Healthy Pregnancy

1
Healthy Pregnancy

• Monica Riccomini, RN, MSN
• Lisa Lottritz RN, BSN

2
Outline of Todays Topics

• Preconception Health
• Prenatal Health
• Fetal Infant Mortality Review
• Case Study
• Discussion
• Closing

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Components of a Healthy Pregnancy

• Preconception Health
• Prenatal Health
• Interconception Health

4
National Objective

• Healthy People 2000 set a goal of 60 of primary
  care physicians will provide age-appropriate
  preconception care
• Estimated 1 in 4 providers currently provide
  preconception care

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Preconception

• Preconception Health
• Defined as a womens health status prior to
  becoming pregnant
• Preconception Care
• Interventions that aim to identify and modify
  risks to a womens health or pregnancy outcome
  through prevention and management

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Preconception Risk Factors

• Chronic Health Conditions
• Obesity
• Substance Use
• Smoking
• Sexual Transmitted Infections
• Teratogenic Drugs
• Vaccinations
• Folic Acid

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Preconception Interventions

• Smoking Cessation
• Folic Acid Supplementation
• Medication Adjustments
• Pre-pregnancy Check Up
• Obesity Control

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Prenatal Health

• Prenatal Care
• Healthy Behaviors
• Community Resources

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National Objectives

• Healthy People 2010 Objective
• Increase the proportion of pregnant women who
  receive early and adequate prenatal care to 90
  of live births

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Nevada Data, 2004
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Pregnancy Weight Gain

• ..\Healthy Pregnancy\INSTITUTE OF
  MEDICINEappendix.doc

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Evaluating Interventions

• Data
• Pregnancy Risk Assessment Monitoring System
  (PRAMS)
• Perinatal Periods of Risk (PPOR)
• Fetal Infant Mortality Review (FIMR)

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National Objectives

• Healthy People 2010 Objective
• Less than 5 percent of the babies born will be
  low birth weight and less than 0.9 percent of the
  babies born will be VLBW

14
Nevada Data, 2004
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National Objective

• Healthy People 2010 Objective
• Reduce fetal deaths to 4.1 per 1,000 live births
  plus fetal deaths
• Reduce all infant deaths to 4.5 per 1,000 live
  births

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Nevada Data, 2004
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Fetal Infant Mortality Review

• FIMR is a process that looks at community level
  factors related to individual cases of fetal and
  infant deaths
• The objective of FIMR is to improve community
  resources and health delivery systems for women,
  infants, and families

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FIMR

• Case Review Team
• Medical Records
• Death Certificate
• Home Interview
• Community Action Team

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Case Study

• 19 year old African American female
• Fetal demise at 27 weeks gestation
• Second pregnancy, living child is 9 months old
• Pre-pregnancy weight is 192, height is 5 foot 4
  inches
• Quit smoking when she found out she was pregnant

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Case Study

• Started prenatal care at 17 weeks
• Has been taking multi-vitamin daily since she was
  6 weeks pregnant
• She had gestational diabetes with both
  pregnancies
• She had 3 prenatal appointments

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Case Review

• Additional information needed
• Preconception risks
• Prenatal risks
• Recommendations

22
Nevada Data, 2004
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Community Action Team

• Interventions/Actions

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Health Care Costs

• The IOM report estimates preterm birth cost the
  US more than 26.2 billion in 2005
• The average hospital charge for the most severe
  (premature) babies was 77,000 per stay, compared
  to 1,700 for an uncomplicated newborn stay

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Conclusion