Antenatal Care and Nursing DSG 2024 PDF

ANTENATAL/PRENATAL CARE AND NURSING Assoc. Prof. Dr. Dilek SARPKAYA GUDER Obstetric and Women Health Nursing-Nursing Faculty-NEU Assoc. Prof. Dr. Dilek Sarpkaya Güder  CONTENT ⸙ Definition and importance of prenatal/antenatal care ⸙ Purposes of pre...

ANTENATAL/PRENATAL CARE AND NURSING Assoc. Prof. Dr. Dilek SARPKAYA GUDER Obstetric and Women Health Nursing-Nursing Faculty-NEU Assoc. Prof. Dr. Dilek Sarpkaya Güder  CONTENT ⸙ Definition and importance of prenatal/antenatal care ⸙ Purposes of prenatal/antenatal care ⸙ Prenatal/antenatal care model (WHO) ⸙ Components of prenatal/antenatal care ⸙ Role of nurse in prenatal/antenatal care Assoc. Prof. Dr. Dilek Sarpkaya Güder  ANTENATAL/PRENATAL CARE ⸙ Antenatal care is the routine health control of presumed healthy pregnant women without symptoms (screening), in order to diagnose diseases or complicating obstetric conditions without symptoms, and to provide information about lifestyle, pregnancy and delivery. Assoc. Prof. Dr. Dilek Sarpkaya Güder  ANTENATAL/PRENATAL CARE ⸙ Antenatal care is the assessment of mother and fetus during pregnancy. ⸙ The objective of antenatal care is to ensure the supervision of maternal and fetal well being during pregnancy, identify and treat conditions that may threaten the health of the fetus/ newborn and mother. Assoc. Prof. Dr. Dilek Sarpkaya Güder  IMPORTANCE OF ANTENATAL/PRENATAL CARE Through timely and appropriate evidence-based actions related to health promotion, disease prevention, screening, and treatment ❑ Reduces complications ❑ Reduces stillbirths and from pregnancy and perinatal deaths childbirth ❑ Integrated care delivery throughout pregnancy Assoc. Prof. Dr. Dilek Sarpkaya Güder  IMPORTANCE OF ANTENATAL/PRENATAL CARE ⸙ Females should not smoke or inhale smoke ⸙ This can cause smaller and unhealthy babies ⸙ Females should not contact with teratogens ⸙ Teratogens any agent that can disturb the development of an embryo or fetus ⸙ It is usually something in the environment that the mother may be exposed to during her pregnancy (Radiation, Maternal infections, Drugs, Alchol, Infections, Disease and Chemicals) Assoc. Prof. Dr. Dilek Sarpkaya Güder  QUALITY throughout the continuum of care WHO envisions a world where “every pregnant woman and newborn receives quality care throughout the pregnancy, childbirth and the postnatal period”. Prioritizes person-centred health and well-being: Reducing mortality and morbidity Providing respectful care that takes into account woman’s views Optimizing service delivery within health systems Assoc. Prof. Dr. Dilek Sarpkaya Güder Women’s views ✓ A healthy pregnancy for mother and Women want a baby (including preventing or treating risks, illness and death) ✓ Physical and sociocultural normality Positive during pregnancy Pregnancy ✓ Effective transition to positive labour and birth Experience ✓ Positive motherhood (including maternal self-esteem, competence from ANC and autonomy) Medical care; relevant and timely information; emotional support and advice Assoc. Prof. Dr. Dilek Sarpkaya Güder Downe S et al, 2016  ANTENATAL/PRENATAL CARE The purpose of antenatal care is to: ⸙ Support and encourage psychological adjustment to pregnancy, childbirth, breastfeeding and parenthood; ⸙ Promote awareness of the social and psychological components of childbearing and their influences on the family; Assoc. Prof. Dr. Dilek Sarpkaya Güder  ANTENATAL/PRENATAL CARE The purpose of antenatal care is to: (CONT.) ⸙ Monitor the progress of pregnancy to ensure the health and wellbeing of mother and fetus; ⸙ Monitor all women for signs of obstetric difficulties through close personal attention and diagnostic tests where essential and indicated; Assoc. Prof. Dr. Dilek Sarpkaya Güder  ANTENATAL/PRENATAL CARE The purpose of antenatal care is to: (CONT.) ⸙ Recognize deviations from the normal, and treat or refer as required; ⸙ Recognize that women who develop warning signs may return to normal following treatment and might not necessarily be continued to be regarded or treated as at risk; ⸙ Build a trusting relationship between the woman and her care givers; Assoc. Prof. Dr. Dilek Sarpkaya Güder  ANTENATAL/PRENATAL CARE The purpose of antenatal care is to: (CONT.) ⸙ Provide the woman with information with which she can make informed decisions; ⸙ Actively involve relevant members of the woman’s family or friends in the experience of pregnancy, encouraging the supportive role that they might play and recognizing that they too might need support. Assoc. Prof. Dr. Dilek Sarpkaya Güder NUMBER ANTENATAL/PRENATAL CARE VISITS? AND WHEN? Assoc. Prof. Dr. Dilek Sarpkaya Güder Antenatal Care Model (WHO, 2016) Assoc. Prof. Dr. Dilek Sarpkaya Güder  COMPONENTS OF ANTENATAL/ PRENATAL CARE Assoc. Prof. Dr. Dilek Sarpkaya Güder  COMPONENTS OF ANTENATAL/PRENATAL CARE The essential components of prenatal care: ⸙ Risk assessment ⸙ Health promotion ⸙ Medical and psychosocial interventions and follow-up. Assoc. Prof. Dr. Dilek Sarpkaya Güder  COMPONENTS OF ANTENATAL/PRENATAL CARE Qualified antenatal care includes; EDUCATION and SUPPORT for the pregnant woman, Ongoing maternal–fetal ASSESSMENT, PREPARATION for parenting, and promotion of a positive physical and emotional family experience. Assoc. Prof. Dr. Dilek Sarpkaya Güder Assoc. Prof. Dr. Dilek Sarpkaya Güder Assoc. Prof. Dr. Dilek Sarpkaya Güder  GOALS Assoc. Prof. Dr. Dilek Sarpkaya Güder ACTIVITIES Assoc. Prof. Dr. Dilek Sarpkaya Güder PREVENTIVE MEASURES AND HEALTH EDUCATION Assoc. Prof. Dr. Dilek Sarpkaya Güder RISK ASSESSMENT Assoc. Prof. Dr. Dilek Sarpkaya Güder  RISK ASSESSMENT ⸙ The goal of risk assessment is to identify women and fetuses at risk for developing antepartum, intrapartum, postpartum, or neonatal complications to promote risk- appropriate care that will enhance the perinatal outcome. Assoc. Prof. Dr. Dilek Sarpkaya Güder  RISK ASSESSMENT ⸙ Evaluation of STD ⸙ Blood pressure measurement ⸙ Cervical and breast cancer screenning ⸙ TORCH ⸙ Violance ⸙ Depression ⸙ Weight gain ⸙ Socio-economic condition of woman Assoc. Prof. Dr. Dilek Sarpkaya Güder  HISTORY Welcome the women, and ensure a quite place where she can express concerns and anxiety without being overheard by other people Assoc. Prof. Dr. Dilek Sarpkaya Güder COMPONENTS OF PRENATAL HEALTH HISTORY ⸙ Obstetric (and outcomes of past pregnancies; problems in mother or infant) ⸙ Menstrual ⸙ Contraceptive ⸙ Medical and surgical (Infections, surgical procedures, trauma that involved pelvis or reprod) Assoc. Prof. Dr. Dilek Sarpkaya Güder COMPONENTS OF PRENATAL HEALTH HISTORY ⸙ Women’s family (genetic or other factors that may pose a risk for the preg) ⸙ Partners family ⸙ Women and partners to identify risk factors ⸙ Psychosocial (stability of lifestyle and ability to parent a child; cultural influences) Assoc. Prof. Dr. Dilek Sarpkaya Güder  PHYSICAL EXAMINATION Physical examination is important to: Detect previously undiagnosed physical problems that may affect the pregnancy outcome. Establish baseline levels that will guide the treatment of the expectant mother and fetus throughout pregnancy Assoc. Prof. Dr. Dilek Sarpkaya Güder  PHYSICAL EXAMINATION Evaluate women’s general health Determine baseline weight and vital signs Evaluate nutritional status Identify current physical/social problems Assoc. Prof. Dr. Dilek Sarpkaya Güder  PHYSICAL EXAMINATION Determines the estimated date of delivery Evaluate the size, adequacy, and condition of the pelvis and reproductive organs Assess for signs of pregnancy Assoc. Prof. Dr. Dilek Sarpkaya Güder  LABORATORY ASSESSMENT Papanicolaou Smear (Pap smear) Blood Studies Glucose Tolerance Test Urinalysis Ultrasonography Assoc. Prof. Dr. Dilek Sarpkaya Güder  HEALTH TEACHING DURING PREGNANT ⸙ Hygiene ⸙ Breast care ⸙ Dental care ⸙ Dressing ⸙ Travel ⸙ Sexual activity ⸙ Exercises ⸙ Sleep Assoc. Prof. Dr. Dilek Sarpkaya Güder PRENATAL EDUCATION CLASSES Assoc. Prof. Dr. Dilek Sarpkaya Güder  PRENATAL EDUCATION CLASSES Childbirth preperation classes help building confidence in body’s ability to give birth. Parents can discuss their fears about labor and birth with the instructor and other couples with the same concerns. Assoc. Prof. Dr. Dilek Sarpkaya Güder  PRENATAL EDUCATION CLASSES Partner will learn about childbirth and how to support spouse on the big day and period of pregnancy. Parents should discuss type and place of birth with their nurse and midwife Assoc. Prof. Dr. Dilek Sarpkaya Güder  PRENATAL EDUCATION CLASSES Doulas (Person who supports pregnant woman during labor. He/she attends prenatal classes with woman) Hypnosis and other type of coping methods with pain Assoc. Prof. Dr. Dilek Sarpkaya Güder  BIRTH PLAN Birth plan enables parents to plan their birth process Pregnant women should be informed of their maternity rights and benefits Complementary therapies have been established as being safe and effective during pregnancy Assoc. Prof. Dr. Dilek Sarpkaya Güder Assoc. Prof. Dr. Dilek Sarpkaya Güder Assoc. Prof. Dr. Dilek Sarpkaya Güder  NURSES ROLE OF ANTENATAL/PRENATAL CARE Assoc. Prof. Dr. Dilek Sarpkaya Güder  NURSES ROLE OF ANTENATAL/PRENATAL CARE It is the responsibility of the health care service, and often of midwives in particular or community nurses, to seek out these women in their home environments and assist them to obtain the health care they need. Assoc. Prof. Dr. Dilek Sarpkaya Güder  ANTENATAL/PRENATAL CARE NURSES ROLE If women are unable or unwilling to come to the health services, persistent attempts to reach them must be made. They should not be disregarded as ungrateful, unintelligent or spoiled; rather they should be considered in special need of attention and supportive care. Assoc. Prof. Dr. Dilek Sarpkaya Güder  ANTENATAL/PRENATAL CARE NURSES ROLE Women who do not seek care at the right time may be at higher risk of developing complications of pregnancy which, because they are undetected at a stage when preventive action could be beneficial, might be of a more serious nature Assoc. Prof. Dr. Dilek Sarpkaya Güder  ANTENATAL/PRENATAL CARE NURSES ROLE ⸙ Collecting data from pregnant women ⸙ Identifying and reevaluating risk factors ⸙ Educating in self-care ⸙ Providing nutrition counseling ⸙ Promoting the family’s adaptation to pregnancy Assoc. Prof. Dr. Dilek Sarpkaya Güder Assoc. Prof. Dr. Dilek Sarpkaya Güder  NURSING DIAGNOSIS FOR PREGNANT WOMEN ⸙ Anxiety related to physical discomforts of pregnancy ⸙ Ambivalent and labile emotions changes in family dynamics fetal well-being Assoc. Prof. Dr. Dilek Sarpkaya Güder  NURSING DIAGNOSIS ⸙ Interrupted family processes related to changing roles and responsibilities ⸙ Inadequate understanding of physical and emotional changes in pregnancy ⸙ Increased concern about labor ⸙ Disturbed body image related to anatomic and physiologic changes of pregnancy Assoc. Prof. Dr. Dilek Sarpkaya Güder  NURSING DIAGNOSIS Ineffective health maintenance related to deficient knowledge regarding self-care measures for – Posture and body mechanics – Rest and relaxation – Personal hygiene – Activity and exercise – Safety Assoc. Prof. Dr. Dilek Sarpkaya Güder  NURSING DIAGNOSIS ⸙ Ineffective individual coping related to deficient knowledge regarding ⸙ Recognizing onset of complications ⸙ Distinguishing between true and false labor ⸙ Emergency arrangements ⸙ Disturbed sleep pattern related to discomforts of late pregnancy. Assoc. Prof. Dr. Dilek Sarpkaya Güder  NURSING-HEALTH EDUCATION The nurse should the mother regarding- – Breast feeding – Nutrition – Family planning – Postnatal exercises – Child care – Dental care – Clothing, shoes and belt – Care of breast – Smoking and alcohol – Birth plan – Mental preparation – Diet – Sleep and rest – To avoid stressor – Minor ailments Assoc. Prof. Dr. Dilek Sarpkaya Güder Geneva, Switzerland WHO Guideline on Antenatal Care (2016) Overview Reproductive Health and Research (RHR) Nutrition for Health and Development (NHD) Maternal, Newborn, Child and Adolescent Health (MCA) 52  DEVELOPMENT OF THE GUIDELINE RECOMMENDATIONS 53 Assoc. Prof. Dr. Dilek Sarpkaya Güder  A. Nutritional interventions - 1 A.1.1: Counselling about healthy Recommended eating and keeping physically active during pregnancy is recommended for pregnant women to stay healthy and to prevent excessive weight gain during pregnancy. 54 Assoc. Prof. Dr. Dilek Sarpkaya Güder  A. Nutritional interventions -2 A.2.1: Daily oral iron and folic acid Recommended supplementation with 30 mg to 60 mg of elemental iron and 400 µg (0.4 mg) of folic acid is recommended for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth. 55 Assoc. Prof. Dr. Dilek Sarpkaya Güder  B.1. Maternal assessment - 1 B.1.4: Hyperglycaemia first detected at Recommended any time during pregnancy should be classified as either gestational diabetes mellitus (GDM) or diabetes mellitus in pregnancy, according to WHO criteria. 56 Assoc. Prof. Dr. Dilek Sarpkaya Güder  B.1. Maternal assessment - 1 B.1.5: Health-care providers should ask Recommended all pregnant women about their tobacco use (past and present) and exposure to second-hand smoke as early as possible in the pregnancy and at every antenatal care visit. 57 Assoc. Prof. Dr. Dilek Sarpkaya Güder  B.1. Maternal assessment - 2 B.1.6: Health-care providers should ask Recommended all pregnant women about their use of alcohol and other substances (past and present) as early as possible in the pregnancy and at every antenatal care visit. 58 Assoc. Prof. Dr. Dilek Sarpkaya Güder  B.1. Maternal assessment - 2 B.1.7: In high-prevalence settings, provider-initiated Recommended testing and counselling (PITC) for HIV should be considered a routine component of the package of care for pregnant women in all antenatal care settings. In low- prevalence settings, PITC can be considered for pregnant women in antenatal care settings as a key component of the effort to eliminate mother-to-child transmission of HIV, and to integrate HIV testing with syphilis, viral or other key tests, as relevant to the setting, and to strengthen the underlying maternal and child health systems. 59 Assoc. Prof. Dr. Dilek Sarpkaya Güder  B.2.Fetal assessment One ultrasound scan before 24 weeks of Recommended gestation (early ultrasound) is recommended for pregnant women to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve a woman’s pregnancy experience. 60 Assoc. Prof. Dr. Dilek Sarpkaya Güder  C. Preventive measures - 1 C.1: A seven-day antibiotic regimen is Recommended recommended for all pregnant women with asymptomatic bacteriuria (ASB) to prevent persistent bacteriuria, preterm birth and low birth weight. C.2: Tetanus toxoid vaccination is Recommended recommended for all pregnant women, depending on previous tetanus vaccination exposure, to prevent neonatal mortality from tetanus. 61 Assoc. Prof. Dr. Dilek Sarpkaya Güder  D. Common physiological symptoms D.1: Ginger, chamomile, vitamin B6 and/or Recommended acupuncture are recommended for the relief of nausea in early pregnancy, based on a woman’s preferences and available options. D.2: Advice on diet and lifestyle is recommended to Recommended prevent and relieve heartburn in pregnancy. Antacid preparations can be offered to women with troublesome symptoms that are not relieved by lifestyle modification. 62 Assoc. Prof. Dr. Dilek Sarpkaya Güder  D. Common physiological symptoms D.3: Magnesium, calcium or non-pharmacological Recommended treatment options can be used for the relief of leg cramps in pregnancy, based on a woman’s preferences and available options. D.4: Regular exercise throughout pregnancy is Recommended recommended to prevent low back and pelvic pain. There are a number of different treatment options that can be used, such as physiotherapy, support belts and acupuncture, based on a woman’s preferences and available options. 63 Assoc. Prof. Dr. Dilek Sarpkaya Güder  D. Common physiological symptoms D.5: Wheat bran or other fibre supplements can Recommended be used to relieve constipation in pregnancy if the condition fails to respond to dietary modification, based on a woman’s preferences and available options. D.6: Non-pharmacological options, such as Recommended compression stockings, leg elevation and water immersion, can be used for the management of varicose veins and oedema in pregnancy, based on a woman’s preferences and available options. 64 Assoc. Prof. Dr. Dilek Sarpkaya Güder  E. Health systems interventions to improve the utilization and quality of ANC – 1 E.1: It is recommended that each pregnant Recommended woman carries her own case notes during pregnancy to improve continuity, quality of care and her pregnancy experience. 65 Assoc. Prof. Dr. Dilek Sarpkaya Güder  E. Health systems interventions to improve the utilization and quality of ANC – 2 E.2: Task shifting the promotion of health-related Recommended behaviours for maternal and newborn health to a broad range of cadres, including lay health workers, auxiliary nurses, nurses, midwives and doctors is recommended. E.3: Task shifting the distribution of recommended Recommended nutritional supplements and intermittent preventative treatment in pregnancy (IPTp) for malaria prevention to a broad range of cadres, including auxiliary nurses, nurses, midwives and doctors is recommended. 66 Assoc. Prof. Dr. Dilek Sarpkaya Güder  E. Health systems interventions to improve the utilization and quality of ANC – 4 E.4: Antenatal care models with a Recommended minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s experience of care. 67 Assoc. Prof. Dr. Dilek Sarpkaya Güder  Recommendations ❑ Women who plan to get pregnant should start with folic acid (Vit B9) 0.4 mg daily (Strong recommendation) ❑ ∗ All pregnant women should participate in the antenatal care program (Strong recommendation ) ❑ ∗ The first antenatal care visit should take place in gestational week 8-12 (Strong recommendation) 68 Assoc. Prof. Dr. Dilek Sarpkaya Güder  Recommendations ❑ Antenatal care performers should be a midwife or a general practitioner, or shared care where doctor and midwife cooperate (Strong recommendation) ❑ ∗ The standard preformed antenatal record "Helsekort for gravide" should be used and the woman should keep the record (Strong recommendation) ❑ ∗ Continuity of care should be attempted so that the woman know her caretakers (Strong recommendation) 69 Assoc. Prof. Dr. Dilek Sarpkaya Güder  Recommendations ❑ In healthy pregnant women, a basis program is recommended comprising 8 antenatal care visits up to and including the visit in week 40 (Recommendation) ❑ ∗ All pregnant women should have one routine ultrasound examination in week 17-19 (Strong recommendation) ❑ ∗ The attendancy rates as well as the patterns of antenatal care use, the content of the care provided care as well as the results of antenatal care should be routinely monitored (Proposal) 70 Assoc. Prof. Dr. Dilek Sarpkaya Güder  Relevant links – 1 About the guidelines: www.who.int/reproductivehealth/news/ant enatal-care/en/index.html South Africa story from the field: www.who.int/reproductivehealth/news/ant enatal-care-south-africa/en/index.html The guideline www.who.int/reproductivehealth/publicati ons/maternal_perinatal_health/anc- positive-pregnancy-experience/en/ Press release www.who.int/entity/mediacentre/news/rel eases/2016/antenatal-care- guidelines/en/index.html 71 Assoc. Prof. Dr. Dilek Sarpkaya Güder  Relevant links – 2 Infographics www.who.int/reproductiv ehealth/publications/mat ernal_perinatal_health/A NC_infographics/en/index.html 72 Assoc. Prof. Dr. Dilek Sarpkaya Güder 73 Assoc. Prof. Dr. Dilek Sarpkaya Güder 74 Assoc. Prof. Dr. Dilek Sarpkaya Güder  "To achieve the Every Woman Every Child vision and the Global Strategy for Women's Children's and Adolescents' Health, we need innovative, evidence- based approaches to antenatal care. I welcome these guidelines, which aim to put women at the centre of care, enhancing their experience of pregnancy and ensuring that babies have the best possible start in life." Ban Ki-moon, UN Secretary-General 75 Assoc. Prof. Dr. Dilek Sarpkaya Güder  THANK YOU 76 Assoc. Prof. Dr. Dilek Sarpkaya Güder