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

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Presentation transcript:

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

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

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:

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

Demographics Race/Ethnicity: Genetic Screening Culturally Competent Care

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

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

Pregnancy Dating Dating: LMP (last menstrual period) –Certainty of dates, regular cycle –Naegles rule: June 8 th, 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

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

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

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

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

Present Pregnancy Depression – Stage 1 & 2 6E7080D6ABA9/18624/Perinatal_Brochure1.pdf Bleeding – Rh Smoking Alcohol and substance use

Depression: Stage 1 Asking Educating History of depression Substance use

Depression: Stage 2 Screening for all women using EPDS edinburghscale.pdf edinburghscale.pdf Education, emotional and practical support Diagnostic assessment and treatment Immediate intervention

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

Bleeding First Trimester Implantation Infection Miscarriage

Bleeding Second Trimester Placental abruption Placenta previa

Rh Program of NS: –Telehealth:

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

Smoking Motherisk : – Public Health Agency of Canada : –

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

Substance Use PRIMA (Pregnancy- Related Issues in the Management of Addictions) Provincial Alcohol Strategy - FASD

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

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

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

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

Physical Assessment: Body Mass Index

Maternal Pre-pregnancy BMI NSAPD 2010

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:

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

Abuse in Pregnancy Prevalence Assessing Intervention Resources:

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

Genetic Screening

Guidelines for Antenatal Laboratory Screening and Testing -RCP July 2007

First Prenatal Visit

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: –

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

Prenatal education –Physical and emotional well-being Breastfeeding Plans for Labour and Birth Newborn screening Cord blood banking RCP Prenatal Record Companion Document reports/pnr_comp_doc_july2007.pdf reports/pnr_comp_doc_july2007.pdf

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

Questions and Comments? We welcome your feedback. Please click on this link to complete a quick evaluation form: Please contact one of the Perinatal Nurse Consultants with RCP at: THANK YOU !