NCM 109

A FRAMEWORK FOR MATERNAL AND

CHILD HEALTH NURSING CARE 4 Phases of
CARE OF MOTHER AND CHILD AT RISK OR Health care:
WITH PROBLEMS – ACUTE AND CHRONIC
1. Health Promotion – Educating clients to be
aware of good health through teaching and role
modeling (e.g., teaching woman the importance
I. Framework for Maternal and of rubella vaccine)

Child Health Nursing (MCN) 2. Health Maintenance – intervening to

Focusing on at-Risk, High Risk, maintain health when risk of illness is present
(e.g., encouraging women to come for prenatal
and Sick Clients care)

3. Health Restoration – promptly diagnosing

Primary Goal of MCN: is the promotion and and treating illness using interventions that will
maintenance of optimal family health. return client to wellness most rapidly (e.g.,
caring for a woman during a complication of
MCN: Family-centered; Community-centered; pregnancy)
Research-oriented; Nursing theory and
evidence-based practice provide a foundation 4. Health Rehabilitation – preventing further
for nursing care. complications from an illness bringing ill client
back to optimal state of wellness; helping client
MCN Nurse serves as an: Advocate to protect to accept inevitable death (e.g., encouraging
the rights of all family members, including the woman with trophoblastic disease to continue
fetus. therapy)
STANDARDS OF MATERNAL AND CHILD GENETICS AND GENETIC COUNSELING
HEALTH NURSING PRACTICE
Genetics is the study of the way such disorder
1. Nurse helps attain optimum health occur. It is a constant changing field of study it
is important for nurses to keep current with the
2. Nurses assist the family in maintaining
new advances.
balance between personal growth needs and
family functioning Genetic counseling gives you information about
how genetic conditions might affect you or your
3. Nurse intervenes with vulnerable families
family.
4. Nurse promotes a healthy environment
Assessment: Data/History Collection->Physical
5. Nurse detects changes and deviations Exam->Laboratory

6. Nurse carries out interventions and 1st trimester of Pregnancy

treatments
◦ Routine sonogram screening (a nuchal
7. Nurses assist in the Coping period translucency scan)

8. Nurse actively pursues strategies - detect the risk of several chromosomal

abnormalities; ultrasound scan at
9. Nurse continues to improve MCN practice around 12 weeks of pregnancy.
◦ Analysis of maternal serum levels all Alpha physical abnormalities in many parts of the
fetoprotein A(PAPP-A) body.

- measure the amounts of two • heart defects, brain, or spinal cord

substances in blood: beta human abnormalities, very small or poorly developed
chorionic gonadotropin (beta-hCG) and eyes (microphthalmia), extra fingers or toes, an
pregnancy-associated plasma protein A opening in the lip {a cleft lip) with or without an
(PAPP-A). Beta-hCG is a hormone made opening in the roof of the mouth (a clef palate),
by the placenta. High or low levels may and weak muscle tone (hypotonia).
be related to certain birth defects.
PAPP-A is a protein in the blood. • many dies within their first days or weeks of
- A Papp-A level more than or equal to life; 5% to 10% of children live past their first
0.5 MOM is considered normal, while year.
levels less than 0.5 MOM are marked as
low.
Trisomy 18 Syndrome (47 XY 18+ or 47XX18+)
◦ Free beta hCG to evaluate for chromosomal
disorders in the fetus • is caused by the presence of an extra
Chromosome 18 in every cell of the body in 94%
of cases.
Genetic disorder occurs the moment an Ovum • majority cases are due maternal
and sperm fuse or even earlier in the mitotic nondisjunction in meiosis II. Rarely, paternal
division piece of the album or sperm when the meiosis II errors are causative.
chromosome count is halved from 46 to 23.
• The risk increases with maternal age.

Genes are the basic units of heredity.

Turner Syndrome (45XO)
XX = Female, XY=Male
• also known 45, X, or 45, XO, is a genetic
•Phenotype refers to his or her outward condition in which a female is partly or
appearance or the expression of genes. completely missing an X chromosome.
• Genotype refers though his or her actual gene • Signs and symptoms vary among those
composition affected.
• Genome is the complete set of genes present
(50,000 to 100,000)

COMMON CHROMOSOMAL DISORDERS

RESULTING IN PHYSICAL OR COGNITIVE
DEVELOPMENTAL DISORDERS

Trisomy 13 syndrome (47 XY 13+ ac 47XX13+)

• Patau syndrome, is a chromosomal condition

associated with severe intellectual disability and
II. INTRODUCTION OF HIGH- FACTORS THAT CATEGORIZE A PREGNANCY AS
HIGH RISK
RISK PREGNANCY
During pre-pregnancy, during pregnancy, during
labor and birth
• Majority of the high-risk pregnancies are
identified during the first prenatal visit through • Psychological Factors
careful history taking, complete physical • Social Factors
examination, and laboratory studies. • Physical Factors

(See criteria on #2 pg. 18)

1. Women with preexisting or newly acquired

illness such as:
VULNERABLE GROUPS OF PREGNANT WOMEN:
- CVD, DM, Substance Abuse, HIV/AIDS, RH
Incompatibility and Anemia • Adolescent
• Mentally ill
• 18 y/o and below
• Women over 40 y/o
2. Women who develop complications of
• Physically and cognitively challenge
pregnancy such as:
• Woman who is a substance dependent
- Hyperemesis Gravidarum - PROM
Prevention Before and During Pregnancy (See
- Ectopic Pregnancy - PIN criteria on #2 pg. 35)

- Hydatidiform Mole - Multiple Pregnancies

- Premature Cervical Dilatation - DIC MANAGEMENT OF HIGH-RISK PREGNANCY

- Abortion - APAS • More frequent prenatal visits and specialist
consultations are a must in high-risk
- Placenta Previa - HELLP Syndrome pregnancies to closely monitor maternal health
and fetal development.
- Abruptio Placenta
• Additional or specialized prenatal testing
might include laboratory work and diagnostic
Areas to be assessed for high-risk factors tests, like amniocentesis, biophysical profile,
include: and others.

1. Obstetrical history • Bed rest or hospitalization might be necessary

2. Medical history, to help a woman safely carry her baby to term.
3. Current obstetric status
• Medications or surgery can be used to treat
4. Social-personal characteristics.
the underlying problem and stop its
(See criteria on #2 pg. 9) progression.

• A premature delivery might sometimes be the

safest way to manage a high-risk pregnancy and
prevent further life-threatening complications.
III. IDENTIFYING CLIENT AT 6. Previous uterine or cervical abnormality

RISK 7. Previous abnormal labor, premature labor or

postmature labor prolonged labor

RISK FACTORS 8. Previous high-risk infant: low-birthweight

(LBW), macrosomic (LGA), with neurologic
deficit, birth injury or malformation
A. DEMOGRAPHIC FACTORS
9. Previous hydatidiform mole
1. Age – under 16 or over 35 years old. Optimal
age for childbearing is between 20 and 30 years.

2. Weight – overweight or underweight before D. CURRENT OB STATUS

pregnancy
1. Late or no prenatal care
3. Height – less than 5 feet
2. Maternal anemia

3. Rh Sensitization
B. SOCIOECONOMIC STATUS 4. Antepartal bleeding: placenta previa and
1. Inadequate finances abruptio placenta

2. Overcrowding, poor standards of housing, 5. Pregnancy-induced hypertension

poor hygiene 6. Multiple gestation
3. Nutritional deprivation 7. Premature or postmature labor
4. Severe social problems 8. Polyhydramnios
5. Unplanned and unprepared pregnancy, 9. PROM
especially among adolescents
10. Fetus inappropriately large or small;
*At the root of these problems are poverty and abnormality in tests for fetal well-being;
low educational status abnormality in presentation

C. OBSTETRIC HISTORY E. MATERNAL MEDICAL HISTORY/STATUS

1. History of infertility or multiple gestation 1. Cardiac or pulmonary disease
2. Grand multiparity 2. Metabolic disease: diabetes, thyroid disease
3. Previous abortion or ectopic pregnancy 3. Endocrine disorders: pituitary, adrenal
4. Previous loses, fetal death, stillbirth, neonatal 4. Chronic renal disease: repeated UTI,
or perinatal deaths bacteriuria
5. Previous operative OB: cesarian section, mid 5. Chronic hypertension
forceps delivery
6. Venereal and other infectious diseases SEROLOGIC TEST FOR SYPHILIS (VDRL or
rapid plasma regain test)
7. Major congenital anomalies of the
reproductive tract If present, must be treated early in pregnancy,
plus blood sample for a serologic test for
8. Hemoglobinopathies
gonorrhea.
9. Seizure disorder

10. Malignancy
BLOOD TYPING (including Rh factor)
11. Major emotional disorders, mental
retardation Blood type is documented: may have to be
made available if a woman has bleeding
during pregnancy; detect the possibility of
Rh isoimmunization.
F. HABITS/HABITUATION
1. Smoking during pregnancy
MATERNAL SERUM FOR ALPHA-
2. Regular alcohol intake
FETOPROTEIN (AFP) (MSAFP)
3. Drug use/abuse
Elevated if a neural tube/abdominal defect
is present in the fetus; decreased if a
chromosomal anomaly is present.
LABORATORY ASSESSMENT
Done at 16 to 18 weeks pregnancy.
COMPLETE BLOOD COUNT The level in serum is expressed as
“multiples of the mean” (MOM).
Including hemoglobin/hematocrit + red cell
index (determine the presence of anemia), a Normal value = 2.5 MOM. If elevated or
white blood cell counts (determine infection), decreased, ultrasound/amniocentesis will
and a platelet count (estimate clotting ability). be ordered to assess for a fetal disorder.

GENETIC SCREEN
INDIRECT COOMBS’ TEST
e.g., blood sample taken to screen for sickle
Determination if Rh antibodies are present in a
cell trait; glucose-6-phosphate dehydrogenase
Rh-negative woman).
(G6PD).
Generally repeated at 28 weeks of pregnancy.
Asian and Mediterranean (beta-Thalassemia)
If the titers not elevated, Rh-negative woman
Jewish ancestry (Tay-Sachs disease)
would receive RhIG (RhoGAM) at 28 weeks of
Caucasian (cystic fibrosis) pregnancy and after any procedure that might
cause placental bleeding, such as amniocentesis
or external version.
ANTIBODY TITERS FOR RUBELLA AND IV. PREGESTATIONAL
HEPATITIS B (HBsAg)
CONDITIONS
Determine whether a woman is: protected 70 SLIDES
against rubella; newborn will have a chance of
developing hepatitis B. V. GESTATIONAL CONDITIONS
106 SLIDES
HBsAg testing may repeat at about 36 weeks.

Antibodies for varicella (chickenpox) may also VI. COMPLICATIONS OF LABOR

be assessed. Vaccine against these diseases can 82 SLIDES
then be offered in the postpartum period.
VII. COMPLCATIONS OF
PUERPERIUM
HIV SCREENING 45 SLIDES

High-risk criteria include: +++PARTOGRAPH

women who have used or are using
intravenous drugs. +++UNANG YAKAP
have engaged in sex with multiple partners.

have had sexual partners who are infected or

are at risk because they are bisexual,

intravenous drug abusers, or hemophiliacs. NCM 109L

women who received a blood transfusion MANAGEMENT OF CLIENTS AT RISK
between 1977 and 1985.
I. HIGH RISK PREGNANCY
38 SLIDES
SIGNS INDICATING HIGH RISK
PREGNANCY
II. PREGNANCY SCREENING
PROCEDURES
1. Vaginal bleeding
65 SLIDES
2. Persistent Vomiting

3. Chills and Fever

III. MANAGEMENT OF MOTHERS WHO
4. Sudden Escape of Fluid from the Vagina ARE AT HIGH RISK
107 SLIDES
5. Abdominal or Chest Pain

6. Pregnancy-Induced Hypertension

7. Increase or Decrease in Fetal Movement