Maternal and Child Nursing: Key Concepts

National Health Situation on Maternal and Child Nursing (MCN)

• High-risk pregnancies involve conditions that threaten the health of the woman, fetus, or both
• Nursing responsibilities include preventing disorders affecting the fetus, promoting maternal well-being, and providing health education
• Maternal and child health nursing is supported by nursing processes, theories, and Quality & Safety Education for Nurses (QSEN) competencies
• Care extends through health promotion, maintenance, restoration, and rehabilitation phases

Four Phases of Health Care

• Health promotion involves educating parents and children about healthy practices
• Health maintenance includes screenings and interventions to maintain health
• Health restoration uses assessments and interventions to restore wellness
• Health rehabilitation focuses on preventing complications and helping patients achieve optimal wellness

Definitions of Terms

• Birth Rate: Number of births per 1,000 population
  • In 2013, 1.76 million births were recorded; in 2022, 1.4 million births were documented
  • The decline is attributed to more progressive mindsets prioritizing career, education, and financial stability
• Fertility Rate: Number of pregnancies per 1,000 women of childbearing age (WRA, 15-49 years)
• Fetal Death Rate: Number of fetal deaths (stillbirths) per 1,000 live births after 20 weeks of gestation or 500g in weight (Stillbirth)
• Neonatal Death Rate: Number of deaths per 1,000 live births within the first 28 days of life (Miscarriage or Abortion)
• Perinatal Mortality Rate: Number of deaths from 20 weeks of pregnancy to 4–6 weeks after birth, when a fetus reaches 500g
• Maternal Mortality Rate (MMR): Number of maternal deaths per 100,000 live births from the reproductive process
• Infant Mortality Rate (IMR): Number of deaths per 1,000 live births at birth or within the first 12 months of life
• Childhood Mortality Rate: Number of deaths per 1,000 population in children aged 1-4 years

Policy

• Administrative Order 2008-0029 covers maternal, newborn, and child health and nutrition strategy
• The "No Home Birth" Policy (2008) discourages home births due to the lack of sterile environments and skilled personnel and seeks to reduce risks
• Preferred Settings: Lying-in clinics, hospitals, and birthing facilities are encouraged

Facts and Figures

• Adolescent mothers (10-14) have a higher risk of complications than older women
• Developing regions have maternal mortality ratios 14 times higher than developed regions
• 94% of global maternal deaths occur in low- and lower-middle-income countries (World Health Organization)

NURSING ROLE IN GENETICS ASSESSMENT AND COUNSELING

• Genetics is The study of how disorders occur because of gene or chromosome variations
• A genetic disorder involves conditions passed down due to gene or chromosome abnormalities
• It provides information about genetic disorders by checking 23 pairs of chromosomes to identify missing or extra chromosomes that could indicate a genetic condition
• It reassures concerned couples about the likelihood of their child inheriting a condition, clarifying risks
• It empowers informed choices about reproduction with timely decisions for intervention
• In cases of birth defects, such as cleft lip, timely decisions for intervention with prenatal treatments like fetal surgery are facilitated
• It eases early planning enabling families to prepare for raising a child with special needs

Ideal Timing (Genetics Assessment)

• Genetics assessment and counseling are ideally performed before pregnancy
• This can ensure potential genetic issues are identified early allowing families to make informed reproductive decisions, plan interventions, and prepare properly

SCREENING AND DIAGNOSTIC TESTS IN PRENATAL CARE

• Chorionic Villus Sampling (CVS): Timing: 10-12 weeks, biopsy of placental tissue to test for fetal karyotype
• Amniocentesis: 16-18 weeks, amniotic fluid collection to test for fetal karyotype and chromosomal disorders
• Percutaneous Umbilical Blood Sampling (PUBS): 17 weeks, fetal umbilical blood sampling to test for fetal karyotype and blood diseases
• Fetal Anatomy Ultrasound: 18-22 weeks, to evaluate and see fine details of fetal anatomy
• Newborn Screening ((RA 9288 - Newborn Screening Act of 2004))
  • Screening for genetic disorders from Day 2 or several weeks for blood sample via heel prick or blood draw from the newborn

COMMON CHROMOSOME DISORDER

• Trisomy 13 Syndrome (Patau Syndrome) - Cause: extra copy of chromosome 13.
• Trisomy 18 Syndrome (Edwards Syndrome) - Cause: three copies of chromosome 18.
• Cri-Du-Chat Syndrome - Cause: deletion or missing portion of chromosome 5
• Turner Syndrome - Cause: missing or structurally altered X chromosome in females
• Klinefelter Syndrome - Cause: additional X chromosome in males (XXX karyotype)
• Down Syndrome - Cause: extra copy of chromosome 21 (Trisomy 21)

Nursing Assessment

If the patient states a complaint of one of the following:

• Increased pulse rate means heart attempts to circulate decreased blood volume
• Decreased blood pressure shows less peripheral resistance is present because of decreased blood volume
• Increased respiratory rate, shows the respiratory system is attempting to increase gas exchange to better oxygenate decreased red blood cell volume
• Cold and clammy skin means vasoconstriction occurs to maintain blood volume in the central body core
• Decreased urine output shows that inadequate blood is entering kidneys, because of decreased blood volume
• Restlessness or confusion shows that inadequate blood is reaching the cerebrum because of decreased blood volume
• Decreased central venous pressure shows that decreased blood is returning to the heart because of reduced blood volume

Bleeding During Pregnancy

• Vaginal bleeding at any point during pregnancy is always abnormal and places the fetus at risk due to maternal blood los
• Interventions include alerting the healthcare team, placing the woman flat on her side, starting IV fluids, administering oxygen, and monitoring contractions

ABORTION

• Abortion/Termination of pregnancy before the age of fetus viability (
• Types
  • Spontaneous Abortion (Nature's way of expelling a defective fetus)
  • Induced Abortion (Abortion that is brought about intentionally)
• Assessment (Confirmation of pregnancy, Pregnancy length, Duration and intensity of bleeding, Frequency of episodes and associated symptoms)
• Nursing actions (Note blood type in case of an emergency, Provide emotional support and counseling, Anticipate administering medication to induce expulsion of any remaining tissue)

ECTOPIC PREGNANCY

• A ectopic pregnancy happens hen implantation occurs outside the uterus
• It is caused by an obstruction in the fallopian and can be due to Sexually transmitted diseases, pelvic surgery, congenital malformation or scaring from tubular surgery
• Hallmark signs are - Sharp abdominal pain as the pregnancy progresses, Possible vaginal bleeding, Signs of hypovolemic shock in cases of rupture

HYDATIDIFORM MOLE (GESTATIONAL TROPHOBLASTIC DISEASE)

• As the cells degenerate, they become fluid-filled, grape-sized vesicles

PLACENTA PREVIA

• A placenta with an increased surface area may lead to implantation issues
• Occurs after C-section, Abortion and Uterine Surgery
• Bleeding occurs because- the placenta is positioned over or near the cervix, leading to abrupt, painless bleeding with bright red blood.
• Nursing intervention would be - sexual activity, internal examinations, or enemas (to prevent sudden fetal blood loss)

ABRUPTIO PLACENTA

• It is caused by - Preeclampsia and hypertensive disorders, Illicit drug use (e.g., cocaine) accidents or Trauma
• A nursing intervention would be to infuse IV fluids and blood as prescribed, check the blood, Monitor fetal heart tones (FHT),and insert a foley

DISSEMINATED INTRAVASCULAR COAGULATION (DIC)

• Disseminated Intravascular Coagulation (DIC) is a clotting disorder causing abnormal blood clotting throughout the body's blood vessels
• Early sign for pregnant woman is Easy bruising or bleeding (especially from a puncture site)
• Nursing care Heparin to prevent excessive clotting & prepare for Blood transfusion (BT) or plasma transfusion (if required)

GESTATIONAL DIABETES MELLITUS

• Gestational diabetes, occurs when hormones prevent the body from properly using insulin produced by the pancreas.
• Maternal effects are frequent infections like moniliasis due to moist virginal environment
• During Nursing Care give blood glucose monitoring
  • patient's blood glucose with fasting numbers that are 90 and below and postprandial values that are less than 140.

Cardiac function

Three causes of cardiac function are -

• Avoid a lithotomy position and any Valsalva maneuver
• position in a semi fowlers position
• use oxygen and breathing techniques
• Causes constant coughing and short of breath Cardiomegaly are enlarged hearts and need medical monitoring.