Prenatal Care, Assessment and Screening

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


11Obstetrical HistoryPain preferencesConfidence or fearEducation, support, individualized care


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


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


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


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


33Abuse in PregnancyPrevalenceAssessingInterventionResources:http://www.cdc.gov/reproductivehealth/violence/IntimatePartnerViolence/sld011.htm#12 http://www.sogc.org/health/health-ipv_e.asp


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


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:[email protected]

THANK YOU!

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Documents

Prenatal Care, Assessment and Screening