THE BEGINNING FAMILY Part1 Maternal & Child Health NursingAntenatal CareOBJECTIVES

At the end of the lecture session students will be able to:

1. Define key terms related to normal pregnancy, antenatal care, pregnancy, gestation, lie, position, attitude, presentation, engagement. 2. Explain the purpose of ante natal care3. State the aim and objectives of Ante-Natal Care

4. Outline the Nursing Goal in caring for the pregnant woman during ante natal period. 5. List the routine tests & investigations done in pregnancy 6. Outline the frequency of visits7. Identify pre-natal danger signals and their management 8. Describe the nursing management of a pregnant woman9. Discuss the nursing responsibility to the fetus (unborn child) OBJECTIVE 1: INTRODUCTION/definitions Antenatal care: is a planned programme of observation, education, medical and obstetric management of the pregnant woman aimed at making pregnancy and delivery a safe and satisfying experience. ANC is Health care & supervision given to a woman during gestation to onset of labour and delivery. Pregnancy: The condition of having a developing embryo or fetus within the body. The state from conception to delivery of the fetus and products of conception

Gestation Period: 40 weeks from the 1st day of the last normal menstrual period or 38 weeks from the date of conception.

Maternal/Antenatal & Postnatal Care: Consists of care of the pregnant woman; a safe labour and delivery; care & examination of the woman during the postnatal period; maintenance of lactation; care of the newborn baby.

Lie: this is the relationship of the long axis of the fetus to the long axis of the mothers uterus. The normal lie is longitudinal.

Presentation: this refers to the part of the fetus that lies lowest in the birth canal. The normal presentation is vertex.

Attitude: it is the relationship of the fetal limbs and head to its trunk. It is normally flexion.

Position: it is the relationship of the presentation to the 4 quadrants of the pelvic brim.

Engagement: head is said to be engaged when the greatest circumference of the head has passed through the brim.

OBJECTIVE 2: PURPOSE OF ANCIts broad purpose of ante natal care is to ensure that a live, healthy child is born to the mother without harm to her in anyway, physically, psychologically and that wherever possible she is enriched by the experience.

OBJECTIVE 3: AIM OF ANC

1. To promote and maintain good physical and mental health during pregnancy (health promotion and education coupled with good nutrition)2. To ensure a mature life and healthy infant (avoidance of unprescribed drugs, systemic infections that could bring about congenital abnormalities).3. To prepare the mother for labour, lactation, and subsequent care of her child from physical, psychological, social and educational points of views.4. To detect early and treat promptly conditions that is whether medical, surgical and obstetrical that can endanger the life of the mother and or baby.OBJECTIVES OF ANTE NATAL CARE1. Assist the pregnant woman to promote and maintain good physical and mental health during pregnancy. 2. Work effectively with other members of the health team in delivering care to pregnant women and their families in meeting their basic needs.3. Prepare the pregnant woman for labour, lactation and care of her child from a physical, psychological, social and educational perspectiveOBJECTIVE 4: NURSING GOALS

Nursing Goals: are two-fold: to provide physiological & psychological care A) Physiological Care: 1. To alert women/clients to the symptoms that indicates deviations from normal progress & the guidelines for reporting them. 2. To provide clients with relevant knowledge of the adaptation of the maternal body to the developing foetus; 3. To facilitate their understanding of the rationale & methods of ANC4. To provide clients with information & counseling, including those relating to nutritional needs, sexual needs, activities of daily living, and discomforts of pre B) Psychological Care: 1. To encourage participation of clients & their families in their antenatal care. 2. To provide support for clients & families during stress. 3. To establish an environment that promotes an emotionally satisfying pregnancy. OBJECTIVE 5: ROUTINE TESTS AND INVESTIGATIONSNosPrenatal tests Purpose of investigation

1.History

Family; medical; Obstetrical; Present Pregnancy

2.Physical Examination

Systematic; Skeletal; Abdominal; Vaginal; Blood Pressure; Weight gain

3.Urine

Protein; Glucose; Oestriol

4.Blood tests

Hb; Rh Factor & Antibodies; ABO; VDRL; Rubella Antibodies; Sickle Cell; Alpha feto-proteins; Placental lactogen; HIV

5.Vaginal swabs

To rule out infection

6.Weight

To monitor & identify deviations

7.Auscultation

Intermittent; Doptone; Continuous Electronic Monitoring of Foetal Heart

8Ultrasonography

Assess Gestational Age; foetal growth; Bi-parietal Cephalometry

9. AmniocentesisDetect chromosomal anomalis, neural tube lecithin sphyngomyelin ratio

10.ElectrocardiographyAssess heart function

OBJECTIVE 6: FREQUENCY OF VISITS

It has been noted that the best results should obtain if the patient is seen approximately the 12th week of pregnancy, and thereafter at four weekly intervals until the 28thweek, two weekly interval until the 36th week and then weekly until the woman delivers.a. INITIAL VISITDuring this visit it is sometimes viewed as the longest visit. As during this visit many details must be collected. This will better aid the midwife or nurse to coordinate the care for the pregnant woman. This visit is arranged in such a way that full record of the patients past and present social, medical surgical and obstetrical histories are obtained. During this visit the nurse enquiries as to where the woman wishes to be delivered. History taking include: ..

History taking includes:

Surname in block letters

Maiden name to trace her records and prevent confusion since two people can bear the same name

Christian name must be obtained

Address and important landmarks, telephone numbers

Age of the pregnant woman

#of pregnancies

Marital status in order to know how she will cope with the pregnancy or if she need the services of the social worker

Occupation-type of work, working hours, distance to work

Religion

NOK

Family Medical history( pt is asked whether medical conditions runs in the family such as sickle cell, HTN, DM, heart dx, TB, Mental illness, epilepsy, twin gestation, and congenital abnormalities

PMH find out if she has any of the above mentioned condition

Surgical HX

Obstetric hx- previous pregnancies, labor and puerperia.

Previous pregnancies- duration, history of abortion, or evacuation, history of complications

Previous labours- spontaneous or induced, duration of labour mode of delivery

Previous puerperium-amt of blood loss, hx surgical intervention, hx of fever, hx of prolonged hospitalization

Previous babies alive or dead if dead cause of death, wt at birth, hx of still birth, neonatal jaundice, or neaonatal death, sex of baby, age of baby.

Present pregnancy-duration of pregnancy, LNMP in order to calculate the EDD.( Add nine months and seven days to the 1st day of the LNMP. E.g. inform patient of the possibility of delivery two weeks before the calculated EDD or two weeks after.SUBSEQUENT VISITSAt each visits the midwife or nurse should;

a. Assess the patients general health: ask her for any complaint and exclude anaemia by checking her hemoglobin or packed cell volume.b. Test the urine for sugar, protein and ketonec. Check the blood pressure and weightd. Examine her for oedema and rule out signs of pre-eclampsiae. Check antibodies in rhesus negative patients or patients with previous history of blood transfusion. Usually in such cases antibody tests are done at 28, 32, 36 and 40 weeks of gestation or as often as antibodies dictate.f. Examine breasts to ensure continuity of care especially in cases of flat or retracted nipples.g. Determine the growth of pregnancy and viability of the fetus by abdominal examination including auscultationh. Examine the vulva for vaginal discharge.OBJECTIVE 7: Identify Pre-natal danger signals i. Visual disturbance. ii. Swelling of the face and or fingers. iii. Severe, frequent or continuous headaches. iv. Muscular irritability or convulsions. v. Epigastric pain. vi. Persistent vomiting beyond the first trimester or severe vomiting at any time. vii. Fluid discharge from vagina: bleeding or amniotic fluid (anything besides leukorrhoea.viii. Signs of infection: fever or chills, burning on micturition.ix. Severe/unusual abdominal pain x. Absence of foetal movement after quickening. OBJECTIVE 8: Describe the nursing management of a pregnant womanGoal ) To obtain evidence of foetal wellbeing Interventions During Normal Pregnancy: The Nurses Roles during this time includes: Counsellor; Advocate; Teacher and clinician.Nursing Assessment: General & Specific History Taking involves: 1) Assessment of clients health & identifying defects which may adversely affect childbearing. 2) Collecting & recording facts/data that should lead to remedial action where possible. 3) Establish adequacy of home conditions e.g. Adequate space; Health hazards; Source of income/Financial support; Marital status; Spouses position/status; Nutritional status & availability of nutrients; Ability to budget & to care for baby. To determine occupation & assess working conditions if applicable.4) identify Genetic predisposition to diseases psychiatric disorders; diabetes; essential hypertension; allergies, Tendency to produce twins, Cause of death of near relatives e.g. parent (s), sibling if applicable.5. Medical History to: establish present & previous health Previous illness may have damaged certain structure/s & organs resulting in complications of pregnancy/labour Discuss examples. 6. (iv) Obstetric History: Record of previous pregnancies, labours & puerperia will enable one to anticipate possible progress and or outcome of present pregnancy. Details of any previous complications Particulars of abortions time & cause Previous history of excessive sickness, Pyelonephritis or pre-eclampsia. Normal/Abnormal Any Complications Where Antenatal Care was obtained Duration of pregnancy Immunization (Tet Tox) Antepartum haemorrhage Premature/Postmature /post dates Spontaneous/Induced

Length of Labour Babys weight

Assisted Forceps etc. (3.5 kg normal pelvic size) Caesarean Section Postpartum Haemorrhage Date & Place of Delivery Tear (3rd.degree) or Episiotomy Adherent Placenta SUMMARY

0-28 weeks

4 weekly appointment

28-36weeks

2 weekly appointment

36- Delivery

weekly

REFERENCES1. Clarke, Mary Jo, 1996 Nursing in the Community 2nd Ed. Appleton & Lange, Stamford CA 2. Duval, E. M. Marriage & Family Development (5th Ed.) in Ludewig et al Contemporary Maternal Newborn Nursing (7th ed.) 3. Ladewig , P.W. et al 2002. Contemporary Maternal Newborn Nursing Care , New Jersey: Prentice Hall4. Ricci , susan, 2007. Essentials of Maternity, Newborn and Womens Health nursing , Lippincott Williams and Wilkins Philadelphia