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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 - PowerPoint PPT Presentation
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Prenatal Care, Education and Screening
Prenatal Care,Assessment and ScreeningMaternal Newborn Orientation Learning ModuleJuly 2012
1ObjectivesOn 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
IntroductionTo 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
4
Nova Scotia Prenatal Record 1DemographicsPregnancy DatingObstetrical HistoryProblems/Comments/ReferralsPresent PregnancyPast Illnesses
5
6DemographicsRace/Ethnicity:Genetic ScreeningCulturally Competent Carehttp://www.gov.ns.ca/health/primaryhealthcare/diversity.asp
7Nova Scotia Prenatal Record 1DemographicsPregnancy DatingObstetrical HistoryProblems/Comments/ReferralsPresent PregnancyPast Illnesses
8
Why is this so important?How do I do this?
9Pregnancy DatingDating:LMP (last menstrual period)Certainty of dates, regular cycleNaegles rule: June 8th, 2011 + 7 days = June 15th, - 3 months = March 15th 2012 EDBUltrasound (SOGC)1st trimester ultrasound between 11 and 14 weeksUse 1st trimester U/S If > 5 days difference between U/S and LMPUse 2nd trimester U/S if > 10 days difference between U/S and LMPGestational age should be determined by the earliest ultrasound
http://www.sogc.org/guidelines/documents/gui214CPG0809.pdf
10Nova Scotia Prenatal Record 1DemographicsPregnancy DatingObstetrical HistoryProblems/Comments/ReferralsPresent PregnancyPast Illnesses
11Obstetrical HistoryPain preferencesConfidence or fearEducation, support, individualized care
12Nova Scotia Prenatal Record 1DemographicsPregnancy DatingObstetrical HistoryProblems/Comments/ReferralsPresent PregnancyPast Illnesses
13Present PregnancyDepression/AnxietyBleeding RhSmokingAlcohol & substance use
14Present PregnancyDepression Stage 1 & 2http://www.bcwomens.ca/NR/rdonlyres/483927DE-698E-42A7-89E5-6E7080D6ABA9/18624/Perinatal_Brochure1.pdf Bleeding RhSmokingAlcohol and substance use
15Depression: Stage 1AskingEducatingHistory of depressionSubstance use
16Depression: Stage 2Screening for all women using EPDS http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf Education, emotional and practical supportDiagnostic assessment and treatmentImmediate intervention
17Present PregnancyDepression/AnxietyBleeding RhSmokingAlcohol & substance use
18BleedingFirst TrimesterImplantationInfectionMiscarriage
19BleedingSecond Trimester
Placental abruption
Placenta previa
20Rh Program of NS: http://rcp.nshealth.ca/rh Telehealth: http://videtis.ucis.dal.ca/MedIT/RHTeleH2010-05-10.wmv
21Present PregnancyDepression/AnxietyBleeding RhSmokingAlcohol & substance use
22SmokingMotherisk: 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
23Present PregnancyDepression/AnxietyBleeding RhSmokingAlcohol & substance use
24Substance UsePRIMA (Pregnancy-Related Issues in the Management of Addictions) www.addictionpregnancy.ca Provincial Alcohol Strategy - FASDhttp://www.motherisk.org/women/alcohol.jsp
25TPTL Threatened Preterm LabourPredicting Preterm LabourfFNCervical lengthDigital examination
Audibert et al., JOGC April 2010
Nova Scotia Prenatal Record 1DemographicsPregnancy DatingObstetrical HistoryProblems/Comments/ReferralsPresent PregnancyPast Illnesses
27Past IllnessesAcute and Chronic IllnessesPhysiological and emotional componentsExperiences of hospitalizationsPainFearHealth care providers
28Nova Scotia Prenatal Record 2Physical Assessment BMIPsychosocial/Environmental FactorsPrenatal Genetic ScreeningEducation/Discussion
Physical Assessment:Body Mass Index
30Maternal Pre-pregnancy BMINSAPD 2010
31Maternal BMI and Weight GainBMI 29:15 lbsHealth Canada Gestational Weight Gain Recommendations: http://www.hc-sc.gc.ca/fn-an/nutrition/prenatal/qa-gest-gros-qr-eng.php
32Nova Scotia Prenatal Record 2Physical Assessment BMIPsychosocial/Environmental FactorsPrenatal Genetic ScreeningEducation/Discussion
33Abuse in PregnancyPrevalenceAssessingInterventionResources:http://www.cdc.gov/reproductivehealth/violence/IntimatePartnerViolence/sld011.htm#12 http://www.sogc.org/health/health-ipv_e.asp
34Nova Scotia Prenatal Record 2Physical Assessment BMIPsychosocial/Environmental FactorsPrenatal Genetic ScreeningEducation/Discussion
35Genetic Screening
36
Guidelines for Antenatal Laboratory Screening and Testing -RCP July 2007
37
First Prenatal Visit
38Guidelines for Genetic Screening and TestingScreening:Maternal Serum Testing (MST)Integrated Maternal Serum Testing (IMST)Early Pregnancy Review (EPR)Diagnostic UltrasoundDiagnostic TestsCVS and amniocentesisEthical considerationsRCP: http://rcp.nshealth.ca/clinical-practice-guidelines/antenatal-laboratory-screening-testing
39Nova Scotia Prenatal Record 2Physical Assessment BMIPsychosocial/Environmental FactorsPrenatal Genetic ScreeningEducation/Discussion
Education/DiscussionPrenatal educationPhysical and emotional well-beingBreastfeedingPlans for Labour and BirthNewborn screeningCord blood bankingRCP Prenatal Record Companion Document http://rcp.nshealth.ca/sites/default/files/resources-reports/pnr_comp_doc_july2007.pdf
41Prenatal Record: Relevance to Nursing careIndividualized nursing careEducation and supportReferralsResources
42Questions and Comments?We welcome your feedback. Please click on this link to complete a quick evaluation form: http://rcp.nshealth.ca/education/learning-modules/evaluationPlease contact one of the Perinatal Nurse Consultants with RCP at:rcp@iwk.nshealth.ca
THANK YOU!
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