Teaching Plan PDF

College of Nursing, Christian University of Thailand
Teaching Plan (Theory)

Semester 1 Academic Year 2558
Course code: INUR 3314 Course Title: Midwifery I

Teaching topics: Evolution, concepts, and theories related to midwifery
Name of Instructor: Mrs. Rungaroon Pumcharoen
Day/Month/Year: 29/08/ 2015 Time: 9:00-11:00 Venue: Christian University Room 401
Year of Students: Third Year
Course Behavioral Objectives:
1.Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
2. Examine the Five Critical Factors that affect the labor process.
3. Describe the physiology of labor.
4. Describe the characteristics of the four stages of labor and their accompanying phases.
5. Describe the Physiologic and Psychosocial changes that are indicative of the maternal progress during each of the stages of labor.
6. Describe Fetal Adaptations to Labor.
7. Summarize and describe intrapartal physical, psychosocial, and cultural assessments necessary for optimum maternal-fetal outcome.
8. Compare and evaluate the various methods of monitoring fetal heart rate and contractions, giving advantages and disadvantages of
each.
9. Evaluate high risk and complicated pregnancies and implement proper nursing care.
Teaching Units
1. Evolution concepts and theories related to midwifery
Behavioral Teaching and
Content of Each Teaching Topic (in Teaching Evaluation Evaluation
Objectives of each Learning
brief) Aides Methods results
teaching topic Activities
1. Define 1. Midwifery -Lecture -PowerPoint Class -The students
midwifery. Introduction Discussion presentation Participation were able to:
2. Discuss the Defined as the practice of assisting in -Video -Board and and answering - distinguish
evolution of childbirth. Presentation marker and
questions
midwifery. “Midwifery”- meant with woman. about the -Video clip comprehend
3. Explain the France- "wise woman," or "sage history of about the about the the topics
concepts and femme.“ Midwifery and history of evolution of discussed.
theories related to Content methods of midwifery and midwifery -showed great
midwifery. 1.1Evolution of midwifery ancient times methods of -Class enthusiasm in
4. Identify and Ancient civilizations of the West- birth and ancient times feedback about learning the
describe the roles midwives were women with some delivery. and birth and the video topics
and responsibilities. medical training. -Questions delivery discussed.
presentation on
*1.5,2.2,5.3 By the Middle Ages, though, about the -defined
midwives basically used the evolution of the history of midwifery.
knowledge acquired through their own midwifery. midwifery and -distinguish
experience to assist in deliveries. methods of the evolution
In the 16th century, childbirth was ancient times of midwifery.
placed squarely in the realm of birth and -understand
physicians for the first time. delivery. the concepts
Contemporary Midwives and theories
Midwives of today work in hospitals, related to
homes and birthing centers and have midwifery.
different programs for training and
certification.
1.2 Concepts and theories related
to midwifery
Theory is the acknowledged
foundation to practice methodology,
professional identity and growth of
formalized knowledge. It has been
noted that practice must not only be
evidence-based but also theory-based.
Hence, midwifery must be theory
based because theories serve as a
broad framework for practice and may
also articulate the goals of a profession
and core values. In this paper, an
evolving theory on the empowerment
of childbearing women is introduced,
where the midwife’s professionalism is
central. The theory is synthesized from
nine datasets and scholarly work, and
then more than three hundred studies
were reviewed for clarification and
confirmation. According to the theory,
the midwife’s professionalism is
constructed from five main aspects:
The professional midwife cares for the
childbearing woman and her family.
This caring within the professional
domain is seen as the core of
midwifery. The professional midwife
is professionally competent. This
professional competence must always
have primacy for the sake of safety of
woman and child.
1.3 The roles and responsibility of
midwives
1.3.1 Certified Nurse Midwife
Have atleast a bachelor’s degree or
doctoral degree.
Have completed both nursing and
midwifery training.
Have passed national and state
licensing exams to become certified.
May work in conjunction with doctors.
1.3.2 Certified Midwife- is not a
registered nurse but otherwise meets
the same qualifications as a certified
nurse-midwife. Because this
certification has only existed since
1996, there are few CMs. Currently,
only some states recognize this
certification as sufficient for licensing.
1.3.3 A lay or direct-entry midwife
may or may not have a college degree
or a certification. Direct-entry
midwives may have trained through
apprenticeship, workshops, formal
instruction, or a combination of these.
Not all states require them to work in
conjunction with doctors, and they
usually practice in homes or non-
hospital birth centers. But not every
state regulates direct-entry midwives
or allows them to practice.
Summary
World Health Organization-
distinguishes midwifery for its
continual health care of women and
infants worldwide.
Hence, midwifery must be theory
based because theories serve as a
broad framework for practice and may
also articulate the goals of a profession
and core values. In this paper, an
evolving theory on the empowerment
of childbearing women is introduced,
where the midwife’s professionalism is
central.
Reference:
1. Olds. S.B. al (2008). Maternal – Newborn Nursing Women’s Health Care. 8th ed. New Jersey : Pearson.
2. Goorrle, T.M. McKinney, E.S. Murray, S.S. (1998) Foundation of Maternal Newborn
Nursing. 2nd ed. Philadelphia : W.B. Saunders Company.
3. Lowdermilk, D.L. and Perry, S.E. (2004) Maternity and Women’ Health Care.8th ed.
St. Louis : Mosby-Year. Book, Inc.
4. Lawdermilk. D.L. and Perry. S.E. (2004) Maternity and women’s Health Care. 8th ed. Missuri.
Mosby.
Overview Assessment
After learning this topic, the students were able to answer the questions raised by the lecturer and they showed a very high
participation in the class discuss

Teaching topic: Fetal Assessment
Day/Month/Year: 05/09/2015 Time: 9:00-11:00 Venue: Christian University Room 401
each.
Teaching Units
1. Fetal Assessment
Content of Each Teaching Topic Teaching Evaluation Evaluation
(in brief) Aides Methods results
1.Identify typical Fetal Assessment -Lecture -Powerpoint -Quiz about The students
signs Introduction Discussion presentation types of fetal are able to:
of normal and Fetal monitoring during pregnancy -Questions -Board and assessment and -differentiate
abnormal fetal heart is used to prevent fetal death. about types of marker the nursing and identify
rate patterns. Content fetal -Video clip management. the types of
2. Identify and discuss 1 Fetal movement counting assessment. on non-stress -Class fetal
different types of fetal Fetal movement refers to motion of -Video test, participation assessment.
assessment. a fetus caused by its own muscle presentation amniocentesis and answering -distinguish
3. Compare FHR activity. Locomotor activity begins about non- and ultrasound questions about and
monitoring performed during the late embryological stress test, types of fetal comprehend
by intermittent stage, and changes in nature amniocentesis assessment. the topics
auscultation with throughout development. Muscles and ultrasound -Class feedback discussed.
external and internal begin to move as soon as they are -Demonstration about the video -showed great
electronic methods. innervated. These first movements On Leopold’s presentation on enthusiasm in
4. Explain the are not reflexive, but arise from Maneuver non-stress test, learning the
baseline self-generated nerve impulses amniocentesis topics
FHR and evaluate originating in the spinal cord. As and ultrasound. discussed.
periodic changes. the nervous system matures, -Return
5. Discuss and muscles can move in response to Demonstration
demonstrate stimuli. on Leopold’s
abdominal Generally speaking, fetal motility Maneuver
Assessment/Leopold can be classified as either elicited
maneuver using the or spontaneous, and spontaneous
correct sequence of movements may be triggered by
the procedure with either the spine or the brain.
emphasis on Whether a movement is
professional code of supraspinally determined can be
ethics inferred by comparison to
*1.5,2.2,5.3 movements of an anencephalic
fetus.
Although the heart begins to beat
on the 23rd day after conception,
this article primarily deals with
voluntary and reflex movements.
Ages are given as age from
fertilization rather than as
gestational age.
Some sources contend that there is
no voluntary movement until after
birth. Other sources say that
purposive movement begins
months earlier.3D ultrasound has
been used to create motion pictures
of fetal movement, which are
called "4D ultrasound
2. Non-stress test
A nonstress test (NST) is a
screening test used in pregnancy. A
cardiotocograph is used to monitor
the fetal heart rate.
3. Contraction stress test
A contraction stress test (CST) is
performed near the end of
pregnancy to determine how well
the fetus will cope with the
contractions of childbirth. The aim
is to induce contractions and
monitor the fetus to check for heart
rate abnormalities using a
cardiotocograph. A CST is one
type of antenatal fetal surveillance
technique.
4.Ultrasound
Ultrasounds are sound waves with
frequencies higher than the upper
audible limit of human hearing.
Ultrasound is no different from
'normal' (audible) sound in its
physical properties, except in that
humans cannot hear it. This limit
varies from person to person and is
approximately 20 kilohertz (20,000
hertz) in healthy, young adults.
Ultrasound devices operate with
frequencies from 20 kHz up to
several gigahertz.
5.Amniocentesis
Amniocentesis (also referred to as
amniotic fluid test or AFT) is a
medical procedure used in prenatal
diagnosis of chromosomal
abnormalities and fetal infections,
and also used for sex determination
in which a small amount of
amniotic fluid, which contains fetal
tissues, is sampled from the
amniotic sac surrounding a
developing fetus, and the fetal
DNA is examined for genetic
abnormalities. The most common
reason to have an "amnio" is to
determine whether a baby has
certain genetic disorders or a
chromosomal abnormality, such as
Down syndrome. Amniocentesis
(or another procedure, called
chorionic villus sampling (CVS))
can diagnose these problems in the
womb. Amniocentesis is usually
done when a woman is between 14
and 16 weeks pregnant.
6. Foam’s test
Amniotic fluid samples were
obtained from 203 pregnant
women who delivered within 72
hours after amniotic fluid
collection. Each sample of
amniotic fluid was taken to
perform both foam stability index
(FSI) test and simple shake test
immediately. The both tests are
functional test to evaluate amount
of lung surfactants in amniotic
fluid to predict the development of
respiratory distress syndrome in the
newborns.
7. Biophysical Profile
A biophysical profile (BPP) is a
prenatal ultrasound evaluation of
fetal well-being involving a scoring
system,[1] with the score being
termed Manning's score. It is often
done when a non-stress test (NST)
is non reactive, or for other
obstetrical indications.
The "modified biophysical profile"
consists of the NST and amniotic
fluid index only.
Reference:
Mosby.
Overview Assessment
1. After learning this topic, the students can answer the questions accordingly and they can participate in the class discussion.

Teaching topic: Fetal Assessment
each.
Teaching Units
1. Fetal Assessment
1. Identify the Fetal Assessment -Lecture -Powerpoint -Class The students
different types of Content Discussion presentation participation were able to:
indirect method of 8. Indirect fetal assessment -Questions -Board and and answering -identify and
fetal assessment A general term which can refer to any about scalp marker questions about distinguish
2. Discuss cord maneuver used to evaluate the fetus' stimulation test -Video clip on scalp indirect
blood analysis at status during pregnancy–eg, and cord blood indirect fetal stimulation test method of fetal
birth. measurement of heartbeat and visual analysis assessment and cord blood assessment.
*1.5,2.2,5.3 examination of the amniotic sac; -Video Scalp analysis. -discuss cord
however, as used, FM usually refers to presentation stimulation test -Class blood analysis
the use of electronic devices during about indirect and cord blood feedback on and scalp
L&D to assess the baby's heartbeat and fetal analysis the video stimulation
uterine contraction. assessment, presentation test.
9. Scalp stimulation scalp about indirect -distinguish
Fetal scalp stimulation test is a stimulation fetal and
diagnostic test used to detect fetal and cord blood assessment, comprehend
metabolic acidemia. It can be used as a analysis scalp the topics
non-invasive alternative to fetal scalp stimulation test discussed.
blood testing. and cord blood -showed great
10. Cord blood analysis at birth analysis. enthusiasm in
Cord blood refers to a sample of blood learning the
collected from the umbilical cord when topics
a baby is born. The umbilical cord is discussed.
the cord connecting the baby to the
mother's womb.
Reference:
Mosby.
Overview Assessment
The students need are meet according to the objectives and plans of the topic.

Teaching topic: Mechanism of labor
each.
Teaching Units
1. Mechanism of labor
1. Discuss about Mechanism of labor -Lecture -Powerpoint -Class The students
theories of labor. Introduction Discussion presentation participation were able to:
2. Describe and The mechanisms of labor, also known -Questions -Board and and answering -discuss
discuss physiologic as the cardinal movements, involve about the marker questions about theories of
forces of changes in the position of the fetus’s theories of -Video clip on the theories of labor.
labor. head during its passage in labor. labor and mechanism of labor and -differentiate
3. Identify the Content premonitory labor premonitory between true
premonitory signs Mechanism of labor signs of labor signs of labor and false labor
of labor 1. Theories of labor -Video -Class feedback -distinguish
4. Differentiate a. Uterine Stretch theory presentation on the video and
between true and The idea is based on the concept that about the presentation comprehend
false labor. any hollow body organ when mechanism of about the the topics
5. Enumerate the stretched to its capacity will inevitably labor mechanism of discussed.
cardinal contract to expel its contents. -Demonstration labor. -showed great
movements of b. Oxytocin theory of the -Return enthusiasm in
birth. Pressure on the cervix stimulates the mechanism of demonstration learning the
6. Define induction hypophysis to release oxytocin from labor on the topics
of labor. the maternal posterior pituitary gland. mechanism of discussed.
*1.5,2.2,5.3 As pregnancy advances, the uterus labor.
becomes more sensitive to oxytocin.
c. Progesterone deprivation theory
Progesterone is the hormone designed
to promote pregnancy. It is believed
that presence of this hormone inhibits
uterine motility.
d. Prostaglandin theory
In the latter part of pregnancy, fetal
membranes and uterine decidua
increase prostaglandin levels. This
hormone is secreted from the lower
area of the fetal membrane (forebag).
e. Theory of Aging Placenta
Advance placental age decreases
blood supply to the uterus. This event
triggers uterine contractions, thereby,
starting the labor.
2. Possible causes of labor onset
Normal Causes. While no one knows
the exact cause of labor, several
factors come into play during this
final stage of pregnancy. First, the
level of prostaglandin, a hormone,
increases, causing the cervix to soften.
Second, the levels of the hormone
oxytocin increase, triggering
contractions
3. Premonitory signs of labor
o A feeling of activity and lightness
on the part of the patient
o A diminution of the abdominal
protuberance
o An increased vaginal secretion
o Frequently a sympathetic
irritability of the bladder, and
sometimes of the rectum also.
o Lightening: the mother would feel
the descent of the fetus and changes
the abdominal contour.
o Braxton hicks contraction: painless
irregular contractions
o Bloody show
o Sudden rush of energy: due to
change in levels of estrogen and
progesterone
o Increased backache and sacroiliac
pressure
o Ripening of cervix: soft (as butter)
feeling of the cervix
o Rupture of the membrane: “bag of
water”
4. Differences between true and false
labor
Before "true" labor begins, you might
have "false" labor pains, also known
as Braxton Hicks contractions. These
irregular uterine contractions are
perfectly normal and might start to
occur from your fourth month of
pregnancy.
False labor: Intermittent non-
productive muscular contractions of
the womb (uterus) during pregnancy,
most commonly in the last two
months before full term. These
contractions are non-productive in the
sense that they do not produce any
flattening (effacement) or dilation
(opening up) of the cervix.
5. Cardinal movements of labor
The seven cardinal movements of
labor are: engagement, descent,
flexion, internal rotation, extension,
external rotation and expulsion.
6. Induction of labor
Labor induction — also known as
inducing labor — is a procedure used
to stimulate uterine contractions
during pregnancy before labor begins
on its own. Successful labor induction
leads to a vaginal birth.
Reference:
Mosby.
Overview Assessment
The students demonstrate knowledge and understand the content.

Teaching topic: Nursing care on Stages of labor and birth
each.
Teaching Units
1. Stages of labor and birth
Behavioral
Teaching and
Objectives of Content of Each Teaching Topic (in Teaching Evaluation Evaluation
Learning
each teaching brief) Aides Methods results
Activities
topic
1. Describe the Nursing care on Stages of Labor -Lecture -PowerPoint -Class - The students
ongoing Introduction Discussion presentation participation were able to:
assessment of Childbirth, labour, delivery, birth, -Questions -Board and and answering -describe the
maternal progress partus, or parturition is the culmination about the marker questions on stages of labor.
during the of a period of pregnancy with the nursing care on -Video clip on nursing care of -identify
first, second, third expulsion of one or more newborn the four stages birth and the four stages physiological
and infants from a woman's uterus. The of labor. delivery of labor. signs.
fourth stages of process of normal childbirth is -Video -Class feedback -give correct
labor. categorized in three stages of labour: presentation on the video answers to
2. Identify the the shortening and dilation of the about birth and presentation on questions
physical and cervix, descent and birth of the infant, delivery. birth and -distinguish
psychological and the expulsion of the placenta. -Demonstration delivery. and
findings indicative Each year about 0.5 million women on assisting - Return comprehend
of maternal die due to pregnancy and childbirth, 7 birth and demonstration the topics
progress during million have serious long term delivery on assisting discussed.
labor. complications, and 50 million have birth and -showed great
3. Identify signs of negative outcomes following delivery. delivery. enthusiasm in
developing Most of these issues occur in the learning topics
complications developing world. discussed.
during Content
labor and birth. 1.First Stage of Labor
*1.5,2.2,5.3 From the beginning of labor to the full
opening (dilation)of the cervix(about
4inches or 10cm).
1.1 Three phases
1.1.1 Latent Phase
-cervix dilates at 0-3cm
-mild contractions
-duration of 20-40sec
-frequency of every 5-
10min
1.1.2 Active Phase
-cervical dilatation
reaches 4-7cm
-moderate contractions
-frequency of 3-5min
1.1.3 Transition Phase
-cervix at 8-10cm
-strong contractions
-frequency of 2-3min
1.2 Nursing interventions
Hospital admission: a. personal data
b. obstetrical data, Vital Signs, FHR-
normally 120-160/min, Laboratory
routine: CBC, Hgb, Hct, Enema,
Perineal Shaving, Provide emotional
and psychological support, Timing of
uterine contractions, Assisting the
doctor in giving meds or analgesia and
Giving local anesthesia (lidocaine)
when in DR table.
2. Second Stage of Labor
From the complete dilatation of the
cervix to delivery of the baby.
- CROWNING –hallmark of 2nd stage
-PRIMI—50 minutes
-MULTIGRAVID-20minutes
Position legs into stirrups at the same
time, when the head crowns, instruct
mother not to push but to pant and
assist in episiotomy.
3. Third Stage of Labor
From delivery of the baby to delivery
of the placenta.
3.1 Types of placental delivery
3.1.1 SCHULTZ – fetal surface,
bluish and shiny.
3.1.2 DUNCAN-uterine surface,
reddish and rough.
3.2 Signs of placental separation
Lengthening of the cord, sudden gush
if blood
Change in the shape of the uterus of
Calkin’s sign and firm contraction of
uterus
Just watch for the signs of placental
separation
Take note of the time of placental
delivery
Inspect for the completeness of the
cotyledons
Check for the condition of the fundus
-massage carefully
-apply ice cap over abdomen to help
contract the uterus
-injection of Methergin or Syntocinon
(IM) to maintain uterine contraction
and prevents hemorrhage.
Inspect the perineum for laceration
Make mother comfortable
Position the newly delivered mother
flat on her back without pillows
Give initial nourishment (milk, soup,
tea)
Allow patient to sleep
4. Fourth Stage of Labor
Critical period for the mother on the
1st 1-2hrs after delivery
Monitor VS every 15 minutes
Fundus should be checked every 15
minutes x 1 hr then every 30 minutes
for the next 4 hours
Check for the amount of bleeding
Check for bladder distention
Encourage rooming-in
Summary
The process of having a baby occurs in
several stages over many hours or even
a few days—from early labor through
delivering the baby and the placenta.
During labor, contractions in your
uterus open your cervix and move the
baby into position to be born.
Reference:
Mosby.
Overview Assessment
The students need is meet according to the objectives and plans of the topic. The topic has been interesting to the students and
students are able to exhibit a very high cooperation.

Teaching topic: Maternal systemic response to labor
each.
Teaching Units
1. Maternal systemic response to labor

1. Identify the Physiological changes during -Lecture -Powerpoint -Class The students
maternal anatomic pregnancy Discussion presentation Participation were able to:
and physiologic Introduction -Questions -Board and and answering -identify the
adaptations to Maternal physiological changes in about the marker questions about maternal
labor. pregnancy are the normal adaptations maternal maternal anatomic and
2.Identify non- that a woman undergoes during physiological physiological physiological
pharmacologic pregnancy to better accommodate the changes. changes changes to
strategies to embryo or fetus. They are labor.
enhance relaxation physiological changes, that is, they are - distinguish
and decrease pain entirely normal, and include and
and discomfort cardiovascular, hematologic, comprehend
during metabolic, renal and respiratory the topics
labor. changes that become very important in discussed.
*1.5,2.2,5.3 the event of complications. - showed great
Content enthusiasm in
1. Cardiovascular System learning the
Cardiac output—increases about 12 - topics
31% in the 1st stage. -Increases about discussed.
50% in the second stage. Heart rate—
increases slightly
2. Blood Pressure
Systolic increases in 1st stage
Systolic and Diastolic increase in 2nd
stage. Rises with each contraction. May
rise further with pushing.
3. Fluid and Electrolyte Balance
Increase in renin, plasma renin activity,
and angiotensinogen.
Edema may occur at base of bladder
due to pressure of fetal head.
4. Respiratory System
Respiratory rate increases. Increase in
oxygen demand and consumption.
Mild respiratory acidosis usually
occurs by time of birth.
5. Renal System
Nephrology findings—slight
proteinuria may occur; polyuria; GFR
increased due to increased CO.
6. Gastrointestinal System
Gastric Motility—decreased
Gastric emptying is prolonged.
Gastric volume remains increased.
7. Immune System and other
blood values
WBC—increase due to stress
Temp—may slightly increase
especially if mom is dehydrated, Blood
glucose—decreases
8. Pain
In the first stage: arises from dilatation
of cervix, stretching of lower uterine
segment, pressure, and hypoxia of
uterine muscle cells during
contractions.
In the second stage: arises from
hypoxia of contracting uterine muscle
cells, distention of the vagina and
perineum, and pressure.
In the third stage: arises from
contractions and dilatation of cervix as
placenta is expelled.
Summary
The body must change its physiological
and homeostatic mechanisms in
pregnancy to ensure the fetus is
provided for. Increases in blood sugar,
breathing and cardiac output are all
required. Levels of progesterone and
estrogens rise continually throughout
pregnancy, suppressing the
hypothalamic axis and subsequently
the menstrual cycle. The woman and
the placenta also produce many
hormones.
Reference:
Mosby.
Overview Assessment
1. After learning this topic, the students can answer the questions raised by the lecturer and they were able to comprehend the
topic discussed.

Teaching topic: Fetal response to labor
Name of Instructor: Dr. Punyanut Phimchaisai
each.
Teaching Units
1. Fetal response to labor
Behavioral
Teaching and
Objectives of Content of Each Teaching Topic (in Teaching Evaluation Evaluation
Learning
each teaching brief) Aides Methods results
Activities
topic
1. Identify and Fetal Heart rate adaptations to labor -Lecture -Powerpoint -Class The students
discuss the fetal Introduction Discussion presentation Participation were able to:
anatomic and Although the fetus experiences -Questions -Board and and answering -identify the
physiologic mechanical and hemodynamic changes about the marker questions on fetal
adaptations to during pregnancy and birth, the full hemodynamic hemodynamic adaptations to
labor. term infant can withstand these changes changes during changes during labor.
*1.5,2.2,5.3 without adverse effects. pregnancy and pregnancy and -distinguish
Content birth birth and
1. Heart rate changes -Midterm quiz comprehend
The presence of fetal heart rate On the history, the topics
accelerations is one of the most evolution of discussed.
important signs of well-being during midwifery, fetal -showed great
labor. Accelerations are defined as assessment, enthusiasm in
short-term rises in the heart rate of at mechanism of learning the
least 15 beats per minute, which last at labor, stages of topics
least 15 seconds. In many cases, they labor, maternal discussed.
last longer. and fetal
1. Acid base Status in Laboratory response to
Care provider sometimes need to labor.
employ additional methods to further
assess fetal oxygenation and acid base
status.
2. Hemodynamic Changes
Plasma volume increases 45% at term,
RBC volume increases 20%, thus while
pregnant patients have increased RBC
mass, they appear anemic. Normal
hemoglobin is 12 g/dL. During labor,
contractions squeeze blood into the
systemic circulation, and after delivery,
uterine involution autotransfuses 500
cc/blood.
Summary
Changes in the fetal heart rate(FHR)
reflect fetal response to the labor
process. Assessment of the FHR is a
critical nursing responsibility.
Reference:
Mosby.
Overview Assessment
topic discussed.

Teaching topic: Maternal Assessment
1. Explain evolution of concepts and theories related to midwifery, the roles and responsibilities of midwives.
each.
Teaching Units
1. Maternal Assessment
Behavioral
Teaching and
Objectives of Content of Each Teaching Topic Teaching Evaluation Evaluation
Learning
each teaching (in brief) Aides Methods results
Activities
topic
1. Discuss 1. Prenatal Record -Lecture -Powerpoint -Class Participation The students
prenatal Introduction Discussion presentation And answering were able to:
record. Prenatal care is often the primary -Questions about -Board ands question on -discuss
2. Discuss high- way young women access basic intrapartal high risk marker intrapartal high risk prenatal
risk health care. The prenatal record screening, physical screening, physical record.
screening and and the initial prenatal evaluation and and -discuss
intrapartal are so closely linked that they psychosociocultural psychosociocultural methods used
assessment of must be discussed together. Assessment Assessment to evaluate
maternal Content progress of
physical and 1 Intrapartal High-Risk Screening labor
psycho- Screening for intrapartal high-risk - distinguish
sociocultural factors is an integral part of and
factors. assessing the normal laboring comprehend
3. Discuss woman. As the history is the topics
methods obtained,note the presence of any discussed.
used to evaluate factors that may be associated with -The students
the a high-risk condition.For are able to
progress of example,the woman who reports a showed great
labour physical symptom such as enthusiasm in
*1.5,2.2,5.3 intermittent bleeding needs further learning the
assessment to rule out abruptio topics
placentae or placenta previa before discussed.
the admission process continues. It
is also important to recognize the
implications ofa highrisk condition
for the laboring woman and her
fetus.For example,if there is an
abnormal fetal presentation,labor
may be prolonged,prolapse of the
umbilical cord is more likely, and
the possibility of a cesarean birth
is increased.
2 Intrapartal Physical and
Psyhosociocultural Assessment
The physical assessment portion
includes assessments performed
immediately on admission as well
as ongoing assessments.When
labor is progressing very
quickly,there may not be time for a
complete nursing assessment. In
that case the critical physical
assessments include maternal vital
signs, labor status, fetal status, and
laboratory findings. The cultural
assessment portion provides a
starting point for this increasingly
important aspect of assessment.
Individualized nursing care can
best be planned and implemented
when the values and beliefs of the
laboring woman are known and
honored. It is sometimes
challenging to achieve a balance
between cultural awareness and
the risk of stereotyping because
cultural responses are influenced
by so many factors. Nurses are
most effective when they combine
an awareness of the major cultural
values and beliefs of a specific
group with the recognition that
individual differences have an
impact.“Developing Cultural
Competence”provides examples of
selected beliefs of some Native
American women.
4 Evaluating Labor Progress
The nurse assesses the woman’s
contractions and cervical dilatation
and effacement to evaluate labor
progress.
Contraction Assessment Uterine
contractions may be assessed by
palpation or continuous electronic
monitoring. Palpation. Assess
contractions for frequency,
duration, and intensity by placing
one hand on the uterine fundus. It
is important to keep the hand
relatively still because excessive
movement may stimulate
contractions or cause discomfort.
Determine the frequency of the
contractions by noting the time
from the beginning of one
contraction to the beginning of the
next.
Summary
During the initial prenatal visit, the
practitioner collects most of the
information that will be used to
evaluate obstetrical risks and
determine what special
interventions, if any, are needed.
This visit establishes the
foundation for the physician–
patient relationship, particularly
when the patient is new to the
physician.
Reference:
Mosby.
Overview Assessment
1. The students need are meet according to the objectives and plans of the topic. The topic has been interesting to the students
and students are able to exhibit a very high cooperation.

Teaching topic: High risk pregnancies
Name of Instructor: Mrs. Nongnaphat Wongchantorn
each.
Teaching Units
1. Nursing therapeutics for high risk and complicated pregnancies
1. Identify high risk High risk pregnancies -Lecture- -Powerpoint -Class The students
and complicated Introduction Discussion presentation participation were able to:
pregnancies A high-risk pregnancy is one of greater -Questions -Board and and answering -evaluate high
2. Discuss the risk to the mother or her fetus than an About fetal Marker questions on risk and
nursing uncomplicated pregnancy. Pregnancy anomalies, fetal complicated
management. places additional physical and dead fetus, anomalies, pregnancies
*1.5,2.2,5.3 emotional stress on a woman’s body. teenage dead fetus, -give correct
Health problems that occur before a pregnancy and teenage answers to
woman becomes pregnant or during elderly pregnancy and questions
pregnancy may also increase the gravida elderly gravida - distinguish
likelihood for a high-risk pregnancy. and
Content comprehend
1. Fetal anomalies the topics
Congenital anomalies are also known discussed.
as birth defects, congenital disorders or -showed great
congenital malformations. Congenital enthusiasm in
anomalies can be defined as structural learning the
or functional anomalies (e.g. metabolic topics
disorders) that occur during intrauterine discussed.
life and can be identified prenatally, at
birth or later in life.
2. Dead fetus
Fetal death" means death prior to the
complete expulsion or extraction from
its mother of a product of human
conception, irrespective of the duration
of pregnancy and which is not an
induced termination of pregnancy.
3. Elderly gravida
The elderly primigravida is defined as a
woman who goes into pregnancy for
the first time at the age of 35 years or
older. Progressively, this has become
more common in our contemporary
society and traditionally such
pregnancy is regarded as high risk.
4. Teenage pregnancy
Teenage pregnancy is defined as a
teenage girl, usually within the ages of
13-19, becoming pregnant. The term in
everyday speech usually refers to girls
who have not reached legal adulthood,
which varies across the world, who
become pregnant.
5. Unwanted pregnancy
Unintended pregnancy is a core concept
that is used to better understand the
fertility of populations and the unmet
need for contraception (birth control)
and family planning. Unintended
pregnancy mainly results from not
using contraception, or inconsistent or
incorrect use of effective contraceptive
methods.
6. Drug addiction during
pregnancy
Substance abuse during pregnancy is
more prevalent than commonly
realized, with up to 25% of gravidas
using illicit drugs.1 In fact, substance
abuse is more common among women
of reproductive age than among the
general population.2 The average
pregnant woman will take four or five
drugs during her pregnancy, with 82%
of pregnant women taking prescribed
substances and 65% using
nonprescription substances, including
illicit drugs.1 Substance abuse during
pregnancy is difficult to detect because
the signs and symptoms of this
behavior are often subtle, self-reports of
substance use may be misleading or
infrequently elicited, physicians may
fail to routinely screen for use, and
substance abusing pregnant women
may seek little or no prenatal care.
7. Abuse during pregnancy
Abuse, whether emotional or physical,
is never okay. Unfortunately, some
women experience abuse from a
partner. Abuse crosses all racial, ethnic
and economic lines. Abuse often gets
worse during pregnancy. Almost 1 in 6
pregnant women have been abused by a
partner.
Reference:
Mosby.
Overview Assessment

Teaching topic: High risk pregnancies
Name of Instructor: Ms.Nongnaphat Wongchantorn
each.
Teaching Units
1. High risk pregnancies
1. Identify the risk Nursing therapeutics for high risk and -Lecture -Powerpoint -Class -The students
factors, etiology, complicated pregnancies Discussion presentation participation were able to:
medical and nursing Introduction -Questions -Board and and answering -differentiate
management of A high-risk pregnancy is one of about Marker questions about hyperemesis
hyperemesis greater risk to the mother or her fetus hyperemesis hyperemesis gravidarum,
gravidarum and PIH. than an uncomplicated pregnancy. gravidarum gravidarum PIH and
2. Compare Pregnancy places additional physical and and hydramnios.
hydramnios and and emotional stress on a woman’s hydramnios hydramnios. -give correct
oligohydramnios. body. Health problems that occur -Case study -Case study answers to
3. Identify the risks before a woman becomes pregnant or about evaluation questions.
factors, during pregnancy may also increase hyperemesis On -distinguish
classification, the likelihood for a high-risk gravidarum Hyperemesis and
medical and nursing pregnancy. and gravidarum comprehend
managements and Content hydramnios and the topics
the complications of 1.Hyperemesis Gravidarum Hydramnios discussed.
twin pregnancy gravidarum (HG) is a complication of -showed great
*1.5,2.2,5.3 pregnancy characterized by intractable enthusiasm in
nausea, vomiting, and dehydration learning the
and is estimated to affect 0.5–2.0% of topics
pregnant women. Malnutrition and discussed.
other serious complications, such as
fluid or electrolyte imbalances, may
result.
Hyperemesis is considered a rare
complication of pregnancy, but
because nausea and vomiting during
pregnancy exist on a spectrum, it is
often difficult to distinguish this
condition from the more common
form of nausea and vomiting
experienced during pregnancy known
as morning sickness.
1.1 Nursing care
Dry bland food and oral rehydration
are first-line treatments. Due to the
potential for severe dehydration and
other complications, HG is treated as
an emergency. If conservative dietary
measures fail, more extensive
treatment such as the use of
antiemetic medications and
intravenous rehydration may be
required. If oral nutrition is
insufficient, intravenous nutritional
support may be needed. For women
who require hospital admission,
thromboembolic stockings or low-
molecular-weight heparin may be
used as measures to prevent the
formation of a blood clot.
2. PIH
Gestational hypertension or
pregnancy-induced hypertension
(PIH) is the development of new
hypertension in a pregnant woman
after 20 weeks gestation without the
presence of protein in the urine or
other signs of preeclampsia.
Hypertension is defined as having a
blood pressure greater than 140/90
mm Hg.
3.Polyhydramnios and
Oligohydramnios
Polyhydramnios (polyhydramnion,
hydramnios, polyhydramnios) is a
medical condition describing an
excess of amniotic fluid in the
amniotic sac. It is seen in about 1% of
pregnancies. It is typically diagnosed
when the amniotic fluid index (AFI) is
greater than 24 cm.There are two
clinical varieties of polyhydramnios:
Chronic polyhydramnios where
excess amniotic fluid accumulates
gradually
Acute polyhydramnios where excess
amniotic fluid collects rapidly.
Oligohydramnios is a condition in
pregnancy characterized by a
deficiency of amniotic fluid. It is the
opposite of polyhydramnios.
The common clinical features are
smaller symphysiofundal height, fetal
malpresentation, undue prominence of
fetal parts and reduced amount of
amniotic fluid.
4.Twins
Twins are two offspring produced by
the same pregnancy. Twins can either
be monozygotic ("identical"),
meaning that they can develop from
just one zygote that will then split and
form two embryos, or dizygotic
("fraternal"), meaning that they can
develop from two different eggs, each
are fertilized by separate sperm cells.
In contrast, a fetus which develops
alone in the womb is called a
singleton, and the general term for one
offspring of a multiple birth is
multiple.
Summary
Complications of pregnancy are
problems that are caused by
pregnancy. There is no clear
distinction between complications of
pregnancy and symptoms and
discomforts of pregnancy. However,
the latter do not significantly interfere
with activities of daily living or pose
any significant threat to the health of
the mother or baby. In contrast,
pregnancy complications may cause
both maternal death and fetal death if
untreated. Still, in some cases the
same basic feature can manifest as
either a discomfort or a complication
depending on the severity.
Reference:
Mosby.
Overview Assessment

Teaching topic: Complicated pregnancies
each.
Teaching Unit
1. Complicated pregnancies
1. Describe common Nursing therapeutics for high risk and -Lecture -Powerpoint -Class -The students
illnesses such as complicated pregnancies Discussion presentation participation were able to:
diabetes mellitus, Introduction -Questions -Board and and answer -describe and
heart Some disorders and conditions can about DM and marker questions differentiate
disease, asthma, mean that pregnancy is considered high- heart disease. about DM and DM, heart
anemia and risk (about 6-8% of pregnancies in the - Case study heart disease. disease,
Thallasemia that can USA) and in extreme cases may be presentation -Case study asthma,
result in contraindicated. High-risk pregnancies About DM evaluation on anemia and
complication when are the main focus of doctors and heart DM during thallasemia.
they exist with specialising in maternal-fetal medicine. disease during pregnancy and -distinguish
pregnancy. Content pregnancy. heart disease and
2. Discuss the 1.DM during comprehend
medical and nursing Gestational diabetes (or gestational pregnancy. the topics
care for a woman diabetes mellitus, GDM) is a condition discussed.
with diabetes in which women without previously -showed great
mellitus,heart diagnosed diabetes exhibit high blood enthusiasm in
disease, asthma, glucose (blood sugar) levels during learning the
anemia and pregnancy (especially during their third topics
thallasemia during trimester). Gestational diabetes is discussed.
pregnancy. caused when insulin receptors do not
Hyperemesis function properly. This is likely due to
gravidarum. pregnancy-related factors such as the
3. Identify the risks presence of human placental lactogen
factors, that interferes with susceptible insulin
classification, receptors. This in turn causes
clinical
manifestations, and inappropriately elevated blood sugar
medical and nursing levels.
management 1.1 Management
thallasemia. The goal of treatment is to reduce the
1.1,2.1,2.2,2.3,3.2 risks of GDM for mother and child.
3.3 Scientific evidence is beginning to show
that controlling glucose levels can result
in less serious fetal complications (such
as macrosomia) and increased maternal
quality of life. Unfortunately, treatment
of GDM is also accompanied by more
infants admitted to neonatal wards and
more inductions of labour, with no
proven decrease in cesarean section
rates or perinatal mortality.
2. Heart Disease
Mechanical artificial heart valves also
pose serious risks during pregnancy due
to the need to adjust use of blood
thinners and the potential for life-
threatening clotting (thrombosis) of
heart valves. Congestive heart failure.
As blood volume increases, congestive
heart failure can get worse. Congenital
heart defect. Pregnancy stresses your
heart and circulatory system. During
pregnancy, your blood volume increases
by 30 to 50 percent to nourish your
growing baby. The amount of blood
your heart pumps each minute also
increases by 30 to 50 percent. Your
heart rate increases as well. These
changes cause your heart to work
harder.
Labor and delivery add to your heart's
workload, too. During labor —
particularly when you push — you'll
experience abrupt changes in blood flow
and pressure. When your baby is born,
decreased blood flow through the uterus
also stresses your heart
3. Asthma
Asthma is a fairly common health
problem for pregnant women, including
some women who have never had it
before. During pregnancy, asthma not
only affects you, but it can also cut back
on the oxygen your fetus gets from you.
But this does not mean that having
asthma will make your pregnancy more
difficult or dangerous to you or your
fetus. Pregnant women who have
asthma that is properly controlled
generally have normal pregnancies with
little or no increased risk to themselves
or their developing babies.
4. Anemia
During pregnancy, your body produces
more blood to support the growth of
your baby. If you're not getting enough
iron or certain other nutrients, your
body might not be able to produce the
amount of red blood cells it needs to
make this additional blood.
It's normal to have mild anemia when
you are pregnant. But you may have
more severe anemia from low iron or
vitamin levels or from other reasons.
Anemia can leave you feeling tired and
weak. If it is severe but goes untreated,
it can increase your risk of serious
complications like preterm delivery.
4.1 Types of anemia
4.1.1 Iron-deficiency anemia.
This type of anemia occurs
when the body doesn't have
enough iron to produce
adequate amounts of
hemoglobin. That's a protein in
red blood cells. It carries
oxygen from the lungs to the
rest of the body.
In iron-deficiency anemia, the

blood cannot carry enough
oxygen to tissues throughout the
body.
Iron deficiency is the most
common cause of anemia in
pregnancy
1.1.2 Folate-deficiency
anemia. Folate, also
called folic acid, is a
type of B vitamin. The
body needs folate to
produce new cells,
including healthy red
blood cells.
1.1.3 Vitamin B12 deficiency.
The body needs vitamin
B12 to form healthy red
blood cells
5. Thallasemia
The thalassemias are a group of genetic
blood diseases that cause a reduction of
the production of normal hemoglobin in
the red blood cells. Hemoglobin is a
protein carried by the red blood cells,
which brings oxygen to all the parts of
the body
Summary
Serious pre-existing disorders which
can reduce a woman's physical ability to
survive pregnancy include a range of
congenital defects (that is, conditions
with which the woman herself was born,
for example, those of the heart or
reproductive organs, some of which are
listed above) and diseases acquired at
any time during the woman's life.
Reference:
Mosby.
Overview Assessment
1. The students need are meet according to the objectives and plans of the topic. The topic has been interesting to the students
and students are able to exhibit a very high cooperation.

Teaching topic: Complicated pregnancies(cont.)
Name of Instructor: Ms. Nongnaphat Wongchantorn
each.
Teaching Units
1. Complicated pregnancies
1.Describe Nursing therapeutics for high risk and -Lecture -Powerpoint -Class The students
common complicated pregnancies Discussion presentation participation were able to:
illnesses such as Introduction -Questions -Board and and answering -describe and
urinary tract For the vast majority of women, about marker questions differentiate
infection, thyroid pregnancy follows a routine course. UTI,thyroid about UTI, the common
disorders, Some women, however, have medical disorders, and thyroid illnesses
appendicitis, and difficulties related to their health or the appendicitis disorders, and during
uterine myoma that health of their baby. These women during appendicitis pregnancy.
can result experience what is called a high-risk pregnancy during - showed a
complications pregnancy. -Case study pregnancy high
when they exist Content presentation -Case study enthusiasm
with pregnancy. 1. Urinary Tract Infection about uterine evaluation regarding the
2. Discuss the A urinary tract infection (UTI), also myoma on Uterine content.
medical called bladder infection, is a bacterial myoma -distinguish
and nursing care inflammation in the urinary tract. and
for a woman Pregnant women are at increased risk comprehend
infection, thyroid for UTI’s starting in week 6 through the topics
with urinary tract week 24. UTI’s are more common discussed.
disorders, during pregnancy because of changes in
appendicitis, and the urinary tract. The uterus sits directly
uterine myoma on top of the bladder. As the uterus
during pregnancy grows, its increased weight can block
*1.5,2.2,5.3 the drainage of urine from the bladder,
causing an infection.
2. Thyroid disorders
Pregnancy has a profound impact on
the thyroid gland and thyroid function
since the thyroid may encounter
changes to hormones and size during
pregnancy.
3. Appendicitis
Appendicitis in pregnancy is a
relatively common phenomenon. Rates
of between 1 in every 1000 to 1 in 2000
pregnancy have been reported.
Pregnant mothers thus do develop
appendicitis too. Not uncommonly,
attending physicians and patients
develop a lot of anxiety about the
occurrence of appendicitis during
pregnancy and as to what is the best
way to manage this condition.
4. Uterine myoma
Uterine fibroids are large masses made
up of tissue cells from your uterus.
Actually a type of non-cancerous
tumor, fibroids can grow in and around
your uterus, distorting the shape and
size of this organ. Fibroids typically
range in size, from just a few
centimeters in length to up to 15
centimeters or more. Fibroid tumors
often grow in clusters, so if you have
one uterine fibroid, it is likely that you
may also have more. Fibroids are
actually quite common - between 50%
and 80% of all women have at least
one. For the most part, these fibroids
cause no symptoms, though they can be
problematic for about 20% of women.
Between 10% and 30% of pregnant
women also have fibroids. Uterine
fibroids are usually discovered during
your annual pelvic exam
Summary
High-risk complications occur in only 6
percent to 8 percent of all pregnancies.
These complications can be serious and
require special care to ensure the best
possible outcome.
Reference:
Mosby.
Overview Assessment
topic discussed.

Teaching topic: Pregnancy with bleeding
Name of Instructor: Ms. Rungaroon Pumcharoen
each.
Teaching Units
1. Pregnancy with bleeding
1. Define abortion. Nursing therapeutics for high risk and -Lecture Powerpoint Class The students
2. Identify and complicated pregnancies Discussion presentation participation were able to:
discuss the causes Introduction -Questions Board and and answering -define and
and types of A high risk pregnancy is one in which about the types marker questions on identify types
abortion. some condition puts the mother, the of abortion, the types of of abortion.
3. Identify the developing fetus, or both at higher- molar abortion, molar -differentiate
clinical than-normal risk for complications pregnancy, pregnancy, molar between
manifestations of during or after the pregnancy and birth. ectopic ectopic ectopic
abortion. Content pregnancy. pregnancy. pregnancy.
4. Explain the 1.Abortion -Case study Case study - distinguish
medical and nursing Abortion is the ending of pregnancy by presentation evaluation on and
management of the removal or forcing out from the about abortion, Abortion, comprehend
abortion. womb of a fetus or embryo before it is ectopic and ectopic and the topics
5. Define molar able to survive on its own. An abortion molar molar discussed.
pregnancy. can occur spontaneously, in which case pregnancy. pregnancy. - showed great
6. Explain the it is often called a miscarriage. enthusiasm in
causes 1.1. Types of abortion learning the
of molar 1.1.1. Induced. topics
pregnancy. Reasons for procuring induced discussed.
7. Identify the abortions are typically characterized as
clinical either therapeutic or elective. An
manifestations of abortion is medically referred to as a
molar pregnancy. therapeutic abortion when it is
8. Explain the performed to save the life of the
medical and nursing pregnant woman; prevent harm to the
woman's physical or mental health;
management of terminate a pregnancy where
molar pregnancy. indications are that the child will have
9. Discuss the a significantly increased chance of
causes of ectopic premature morbidity or mortality or be
pregnancy. otherwise disabled; or to selectively
10. Identify the reduce the number of fetuses to lessen
clinical health risks associated with multiple
manifestations of pregnancy.
ectopic pregnancy. 1.1.2 Spontaneous
11. Explain the Spontaneous abortion, also known as
medical and nursing miscarriage, is the unintentional
management of expulsion of an embryo or fetus before
ectopic pregnancy. the 24th week of gestation A
12. Compare pregnancy that ends before 37 weeks of
abruption placenta gestation resulting in a live-born infant
and placenta previa is known as a "premature birth" or a
in terms of causes, "preterm birth". When a fetus dies in
Clinical utero after viability, or during delivery,
manifestations, it is usually termed "stillborn".
medical and nursing Premature births and stillbirths are
management. generally not considered to be
*1.5,2.2,5.3 miscarriages although usage of these
terms can sometimes overlap.
2. Molar Pregnancy
Molar pregnancy is an abnormal form
of pregnancy in which a non-viable
fertilized egg implants in the uterus and
will fail to come to term. A molar
pregnancy is a gestational trophoblastic
disease which grows into a mass in the
uterus that has swollen chorionic villi.
These villi grow in clusters that
resemble grapes. A molar pregnancy
can develop when fertilized egg had
not contained an original maternal
nucleus. The products of conception
may or may not contain fetal tissue. It
is characterized by the presence of a
hydatidiform mole (or hydatid mole,
mola hydatidosa). Molar pregnancies
are categorized as partial moles or
complete moles, with the word mole,
being used to denote simply a clump of
growing tissue, or a growth.
3. Ectopic Pregnancy
An ectopic pregnancy, or eccyesis, is a
complication of pregnancy in which the
embryo is implanted outside the uterine
cavity.With rare exceptions, ectopic
pregnancies are not viable.
Furthermore, they are dangerous for
the mother, since internal bleeding is a
life-threatening complication. Most
ectopic pregnancies (93-97%) occur in
the distal Fallopian tube (so-called
tubal pregnancies), but implantation
can also occur in the cervix, ovaries,
and abdomen. An ectopic pregnancy is
a potential medical emergency, and, if
not treated properly, can lead to death
4. Abruptio Placenta
Placental abruption (also known as
abruptio placentae) is a complication of
pregnancy, wherein the placental lining
has separated from the uterus of the
mother prior to delivery. It is the most
common pathological cause of late
pregnancy bleeding. In humans, it
refers to the abnormal separation after
20 weeks of gestation and prior to
birth. It occurs on average of 0.5% or 1
in 200 deliveries. Placental abruption is
a significant contributor to maternal
mortality worldwide; early and skilled
medical intervention is needed to
ensure a good outcome, and this is not
available in many parts of the world.
Treatment depends on how serious the
abruption is and how far along the
woman is in her pregnancy
5. Placenta Previa
Placenta praevia (placenta previa AE)
is an obstetric complication in which
the placenta is inserted partially or
wholly in the lower uterine segment. It
is a leading cause of antepartum
haemorrhage (vaginal bleeding). It
affects approximately 0.4-0.5% of all
labours.
In the last trimester of pregnancy the
isthmus of the uterus unfolds and forms
the lower segment. In a normal
pregnancy the placenta does not
overlie. If the placenta does overlie the
lower segment, as is the case with
placenta praevia, it may shear off and a
small section may bleed.
Summary
A pregnancy can be considered a high-
risk pregnancy for a variety of reasons.
Factors can be divided into maternal
and fetal. Maternal factors include age
(younger than age 15, older than age
35); weight (pre-pregnancy weight
under 100 lb or obesity); height (under
five feet); history of complications
during previous pregnancies (including
stillbirth, fetal loss, preterm labor
and/or delivery, small-for-gestational
age baby, large baby, pre-eclampsia or
eclampsia); more than five previous
pregnancies; bleeding during the third
trimester; abnormalities of the
reproductive tract; uterine fibroids;
hypertension; Rh incompatability;
gestational diabetes; infections of the
vagina and/or cervix; kidney infection;
fever; acute surgical emergency
(appendicitis, gallbladder disease,
bowel obstruction); post-term
pregnancy; pre-existing chronic illness
(such as asthma, autoimmune disease,
cancer, sickle cell anemia, tuberculosis,
herpes, AIDS, heart disease, kidney
disease, Crohn's disease, ulcerative
colitis, diabetes). Fetal factors include
exposure to infection (especially herpes
simplex, viral hepatitis, mumps,
rubella, varicella, syphilis,
toxoplasmosis, and infections caused
by coxsackievirus); exposure to
damaging medications (especially
phenytoin, folic acid antagonists,
lithium, streptomycin, tetracycline,
thalidomide, and warfarin); exposure to
addictive substances (cigarette
smoking, alcohol intake, and illicit or
abused drugs). A pregnancy is also
considered high-risk when prenatal
tests indicate that the baby has a
serious health problem (for example, a
heart defect). In such cases, the mother
will need special tests, and possibly
medication, to carry the baby safely
through to delivery. Furthermore,
certain maternal or fetal problems may
prompt a physician to deliver a baby
early, or to choose a surgical delivery
(cesarean section) rather than a vaginal
delivery.
Reference:
Mosby.
Overview Assessment
1. The students need are meet according to the objectives and plans of the topic. Students exhibit a high participation.

Teaching topic: Pregnancy with infectious diseases
each.
Teaching Units
1. Pregnancy with infectious diseases
Teaching
Behavioral
Content of Each Teaching and Teaching Evaluation
Objectives of each Evaluation Methods
Topic (in brief) Learning Aides results
teaching topic
Activities
1. Differentiate the Pregnancy with infectious -Lecture -Powerpoint Class participation and The students
signs and symptoms diseases Discussion presentation answering questions were able to:
diagnoses and Introduction -Question -Board and on Hepatitis B, herpes, -differentiate
medical and nursing Most common maternal about Marker syphilis and rubella the common
management among infections (eg, UTIs, skin and Hepatitis B, during pregnancy maternal
common infectious respiratory tract infections) are herpes, -Final Quiz on infections
diseases such as usually not serious problems syphilis and Nursing therapeutics affecting
hepatitis B, herpes, during pregnancy, although some rubella for high risk and labor and
syphilis, rubella, and genital infections (bacterial during complicated choice of
HIV. vaginosis and genital herpes) pregnancy. pregnancies,pregnancy delivery
2. Identify the causes affect labor or choice of delivery with bleeding and method.
of infectious method. Thus, the main issue is pregnancy with -give correct
diseases during usually use and safety of infectious diseases. answers to
pregnancy. antimicrobial drugs. However, questions
3. Explain the effects certain maternal infections can -showed a
of on and damage the fetus (for congenital high
management of cytomegalovirus or herpes enthusiasm
pregnant women simplex virus infection, rubella, regarding the
who have human toxoplasmosis, hepatitis, or content.
immunodeficiency syphilis
virus (HIV) infection Content
and AIDS. 1.Hepatitis B Virus
4. Describe the Hepatitis B (also referred to as
prevention of hep B) is a highly infectious virus
that's spread through blood,
infectious diseases in semen, and other bodily fluids. If
women. you're a carrier, you may have
*1.5,2.2,5.3 contracted the virus:
•Through sexual contact with
another carrier
•At birth, if your mother was a
carrier
•By sharing needles or getting
stuck by a needle accidentally
•By using a toothbrush or razor
that has even a small trace of a
carrier's blood on it (even one
you can't see)
•By getting a body piercing or
tattoo at a place where good
health practices aren't followed
1.1 Signs and symptoms
you contract hepatitis B, you may
feel very tired. You may also
have abdominal pain, nausea and
vomiting, a loss of appetite, joint
pain, or jaundice (your eyes and
skin take on a yellow tinge). But
many people have no symptoms
and never even know they've
been infected.
About 10 to 15 percent of people
who are 5 years of age or older
when they contract HBV end up
as hepatitis B carriers — meaning
that their body never gets rid of
the virus. About a quarter of
those with a chronic HBV
infection will eventually end up
with a life-threatening liver
disease, and about 20 percent of
those with liver disease develop
liver cancer. An estimated 5,000
people in the United States die
every year from illness caused by
HBV.
2. Herpes
The biggest concern with genital
herpes during pregnancy is that
you might transmit it to your
baby during labor and delivery.
Newborn herpes is relatively rare
(about 1,500 newborns are
affected each year), but the
disease can be devastating, so it's
important to learn how to reduce
your baby's risk of becoming
infected.
You can transmit herpes to your
baby during labor and delivery if
you're contagious, or "shedding
virus," at that time. The risk of
transmission is high if you get
herpes for the first time (a
primary infection) late in your
pregnancy.
3. Syphilis
Syphilis is a sexually transmitted
infection (STI) that's caused by a
type of bacterium. If left
untreated, syphilis can have very
serious long-term consequences.
Fortunately, if caught in time, it
can be treated with antibiotics.
Syphilis is transmitted by direct
contact with a sore on an infected
person. The most common way
to get syphilis is through vaginal,
anal, or oral sex, but it's also
possible to get it by kissing
someone with a syphilitic sore on
or around the lips or in the mouth
or by exposing an area of broken
skin to a sore.
Syphilis can be transmitted to
your baby through the placenta
during pregnancy or by contact
with a sore during birth.
The infection is relatively rare
among women in the United
States, with 1 case per 100,000
women in 2011. The rates are
significantly higher in
communities with high levels of
poverty, low levels of education,
and inadequate access to health
care.
4. Rubella
Rubella, also known as German
measles, is a short-lived
infectious disease of childhood
caused by a togavirus. German
measles and so-called red
measles, or rubeola, are not
directly related to each other,
though both are covered by the
common MMR (measles,
mumps, rubella) vaccine. Most
women of childbearing age either
have had the disease or have been
immunized against it as a child.
Even if you're not immune, the
risk that you might contract
rubella is practically nil since the
disease has been eliminated in
this country and most people are
immune and unlikely to come
down with it in the first place.
However, since rubella is
contagious and since it hasn't
been eliminated abroad, a
nonimmune person is at risk of
getting the illness if she comes
into contact with someone who is
infected. The rubella virus is able
to cross the placenta and is most
dangerous early in pregnancy,
when babies exposed to the virus
are at risk of a condition called
congenital rubella syndrome,
characterized by eye defects,
heart defects, and mental
retardation. The risk of
miscarriage or stillbirth also
increases if a pregnant woman
contracts rubella. Exposure after
20 weeks of pregnancy rarely
results in such defects
Summary
Getting prenatal care is crucial.
For example, simple blood tests
can tell you whether you're
immune to certain infections,
such as chicken pox and rubella..
Basic measures like washing
your hands, not sharing drinking
glasses or utensils, not changing
cat litter, using gloves when
gardening, and staying away
from anyone with a contagious
disease will reduce your risk of
getting sick.
Practicing safe sex will help
prevent many sexually
transmitted infections. And you
can take measures to avoid food-
borne infections too — such as
not eating certain foods, washing
fruits and vegetables, and making
sure that your meat, fish, and
eggs are well cooked and your
work surfaces aren't
contaminated.
Reference:
Mosby.
Overview Assessment
1. After learning this topic, the students were able to answer the questions raised by the lecturer and they showed a very high
participation in the class discussion.

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College of Nursing, Christian University of Thailand

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Course code: INUR 3314 Course Title: Midwifery I

Course code: INUR 3314 Course Title: Midwifery I

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Course code: INUR 3314 Course Title: Midwifery I

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