Question

Case Scenario:

Ruba is a 39 years old, pregnant woman at 8 weeks gestation, and her husband, Ali, is 50 years old, arrives at antenatal clinic for follow-up. The couples have been married for 12 years. Ruba completes the initial paperwork, and the nurse notes the following obstetric history: G6 T0 P0 A5 L0 M0. Ruba and Ali asked the nurse many questions regarding Down syndrome as Ali’s sister, recently, has a boy with Down syndrome.

Q1:What are the 5 questions in the history taking are the highest priority for the nurse to ask, given Ruba’s obstetric history?

Q2:What are the initial prenatal assessment and screening tests would the nurse anticipate for Ruba at this antenatal visit?                                                                

Answer 1

1. Important questions in history taking includes:

• Immunization status of the woman
• Underlying medical conditions : cardiovascular, respiratory or genetic disorders
• Reproductive health history : when the patient had pelvic examinations, long term use of contraceptives and any past sexually transmitted infections (STIs)
• Sexuality and sexual practices, such as safer-sex practices
• Nutrition history and diet of the patient (dietary intake), Lifestyle practices, including occupation and recreational activities
• Psychosocial issues such as levels of stress, exposure to abuse and violence
• Medication and drug use, including use of tobacco, alcohol, over-the-counter and prescription medications, and illicit drugs • Support system, including family, friends, and community

2. Pre antal assessment: should include all the history taking all the previous history gestations: live birth, still born, multiple birth pregnancy, miscarriages.

• At every antenatal visit should consist of checking the signs and symptoms of poor nutrition -iodine deficiency, energy deficit,  pallor or goitre.
• Weight gain : Normal gain dring pregnancy is 9-12 kg . Sudden gain near to delivery could indicate possible pre-eclampsia.
• Temperature should be measure during visits, temperature of above 37.5°C should be treated initially with fluids, paracetamol and cold sponging. Should be refered to health care provider f teperatire stays high. Malaria screening should be done.
• Pulse rate: If rises above 100 beats per minute must be refered to doctor.
• Signs of anemia be checked. includes pallor, tiredness, fast pulse and shortness of breath.
• Shortness of breath is normal but excess should be referred to the doctor
• Blood pressure: If the blood pressure of a pregnant woman reaches 140/90 mmHg or higher, she has hypertension. Pregnancy related HTN is serious problem should be Immediately reffered.

Screening tests include:

blood tests include free B-hCG and PAPP-A hormal level in blood. Changes in these level indicate chromosomal abnormality. Rh (rhesus) factor, test for hepatitis B, syphilis, and HIV and other sexually transmitted diseases.

Urine sample check for diabetes.

Non-Invasive Prenatal Testing (NIPT) screening, Chorionic villus sampling (CVS)testing,

Ultrasound to check for Downs syndrome (First trimetser considering the history of live birth Down syndome)