MEASURING Birth rate: The number of births per 1,000 population.
MATERNAL
AND CHILD
HEALTH
Fertility rate: The number of pregnancies per 1,000 women of childbearing age.
Fetal death rate: The number of fetal deaths (over 500 g) per 1,000 live births.
Neonatal death rate: The number of deaths per 1,000 live births occurring at birth
or in the first 28 days of life.
Perinatal death rate: The number of deaths during the perinatal time period
(beginning when a fetus reaches 500 g, about week 20 of pregnancy,
and ending about 4 to 6 weeks after birth); it is the sum of the fetal and neonatal rates.
Maternal mortality rate: The number of maternal deaths per 100,000 live births
that occur as a direct result of the reproductive process.
Infant mortality rate: The number of deaths per 1,000 live births
occurring at birth or in the first 12 months of life.
Childhood mortality rate: The number of deaths per 1,000 population in children aged 1 to 14 years.
Cultural Culture-specific values are norms and patterns of behavior unique to one culture.
Competency Culture universal values refers to values, norms, and patterns shared across almost all cultures.
Terminology Ethnicity refers to the cultural group into which a person was born, although t
for Nurses he term is sometimes used in a narrower context to mean only race.
Race, a social construct, refers to a category of people who share a socially
recognized physical characteristic, often skin color or facial features. It can
also refer to a group of people who share the same ancestry.
Acculturation refers to the loss of ethnic traditions because of disuse.
Cultural assimilation means people blend into the general population
or adopt the values of the dominant culture.
Ethnocentrism is the belief one’s own culture is superior to all others.
Cultural awareness is being aware cultural differences exist.
Cultural competence is respecting cultural differences or diversity.
Cultural humility is a lifelong process of self-reflection and self-critique
that begins, not with an assessment of a patient’s beliefs, but rather with an assessment of your own.
GBS GBS most often is found in the vagina and rectum. GBS can to your fetus during labor.
Occurrence 1 or 2 babies out of 100 for untreated mothers.
Mother needs 2 doses of Antibiotics 4 hours prior to delivery.
• Fetal Effects : PMS
• Early-onset disease can cause severe problems, such as
, • Pneumonia infection of the lungs (pneumonia)
•
• Meningitis inflammation of the covering of the brain or spinal cord (
• Sepsis infection in the blood (sepsis)
A small number of babies with early-onset disease die even with immediate treatment
Maternal Effects :
Preterm labor and delivery
Chorioamnionitis
Infections of the urinary tract
Maternal sepsis
Endometritis after delivery
Administer intrapartum antibiotic prophylaxis to the following clients to decrease tra
to the neonate.
● Client who has a GBS-positive screening during current pregnancy
● Client who has unknown GBS status who is delivering at less than 37 weeks of ges
● Client who has maternal fever of 38° C (100.4° F) or greater
● Client who has rupture of membranes for 18 hr or longer
Maternal • Normal weight patients Healthy weight BMI: 25 to 35 lb
Weight First trimester: 3.5 to 5 lb
•
Gain Second and third trimesters: 1 lb/wk
•
• Underweight patients.
• BMI <19.8: 28 to 40 lb .
• First trimester: 5 lb
• Second and third trimesters: 1+ lb/wk
• Overweight patients
• BMI >25: 15 to 25 lb
• First trimester: 2 lb
• Second and third trimesters: 2/3 lb/wk
Overweight clients, 6.8 to 11.3 kg (15 to 25 lb)
Chorionic Villus • Chorionic villus =10-12 weeks gestation to detect anomalies in the fetus
Testing • (optional)Results 1 day
• Limited: Does not detect spinal cord abnormalities
• Chorionic villus sampling (CVS) is the assessment
of a portion of the developing placenta (chorionic
villi), which is aspirated through a thin sterile
catheter or syringe inserted through the abdominal
wall or intravaginally through the cervix under
ultrasound guidance.
● CVS is a first-trimester alternative to amniocentesis
with one of its advantages being an earlier diagnosis of
any abnormalities. CVS is ideally performed at 10 to 13
weeks of gestation
1. earlier diagnosis
should be weighed against the increased risk of fetal anomalies and death.
INDICATIONS
, POTENTIAL DIAGNOSES
: Risk for giving birth to a neonate who has a genetic chromosomal abnormality
NURSING ACTIONS
CLIENT EDUCATION: Drink 1 to 2 glasses of fluid prior to the test and avoid urination for
several hours prior to testing. A full bladder is necessary for testing.
COMPLICATIONS
● Spontaneous abortion (higher risk with CVS than with amniocentesis)
● Risk for fetal limb loss (greatest risk prior to 9 weeks of gestation)
● Miscarriage
● Chorioamnionitis and rupture of membranes
MSAFP • 16th week
• Maternal Screening: Alpha-Fetoprotein (MSAFP, maternal serum &
• amniotic fluid AFP)to check for Down syndrome (trisomy 21)
• neural tube defects(NTD), spina bifida and anencephaly
• Amniocentesis = between 16 and 20 weeks gestation
• (earlier is associated with increase in fetal loss)
• done to evaluate fetal condition, test AFP when MSAFP is abnormal
• Alpha-fetoprotein
HIGH LEVELS: Associated with neural tube defects, such as anencephaly
• (incomplete development of fetal skull and brain), spina bifida (open spine)
• , or omphalocele
(abdominal wall defect). High AFP levels also can be present with
• normal multifetal pregnancies.
•
LOW LEVELS: Associated with chromosomal disorders
(Down syndrome) or gestational trophoblastic disease
(hydatidiform mole).
• High-risk pregnancy:
Quad marker screening
•
A blood test that ascertains information about the
likelihood of fetal birth defects. It does not diagnose the
actual defect. It can be performed instead of the maternal
AFP blood level yielding more reliable findings. Includes
testing for:
● Human chorionic gonadotropin (hCG): a hormone
produced by the placenta
● Alpha-fetoprotein (AFP): a protein produced
by the fetus
● Estriol: a protein produced by the fetus and placenta
● Inhibin A: a protein produced by the ovaries
and placenta
● Low levels of AFP can indicate a risk for
Down syndrome.
● High levels of AFP can indicate a risk for neural
tube defects.
● Levels higher than the expected reference range of hCG
and inhibin A indicates a risk for Down syndrome.
● Lower levels than the expected reference range of
estriol can indicate a risk for Down syndrome
CLIENT PRESENTATION
, ● Preferred at 16 to 18 weeks gestation
● Risk for giving birth to a neonate who has a genetic
chromosomal abnormality
INTERPRETATION OF FINDINGS
● Low levels of AFP can indicate a risk for
Down syndrome.
● High levels of AFP can indicate a risk for neural
tube defects.
● Levels higher than the expected reference range of hCG
and inhibin A indicates a risk for Down syndrome.
● Lower levels than the expected reference range of
estriol can indicate a risk for Down syndrome
Contraction • Contraction stress test:
stress Test • Nipple-stimulated contraction test
• Client lightly brushing their palm across the nipple for 2 min
• Pituitary gland stimulated to release endogenous oxytocin and
• then stopping the nipple stimulation when contraction begins.
• The same process is repeated after a 5 min. rest period.
• Ordered if nonstress test nonreactive
• Monitoring the fetal heart rate for stress induced by uterine contractions
• CST = three contractions within a 10-minute period
D
● Analysis of the FHR response to contractions (which
decrease placental blood flow) determines how the fetus
will tolerate the stress of labor. A pattern of at least three contractions
within a 10-min time period with duration of 40 to 60 seconds each must be obtained
to use for assessment data.
● Hyperstimulation of the uterus (uterine contraction longer
than 90 seconds or five or more contractions in 10 min)
should be avoided by stimulating the nipple intermittently with rest periods in between and
avoiding bimanual stimulation of both nipples unless stimulation of one nipple is unsuccessful.
Oxytocin-stimulated contraction test
Also known as an oxytocin challenge test (OCT),
it is used if nipple stimulation fails and consists of the
IV administration of oxytocin to induce uterine contractions.
● Contractions started with oxytocin can be difficult to
stop and can lead to preterm labor.
● Contraindications include placenta previa, vasa
previa, preterm labor, multiple gestations, previous
classic incision from a cesarean birth, and reduced
cervical competence.
INDICATIONS
POTENTIAL DIAGNOSES
● High-risk pregnancies (gestational diabetes mellitus,
postterm pregnancy)
● Nonreactive stress test
CLIENT Presentation
● Decreased fetal movement
● Intrauterine growth restriction
● Postmaturity
● Diabetes mellitus
● Hypertension
MATERNAL
AND CHILD
HEALTH
Fertility rate: The number of pregnancies per 1,000 women of childbearing age.
Fetal death rate: The number of fetal deaths (over 500 g) per 1,000 live births.
Neonatal death rate: The number of deaths per 1,000 live births occurring at birth
or in the first 28 days of life.
Perinatal death rate: The number of deaths during the perinatal time period
(beginning when a fetus reaches 500 g, about week 20 of pregnancy,
and ending about 4 to 6 weeks after birth); it is the sum of the fetal and neonatal rates.
Maternal mortality rate: The number of maternal deaths per 100,000 live births
that occur as a direct result of the reproductive process.
Infant mortality rate: The number of deaths per 1,000 live births
occurring at birth or in the first 12 months of life.
Childhood mortality rate: The number of deaths per 1,000 population in children aged 1 to 14 years.
Cultural Culture-specific values are norms and patterns of behavior unique to one culture.
Competency Culture universal values refers to values, norms, and patterns shared across almost all cultures.
Terminology Ethnicity refers to the cultural group into which a person was born, although t
for Nurses he term is sometimes used in a narrower context to mean only race.
Race, a social construct, refers to a category of people who share a socially
recognized physical characteristic, often skin color or facial features. It can
also refer to a group of people who share the same ancestry.
Acculturation refers to the loss of ethnic traditions because of disuse.
Cultural assimilation means people blend into the general population
or adopt the values of the dominant culture.
Ethnocentrism is the belief one’s own culture is superior to all others.
Cultural awareness is being aware cultural differences exist.
Cultural competence is respecting cultural differences or diversity.
Cultural humility is a lifelong process of self-reflection and self-critique
that begins, not with an assessment of a patient’s beliefs, but rather with an assessment of your own.
GBS GBS most often is found in the vagina and rectum. GBS can to your fetus during labor.
Occurrence 1 or 2 babies out of 100 for untreated mothers.
Mother needs 2 doses of Antibiotics 4 hours prior to delivery.
• Fetal Effects : PMS
• Early-onset disease can cause severe problems, such as
, • Pneumonia infection of the lungs (pneumonia)
•
• Meningitis inflammation of the covering of the brain or spinal cord (
• Sepsis infection in the blood (sepsis)
A small number of babies with early-onset disease die even with immediate treatment
Maternal Effects :
Preterm labor and delivery
Chorioamnionitis
Infections of the urinary tract
Maternal sepsis
Endometritis after delivery
Administer intrapartum antibiotic prophylaxis to the following clients to decrease tra
to the neonate.
● Client who has a GBS-positive screening during current pregnancy
● Client who has unknown GBS status who is delivering at less than 37 weeks of ges
● Client who has maternal fever of 38° C (100.4° F) or greater
● Client who has rupture of membranes for 18 hr or longer
Maternal • Normal weight patients Healthy weight BMI: 25 to 35 lb
Weight First trimester: 3.5 to 5 lb
•
Gain Second and third trimesters: 1 lb/wk
•
• Underweight patients.
• BMI <19.8: 28 to 40 lb .
• First trimester: 5 lb
• Second and third trimesters: 1+ lb/wk
• Overweight patients
• BMI >25: 15 to 25 lb
• First trimester: 2 lb
• Second and third trimesters: 2/3 lb/wk
Overweight clients, 6.8 to 11.3 kg (15 to 25 lb)
Chorionic Villus • Chorionic villus =10-12 weeks gestation to detect anomalies in the fetus
Testing • (optional)Results 1 day
• Limited: Does not detect spinal cord abnormalities
• Chorionic villus sampling (CVS) is the assessment
of a portion of the developing placenta (chorionic
villi), which is aspirated through a thin sterile
catheter or syringe inserted through the abdominal
wall or intravaginally through the cervix under
ultrasound guidance.
● CVS is a first-trimester alternative to amniocentesis
with one of its advantages being an earlier diagnosis of
any abnormalities. CVS is ideally performed at 10 to 13
weeks of gestation
1. earlier diagnosis
should be weighed against the increased risk of fetal anomalies and death.
INDICATIONS
, POTENTIAL DIAGNOSES
: Risk for giving birth to a neonate who has a genetic chromosomal abnormality
NURSING ACTIONS
CLIENT EDUCATION: Drink 1 to 2 glasses of fluid prior to the test and avoid urination for
several hours prior to testing. A full bladder is necessary for testing.
COMPLICATIONS
● Spontaneous abortion (higher risk with CVS than with amniocentesis)
● Risk for fetal limb loss (greatest risk prior to 9 weeks of gestation)
● Miscarriage
● Chorioamnionitis and rupture of membranes
MSAFP • 16th week
• Maternal Screening: Alpha-Fetoprotein (MSAFP, maternal serum &
• amniotic fluid AFP)to check for Down syndrome (trisomy 21)
• neural tube defects(NTD), spina bifida and anencephaly
• Amniocentesis = between 16 and 20 weeks gestation
• (earlier is associated with increase in fetal loss)
• done to evaluate fetal condition, test AFP when MSAFP is abnormal
• Alpha-fetoprotein
HIGH LEVELS: Associated with neural tube defects, such as anencephaly
• (incomplete development of fetal skull and brain), spina bifida (open spine)
• , or omphalocele
(abdominal wall defect). High AFP levels also can be present with
• normal multifetal pregnancies.
•
LOW LEVELS: Associated with chromosomal disorders
(Down syndrome) or gestational trophoblastic disease
(hydatidiform mole).
• High-risk pregnancy:
Quad marker screening
•
A blood test that ascertains information about the
likelihood of fetal birth defects. It does not diagnose the
actual defect. It can be performed instead of the maternal
AFP blood level yielding more reliable findings. Includes
testing for:
● Human chorionic gonadotropin (hCG): a hormone
produced by the placenta
● Alpha-fetoprotein (AFP): a protein produced
by the fetus
● Estriol: a protein produced by the fetus and placenta
● Inhibin A: a protein produced by the ovaries
and placenta
● Low levels of AFP can indicate a risk for
Down syndrome.
● High levels of AFP can indicate a risk for neural
tube defects.
● Levels higher than the expected reference range of hCG
and inhibin A indicates a risk for Down syndrome.
● Lower levels than the expected reference range of
estriol can indicate a risk for Down syndrome
CLIENT PRESENTATION
, ● Preferred at 16 to 18 weeks gestation
● Risk for giving birth to a neonate who has a genetic
chromosomal abnormality
INTERPRETATION OF FINDINGS
● Low levels of AFP can indicate a risk for
Down syndrome.
● High levels of AFP can indicate a risk for neural
tube defects.
● Levels higher than the expected reference range of hCG
and inhibin A indicates a risk for Down syndrome.
● Lower levels than the expected reference range of
estriol can indicate a risk for Down syndrome
Contraction • Contraction stress test:
stress Test • Nipple-stimulated contraction test
• Client lightly brushing their palm across the nipple for 2 min
• Pituitary gland stimulated to release endogenous oxytocin and
• then stopping the nipple stimulation when contraction begins.
• The same process is repeated after a 5 min. rest period.
• Ordered if nonstress test nonreactive
• Monitoring the fetal heart rate for stress induced by uterine contractions
• CST = three contractions within a 10-minute period
D
● Analysis of the FHR response to contractions (which
decrease placental blood flow) determines how the fetus
will tolerate the stress of labor. A pattern of at least three contractions
within a 10-min time period with duration of 40 to 60 seconds each must be obtained
to use for assessment data.
● Hyperstimulation of the uterus (uterine contraction longer
than 90 seconds or five or more contractions in 10 min)
should be avoided by stimulating the nipple intermittently with rest periods in between and
avoiding bimanual stimulation of both nipples unless stimulation of one nipple is unsuccessful.
Oxytocin-stimulated contraction test
Also known as an oxytocin challenge test (OCT),
it is used if nipple stimulation fails and consists of the
IV administration of oxytocin to induce uterine contractions.
● Contractions started with oxytocin can be difficult to
stop and can lead to preterm labor.
● Contraindications include placenta previa, vasa
previa, preterm labor, multiple gestations, previous
classic incision from a cesarean birth, and reduced
cervical competence.
INDICATIONS
POTENTIAL DIAGNOSES
● High-risk pregnancies (gestational diabetes mellitus,
postterm pregnancy)
● Nonreactive stress test
CLIENT Presentation
● Decreased fetal movement
● Intrauterine growth restriction
● Postmaturity
● Diabetes mellitus
● Hypertension
