMI Psychosocial/Environmental Factors Prenatal Genetic Screening Education/Discussion

37. Genetic Screening

38. Guidelines for Antenatal Laboratory Screening and Testing -RCP July 2007

39. First Prenatal Visit

40. Guidelines for Genetic Screening and Testing Screening: Maternal Serum Testing (MST) Integrated Maternal Serum Testing (IMST) Early Pregnancy Review (EPR) Diagnostic Ultrasound Diagnostic Tests CVS and amniocentesis Ethical considerations RCP: –http://rcp.nshealth.ca/clinical-practice-guidelines/antenatal-laboratory-screening-testinghttp://rcp.nshealth.ca/clinical-practice-guidelines/antenatal-laboratory-screening-testing

41. Nova Scotia Prenatal Record 2 Physical Assessment – BMI Psychosocial/Environmental Factors Prenatal Genetic Screening Education/Discussion

42. Prenatal education –Physical and emotional well-being Breastfeeding Plans for Labour and Birth Newborn screening Cord blood banking RCP Prenatal Record Companion Document http://rcp.nshealth.ca/sites/default/files/resources- reports/pnr_comp_doc_july2007.pdf http://rcp.nshealth.ca/sites/default/files/resources- reports/pnr_comp_doc_july2007.pdf

43. Prenatal Record: Relevance to Nursing care Individualized nursing care Education and support Referrals Resources

44. Questions and Comments? We welcome your feedback. Please click on this link to complete a quick evaluation form: http://rcp.nshealth.ca/education/learning-modules/evaluation Please contact one of the Perinatal Nurse Consultants with RCP at: rcp@iwk.nshealth.ca THANK YOU !