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Care of the Pregnant Woman with Prenatal Conditions

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Care of the Pregnant Woman with Prenatal Conditions © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR CHAPTERDISTRIBUTION 3 © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT Care FOR SALEof theOR DISTRIBUTION Pregnant WomanNOT FOR SALE OR DISTRIBUTION with Prenatal Conditions © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlettidwives Learning, support womenLLC with pregnancy-related© Jones conditions & Bartlett and complications Learning, LLC NOT FOR SALEthrough OR DISTRIBUTION prompt identification and initiationNOT of treatment FOR SALE of these OR DISTRIBUTIONconcerns to M ensure the best possible outcome for mother and baby. Midwives accept pregnancy as a normal physiologic condition while retaining a healthy respect and awareness of problems and complications that can develop. This overarching perspective is one of the reasons women© seek Jones midwifery & Bartlett care (Parry,Learning, 2008). LLC During evaluation for poten-© Jones & Bartlett Learning, LLC tial or developing conditions,NOT FOR theSALE midwife OR DISTRIBUTIONactively engages the woman in discussionNOT FOR SALE OR DISTRIBUTION and decisions regarding care of herself and her unborn baby. The ability to anticipate problems in pregnancy is an essential component of skilled midwifery practice. Among© Jones the hallmarks & Bartlett of midwifery Learning, care are LLC advocacy for informed choice,© Jones shared decision& Bartlett Learning, LLC making,NOT and FOR the SALEright to self-determinationOR DISTRIBUTION (American College of Nurse–MidwivesNOT FOR [ACNM],SALE OR DISTRIBUTION 2012). Although the woman may have limited or no control over the development of problems during her pregnancy and may feel threatened when they arise, the midwife can enhance the woman’s sense of control by presenting options in the areas where choice is possible. Respect © Jones &for Bartlett each woman’s Learning, needs isLLC especially important when an© Jonesunexpected & Bartlettproblem develops Learning, and LLC NOT FOR requiresSALE ORactive DISTRIBUTION intervention. NOT FOR SALE OR DISTRIBUTION Many women look to their midwife for a balanced view of developing problems, diagnostic evaluation and treatment recommendations, and the anticipated outcomes of treatment options. Women can simultaneously choose to be active participants in their healthcare decisions and expect their midwife to clearly recommend a course of action. Recommendations are based on the © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC midwife’s judgment of what constitutes best care for this mother and her fetus based on the pre- NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION senting problem and the woman’s specific situation. At times, the midwife’s recommendations can run contrary to either the woman’s preferences or standard hospital-based expectations for mater- nity care. A clear, focused, and confidently presented midwifery plan of care, accompanied by a sound rationale backed by evidence-based resources, can be helpful in providing guidance to the woman© Jones who hesitates & Bartlett at an indicated Learning, intervention, LLC or in promoting understanding© Jones among & Bartlett providers Learning, LLC in theNOT medical FOR setting SALE where OR the DISTRIBUTION midwife may be pressured to intervene withoutNOT FORa clear SALE indication. OR DISTRIBUTION Several common infections with implications for pregnancy are addressed in this chapter, however, there are many pathogens with potential for causing harm in pregnancy. The effects of an infection for the woman and fetus vary with gestational age at time of exposure and © Jones &with Bartlett the virulence Learning, of the LLCinfecting agent. Microbes with© Jonesantibiotic & resistance Bartlett or Learning, no known LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 9781284083415_CH03_Pass03.indd 93 20/04/16 2:50 pm © Jones94 & BartlettChapter Learning, 3 Care ofLLC the Pregnant Woman with© JonesPrenatal & Conditions Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION treatment are emerging. Pandemics are a concern; global- Midwifery care for women experiencing problems dur- ization and increased travel and trade within and between ing pregnancy forms a continuum from minimal interven- countries have resulted in© the Jones rapid spread & Bartlett of infectious Learning, tion LLC to maximum intervention. The© Jones skilled midwife& Bartlett can Learning, LLC disease (see Zika Virus textNOT box). FORTo reduce SALE the ORburden DISTRIBUTION move along this continuum in eitherNOT direction, FOR SALE under- OR DISTRIBUTION of infectious disease in pregnant women, midwives use standing that appropriate midwifery, medical, or obstetric an integrated approach, combining awareness of emerg- intervention should always serve the mother’s and baby’s ing infections, health promotion, disease prevention, and needs and be congruent with best evidence and midwifery treatment.© Jones & Bartlett Learning, LLC philosophy of care.© Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION Zika virus: An emerging pandemic © JonesAs & this Bartlett text goes Learning, to press, Zika LLC virus is emerging as a serious© Jonesglobal health & Bartlett concern Learning, for pregnant LLCwomen. The World Health Organization believes this current outbreak, which began in Brazil in 2015, will spread to the majority NOT FORof the SALE Americas OR includingDISTRIBUTION the continental United States, byNOT the endFOR of 2016.SALE Currently, OR DISTRIBUTION outbreaks are occurring in many areas including South America, Central America, Mexico, the Caribbean, and in the Commonwealth of Puerto Rico, the U.S. Virgin Islands, and American Samoa. The Zika virus is spread by the Aedes aegypti and the Aedes albopictus mosquito, aggressive daytime biters common in the Americas,© andJones the same & Bartlett mosquito Learning, species that LLCare vectors for dengue, chikungunya,© Jones and & yellowBartlett Learning, LLC fever viruses. Sexual transmissionNOT FOR of ZikaSALE virus OR can DISTRIBUTION occur, although there is limited data aboutNOT the FOR risk. Only SALE 1 in OR DISTRIBUTION 5 people infected will have symptoms, which include acute onset of low-grade fever, maculopapular rash, arthral- gia and nonpurulent conjunctivitis. If symptomatic, the illness is usually mild, lasting for several days to a week. The incubation period is uncertain but is thought to be from several days to several weeks. The Zika virus can be transmitted from a pregnant mother to her fetus anytime during pregnancy. Infection during pregnancy© Jones is associated & Bartlett with congenital Learning, microcephaly LLC and other brain lesions© Jones in the newborn & Bartlett and possiblyLearning, with LLC Guillain–BarréNOT FOR syndrome SALE in infectedOR DISTRIBUTION individuals. The CDC (2016) has issuedNOT interim FOR guidelines SALE ORfor the DISTRIBUTION screening, diagnosis, and management of women at risk for the Zika virus. Currently, pregnant women who meet the following criteria should be tested for the Zika virus: • Pregnant women presenting with clinical illness consistent with Zika virus disease during or within 2 weeks of © Jones &tr avelBartlett to areas Learning, with ongoing LLC Zika virus transmission © Jones & Bartlett Learning, LLC NOT FOR• AsymptomaticSALE OR DISTRIBUTION pregnant women who have traveled to orNOT live inFOR areas SALE with ongoing OR DISTRIBUTION transmission of Zika virus (at the first prenatal visit with follow-up testing mid-second trimester) • Pregnant women with partners who test positive for Zika virus or who have traveled to areas with ongoing Zika virus transmission Maternal serum testing for© ZikaJones virus & includes Bartlett reverse Learning, transcription-polymerase LLC chain reaction© Jones (RT-PCR) & testing Bartlett for Learning, LLC symptomatic women with onset of symptoms during the previous week. Virus-specific immunoglobulin M (IgM) and plaque-reduction neutralizingNOT FOR antibody SALE testing OR DISTRIBUTION should be performed an specimens collectedNOT ≥FOR4 days SALE after OR DISTRIBUTION onset of symptoms. For asymptomatic women who have traveled to an area with an ongoing outbreak, RT-PCR testing can be done 2–12 weeks after return. Diagnosis by serologic testing can be challenging, and clinicians should contact local or state health department for assistance with arranging testing and interpreting results. Cases of Zika© virus Jones are reportable & Bartlett to local Learning, or state health LLC departments. © Jones & Bartlett Learning, LLC WomenNOT who FORtest positive SALE or OR have DISTRIBUTION inconclusive Zika virus test results shouldNOT be FOR offered SALE serial fetalOR ultrasoundsDISTRIBUTION to monitor fetal anatomy and growth every 3–4 weeks. Collaboration with a maternal–fetal medicine specialist is recommended. Testing is recommended immediately after birth, including histopathologic examination of the placenta and umbilical cord, testing of frozen placental tissue and cord tissue for Zika virus RNA, and testing of cord serum. © Jones & Bartlett Learning, LLC © Jones & Bartlett Learning, LLC NOT FOR SALE OR DISTRIBUTION NOT FOR SALE OR DISTRIBUTION © Jones & Bartlett Learning, LLC. NOT FOR SALE OR DISTRIBUTION. 9781284083415_CH03_Pass03.indd 94 20/04/16
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