Obstetrics Fetal Positioning Quiz

Antenatal Assessment & Care (Part I)

• This is a lecture on antenatal assessment and care, part 1, for Bachelor of Science (Honours) in Nursing students.
• The lecture date is September 13, 2024.

Learning Outcomes

• Students will be able to discuss current trends in maternal and child health.
• Students will be able to describe the purposes and essential components of prenatal care.
• Students will be able to identify critical elements of prenatal assessment, including health history, physical examination, blood, and urine tests.

Vital Statistics

• Birth rate: Number of live births per 1,000 population in one year.
• Maternal mortality rate: Number of maternal deaths per 100,000 live births resulting directly from pregnancy, including the postpartum period.
• Infant mortality rate: Number of infant deaths under 1 year of age per 1,000 live births.
• Neonatal mortality rate: Number of infant deaths younger than 28 days per 1,000 live births.
• Stillbirth: Birth of a baby with no signs of life after pregnancy (and/or weight ≥ 500 gm).
• Perinatal mortality: Number of stillbirths and deaths in the first week of life.

Maternal & Child Health

• In 2020, approximately 800 women died each day from preventable causes related to pregnancy and childbirth.
• Over 95% of maternal deaths occur in low- and lower-middle-income countries.
• In 2020, the maternal mortality ratio was 430 per 100,000 live births in low-income countries compared to 12 per 100,000 in high-income countries.
• Maternal mortality is higher in rural areas, poorer communities, and adolescents.
• Primary causes of maternal deaths worldwide include severe bleeding (mostly after childbirth), infections (usually after childbirth), high blood pressure during pregnancy, complications from delivery (e.g., obstructed labor), and unsafe abortion.

Prenatal Care

• Purposes: Assess health status of mothers and fetus, monitor pregnancy progress, identify at-risk mothers or fetus, promote self-care of pregnant women, and provide holistic care to pregnant women and their family members.
• Schedule: First antenatal visit and subsequent visits.

Prenatal Assessment

• Key elements of prenatal assessment include health history, physical examination, blood tests, and urine tests.

Health History

• Current pregnancy: Signs, symptoms, urine/blood test for hCG, first day of last menstrual period (LMP).
• Reproductive history: Menstrual history, age at menarche, menstrual cycle regularity, number of pregnancies/abortions/living children, previous experience in pregnancy, labor, and puerperium, date of last Pap smear, and contraceptive history.
• Past medical, surgical & personal history: Medical conditions, surgeries, medications, allergies, and personal history.
• Family history: Genetic diseases, multiple pregnancies, hypertension, diabetes mellitus, tuberculosis, and psychiatric disorders.
• Psychosocial health assessment: Mental and emotional wellbeing.

Physical Examination

• Height, weight, vital signs, head-to-toe physical examination, abdominal examination, and vaginal/pelvic examination.
• Specific measurements and findings during physical examinations are included.
• Detailed methods of breast examination (inspection and palpation) are described.
• Abdominal examination method (including inspection, palpation, and auscultation) is documented, alongside examples of Leopold's maneuvers for determining fetal presentation.
• Details on how to determine fetal attitude, fetal lie, fetal position and engagement are included.

Blood Tests

• Complete blood picture, ABO grouping, Rhesus factor (Rh), Rubella antibody, Hepatitis B surface antigen (HbsAg), Venereal disease – Syphilis, and Human Immunodeficiency Virus (HIV) antibody.
• Specific details of how to interpret the results of these blood tests are also detailed.

Urine Tests

• Glycosuria, proteinuria, and ketones.

Prenatal Care (Subsequent)

• Subsequent prenatal assessments, including general condition, body weight and height, blood pressure, urine tests for protein and glucose, and abdominal examination are detailed.

Antenatal Check-up Schedule

• A standard schedule for antenatal check-ups, including the gestational week and the frequency of routine check-ups, as well as other examinations to be performed each week is listed.

Antenatal Assessment & Care (Part II)

• Learning outcomes for this part include discussing common antenatal tests, identifying risk factors for high-risk pregnancies, and describing nursing assessment and management for various complications.

Assessment of Fetal Well-being

• Methods of assessing fetal well-being, such as fetal heart rate (FHR), non-stress test (NST), and cardiotocography (CTG), are included.
• Additional methods and procedures for fetal wellbeing, such as ultrasonography, biochemical screening, amniocentesis, chorionic villus sampling (CVS), and cordocentesis.

Ultrasonography

• Methods and clinical applications of ultrasonography in pregnancy are described.

Prenatal Diagnosis

• Non-invasive and invasive prenatal diagnostic procedures are detailed, including methods and complications.
• Data about gestational age, including 1st and 2nd/3rd trimesters is detailed.

Pregnancy at Risk

• Specific types of high-risk pregnancies, including abortion, antepartum hemorrhage (APH), gestational diabetes mellitus (GDM), and pregnancy-induced hypertension (PIH), are discussed.

Abortion

• Definition and classification of spontaneous and induced abortions.
• Causes of abortion.
• Nursing care management for threatened abortions, including bed rest, bleeding monitoring, and subsequent care.
• Legal aspects, including management methods, and complications of induced abortions.

Antepartum Haemorrhage (APH)

• Various types of APH (including placenta previa and abruptio placenta), causes, clinical features, diagnosis, and management strategies are described.

Gestational Diabetes Mellitus (GDM)

• Risk factors, diagnostic criteria (OGTT), management strategies (diet control, medication, and monitoring), and potential complications for both mother and fetus are detailed.

Hypertension in Pregnancy

• Classification of hypertensive disorders (gestational, pre-eclampsia, eclampsia, chronic hypertension, superimposed pre-eclampsia).
• Diagnosis parameters for hypertension during pregnancy.
• Causes and risk factors for different types of hypertension in pregnancy.
• Potential maternal and fetal complications and management strategies for each type of hypertension.