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Prenatal Care, Assessment and Screening

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

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Prenatal Care, Assessment and Screening

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

  2. 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

  3. 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

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

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

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

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

  8. Pregnancy Dating Dating: • LMP (last menstrual period) • Certainty of dates, regular cycle • Naegle’s rule: June 8th, 2011 + 7 days = June 15th, - 3 months = March 15th 2012 EDB • Ultrasound (SOGC) • 1st trimester ultrasound between 11 and 14 weeks • Use 1st trimester U/S If > 5 days difference between U/S and LMP • Use 2nd 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

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

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

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

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

  13. 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

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

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

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

  17. Bleeding First Trimester • Implantation • Infection • Miscarriage

  18. Bleeding Second Trimester • Placental abruption • Placenta previa

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

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

  21. Smoking • Motherisk: • 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.php

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

  23. Substance Use PRIMA(Pregnancy-Related Issues in the Management of Addictions)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

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

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

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

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

  28. Physical Assessment:Body Mass Index

  29. Maternal Pre-pregnancy BMINSAPD 2010

  30. 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

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

  32. Abuse in Pregnancy • Prevalence • Assessing • Intervention • Resources: http://www.cdc.gov/reproductivehealth/violence/IntimatePartnerViolence http://sogc.org/guidelines/intimate-partner-violence-consensus-statement

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

  34. Genetic Screening

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

  36. First Prenatal Visit

  37. 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-testing

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

  39. 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 http://rcp.nshealth.ca/publications/nova-scotia-prenatal-record-companion-document

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

  41. 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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