EVIDENCE BASED MIDWIFERY IN

PREGNANCY

Evi Wahyuntari, S.ST., M.Keb

 USG
• Has not been proven harmfull to mother or fetus.
• USG performed by trained and experienced professionals,
with continuing education and ongoing quality-monitoring
programs.
• First trimester “ dating” : accurate to determine gestational
age (before 14 week). TM 1 also allows earlier detection of
multiple gestational, diagnosis of non-viable pregnancies.
• Second TM “ anatomy” : to screen stuctural anomalies (18-22
weeks).
• Third TM “growth”: calculation of interval growth suspect
IUGR, assesment of amniotic fluid index, assesment of
malpresentation.
• Routine use USG reduce the incidence of post
term pregnancies and rates of induction of
labor for post term pregnancy, increase
detection of multiple pregnancies, detection
fetal malnutrition, detection fetal anomalies,
 Anemia
• Anaemia is a condition in which the number of red blood cells (and consequently
their oxygen-carrying capacity) is insufficient to meet the body’s physiologic needs.
• Specific physiologic needs vary with a person’s age, gender, residential elevation
above sea level (altitude), smoking behaviour, and different stages of pregnancy.
• Iron deficiency is thought to be the most common cause of anaemia globally, but
other nutritional deficiencies (including folate, vitamin B12 and vitamin A), acute
and chronicinflammation, parasitic infections, and inherited or acquired disorders
that affect haemoglobin synthesis, red blood cell production or red blood cell
survival, can all cause anaemia.
• Haemoglobin concentration alone cannot be used to diagnose iron deficiency.
• the concentration of haemoglobin should be measured, even though not all
anaemia is caused by iron deficiency.
• The prevalence of anaemia is an important health indicator and when it is used
with other measurements of iron status the haemoglobin concentration can
provide information about the severity of iron deficiency
• The plasma volume starts to increase at about 6
weeks of pregnancy in a healthy woman. This
increase, which is disproportionately greater than
the corresponding changes on the red cell mass,
accounts for the physiologic fall in the Hb
concentration during pregnancy.
• This is the result of an initial rapid rise, followed by a
slower rise after the 30th week of pregnancy.
• Several studies demonstrate the positive correlation
between the weight of the newborn and the increase
in the plasma volume
 Clinical Signs and Symptoms
Pregnancy
• Pregnancy anemia can be asymptomatic and
may be diagnosed following routine screening.
• The signs and symptoms are often non-
specific with tiredness being the most
common.
• Women may also complain of weakness,
headaches, palpitations, dizziness, dyspnoea
and hair loss.
 Effect of Anemia on Pregnancy

• prematurity
• intrauterine growth retardation
• developmental anomalies
• neonatal death
• vaginal bleeding during the first trimester
 Management

• women are screened for anaemia at booking

and again at 28 weeks gestation
• All women should be given advice regarding
diet in pregnancy with details of foods rich in
iron along with factors that may promote or
inhibit the absorption of iron
 Risk Factor
• education,
• Malnutrition,
• pregnancy history,
• iron supplementation,
• and height showed that drinking more than three cups of tea
per day before pregnancy
• Primigravid
• short pregnancy interval
• malaria infection during pregnancy
• twin or multiple pregnancies
Hb Level to Diagnose anemia
 MFA

• John Bowlby (1960) in description with the mother-

child relationship. He defined attachment as "a series
of inner behaviors that would cause the infant to
develop an intimate relation with his/her main
caregiver“
• parents who have a high attachment to their infants
are often sensitive to their needs, and this sensitivity
affects many aspects of the infant's personality such
as their sense of curiosity, ability to socialize and
trust
 Factor MFA
• parent education,
• culture,
• anxiety,
• family,
• planning for pregnancy,
• history of fetal loss,
• Substance abuse,
• postpartum attachment,
• fetal anomaly,
• paternal attachment,
• attachment measurement tools,
• and effectiveness of education on prenatal attachment.
 ANC

AIM
• Is to monitor the progress of pregnancy to
optimize maternal and fetal health.
• Midwife critically evaluates the physical,
phychgological and sociological effect of
pregnancy on the women and her family.
 Key Priciples of ANC by Midwife

• Developing a trusting relationship with the women

• Providing a holistic approach to the women care that
meets her individual needs.
• Promoting an awreness of the public helath isues
• Identifying potential risk factors and taking the
appropriate measures to minimize them
• Preparing the women and her family to meet the
chalengges of labour and birth plant.
• Facilitating the women to make an informed
choice.
ANC Schedules
 PRE ECLAMSIA

• Pre-eclampsia is a condition that typically

occurs after 20 weeks of pregnancy. It is a
combination of: protein urine (proteinuria),
raised blood pressure (hypertension)
• Pre-eclampsia is common, affecting between
two and eight in 100 women during
pregnancy. It is usually mild and normally has
very little effect on pregnancy.
• in a small number of cases, it can develop into
a more serious illness. Severe pre- eclampsia
can be life-threatening for both mother and
baby
• Severe PE is defined as a blood pressure
greater than 160mmHg (systolic) or 110mmHg
(diastolic) associated with proteinuria greater
than or equal to 5 grams per day
 The symptoms of severe pre-
eclampsia include:
• severe headache that doesn’t go away with
simple painkillers
• heartburn that doesn’t go away with antacids
• severe pain just below the ribs • problems
with vision, such as blurring or flashing before
the eyes
• rapidly increasing swelling of the face, hands
or feet • feeling very unwell
 risk factor of pre-eclampsia
• blood pressure was high before you became pregnant
• blood pressure was high in a previous pregnancy
• medical problem such as kidney problems or diabetes or a
condition that affects the immune system, such as lupus
• first pregnancy
• aged 40 or over
• last pregnancy was more than 10 years ago
• overweight – a BMI (body mass index) of 35 or more
• mother or sister had pre-eclampsia during pregnancy
• Multiple pregnancy
 Effects ofPreeclampsia

• Risk of Fetal Demise/Stillbirth

• Intrauterine Growth Restriction (IUGR)
• Hematologic Effects. Maternal
 Exercise during pregnancy
• meta-analysis (involving 2059 women) showed that in normal-
weight women with singleton, uncomplicated gestations,
aerobic (stationary cycling, water aerobics, aerobic dance) and
strength or toning exercise of moderate-intensit performed on
3–4 days/week (35–90 minutes/session, or ~60 minutes on
average), starting during late-1st trimester (weeks 8–13) in 5
out of 9 randomized controlled trials (RCTs), or during the 2nd
trimester (weeks 16–22) in 4 out of 9 RCTs and lasting to end
of pregnancy was not associated with a increased risk for
preterm birth
 Benefits of exercise during
pregnancy
• decreased risk of macrosomic newborns,
• gestational diabetes,
• preeclampsia,
• cesarean delivery,
• low back pain,
• urinary incontinence
• Eases constipation
 of exercise during pregnancy

• Cervical insuficiency
• Placenta previa after 26 week after
pregnancy
• Being pregnant with twins with risk factor of
preterm labour
• Pre eclamsia
• Severe anemia
 Nutrition Recommendations in
Pregnancy
Energy Expenditure during Pregnancy

• Caloric intake should increase by approximately 300 kcal/day during

pregnancy
• Macronutrients—Recommended protein intake during pregnancy is
60g/day,
• Micronutrients Vitamin
• Vitamin A is essential for cell differentiation and proliferation as well as
development of the spine, heart, eyes, and ears
• Folic acid is the synthetic form of the naturally occurring B vitamin, folate.
Folic acid is the form used in most vitamin supplements and food
fortification
• Iron supplements have routinely been recommended in pregnancy
because iron needs nearly double during pregnancy.
• Daily oral iron and folic acid supplementation
with 30 mg to 60 mg of elemental ironb and
400 g (0.4 mg) of folic acidc is recommended
for pregnant women to prevent maternal
anaemia, puerperal sepsis, low birth weight,
and preterm birth.
• The nutritional status of a woman during
pregnancy and lactation is not only critical for
her health, but for future generations
 Daftar Pustaka

• Berghella, Vicenzo. Obstetric Evidence Based

Guidlines. UK: nforma Healtcare.
• ACOG. 2012. Pre-eklamsia
• WHO. 2011. Prevention and treatment of pre-
eclampsia and eclampsia. Geneva
• Backes, Carl H. Et all. 2011. Maternal
Preeclampsia and Neonatal Outcomes. Journal
of Pregnancy Page 1-7
TERIMAKASIH