Module 1 Intro to Perinatal Nursing and Antepartum Care STUDENT PDF

BNUR 3002 ~ Concepts in Maternity Nursing Module 1: Introduction to BNUR 3002 Perinatal Nursing Care in Canada AND Antenatal Assessments Keri-Ann Berga, RN, BScN, MScN, IBCLC, PNC(C), CNeoN(C) Welcome back! And Welcome! So happy you’re here  HOW ARE YOU? HOW WAS SUMMER? What’s up for today?...

BNUR 3002 ~ Concepts in Maternity Nursing Module 1: Introduction to BNUR 3002 Perinatal Nursing Care in Canada AND Antenatal Assessments Keri-Ann Berga, RN, BScN, MScN, IBCLC, PNC(C), CNeoN(C) Welcome back! And Welcome! So happy you’re here  HOW ARE YOU? HOW WAS SUMMER? What’s up for today? Course Introduction and Overview Sherpath e-textbook overview and demonstration from Kate Bushuk Tour of Blackboard Introduction to Perinatal Nursing Content Antepartum Assessment and Care Content Keri – your course professor [email protected] Office Hours: Wednesdays 1130- 1230hrs in-person + online Tuesdays and Fridays, and/or by appointment any time in between Keri’s Bio Keri's Nursing Bio Welcome to BNUR 3002! Learning Plan (See Blackboard) Assessments Order of content  Kate Bushuk will be joining us to share more about how to access the course materials  Pay attention to WEEK Sherpath and ONE ONLY at this time (I e-textbook am still building!) Do not buy a physical textbook  BNUR 3002 LABS Sept 11 – Lab #1 – ONLINE e-sims and games Maternity Series Homepage (torontomu.ca) *Submit proof of completion on Blackboard before Sept 25th. Sept 25 – Antepartum Lab Oct 23 – Intrapartum Lab Nov 13 – Postpartum Lab Nov 20 – Neonatal Lab Nov 27 – Community and Transition to Parenting Lab Best Start Course: Optional but recommended especially if in clinical  Complete all components and keep a copy of your certificate!   Module Part A: Learning Objectives 1. Examine the historical context of perinatal health care and current issues affecting nursing practice in Canada. 2. Identify interprofessional team members and the nursing role in providing prenatal care to diverse families in Canada. 3. Describe factors that influence the health of childbearing persons and families in Canada, including social determinants of health. 4. Identify facilitators and barriers for people to access perinatal health care. 5. Explore ways to provide culturally responsive family nursing care while upholding guiding principles for working with childbearing patients and their families. 6. Describe the need for health promotion across the person's lifespan and health screening for pregnant persons in Canada. 7. Review the structures and functions of the female reproductive system (Sherpath) 8. Review etiology, significance, signs, symptoms, and management of selected reproductive conditions.  Before we get started … The terms and language throughout this course are used with the intent of inclusivity. Throughout the course, you will hear me using gender-affirming terms interchangeably, such as human milk, parent, partner, pregnant people, mother, father, pronouns of he, her, they, and more. If you have not already, it is a good idea to start using these terms in your nursing practice to help promote an inclusive environment and to create a safe space where patients and families know that you are aware of gender identity and are promoting an environment of inclusivity for all people, in all social and cultural contexts. Here are some examples of words you will hear throughout the workshop and modules. “Human milk”, “parent milk” versus “breastmilk” or “mother’s milk”. “Parent” in addition to “mother” "Partner " in addition "Father" “They” in addition to “she” or “he” “Breastfeeding” used interchangeably with “chestfeeding” and “nursing” and “human milk feeding”. Contemporary Issues & Perinatal Nursing in Canada Perinatal and Pediatric Nursing Specialty Perinatal nurses work collaboratively with patients and families from the preconception period throughout the child-bearing year. Pediatric nurses care for children from birth up to age 18 years. Care is also provided to the family. Care is provided in a variety of settings. Contemporary Issues and Trends: Building on what you have learned … Social determinants of health (SDOH) ◦ SES associated with better health ◦ Health inequities within certain populations ◦ Indigenous People – impact of colonization ◦ Immigrants and refugees – difficulties finding employment, poverty ◦ Older Women ◦ Homelessness ◦ Children ◦ Health inequity among childbearing patients and families in Canada ◦ Vulnerable patients face health risks ◦ Perinatal care Trauma and Violence-Informed Care (Watch video if this is a new topic for you) If TIC/TVIC is a new topic for you, please watch the video on your own time. TVIC Considers the effects of trauma and violence Can lead to negative health outcomes and behaviours Important to gain knowledge and skills to deliver best possible care Universal trauma informed approach is key Four Principles of Trauma Informed Care Understand trauma and violence and their impacts on people’s lives and behaviours Create emotionally and physically safe environments Foster opportunities for choice, collaboration, and connection Provide a strengths-based and capacity-building approach to support patient coping and resilience  Trauma-Informed (TI) Care Adopting a TI approach can promote empowerment and healing. HCPs should be self-reflective of their position of power and privilege as a health professionals when asking questions. We need to approach conversations considering the social, political, historical context of each person. (Luke et al., 2019; Perinatal Services BC, 2020). Trauma-Informed Practice Guide: Strategies Emphasize the patient’s autonomy throughout the conversation. Ask whether or not they want to answer questions or if they need to take a break. Provide rationale for asking questions and eep the conversation open. Discuss strengths such as their goals and coping skills. What are their goals? Limit the number of questions asked in a row to reduce power dynamics. Engage in reflective listening. Privacy, Dignity and Consent RNAO, 2017; Perinatal Services BC, 2020. (RNAO, 2017. p.24-25)  Contemporary Issues and Trends Adverse Childhood Experiences (ACE) Indigenous People ◦ Truth and Reconciliation Commission 2SLGBTQIA+ health Cultural considerations Perinatal Health  Perinatal Health Indicators The Canadian Perinatal Surveillance System (CPSS) system:  Collects and analyzes data about perinatal health before/after childbirth.  Focuses on aspects like pregnancy outcomes, maternal and infant health, and birth defects.  50 + perinatal health indicators Better Outcomes and Registry Network (BORN Ontario) collects, interprets and shares data regarding births in Ontario:  Gathers data on pregnancies, births, and early childhood development.  Data helps identify trends, assess health outcomes, and inform healthcare policies and practices  In Ontario … How does BORN Ontario influence health care? With over 1 million babies in the BORN Information System (BIS), BORN has world-class data and the technology to leverage it. High-quality data is an indispensable asset in today's health care economy and can be used for performance measurement / benchmarking, health policy work, surveillance and research. Childbirth Related Mortality Rate Significant problem that is preventable by improving access to prenatal care Causes of maternal deaths worldwide: ◦Severe bleeding (PPH) ◦Infections ◦Hypertensive disorders during pregnancy ◦Complications from the birth ◦Unsafe abortion  Maternal Morbidity & Mortality as a contemporary health issue in Canada Maternal Mortality is just the tip of the iceberg, for every woman who dies; 75-100 almost die In Canada, mortality rate is about 53 deaths per year however the WHO estimates this is HIGHER at 84 deaths per year. We can work together to prevent approximately 51 women from dying during pregnancy or postpartum in Canada every year. www.commonwealthfund.org (Dr. Jocelynn Cook,  Maternal Mortality in Canada https://www.cbc.ca/news/canada/canada-maternal-deaths-undercount-1. 6600905 Discussion: ​ How is this connected to health equity? What other factors could be associated with maternal deaths in Canada? https://www.theglobeandmail.com/canada/article-canada-needs-n ational-system-of-mandatory-maternal-mortality-reviews/ How can we do better? The Family and Culture Has anyone in the group worked with families? If so, in what context? Think, Pair, Share What constitutes a family? What is the definition of family? How do you define “Family”  Defining Family Traditionally viewed as the primary unit of socialization No universal definition A family is what an individual considers it to be Types of family relationships ◦ Consanguineous ◦ Affinal ◦ Family of origin  Family Is…. “The family is who they say they are” (Wright & Leahey, 2009, p. 50). “Family refers to two or more individuals who depend on one another for emotional, physical and economic support. The members of the family are self-defined” (Kaakinen et al., 2010). Family Nursing Family plays a pivotal role in health care. Partnerships with families, respect and dignity Family supported in participating in care and decision making at the level of their choice Working “with” families What Is Family Health? Family health is a dynamic, changing state of well- being, which includes the biological, psychological, spiritual, sociological, and culture factors of individual members and the whole family system.  Changes to contempora ry families in Canada… How are families changing? How do you see Canadian families changing? (C) KERI-ANN BERGA 2015-2016 Why does all this matter? Where do we fit as nurses? “The process of providing for the health care needs of families … within the scope of nursing practice. This nursing care can be aimed toward the family as context, the family as a whole, the family as a system or the family as a component of society” (Kaakinen et al., 2015, p. 8). (C) KERI-ANN BERGA 2015-2016 Family Structure: To determine family structure, the nurse identifies: The individuals that comprise family The relationships between them The interactions between the family members The interactions with other social systems Family- Centred Care (FCC) Image Source: www.visitorpasssolutions.com What does FCC mean to you? Role of the RN in Family Centred- Care To assess & understand the make-up, structure and coping capacity of families and then build on the family’s strengths & resources Help families reach a point of optimal functioning To help families reach & maintain maximal health throughout and beyond an illness experience What nursing practices demonstrate FCC? Prenatal – How? Labour & Birth? After the infant is born and while the family is in hospital? When the family is home from the hospital with their newborn? What are the strengths and challenges of Family Centred Care? (C) KERI-ANN BERGA 2018 MACEWAN UNIVERSITY  Health care practitioners Health care practitioners listen to & honour communicate & share complete, patient/family perspectives unbiased info with patients & and choices. families in ways that are Patient/family knowledge, affirming & useful. values, beliefs & diversity Patients & families receive are incorporated into the Respect & Informatio timely, complete, and accurate planning and delivery of Dignity n Sharing information in care order to effectively participate in care & decision-making. Patients/families are Patients & families are encouraged and supported Participatio Collaborati included on an institution- in participating in care & n on wide basis. decision-making at the level Health care leaders they choose. collaborate with patients & The nurse assesses the level families in policy and of participation that the program development, family is comfortable with implementation, and and plans care accordingly. evaluation; in facility design; in professional education; in delivery of care. Family Centred Care http://www.ipfcc.org/ Group Activity 1.Dignity and Respect Shifts conversation with families from: “What’s the matter?” to “What matters to you?” Respects clients’ wishes, concerns, values, priorities, culture, strengths (Registered Nurses’ Association of Ontario (RNAO), 2002) Incorporates family perspectives and choices into care planning and delivery CMNRP (C) 2015  2. Information Sharing Family members are: part of the patient’s health care team respected for their knowledge of the patient and their health and well-being given information to help contribute to the patient’s well-being 3. Participation Patients and families are involved in all aspects of planning, implementation and evaluation of health services. CMNRP © 2015 4. Collaboration Families collaborate with healthcare providers and administrators as they participate in policy and program development, facility design, and professional education. CMNRP © 2015 Are we The birthing parent’s partner is wearing a visitor badge being The paediatrician requests the baby be examined in the nursery where the lighting is ideal family Phototherapy occurs at the parent’s bedside The hospital determines the # of centred? visitors The doctor recommends rupturing membranes at 5 cm on a primip (primipara) who is planning a natural childbirth Barriers to Collaboration Attitudes and perceptions about each other Past experiences Lack of trust Cultural and language differences Socioeconomic and educational influences Lack of skills Lack of logistical and administrative support Different purposes or agendas The Institute of Patient- and Family-Centered Care ( http://www.ipfcc.org/tools/downloads-tools.html) provides various tools to foster collaboration with patients and family advisors.  Family Assessment (C) KERI-ANN BERGA 2015-2016 What is a family assessment?  A collection of data about the family’s type and structure, current level of functioning, support system, socio-cultural background, environment, and needs (London, Ladewig, Ball, Bindler & Cowen, 2016).  “An exploration between the nurse and the family to gain insight into the family’s perspective of the event, their strengths and need for support” (RNAO, 2006; 2013). 2024-10-17 Steps of the Family Nursing Process Assessment Reflection Analysis Evaluation Planning Intervention 2024-10-17  Open ended questions Data collection (sources of data?) Family Ongoing; develops over time Assessmen A process facilitated t by the nurse Foundation for planning interventions WHEN MIGHT WE CARRY OUT A FAMILY ASSESSMENT? 55  Data Collection and Assessment “Tools” 2 data-gathering instruments used in working with families: genogram & ecomap Used to gather information systematically and efficiently Guide the family plan of action and intervention strategies Consider what assessment tool will allow for rich, accurate data collection (= patient and family centred) 2024-10-17 56  Structural Assessment Tool - Genogram Visual diagram of the family constellation – depicts family composition and boundaries Specific “rules” & symbols are used to assure genograms are consistently understood & interpreted 2024-10-17 57 Genogram Data (C) Keri-Ann Berga 2015-2016  Structural Assessment Tool - Ecomap Provides information about systems outside of the immediate family that are sources of social support or that are stressors to the family *we’ll practice in Lab! 2024-10-17 59  Ecomap Sample Family Tommie (18 year Physicia old n boyfriend) (GP/OB) Bio High- school Ani Mom EDD: with childcar February e 14, 2024 Prenatal Nutritio Aunti n PHN e Deb What happens after the assessment? Assessmen t Reflection Analysis Evaluation Planning Intervention 2024-10-17 61 In lab … Health Promotion Health Promotion and Illness Prevention Patient must believe in the efficacy of prevention, early detection, and therapy and in their ability to perform self-management practices Reasons for Entering the Health Care System Essential Includes a person's Reproduction- components of health care needs Requires a holistic system related or health throughout their approach episodic illness maintenance lifetime Identification Physical, of mental or Menstrual Individualized unrecognized emotional, cycles care needs problems and social, and potential risks spiritual health Education and health Pregnancy promotion to help reduce risks Menopause  Adolescent Usually enter the health care system for screening or because of a problem May require contraception and sexual health education Teenage pregnancy ◦ Rates have decreased in Canada ◦ Require education and support This Photo by Unknown author is licensed under CC BY-S Young and Middle Adulthood Gynecological screening Promotion of a healthy lifestyle Common conditions and other specific problems ◦ Urinary tract infections, menstrual variations, sexual and relationship issues, and pregnancy Parenthood after age 35  Late Reproductive Age Change in health status Chronic illness Concerns with perimenopause Health maintenance screening This Photo by Unknown Author is licensed under CC BY Care at Specific Stages Across the Lifespan Fertility control and infertility ◦Approximately 50% of all pregnancies are unplanned. ◦Education is the key to encouraging women to make family-planning choices. ◦Health promotion applied to contraception ◦Sexually transmitted infections ◦Infertility and emotional pain, stress  Care at Specific Stages Across the Lifespan Preconception counselling and care ◦ Activities that promote health ◦ Goal is to promote improve health status prior to pregnancy to optimize normal fetal growth ◦ Identifying and modifying risk factors Care at Specific Stages Across the Lifespan Pregnancy ◦Entry into prenatal care within the first 12 weeks enables identification of women at risk and initiation of measures to prevent problems or treatment. ◦Define health status of mother and fetus. ◦Determine gestational age of fetus and monitor fetal development. ◦Identify women at risk for complications and minimize risk whenever possible. ◦Assess for social support and previous loss. ◦Provide appropriate education and counselling. Approaches to Care at Specific Stages Across the Lifespan Menstrual concerns ◦Issues with menstrual cycle prompt women to seek health care. ◦Include amenorrhea, dysmenorrhea, premenstrual syndrome, endometriosis, and menorrhagia or metrorrhagia Perimenopause and menopause ◦A natural transition caused by a drop in estrogen ◦Vasomotor symptoms such as hot flashes and flushes Risks Factors that Impact Health Substance use Addiction – biopsychosocial diseases ◦ Smoking and electronic cigarettes ◦ Caffeine ◦ Alcohol ◦ Cannabis ◦ Prescription medication use ◦ Illicit drugs ◦ Cocaine ◦ Opioids ◦ Methamphetamine ◦ Other illicit drugs Risk Factors that Impact Health Nutrition ◦ Food insecurity ◦ Nutritional deficiencies ◦ Obesity ◦ Eating disorders (Box 5.5) ◦ Anorexia nervosa ◦ Bulimia nervosa Physical fitness and exercise ◦ Kegel exercise Risk Factors that Impact Health Stress (Box 5.6) ◦ Stress management Depression, anxiety and other mental health conditions Sleep disorders Environmental and workplace hazards Sexual practices ◦ STI and HIV prevention counselling (Box 5.7) Risk Factors that Impact Health Medical or gynecological conditions Female genital cutting (FGC) Human trafficking Intimate partner violence (Gender-based violence) As we close Part A of our module…reflect on and think about some situations when you provided family- centred care…what worked well? What might you implement differently next time, if anything? QUESTIONS OR COMMENTS?  Class Objectives 1. Explain the physiological changes that occur during pregnancy and their implications for antepartum nursing care. 2. Provide rationale for collecting specific information in an antenatal assessment 3. Identify and use methods to calculate expected date of birth (EDD) 4. Use the acronym GTPAL to document a woman’s obstetrical history* 5. Analyze the role of prenatal screening and diagnostic tests in identifying potential complications during pregnancy including appropriate nursing interventions to support families in making informed decisions for prenatal screening 6. Explain recommendations for maternal weight gain during pregnancy 7. Examine the role of nutrition during pregnancy 8. Determine self-care measures and healthy lifestyle behaviours that prevent adverse maternal and fetal outcomes Readings & Prep READINGS: CHAPTERS 9-13 Antepartum Assessment Past Social Medic History al Healt Famil h y Histor Histo y ry Ment Psych al o- Healt social h Image: www.marchofdimes.org  Components of the Antenatal Health History Menstrual History Family History Sexual History & STIs Substance Use Past Pregnancies (we will learn Nutrition Psychosoci GTPAL) Nulligravida, primigravida, IPV/Violence al Factors multigravida (Note re: “para”) Environment Current Pregnancy History Cultural Considerations Past Medical and Surgical History Calculating EDD (EDB): Estimated Due Date / Estimated DOB Naegele’s Rule = Determine the 1st day of LMP Subtract 3 months and add 7 days (LMP – 3 months + 7 days = EDD) Current Best Practices changed in recent years ULTRASOUND (SOGC, 2019). Under what circumstances might EDD wheel or Naegele’s rule Praxis Point – EDD/EDB Jayna’s last menstrual period was May 6, 2023. What is her EDD/EDB, using Naegele’s Rule?  Determination of Gestational Age by Ultrasound (SOGC, 2019). When performed with This isn't meant to be quality and precision, biological dating. We are not ultrasound alone is more trying to predict WHEN accurate than a conception occurred (i.e.: work backwards) but setting “certain” menstrual date up a common frame of for determining reference / starting point to gestational age in the count days of gestation first and second trimesters (≤ 23 weeks) in spontaneous Some women are very aware conceptions, and it is of when they ovulate and we the best method for should not discount this, however many women are not https://www.jogc.com/article/S1701-2163(19)3046 estimating the delivery 4-5/fulltext so. date. Perinatal Services BC (2019).  Obstetrical History: GTPAL G: Total number of pregnancies the woman has had, including the current one T: Total number of term infants born after 37 weeks’ gestation (> 37 weeks) P: Total number of children born prematurely (between 20 and before completion of 37 weeks’ gestation) A: Total number of pregnancies that ended in either therapeutic abortion or spontaneous abortion before 20 weeks gestation L: Total number of children currently alive to whom the woman has given birth  Take 5! – Praxis Point Maricelle is pregnant for the 6th time. She has 4 children currently alive (delivered at 40 weeks, 38 weeks, 32 weeks and 41 weeks gestation) She had a spontaneous abortion at 12 weeks. What is her GTPAL?  Take 5! – Praxis Point Kathy is pregnant for the 3rd time. She gave birth to a single baby at 41 weeks and twins at 35 weeks gestation, all of whom are currently alive. What is her GTPAL? What will her GTPAL be if she delivers her baby at 39 weeks?  Physical Assessment General Survey Peripheral Vasculature Neurological System Genitalia Skin Pelvimetry – sometimes used to Mouth measure pubic arch, curve of Breasts/Chest side walls, prominence of ischial spines & the shape of sacrum. Heart Abdomen – CLASS #6 … Stay Lungs Tuned!!  How does prenatal care impact outcomes? Why is it important? Syphilis in babies: Cases skyro These assessments and individualized care help cket in Canada | CTV News identify and mitigate risks associated with the 13 times more babies born wit pregnancy, and helps the family and healthcare h syphilis in Canada over 4 ye ars, data shows | CBC Radio team to plan appropriate care, and help to ensure positive outcomes The person’s physical and emotional health before pregnancy is as important as physical and emotional health during pregnancy Lacking Prenatal Care = marker of health inequity More in Lab!  Cultural Considerations (Perinatal Services BC, 2021). Varcoe et al. (2013) attribute the decline in the perinatal health of Indigenous women and pregnant individuals to dehumanizing interactions with healthcare providers, loss of autonomy, and discrimination and racism in maternity care in Canada. More recently, Vedam et al. (2019), used seven World Health Organization (WHO) indicators to study childbirth in the US, (identified additional factors, including: mistreatment, such as being shouted at or scolded by healthcare providers; violations of privacy, and threats of withholding treatment or using coercion to have a patient accept it. They noted that rates of mistreatment were consistently higher for Indigenous women and women of colour compared to white women; and compared to other racial groups, Indigenous women were the most likely to report mistreatment. Indigenous women were twice as likely to report that healthcare providers shouted at or scolded them. In addition, women with social, economic, or health challenges experienced mistreatment more frequently in hospitals.  Antenatal Lab Evaluation ABO blood type and Rh Complete blood count/ hemoglobin Pap Smear Vaccines: Rubella & Varicella titre ◦ - if not imummune – we give post partum Genetic Screening HIV testing / TORCH Screening ◦ - toxplasmosis TSH See table 11- 1 in your Syphilis/chlamydia/gonorrhea screen ◦ - giving erythromycin Glucose Test text for a comprehen Hep B surface antigen Urinalysis & urine C&S ve l si ◦ - if no status – vaccine is given ist … Group B Strep (LATER) Group B streptococcus ◦ - avoid risk to the baby If not rubella immune – give PP Ontario Perinatal Record (PCMCH) – Provincial form at this time Alberta Prenatal Record For full PDF form, visit: https://www.pcmch.on.ca/wp-content/uplo ads/2022/02/OPR-2017.pdf Back to Lab Values … WE WILL LIKELY GET TO THIS IN WEEK TWO   Quiz Time! Rh Incompatibility 1. Potential for Rh incompatibility exists when the mother is Rh ________ (lacks the antigen) and the father is Rh _______. 2. If the fetus is Rh positive, and the mother is negative, the mother may be sensitized through mixing of maternal and fetal _____. 3. The mother’s body recognizes the antigen as foreign and begins making antibodies against them. This is called __________. 4. If the fetus is positive, antibodies from the mother cross the placenta, atttach to fetal RBCs and begin to hemolyze them. This can lead to ___________ _________ of the newborn. 5. To prevent this disease from occurring, Rh immunoglobulin (RhIg) is given to the mother to prevent the mother from making _______ and causing possible harm to the next baby.  Quiz Time! Rh Incompatibility 6. When a mother is Rh negative, she is checked for _________ antibodies at the first prenatal visit to determine if she is sensitized to the Rh antigen. This is called an _______ ________ test (checking for sensitization) 7. If Rh antibodies are present, maternal sensitization has occurred and the infant will be monitored closely for isoimmune haemolytic disease. If she is ___________, Rh immune globulin will be given at ___ weeks gestation. 8. RhIg (WinRho) is also administered after an ____________ or if there is any vaginal bleeding, where fetal and maternal blood may be mixing. It is also given again within ___ hours after birth. 9. A _______ ________ test is done on the infant’s blood to detect antibody- coated Rh-positive red blood cells.  Rh Incompatibility Rh incompatibility occurs If some of the fetus' blood passes when the mother's blood into the mother's blood stream, her type is Rh negative and her body will produce antibodies in fetus' blood type is Rh response positive. Usually, maternal and fetal blood do not mix. However mixing of blood can occur in situations such as: CVS, amniocentesis, blunt trauma during Images: https://www.nlm.nih.gov/ pregnancy,  Rh Incompatibility continued Patient Health Teaching These antibodies could pass back Considerations through the placenta and harm the (SEE CLASS ACTIVITY/WORKSHEET) fetus' red blood cells, causing mild to serious anemia in the fetus. What is the Rh Factor? How does someone get it? What happens if I’m pregnant and Rh Negative? How does Rh sensitization occur during pregnancy? Can I still develop antibodies after I’ve had a loss? Can this be prevented? Rh Incompatibility Treatment – Rh immunoglobulin (RhIg – WinRho ® or RhoGam®) Around the 28th week of pregnancy Within 72 hours of delivery of an Rh positive infant After a m/c, abortion, ectopic pregnancy After amnio or CVS  Direct = on the surface of th 10/17/2024 100 Development of maternal sensitization to Rh antigens – what we are trying to avoi A: Fetal Rh-positive erythrocytes enter the maternal system. Maternal anti- B: Anti-Rh antibodies cross the Rh antibodies are formed. placenta and attack fetal erythrocytes. (Perry 2024). Various factors can influence pregnancy outcomes, including maternal nutrition Self Care Nutriti Family on Pregnan Educati SES cy on Outcom e ? ? ? ? 10/17/2024 102  Maternal Nutrition Good nutrition before and during pregnancy is an important preventive measure for a variety of problems Nutrient needs during pregnancy are determined, in part, by the stage of gestation 10/17/2024 103 Maternal Nutrition – Optimal Weight Gain Pre-Pregnancy BMI Recommended Weight Gain Less than 18.5 ____to ____kg Underweight 18.5 to 24.9 ____ to ____kg Healthy weight 25 to 29.9 ____ to ____kg Overweight Equal to or greater than 30 ____ to ____kg Obese 10/17/2024 104 https://www.canada.ca/en/public-health/services/health-pro motion/healthy-pregnancy/healthy-pregnancy-guide.html# Maternal Nutrition – Pattern of Weight Gain Ideal pattern for a normal weight woman: 1st 2nd 3rd 11.5 trimeste trimeste trimeste -16 r r r kg 10/17/2024 106  Maternal Nutrition – Pattern of Weight Gain Optimal rate of weight gain depends on the stage of pregnancy 95 cal Recommended energy 60 cal (125 ml, 2%) 86 cal (kcal) intake 105 cal corresponds to 130 cal recommended pattern of weight (15gainml tbsp) Growth primarily takes place in 1st & 2nd maternal tissues trimester st 1 (no increment) 2nd trimester 34 : ____ kcal/day 0 takes place in fetal Growth primarily 3rd tissues trimester 45 3rd trimester: 2 ____ kcal/day 10/17/2024 107  Maternal Nutrition Distribution of Weight Gain Fat & Protein Uterus Stores Amniotic Fetus Fluid Tissue Fluids Placenta &  Blood Umbilical Volume Cord The numbers represent an average; variation among women is great. The component with the greatest fluctuation is the weight increase Breast Tissue attributed to extravascular 10/17/2024 fluids (edema) & maternal reserves of fat. 108  Increased risk of IUGR Inadequate Increased risk of neonatal Weight Gain mortality Why are we What else? so concerned about Pre-existing obesity nutrition? Macrosomia or obesity that Increased risk of maternal develops in hypertension and gestational pregnancy diabetes What else?  Maternal Nutrition – Selected Nutrients During Pregnancy Nutrient Role Protein Synthesis of products of conception; growth of maternal tissue & expansion of blood volume Iron Maternal hemoglobin formation; fetal liver iron storage Calcium Fetal & infant skeleton and tooth formation; maintenance of maternal bone and tooth mineralization 10/17/2024 110  Nutrient Role Fat- A- cell development, tooth bud formation, bone growth; Soluble development of healthy eyes D-absorption of calcium & phosphorus Vitamins E-antioxidant; prevents RBC breakdown K-synthesis of protein, blood coagulation (clotting) and bone metabolism Water- C- tissue formation; integrity of connective tissue & vascular Soluble system, enhances iron absorption Folate- prevents NTDs; supports increased maternal RBC Vitamins formation B6 (pyridoxine) - needed for protein metabolism B12 - formation of RBC & neural functioning 10/17/2024 111  Maternal Nutrition – Nutritional Issues Pica Food Cravings The practice of consuming The urge to have certain nonfood substances or foods during pregnancy excessive amounts of foodstuffs low in May be caused by an nutritional value innate drive to consume missing nutrients from Often influenced by the diet (research has culture not supported this Related to iron deficiency hypothesis) anemia, low hgb Hyperemesis Gravidarum What else? Severe morning sickness - Dry crackers, Ginger Ale 10/17/2024 112 Antenatal Risk Factors and Pregnancy Outcomes Food Herbal Caffeine Safety Teas Pet Hot Tubs Alcohol Safety Protection from Smoking Drug Use Communicable Diseases 10/17/2024 113 What does each item have to do with pregnancy? Health teaching Subject: Mercury in Fish In pregnancy, women should avoid fish with high mercury content (e.g. shark, swordfish, tilefish, king mackerel & marlin) Subject: Listeriosis Pregnant women (and their fetus) are at greater risk for food-borne illnesses because they have a weaker immune system. 10/17/2024 115 Subject: Caffeine Pregnant women should limit caffeine intake to 500 mg/day, the equivalent of 3-4 cups of brewed coffee/day. FALSE – 1-2 cups, 300mg/day Subject: Toxoplasmosis To prevent toxoplasmosis in pregnancy, women should avoid emptying the litter box and wear gloves while gardening if the area is frequented by cats. 10/17/2024 116 Subject: Dental Health There is some evidence linking periodontal infections and preterm birth. Subject: Smoking Passive (second-hand smoke) is not detrimental to the expectant mom and the fetus during pregnancy. 10/17/2024 117 Subject: Hot Tubs Hot tubs may increase the mother’s core body temperature which can have a detrimental effect on the fetus. 10/17/2024 118  Menti.com 5830 7051 CLEAR VERSUS MUDDY POINTS … CHECKING IN  AFTER THIS WEEK, WE’LL DO THIS IN MS FORMS