Prenatal care diagnosis and measures

The core of prenatal care is to identify potential/existing health problems in the physical, psychological, and social dimensions during pregnancy in advance. The most common clinical high-priority nursing diagnoses focus on the three categories of "risk of injury (both mother and fetus)", "anxiety/depression state" and "lack of knowledge". The corresponding measures are by no means a standardized template and need to be dynamically adjusted based on the gestational age, the mother's underlying diseases, and family support.

Last month, during my rotation at the obstetrics clinic, I picked up a second-born mother who was 32 weeks pregnant. She had a history of type 2 diabetes before pregnancy. She couldn't help but secretly drink pearl milk tea to control her sugar at home. When she came for the prenatal check-up, her glycosylated hemoglobin was 6.3%. The fetus was two weeks older than the actual gestational age, and the umbilical cord was wrapped around the neck. This is a typical diagnosis of "risk of maternal and fetal injury." Regarding intervention in this type of situation, different nursing schools actually have different opinions: traditional obstetric nursing requires strict calculation of daily caloric intake based on pre-pregnancy weight, fixed meal menus, and even the grams of fruit must be accurate to single digits. ； However, evidence-based nursing research in recent years has shown that as long as blood sugar can be stably controlled within 6.7mmol/L 2 hours after a meal, allowing 1-2 "indulgent meals" per week can prevent pregnant women from having an emotional counterattack due to excessive dieting and causing a one-time blood sugar spike. The final plan we made for this mother was not too harsh. She was allowed to drink half a cup of milk tea with 30% sugar every week, coupled with half an hour of slow walking. After two weeks, the blood sugar was stabilized and the fetal growth rate returned to the normal range.

To be honest, what many people tend to overlook are psychological problems, which are much more difficult to identify than physical ones. I have seen too many late-pregnant mothers who look cheerful on the surface, but privately told me during the prenatal check-up that they had watched a short video of a premature baby the day before, had been insomnia all night, felt that the baby was not moving correctly when touching their belly, and even secretly checked the cost of newborn emergency care. This is a nursing diagnosis of "anxiety state", and in severe cases, it can develop into prenatal depression. There are actually differences in the industry on whether to perform routine prenatal psychological screening: Most tertiary hospitals in first-tier cities will routinely give pregnant women the SAS Anxiety Self-Rating Scale at 28 weeks of pregnancy, with full-time psychological nurses providing follow-up intervention. ； However, many colleagues in grassroots hospitals feel that there are not enough psychological counseling resources to support pregnant women who are positive through screening. Instead, it is easy to label pregnant women as having "psychological problems" and increase their psychological burden. Our department's current compromise is not to take the initiative to ask for psychological screening. It is to talk a few more about daily routines during each prenatal check-up, ask whether she has slept well recently, and if she has anything bothering her. When she encounters someone who is in a bad mood, she will be given a small notebook, so that she does not need to write complicated content every day, but just check three boxes: Today's mood is good/average/poor, and if there is anything wrong with her. It’s comfortable. It’s much more useful to have a chat with her during her next prenatal check-up than to fill in a complicated questionnaire. Last month, a mother who was 34 weeks pregnant relied on this method. She slowly revealed that she had trouble with the natural delivery of her first child, and she was afraid that there would be problems with this child as well. We found a nurse in the delivery room for her to take her around the delivery room in advance and explained the process of painless delivery, and most of her anxiety symptoms were relieved.

As for the diagnosis of "lack of knowledge", it is even more common. Last week, a little girl who was just 12 weeks pregnant came over and asked me if I couldn't lie down to sleep, use mobile phones, and even touch hot pots when I was pregnant. She said that it was all told by the elderly at home. At this time, when we are doing missionary work, we will not directly say that the old man’s statement is wrong. After all, different generations have different experiences and cognitions. Take the question of whether sexual intercourse is allowed during pregnancy. The older generation’s concept is that it must be absolutely forbidden during the entire pregnancy. The current evidence-based conclusion is that as long as there are no high-risk factors such as placenta previa, threatened abortion, and premature birth, the second trimester can be carried out normally, and there is no need to deliberately avoid taboos. Our department has printed a small handbook, listing frequently asked questions, and has also established a communication group for pregnant mothers. If you have any questions, you can ask them in the group at any time, so that everyone does not have to search for messy information on the Internet and scare themselves.

After nearly 8 years of obstetrical care, my biggest feeling is that no pregnant woman is exactly the same, and there is no completely universal care plan. There was a mother who was 36 weeks pregnant and had an abnormal fetal position. She couldn't do the regular knee-chest position because of her lumbar protrusion. We later discussed with our colleagues in the Department of Traditional Chinese Medicine and taught her to moxibustion on the Yin points for 15 minutes every day. After a week, the fetal position was reversed after a review, and she finally gave birth to a 6.5-pound girl.

After all, prenatal care is never a one-sided matter of medical care. Your own feelings always come first. If you feel something is wrong during pregnancy, don't force yourself to do it, and don't blindly search for information on your own. It's better to ask your bedside nurse or doctor directly.