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

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Presentation on theme: "Prenatal Care, Assessment and Screening Maternal Newborn Orientation Learning Module July 2012."— Presentation transcript:

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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 & 3) –Guidelines for Antenatal Screening & Testing (card) These may be available on your unit or can be downloaded from: http://rcp.nshealth.ca/chart-prenatal-forms/nova-scotia-prenatal-record http://rcp.nshealth.ca/clinical-practice-guidelines/antenatal-laboratory-screening-testing

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

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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 –Naegle’s 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.phac-aspc.gc.ca/mh-sm/preg_dep-eng.php 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 SOGC Guideline http://sogc.org/guidelines/alcohol-use-and- pregnancy-consensus-clinical-guidelines

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/ewba-mbsa-eng.php http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/ewba-mbsa-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 http://sogc.org/guidelines/intimate-partner-violence-consensus-statement

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/publications/nova-scotia-prenatal-record-companion-document

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 short 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 !


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