Preventive dental care and timely treatment of oral health problems can halt tooth decay, reverse periodontal disease, and improve both oral health and the overall health of pregnant individuals. Although research is not conclusive, results from several well-designed studies also suggest that maternal periodontitis may be an independent risk factor for preterm birth, low birth weight, and other adverse pregnancy outcomes. As a result, prenatal care providers often see preventable and treatable dental problems such as tooth pain, dentoalveolar abscess (pus surrounding the teeth), broken or missing teeth, and periodontitis. Oral health is a lifelong concern that will affect the ongoing health of patients and infants. Therefore, health care providers are advised to incorporate oral health screening and education into routine prenatal care. This chapter discusses the risk factors for periodontal problems. It also discusses physical examination, dental procedures during pregnancy; and complications of dental abscess and/or periodontitis.
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Prenatal visits should be structured to reflect the dynamic nature of risk assessment during pregnancy. Prenatal cell-free
DNAscreening, also known as noninvasive prenatal screening, is a method to screen for certain specific chromosomal abnormalities. Patients must be at least 10 weeks gestation and have adequate counseling regarding the options, benefits, and limits of first-and second-trimester screening. Measurement of crown–rump length of fetus between 7 and 12 weeks gestation for dating information. Stress has been suggested as a potential contributor to preterm birth and physical complications of pregnancy such as prolonged labor. Advise pregnant individuals to continue exercising as this is generally safe. Pregnancy requires only modest increases in calories (350–450 a day on average). This chapter discusses ongoing prenatal care. It also discusses interim history, physical examination, diagnostic examinations, ultrasound examination (second and third trimester), pregnancy management, modifiable risk factors, pregnancy discomforts, second-trimester education, and third-trimester education.
Pregnancy is characterized by insulin resistance and hyperinsulinemia and thus may predispose some individuals to diabetes. These metabolic changes stem from the placental hormones that ensure that the fetus has an abundant and continuous supply of nutrients: growth hormone, cortisol, placental lactogen, prolactin and progesterone. Gestational diabetes mellitus (
GDM) is defined as carbohydrate intolerance that begins or is first recognized during pregnancy. The condition is associated with increased maternal, fetal, and neonatal risks. GDMis associated with increased risks for the fetus and the newborn, including macrosomia, shoulder dystocia, birth injuries, hyperbilirubinemia, hypoglycemia, respiratory distress syndrome, hypocalcemia, polycythemia, and childhood obesity. Maternal risks include preeclampsia, polyhydramnios, gestational hypertension, cesarean delivery, and diabetes occurring later in life. This chapter discusses screening, risk factors, differential diagnosis, management, and patient education of gestational diabetes mellitus during pregnancy.
The purpose of preconception care is to deliver risk screening, health promotion, and effective interventions as a part of routine health care. Preconception health care is essential, because the lifestyle behaviors and exposures that occur before prenatal care is initiated may affect fetal development and subsequent maternal and perinatal outcomes. This chapter discusses 10 recommendations for improving preconception and inter-conception care as part of a strategic plan to improve the health of individuals, their children, and their families. Nurse Practitioners (
NPs) provide healthcare for patients before, during and in between pregnancies in a variety of settings. The care NPs provide seats them at the forefront to assess for and address known risk factors for maternal complications prior to pregnancy and tailor a care plan for each patient’s individual needs to mitigate risks and foster the best patient outcomes.
The prevalence of obesity as a worldwide epidemic has increased dramatically over the past two decades. Obesity before and during pregnancy is associated with fertility problems and numerous maternal and perinatal risks such as pregnancy loss, preeclampsia, gestational diabetes mellitus (
GDM), urinary tract infections, dysfunctional labor, preterm premature rupture of membranes, preterm delivery, and post term birth. Postpartum issues include longer hospital stays, infection (wound, episiotomy, and endometritis), and venous thromboembolism. Some obese individuals have more difficulty initiating and maintaining lactation, partly because of the complications and their effect on a good start to breastfeeding. Specifically, overweight/obese individuals have a lower prolactin response to suckling in the first week postpartum, which may contribute to early lactation failure. This chapter discusses history, physical examination, diagnostic units, management, and patient education for obesity and pregnancy.
The severe acute respiratory syndrome coronavirus 2 (
SARS-CoV-2) was first identified in China in December 2019. The disease caused by the SARS-CoV-2virus is coronavirus disease 2019, or COVID-19. The body of scientific knowledge regarding this recently discovered virus is continuously evolving, and guidance may become out-of-date as new information becomes available. The SARS-CoV-2virus spreads through close person-to-person contact, via inhalation of airborne droplets or direct contact with respiratory secretions on a contaminated surface. The virus can cause a wide range of illness severity, from asymptomatic cases or mild symptoms to more severe disease. Because of the physiologic and immunologic changes of pregnancy, COVD-19is more likely to cause severe illness in pregnant individuals compared with those who are not pregnant. This chapter discusses the history, physical examination, differential diagnosis, management, and prevention of COVID-19during pregnancy and postpartum.
The American Academy of Pediatrics (
AAP) and the American College of Obstetricians and Gynecologists ( ACOG; 2007) describe prenatal care as “A comprehensive antepartum care program involving a coordinated approach to medical care and psychosocial support that optimally begins before conception and extends throughout the antepartum period ”. Comprehensive prenatal care is composed of the following elements: (a) preconceptional care, (b) prompt diagnosis of pregnancy, (c) initial prenatal evaluation, and (d) follow-up prenatal visits. Ongoing maternal–fetal assessment, education and support for the pregnant individual, preparation for parenting, and promotion of a positive physical and emotional family experience are all part of quality prenatal care. This chapter discusses the screening tools, physical examination, diagnostic and laboratory examination for the first prenatal visit, common discomforts in the first trimester, and first-trimester education/anticipatory guidance.
Asymptomatic bacteriuria (
AB) is a microbiologic diagnosis that indicates the presence of a positive urine culture in an asymptomatic person. In the literature, bacteriuria may be defined as a single organism identified in the urine in any amount, but more specifically at a colony count of equal to or greater than 105 (100,000) colony forming units per milliliter. Urinary tract infection is defined as either a lower tract (acute cystitis) or upper tract infection. Cystitis is bacteriuria in the presence of urinary symptoms. Screening should be performed at the first prenatal visit or at 12 to 16 weeks gestation. Generally, penicillins and cephalosporins are safe in pregnancy. However, drugs with very high protein binding, such as ceftriaxone, may be inappropriate the day before parturition because of the possibility of bilirubin displacement and subsequent kernicterus. Suppressive therapy may be appropriate with bacteriuria that persists after two or more courses of therapy.
The third edition is designed for nurse practitioners, nurse midwives, clinical nurse specialists, physician assistants, students in these areas, and other health professionals who provide prenatal and postpartum care in outpatient settings. Since the first edition was published, practice knowledge has changed in many areas and we were aware of the importance of updating the information. The extensive revisions in this edition reflect new guidelines for practice endorsed by professional organizations and/or the government. Each chapter has been updated with new references and each contains new management strategies. Throughout history, quality care before, during, and after childbirth has played an important role in reducing maternal and fetal death, preventing birth defects, and decreasing the incidence of other preventable health problems. Health care providers have a remarkable opportunity to provide health education, assessment, and early problem identification and management during the preconception and childbearing years. To help achieve these goals, this third edition presents the best available practice evidence for providing preconception, prenatal, and postpartum care in one easy-to-use publication. It is organized into four parts. Part I comprehensively covers preconception counseling and care, as well as the latest guidelines on screening for genetic disorders before and during pregnancy. Part II provides a wealth of information on key assessments, including laboratory and ultrasound diagnostics for the initial prenatal visit and for subsequent visits. Throughout the book, it presents topics using a problem-based schema that highlights history, physical examination, laboratory and diagnostic testing, differential diagnosis, management, indications for consultation and/or referral, and follow-up care. This format is particularly evident in Parts III and IV. The third edition has two new chapters to reflect emerging issues and other pertinent practice concerns based on our conversations with students and ambulatory obstetric providers.
This chapter discusses disaster planning for pregnant and postpartum individuals and their infants, and provides guidelines for care whether evacuating or sheltering in place. Because injuries are common during disasters, it provides guidelines for assessment and management of minor trauma. More attention has been given to the need for disaster preparedness as a result of terrorist attacks and natural calamities, such as devastating hurricanes, tornadoes, wild-fires, tsunamis, and earthquakes, in various parts of the world. Despite these incidents, the public is still not adequately prepared to respond to a major disaster. Obstetric and Neonatal Nursing (
AWHONN) position statement encourages nurses to participate in all phases of disaster planning. Obstetric, neonatal, and women’s health care providers can serve a vital role in addressing the many health needs of pregnant individuals, new mothers, and infants and reduce risk and morbidities.