OBJECTIVES

1. Explain the bases for subsequent prenatal care, use and interpretation of prenatal care data 2. Describe the importance of building care based on previous prenatal care assessments and interventions 3. Discuss the key issues for subsequent prenatal care 4. Discuss comprehensive prenatal care and the role of the midwife in these

OBJECTIVES
Data and its use, pertinent client information, major assessments including investigations, major interventions, social support, emotional interventions, client instructions, counseling, client teaching, rest and exercises, preparation for labor and delivery, skills to be attained, attitudes to foster for effective prenatal care

OBJECTIVES
5. Explain the key decisions for prenatal care 6. Explore prenatal conditions for family involvement 7. Explain maternal-infant attachment and prenatal strategies for fostering these

SUBSEQUENT PRENATAL CARE

WHY IS IT NECESSARY TO PROVIDE SUBSEQUENT ANTENATAL CARE? Both maternal and fetal conditions can be jeopardized in the course of pregnancy even if everything was okay at the booking visit

SUBSEQUENT PRENATAL CARE

Fetal Concerns
Growth and development Mal-presentations Fetal wellbeing
Size date relationships >2 or more Decreasing amounts of liquor (oligohydramnious Excess amounts of liquor (polyhydramnious) Compromised fetal movements Premature labor

Maternal illnesses or conditions can affect the fetus Fetal abnormalities that manifest with an increase in gestation can also affect its own wellbeing

SUBSEQUENT PRENATAL CARE

Maternal Concerns Lack of understanding of the changes occurring during pregnancy Illnesses including fever induced illnesses Bad obstetric conditions

SUBSEQUENT PRENATAL CARE

Complications and other conditions of pregnancy Anemia (<10.5g/dl) Protein in urine Vaginal bleeding

SUBSEQUENT PRENATAL CARE

Complications and other conditions of pregnancy High B/P
diastolic values of 90 mmHg (2 consecutive readings of this pressure are a sign of danger A single diastolic B/P reading of 110mmHg is alarming A systolic B/P of 140 mmHg of two consecutive readings at 4 hour intervals is also very worrisome

SUBSQUENT PRENATAL CARE

The purpose of subsequent prenatal visits: Monitoring and promoting maternal health and adaptation to pregnancy monitoring fetal growth and wellbeing Early recognition of and management of complications Preparing mother and family for parenthood

SUBSQUENT PRENATAL CARE

The purpose CONT. Prevention of mother to child transmission of HIV Providing routine medications and counseling for PMTCT Preventing pregnancy complications

Subsequent Prenatal Care Components

BLUE PRINT FOR SUBSEQUENT CARE Review of previous findings and developments since the last visit Assessments: physical, emotional assessment & adaptation to pregnancy, nutritional, abdominal examinations on every visit Laboratory investigations

Subsequent Prenatal Care Components

BLUE PRINT (CONTINUED) Use family centered approach for information, counseling and instructions at every visit.
What would promote fetal growth and wellbeing What would promote maternal Health What the family can do to monitor pregnancy, maternal health and fetal wellbeing Any particular issues identified during the assessment

Subsequent Prenatal Care Components

BLUE PRINT FOR SUBSEQUENT CARE Any issues client needs to know Preparation for labor, delivery and child care
Place of delivery Support system at delivery Reducing anxiety

Decision making Planning for subsequent activities

Subsequent Prenatal Care Components

Maternal condition: Temperature, Pulse, Respirations, Blood Pressure, weight, edema Diagnostic tests if necessary Laboratory evaluation
Hemoglobin Urine tests for protein Glucose Glucose and ketones

Subsequent Prenatal Care Components

Trimester specific assessments Abdominal examination Fetal growth and wellbeing
Assessment of fetal heart

Examination for edema or varicose veins Repeat blood tests when indicated Maternal adaptation Progress of pregnancy

Subsequent Prenatal Care Components

Routine medications given and immunizations _______________________________________ Refer to handout for components of prenatal care ______________________________________