Trends and Issues in Maternal Health
· What do maternal morbidity- illness, sickness, problems related to birth that mothers can
face and mortality- death during birth or 48hrs after birth mean?
Identify various ethical issues in maternal healthcare
● Abortion, refusal of treatment, life support
● Genetic + fetal abnormalities, prenatal care, surrogacy/ picking, jail for substance abuse
Genetics, Conception, and Fetal Development
· What are examples of teratogens and when do they cause the most impact? Table 3-2 first
8 weeks because of organogenesis
● Alcohol, ACE inhibitors, anticonvulsants, cocaine, warfarin, lithium, varicella, rubella,
syphilis, toxoplasmosis, zika, CMV.
· Menstrual cycle- all phases and hormones
· Embryonic and fetal development- germ layers, fetal heart development can be heard by
week 12 and seen by week 4, refer to table 3-4.
● Ectoderm- nervous system, skin ( epidermis, lens + cornea, pituitary, and mucosa of oral
and nasal cavities )
● Mesoderm- muscles, bones, circulatory (dermis, kidneys, bone marrow + bones)
● Endoderm- digestive + respiratory ( liver, thyroid gland, intestines, stomach )
· Fetal circulation and all adaptations
Placental structure and function excretes waste products + nutrients, umbilical cord function connects
fetus to placenta, has AVA and uses wharton’s jelly to protect vessels and amniotic fluid function
cushions, protects, and warms
Physiological and psychological aspects of pregnancy
· Physiological changes with pregnancy (Table 4-1), along with education and comfort
measures
● Cardiovascular - high in blood volume, cardiac output, and plasma volume. Physiological
anemia of pregnancy due to hemodilution
● Respiratory - supine hypotensive syndrome can occur in supine position ( lay on sides )
● Renal - increased urinary output with frequency. Increased risk of uti
● Gi changes- nausea and vomit, heartburn, bloating, flatulence, and constipation
● Musculoskeletal - low back pain or pelvic discomfort, lordosis, increased risk of fall due
to shift in center of gravity, round ligament spasm, diastasis recti
● Integumentary - linea nigra, melasma (melanin), increased pigmentation of nipples,
areola, vulva, scars, and moles, increased perspiration (sweating), striae gravidarum
(stretch marks), varicosities, spider nevi, and palmar erythema
● Endocrine - increased progesterone, estrogen, prolactin, oxytocin, HCG from zygote, and
need for glucose due to developing fetus
· What is pre-conception care? Table 4-2 is a great reference when identifying potential
complications before conception. Nursing role with education
· Nutritional Requirements nausea use ginger, crackers + water. 400 mcg of folic acid to
prevent neuro tube defects
· What are safe versus unsafe foods during pregnancy?
● Safe- milk, cheese (pasteurized), yogurt, broccoli. Eggs, chicken, beans, tofu, spinach
, ● Unsafe- seafood, raw meat, unpasteurized foods
· Weight gain per BMI per trimester
● Underweight <18.5 adds 28-40
● Normal 18.5-24.9 adds 25-35
● Overweight 25-29.9 adds 15-25
● Obese > 30 adds 11-20
· Exercise during pregnancy and education-related light exercises like walking is good.
You can still go to gym but don't do any heavy lifting, only light exercises
· Understand what happens during the first prenatal visit, listen and look at baby, what is
done? ultrasound, assess LMP, what labs are collected, and the rationale for each. Hepatitis B,
syphilis, HIV, Rubella, blood type + screen ( rhogam ), CBC (anemia), platelets (hematocrit), UA
Subsequent visits and frequency. Monthly up to 28 weeks, every 2 weeks between 28-36 weeks,
weekly 36-birth Table 4-3 is a great reference, along with Canvas resources
· 3 P’s- Indicators of pregnancy
● Presumptive- nausea, breast tender, cramps, missed period, vomit
● Probable- anemia, positive test, hagar (shift in uterus), chadwick (discoloration of cervix),
goodell (gooey + soft cervix)
● Positive- ultrasound, heartbeat, kick
· Gravida total numbers of times pregnant , para (T number of full term infants (38- birth)
P number of preterm infants (20- 37 weeks 6 days) A number of abortions ( conception- 19 weeks
6 days ) L living children)
· Naegele’s rule calculation subtract 3 months and add seven days and change the year
from LMP
· Warning and danger signs to educate per trimester bleeding, fever, severe cramps,
· Nursing Teaching per Trimester
● First - conception to 13 weeks 6 days; second- 14 weeks to 27 weeks 6 days; third- 28
weeks to birth
○ Second- A1c (blood glucose), CBC
○ Third- strep B, feeding, birth plan, resources
· What is Rhogam, and who is eligible? When mom is negative and baby is positive. Blood
mixes and can cause sensitivity. Rhogam is a shot to help prevent fetal mortality due to mom’s
immune attacking baby. 28weeks and 72hrs after birth
What are some critical components for maternal adaptation to pregnancy? 1st focus on themselves, 2nd
they do prenatal things to keep baby alive, 3rd- both are anticipating baby to come List nursing actions
that will facilitate adaptation to pregnancy per trimester.
Caring for Women in the Antenatal Period- Testing
· Prenatal diagnostic testing & Genetic Screening-What is it? When is it conducted? How
should she prepare for it? Indications are family history, if parents are carriers, and if previous
pregnancy had something.
● Screening is non invasive (too asses if you have a risk), while diagnostic is invasive ( yes
you do, what is that risk )
● Genetic tests often detect health problems that could affect the women, fetus, or newborn
● It's usually conducted in first trimester or early second
● Ask questions before any tests, understand any risks, and get genetic counseling
, What are post-procedure instructions, if any? Avoid any strenuous activity/ take it easy. look out
for any bleeding, cramping or leaking. Schedule follow up appointment to discuss results
o FKC teach mom to count her baby's movement daily
● 5 in an hour and 10 in 2 hours
● Do it in a quiet area at home and place hands on belly
o NST,looks at baby’s HR when FKC isn't successful
● Make sure the CNS is intact and it takes 20 minutes. Non invasive and you need
at least two accelerations
● Use vibro stimulation, juice, or change in position to wake up baby
o BPP, biophysical profile that looks at NST, Fetal breathing movements, gross body
movements, fetal muscle tone, and amniotic fluid
● 0 = they dont have it, 2 = they do have it. 10 being perfect score
● Further down more stress the baby is under
o CST, contraction stress test that determines the fetus ability to maintain a normal FHR
during uterine contractions in a nonreactive NST. identify if fetus is a risk for
compromise
● Monitor FHR and activity for 20 min, give mom oxytocin or nipple stimulation
● Negative is good because no decelerations, positive is bad because there are
decelerations with increased risk of fetal death and growth restrictions
○ No decelerations in a 10min strip with 3 uc in 40 seconds
● Can cause preterm labor, increase bleeding and uterine rupture
● void before, semi fowler, and vitals 15m before and every 15min until test is
done
o CVS, chorionic villus sampling is taking a piece of the placenta tissue and testing it
for chromosomal abnormalities 10-13 weeks
● Fetal loss, infection, bleeding, miscarriage
o AFP or Quad testing
● AFP is done 15-20 weeks and it checks for open neural tube defects
○ ONTD, and trisomy
○ High = ONTD and low = trisomy levels
○ Abnormal findings can occur, false positives, false negatives
● Multiple Marker screening is done 15-22 weeks and it checks for the same thing
○ ONTD, trisomy ( 13, 18, 21 )
○ If positive then you'll need an amino and it's more sensitive
o Amnio (genetic and 3rd trimester), take amniotic fluid to test for abnormalities like
trisomy 21. 15-20 weeks
● Do it in the third trimester to look at lungs for inducing labor
● Leaking, bleeding, infection, fetal loss
o free cell DNA screens for common abnormalities, by drawing blood from mom. 9- 10
weeks and you can also identify fetal sex
· Fetal Monitoring
o What is the normal baseline? 110-160
o What is variability? How well the baby is oxygenated
· What do maternal morbidity- illness, sickness, problems related to birth that mothers can
face and mortality- death during birth or 48hrs after birth mean?
Identify various ethical issues in maternal healthcare
● Abortion, refusal of treatment, life support
● Genetic + fetal abnormalities, prenatal care, surrogacy/ picking, jail for substance abuse
Genetics, Conception, and Fetal Development
· What are examples of teratogens and when do they cause the most impact? Table 3-2 first
8 weeks because of organogenesis
● Alcohol, ACE inhibitors, anticonvulsants, cocaine, warfarin, lithium, varicella, rubella,
syphilis, toxoplasmosis, zika, CMV.
· Menstrual cycle- all phases and hormones
· Embryonic and fetal development- germ layers, fetal heart development can be heard by
week 12 and seen by week 4, refer to table 3-4.
● Ectoderm- nervous system, skin ( epidermis, lens + cornea, pituitary, and mucosa of oral
and nasal cavities )
● Mesoderm- muscles, bones, circulatory (dermis, kidneys, bone marrow + bones)
● Endoderm- digestive + respiratory ( liver, thyroid gland, intestines, stomach )
· Fetal circulation and all adaptations
Placental structure and function excretes waste products + nutrients, umbilical cord function connects
fetus to placenta, has AVA and uses wharton’s jelly to protect vessels and amniotic fluid function
cushions, protects, and warms
Physiological and psychological aspects of pregnancy
· Physiological changes with pregnancy (Table 4-1), along with education and comfort
measures
● Cardiovascular - high in blood volume, cardiac output, and plasma volume. Physiological
anemia of pregnancy due to hemodilution
● Respiratory - supine hypotensive syndrome can occur in supine position ( lay on sides )
● Renal - increased urinary output with frequency. Increased risk of uti
● Gi changes- nausea and vomit, heartburn, bloating, flatulence, and constipation
● Musculoskeletal - low back pain or pelvic discomfort, lordosis, increased risk of fall due
to shift in center of gravity, round ligament spasm, diastasis recti
● Integumentary - linea nigra, melasma (melanin), increased pigmentation of nipples,
areola, vulva, scars, and moles, increased perspiration (sweating), striae gravidarum
(stretch marks), varicosities, spider nevi, and palmar erythema
● Endocrine - increased progesterone, estrogen, prolactin, oxytocin, HCG from zygote, and
need for glucose due to developing fetus
· What is pre-conception care? Table 4-2 is a great reference when identifying potential
complications before conception. Nursing role with education
· Nutritional Requirements nausea use ginger, crackers + water. 400 mcg of folic acid to
prevent neuro tube defects
· What are safe versus unsafe foods during pregnancy?
● Safe- milk, cheese (pasteurized), yogurt, broccoli. Eggs, chicken, beans, tofu, spinach
, ● Unsafe- seafood, raw meat, unpasteurized foods
· Weight gain per BMI per trimester
● Underweight <18.5 adds 28-40
● Normal 18.5-24.9 adds 25-35
● Overweight 25-29.9 adds 15-25
● Obese > 30 adds 11-20
· Exercise during pregnancy and education-related light exercises like walking is good.
You can still go to gym but don't do any heavy lifting, only light exercises
· Understand what happens during the first prenatal visit, listen and look at baby, what is
done? ultrasound, assess LMP, what labs are collected, and the rationale for each. Hepatitis B,
syphilis, HIV, Rubella, blood type + screen ( rhogam ), CBC (anemia), platelets (hematocrit), UA
Subsequent visits and frequency. Monthly up to 28 weeks, every 2 weeks between 28-36 weeks,
weekly 36-birth Table 4-3 is a great reference, along with Canvas resources
· 3 P’s- Indicators of pregnancy
● Presumptive- nausea, breast tender, cramps, missed period, vomit
● Probable- anemia, positive test, hagar (shift in uterus), chadwick (discoloration of cervix),
goodell (gooey + soft cervix)
● Positive- ultrasound, heartbeat, kick
· Gravida total numbers of times pregnant , para (T number of full term infants (38- birth)
P number of preterm infants (20- 37 weeks 6 days) A number of abortions ( conception- 19 weeks
6 days ) L living children)
· Naegele’s rule calculation subtract 3 months and add seven days and change the year
from LMP
· Warning and danger signs to educate per trimester bleeding, fever, severe cramps,
· Nursing Teaching per Trimester
● First - conception to 13 weeks 6 days; second- 14 weeks to 27 weeks 6 days; third- 28
weeks to birth
○ Second- A1c (blood glucose), CBC
○ Third- strep B, feeding, birth plan, resources
· What is Rhogam, and who is eligible? When mom is negative and baby is positive. Blood
mixes and can cause sensitivity. Rhogam is a shot to help prevent fetal mortality due to mom’s
immune attacking baby. 28weeks and 72hrs after birth
What are some critical components for maternal adaptation to pregnancy? 1st focus on themselves, 2nd
they do prenatal things to keep baby alive, 3rd- both are anticipating baby to come List nursing actions
that will facilitate adaptation to pregnancy per trimester.
Caring for Women in the Antenatal Period- Testing
· Prenatal diagnostic testing & Genetic Screening-What is it? When is it conducted? How
should she prepare for it? Indications are family history, if parents are carriers, and if previous
pregnancy had something.
● Screening is non invasive (too asses if you have a risk), while diagnostic is invasive ( yes
you do, what is that risk )
● Genetic tests often detect health problems that could affect the women, fetus, or newborn
● It's usually conducted in first trimester or early second
● Ask questions before any tests, understand any risks, and get genetic counseling
, What are post-procedure instructions, if any? Avoid any strenuous activity/ take it easy. look out
for any bleeding, cramping or leaking. Schedule follow up appointment to discuss results
o FKC teach mom to count her baby's movement daily
● 5 in an hour and 10 in 2 hours
● Do it in a quiet area at home and place hands on belly
o NST,looks at baby’s HR when FKC isn't successful
● Make sure the CNS is intact and it takes 20 minutes. Non invasive and you need
at least two accelerations
● Use vibro stimulation, juice, or change in position to wake up baby
o BPP, biophysical profile that looks at NST, Fetal breathing movements, gross body
movements, fetal muscle tone, and amniotic fluid
● 0 = they dont have it, 2 = they do have it. 10 being perfect score
● Further down more stress the baby is under
o CST, contraction stress test that determines the fetus ability to maintain a normal FHR
during uterine contractions in a nonreactive NST. identify if fetus is a risk for
compromise
● Monitor FHR and activity for 20 min, give mom oxytocin or nipple stimulation
● Negative is good because no decelerations, positive is bad because there are
decelerations with increased risk of fetal death and growth restrictions
○ No decelerations in a 10min strip with 3 uc in 40 seconds
● Can cause preterm labor, increase bleeding and uterine rupture
● void before, semi fowler, and vitals 15m before and every 15min until test is
done
o CVS, chorionic villus sampling is taking a piece of the placenta tissue and testing it
for chromosomal abnormalities 10-13 weeks
● Fetal loss, infection, bleeding, miscarriage
o AFP or Quad testing
● AFP is done 15-20 weeks and it checks for open neural tube defects
○ ONTD, and trisomy
○ High = ONTD and low = trisomy levels
○ Abnormal findings can occur, false positives, false negatives
● Multiple Marker screening is done 15-22 weeks and it checks for the same thing
○ ONTD, trisomy ( 13, 18, 21 )
○ If positive then you'll need an amino and it's more sensitive
o Amnio (genetic and 3rd trimester), take amniotic fluid to test for abnormalities like
trisomy 21. 15-20 weeks
● Do it in the third trimester to look at lungs for inducing labor
● Leaking, bleeding, infection, fetal loss
o free cell DNA screens for common abnormalities, by drawing blood from mom. 9- 10
weeks and you can also identify fetal sex
· Fetal Monitoring
o What is the normal baseline? 110-160
o What is variability? How well the baby is oxygenated
