Childbearing Antenal Assessment

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The Childbearing FamilyAntenatal Assessment

Antenatal Assessment What is Antenatal Assessment? Why do an Antenatal Assessment? What is Maternal Mortality? What is Maternal Morbidity? What is Perinatal Mortality? What is Neonatal Mortality? What is Infant Mortality?

Antenatal AssessmentTo achieve the goals of antenatal care, the following is necessary; Early, accurate estimation of gestational age Identification of the patient at risk for complications Ongoing evaluation of the health status of both mother and fetus Anticipation of problems and intervention, if possible, to prevent or minimize morbidity Patient education and communication

Antenatal Assessment Maternal Mortality DEFINITION: The quotient between the

number of maternal deaths in a given year and the number of live births in that same year, expressed per 100,000 live births, for a given country, territory, or geographic area, as reported by the national health authority.

Antenatal Assessment Maternal death is defined as the death of awoman while pregnant or within the 42 days after termination of that pregnancy, regardless of the length and site of the pregnancy, due to any cause related to or aggravated by the pregnancy itself or its care, but not due to accidental or incidental causes.

Rate in T&T 70.4per 100,000 per year

Antenatal Assessment The Major causes of death duringpregnancy are; Ectopic pregnancy Hypertension Haemorrhage Embolism Anaesthesia -related complications

Antenatal Assessment Infant Mortality The # of infant deaths in the first year of

life after live birth per 1000, compared with the number of live births in one year from a specific geographic area.

In Trinidad and Tobago -28.9 per 1000

Antenatal Assessment Neonatal Mortality The # of deaths during the first 28 days of life per

1000, live births per year. Neonatal deaths were caused by respiratory distress syndrome (57.8%), birth asphyxia (22.2%) and sepsis (13.5%) . Another study of early onset Group B streptococcal (GBS) infection in neonates at the Mount Hope Women's Hospital over the period 199697 found that the incidence of early onset neonatal GBS sepsis was five to six times higher than that reported in the USA and UK

In Trinidad and Tobago -23/1000 (2000)

Antenatal Assessment Peri-Natal Mortality The # of stillbirths and deaths (from a viable

birth)in the firs week of life per 1000, live births and foetal deaths(after 28 weeks) Stillbirths resulted from the hypertensive disorders of pregnancy, abruptio placentae, diabetes mellitus, intrapartum foetal distress and lethal congenital anomalies

In Trinidad and Tobago 27.7 per 1000 per year

Antenatal Assessment 4MILLION babies die in the 1st. Fourweeks of life. 3Million in early neonatal period. 3.3Million are stillborn. 1.3 preventable. 90% in the developing world

Antenatal Assessment In Trinidad ad Tobago; Over 50% of pregnant women attend free prenatal

clinics that are provided in the health centers in Trinidad and Tobago At each visit a midwife conducts an examination. At least twice during the pregnancy, a medical officer conducts an examination. This system facilitates the referral of women with complications (about 19% of clients) to specialist clinics at six hospitals.

Antenatal Assessment The established protocol for prenatal careat the health centers includes testing for anaemia and VDRL , screening for diabetes, and tetanus immunization. Iron and folic acid supplements are recommended to pregnant women but are not generally available free at the health centers

Antenatal Assessment Tetanus is a life-threatening bacterial disease that iscaused by the toxin of a bacterium called Clostridium tetani. Tetanus bacteria enter the body through an open wound. It could well be a tiny prick or scratch on the skin, although Tetanus infection is more common when there is a deep puncture wound such as a bite, cut, burn or an ulcer. Tetanus affects a persons nervous system and can be fatal if left untreated. It is preventable through immunization.

Antenatal Assessment The Tetanus Toxoid (TT) vaccine is givenduring pregnancy to prevent tetanus to the mother as well as baby. Antibodies formed in the mothers body, after the vaccination, are passed on to the baby and protects for a few months after birth. It also helps prevent premature delivery.

Antenatal Assessment In the first pregnancy, the recommendation is at leasttwo doses of the TT vaccine. The first vaccination is given in the first trimester soon after a pregnancy test is confirmed and after the first antenatal appointment. The second dose of the TT vaccine is given at least four to eight weeks after the first. Some experts recommend that the second dose of the vaccine should be given four weeks prior to the expected date of delivery. The WHO also recommends that a third vaccine be given six months after the second one to provide protection for at least five years.

Antenatal Assessment If this is a second pregnancy and it hasbeen less than two years since the last pregnancy and the patient had received both TT vaccines, then only a booster dose is recommended. In many countries such as the US, the Td or tetanus-diphtheria vaccine is recommended for pregnant women.

Antenatal Assessment About 90% of all deliveries take place in governmentinstitutions, which have facilities for cesarean sections, blood transfusions, and acute neonatal care. The other 10 % take place in private hospitals and nursing homes (most of which have facilities for cesarean sections), with minimal numbers taking place in homes and "other places." Almost 90% of all deliveries are supervised by midwives, the other 10% by doctors or "other persons."

Only about 10% of mothers use postnatal services athealth centers.

Antenatal Assessment The infant mortality rate is estimated at 29 infant deaths per thousand live births, while theprobability of dying before ones fifth birthday, the under-5 mortality rate (U5MR) is estimated to be around 35 per one thousand live births. These estimates have been calculated by averaging mortality estimates obtained from women 25-29 years and 30-34 years, and refer to mid 2004.

Antenatal Assessment Low Birth Weight Weight at birth is a good indicator, not only of a

mothers health and nutritional status but also the newborns chances for survival, growth , long-term health and psychosocial development.

Low birth weight (less than 2,500 grams) carriesa range of grave health risks for children.

Antenatal Assessment Babies who were undernourished in the womb face a greatly increased risk of dying during their early months and years. Those who survive have impaired immune function and increased risk of disease They are likely to remain undernourished, with reduced muscle strength, throughout their lives, and suffer a higher incidence of diabetes and heart disease in later life.

Antenatal AssessmentChildren born underweight also tend to have; - A lower IQ - Cognitive disabilities, affecting their performance in school and their job opportunities as adults.

Antenatal Assessment Early screening therefore is a majorcontributor to better outcomes of pregnancy. Screening and a thorough history are usually the most important activities of the first Ante-natal visit. Pre-conceptive screening would be the option of choice if possible

Antenatal Assessment Think about the setting for the firstinterview. Quiet Focused Privacy Health history

Antenatal Assessment First Trimester Early confirmation gives most reliable assessment of gestational age. Confirm Estimated Date of Delivery(E.D.D) Ask for the first day of the last menstrual period!

Naegeles rule Add seven days Subtract three months ,Adjust the year if needed .There is a 2wk margin of error either side of this date

Antenatal Assessment What can affect the estimation of this date? Does not remember L.M.P Has irregular periods Was taking the contraceptive pill Had a lighter than normal period Just had a baby and has not had a period as yet. Is still having periods

Antenatal assessment Take a complete health history; Social family-partner-housing-work-finances Psychosocial feelings-coping skills-self esteem-

body image Medical- history of any illness or disease, present or past Surgical- surgeries or procedures that may have impact Obstetrical previous pregnancies-results, Parity, Gravida

Antenatal assessment Menstrual history first day of lastmenstrual period Family history -diseases-heredity-genetic This gives a baseline to work with and a basis for referral if necessary

Antenatal assessment Physical Examination Head to toe exam including , breasts for signs of activity . Will give a general assessment of well being and signs and symptoms of pregnancy Weight /height Vital signs baseline Heart, lungs. Urinalysis abnormalities, albumin, blood, sugar, leucocytes Blood tests

Antenatal Assessment Abdominal Palpation The abdominal examination consists of: 1 -Preparation for this 2 -Inspection 3 Fundal palpation, 4 -Lateral palpation 5 -Pelvic palpation 6 -Auscultation 7 -Documentation and decision making

Antenatal Assessment Laboratory TestsHb - Group- Rh factor Platelets- HIV-VDRL(Venereal Disease Research Laboratory) Sickle- WBC Rubella Ultrasound may be done this helps to date the pregnancy if needed. Heart rate/movement depending on stage of pregnancy Advice can be given on nutrition minor problems-exercise-rest-social referral-follow up appointments and supplements

Antenatal Assessment Preparation It is important to carry out the usual

essential care skills such as: Introduce yourself to the woman Consult the anten