Midwife Licensure Exam Normal Pregnancy, Labor & Postpartum — Prenatal Care & Maternal NutritionCheat Sheet

Common Values

Section Title

Antenatal Care Visit Schedule & Content

Important Facts

• DOH recommends **minimum 4 ANC visits**; WHO 2016 recommends **8 contacts** for better outcomes.
• Traditional schedule: **every 4 weeks until 28 wk, every 2 weeks 28–36 wk, every week after 36 wk.**
• High-risk pregnancies (HTN, DM, multiple gestation, prior loss) seen **more frequently**.
• Baseline labs at booking: **blood type/Rh, CBC/Hgb, blood glucose, UA (protein/glucose/infection), VDRL/RPR, HIV, HBsAg.**
• Every-visit assessment: **weight, BP, urine dipstick, fundal height, FHR (110–160 bpm), fetal position by Leopold's, kick counts.**
• Rh-negative women identified early; require **anti-D immunoglobulin at ~28 wk and within 72 hr postpartum** if infant is Rh-positive.

Key Definitions

Diagrams To Know

• ANC visit schedule timeline (trimester-based intervals)
• Components of booking visit
• Every-visit screening checklist

Common Values

Section Title

Tetanus Immunisation (Philippine Td Schedule)

Important Facts

• **Td1** = given as early as possible in pregnancy (first contact); provides **no protection yet**.
• **Td2** = given **≥4 weeks after Td1** (and **≥2 weeks before delivery**); protects infant from neonatal tetanus for **~3 years**.
• **Td3** = **≥6 months after Td2**; protection **~5 years**.
• **Td4** = **≥1 year after Td3**; protection **~10 years**.
• **Td5** = **≥1 year after Td4**; protection **lifetime** (booster complete).
• Route: **intramuscular (IM) deltoid**, dose **0.5 mL**.
• Two Td doses already protect the newborn; spacing and timing are **critical**.
• Reinforced every antenatal visit in the Philippines as part of maternal health programs.

Key Definitions

Diagrams To Know

• Td vaccination schedule table with intervals and protection periods
• Timing of Td2 relative to gestational age

Common Values

Section Title

Supplements in Pregnancy

Important Facts

• **Iron + folic acid**: **60 mg iron + 400 mcg folic acid daily**.
• **Iron**: prevents/treats anaemia; supports maternal blood volume expansion and fetal needs.
• **Folic acid**: prevents NTD (spina bifida, anencephaly); should begin **before conception**; neural tube closes by ~week 4.
• **Iron administration**:
• – Take on **empty stomach** or with **vitamin C (citrus, guava)** for optimal absorption.
• – **AVOID**: milk, tea, coffee, antacids (reduce absorption).
• – **Expect**: dark/black stools (harmless); constipation (common).
• – **Troubleshooting**: if GI upset, take with food, split dose, add fibre; do NOT stop.
• **Calcium**: supports fetal skeleton; may reduce pre-eclampsia risk in low-intake populations; DOH recommends supplementation if dietary intake is low.
• **Iodine**: critical for fetal brain development; partly addressed via **iodised salt (ASIN Law, RA 8172)**.
• **Vitamin A**: needed for fetal development; **HIGH-DOSE vitamin A is TERATOGENIC** — avoid megadoses and isotretinoin.
• Keep iron **away from children** (overdose is dangerous).

Key Definitions

Diagrams To Know

• Iron absorption factors (enhancers vs. inhibitors)
• Timeline of fetal development and supplement timing

Formulas

Common Values

Section Title

Maternal Nutrition & Weight Gain

Important Facts

• **Recommended total weight gain (IOM) by pre-pregnancy BMI:**
• – Underweight (<18.5): **12.5–18 kg**
• – Normal (18.5–24.9): **11.5–16 kg**
• – Overweight (25–29.9): **7–11.5 kg**
• – Obese (≥30): **5–9 kg**
• **Trimester-specific pattern:**
• – **1st trimester**: little gain (~1–2 kg); no extra energy needed.
• – **2nd & 3rd trimesters**: ~0.4 kg/week (normal BMI); ~340 kcal/day in 2nd, ~450 kcal/day in 3rd.
• **Simplified teaching**: ~300 kcal/day extra.
• **Protein**: increased needs **+25 g/day** (from ~50 g to ~75 g/day) for fetal and placental growth.
• **Carbohydrates**: adequate amount to spare protein and prevent ketosis.
• **Key micronutrients & food sources:**
• – **Iron**: meat, fish, dark leafy greens (malunggay, kangkong), dried beans.
• – **Folate**: dark green leafy vegetables, legumes, fortified grains, citrus.
• – **Calcium**: milk, small fish with bones (dilis), tofu, dark greens.
• – **Iodine**: iodised salt, seafood.
• – **Vitamin C**: citrus, guava, tomatoes (aids iron absorption).
• **Local & affordable protein sources**: fish, eggs, poultry, dried beans/monggo, tofu, milk.
• **Malunggay (moringa)**: iron and vitamin-rich; supports lactation.
• **Foods/substances to LIMIT or AVOID:**
• – **Alcohol**: no safe amount; causes **fetal alcohol syndrome (FAS)**.
• – **Smoking & secondhand smoke**: low birth weight, prematurity.
• – **Caffeine**: limit to **≤200 mg/day** (~1–2 cups coffee).
• – **High-mercury fish**: limit (e.g., shark, swordfish).
• – **Raw/undercooked meat, fish, eggs**: listeria, toxoplasma risk.
• – **Unpasteurised dairy**: listeria risk.
• – **Any medication, herbal product, supplement**: only with provider approval.
• **Special nutritional situations:**
• – **Nausea**: small frequent meals, dry crackers before rising, avoid strong odours.
• – **Constipation**: fibre, fluids, activity (worsened by iron); increase fluids.
• – **Pica** (craving non-food items): assess and counsel; may indicate iron deficiency.
• – **Adolescents & closely spaced pregnancies**: higher nutritional needs; extra support required.

Key Definitions

Diagrams To Know

• Weight gain by trimester and BMI category
• Micronutrient sources and functions in pregnancy
• Foods to avoid in pregnancy

Common Values

Section Title

Screening Tests by Timing

Important Facts

• **Glucose screening (gestational diabetes)**: **24–28 weeks** via OGTT.
• **Ultrasound**: 1st trimester for dating (most accurate); ~18–22 weeks for anatomy.
• **Group B Streptococcus (GBS)**: ~**36–37 weeks** where available; IV antibiotics in labour if positive or unknown status.
• **Rh-negative mothers:**
• – Anti-D immunoglobulin (RhoGAM) at **~28 weeks** (standard dose).
• – Repeat dose **within 72 hours postpartum** if infant is Rh-positive.
• – Additional doses if **large fetal–maternal hemorrhage** detected.
• **Asymptomatic bacteriuria/UTI**: treat to prevent pyelonephritis and preterm labour.
• **Infections screened at booking**: syphilis (VDRL/RPR), HIV, Hepatitis B (HBsAg); treatment/prophylaxis protects newborn.

Key Definitions

Diagrams To Know

• Screening test timeline by trimester
• Anti-D administration schedule for Rh-negative mothers

Common Values

Section Title

Health Teaching Across Pregnancy

Important Facts

• **Danger signs** (reinforce every visit):
• – Vaginal **bleeding**
• – **Leaking fluid** (ruptured membranes)
• – **Severe headache** or **visual changes**
• – **Facial/hand swelling** (oedema)
• – **Epigastric pain** (right upper quadrant)
• – **Fever**
• – **Painful urination**
• – **Decreased fetal movement**
• – **Preterm contractions** (before 37 weeks)
• – **Convulsions**
• **Activity & rest**:
• – Moderate exercise (walking, swimming) is **beneficial**.
• – **Left-lateral recumbent position** improves placental perfusion; relieves supine hypotension.
• – Avoid overheating and contact sports.
• **Sexuality**: usually safe in normal pregnancy; avoid if **bleeding, ruptured membranes, or preterm labour risk**.
• **Substance & medication safety:**
• – Avoid alcohol, tobacco, unprescribed drugs.
• – Verify safety of **all medicines** with provider.
• **Immunisation:**
• – Td (tetanus-diphtheria): per schedule above.
• – **Inactivated influenza vaccine**: safe in pregnancy.
• – **Live vaccines (MMR, varicella)**: **contraindicated in pregnancy**.
• **Preparation for birth & newborn:**
• – Birth plan development.
• – Danger-sign recognition.
• – **Exclusive breastfeeding for 6 months** (DOH, WHO).
• – Newborn care (bathing, cord care, signs of distress).
• **Oral health**: dental care is safe and important; gum changes (gingivitis, epulis) are common in pregnancy.
• **Seatbelt use**: lap belt **below the belly**, shoulder strap **between the breasts**.

Key Definitions

Diagrams To Know

• Danger-sign checklist for each trimester
• Safe vs. unsafe activities in pregnancy
• Immunisation safety in pregnancy (live vs. inactivated)

Common Values

Section Title

Common Problems Screened in Prenatal Care

Important Facts

• **Anaemia:**
• – Screened by **Hgb at booking and 3rd trimester**.
• – Managed with **iron-folic acid + dietary counselling**.
• – Persistent low Hgb despite supplements → further work-up (serum ferritin, folate level, B12, parasites).
• **Gestational hypertension / pre-eclampsia:**
• – Detected by **rising BP (≥140/90), proteinuria, oedema**.
• – **Every-visit BP + urine dipstick** = front-line screen.
• – Teach woman **danger signs**: severe headache, visual changes, epigastric pain, facial/hand swelling.
• **Gestational diabetes (GDM):**
• – Screened at **24–28 weeks** via OGTT.
• – Managed with **diet, monitoring, ± insulin** (oral hypoglycaemics used selectively).
• – Key risks: **macrosomia, neonatal hypoglycaemia, later T2DM in mother**.
• **Infections:**
• – **Asymptomatic bacteriuria/UTI**: treat to prevent pyelonephritis & preterm labour.
• – **Syphilis, HIV, Hepatitis B**: screened at booking; treatment/prophylaxis protects newborn (prevent congenital syphilis, PMTCT, vertical transmission).
• **Rh incompatibility:**
• – Rh-negative mother + Rh-positive fetus → risk of **haemolytic disease of newborn (HDN)** in future pregnancies.
• – Prevention: **anti-D immunoglobulin**.
• **Abnormal fetal growth or lie:**
• – Tracked by **fundal height & Leopold's manoeuvres**.
• – Deviations → **ultrasound** confirmation and management.

Key Definitions

Diagrams To Know

• Screening pathway for anaemia
• Pre-eclampsia detection algorithm
• Gestational diabetes management flowchart

Section Title

Nursing Role & Health-Teaching Priorities

Important Facts

• **Build rapport & continuity** → woman keeps appointments, voices concerns; missed visits = red flag for social risk.
• **Reinforce supplement adherence:**
• – Many women **stop iron due to GI upset**.
• – Troubleshoot (take with food, split dose, add fibre) rather than let her quit.
• **Teach danger-sign recognition every visit** → **single most protective prenatal education**; timely reporting of bleeding, leaking fluid, or pre-eclampsia signs = lifesaving.
• **Address social determinants:**
• – Nutrition on limited budget (use local, affordable foods; e.g., malunggay, dried fish, monggo beans).
• – Safe home environment (screen for intimate-partner violence, child safety).
• – Support system (presence of partner, family, community).
• – Refer to **DOH social services, community health workers, women's centres** as needed.
• **Prepare for birth & newborn:**
• – Encourage **facility-based delivery** (reduces maternal/neonatal mortality; RA 9173 standards).
• – Develop **birth plan** (partner presence, pain relief options, cord banking, delayed clamping).
• – Teach **exclusive breastfeeding intent & benefits**; offer lactation support.
• – Teach **newborn care** (thermoregulation, feeding, cord care, signs of distress).
• – Align with **DOH maternal & newborn health programs**.

Key Definitions

Diagrams To Know

• Nursing interventions by visit phase
• Social risk assessment and referral pathway

Rows

Columns

• Dose
• Timing
• Interval from Previous
• Protection Level
• Duration

Table Title

Td Vaccination Schedule & Protection by Dose

Rows

Columns

• Pre-pregnancy BMI
• Category
• Total Recommended Gain
• Average/Week (2nd & 3rd trimester)

Table Title

Recommended Weight Gain in Pregnancy by Pre-pregnancy BMI (IOM)

Rows

Columns

• Period
• Weeks Gestation
• Visit Frequency
• Key Focus

Table Title

ANC Visit Frequency & Key Assessments by Gestation

Rows

Columns

• Category
• AVOID
• WHY
• SAFE ALTERNATIVE

Table Title

Foods to Limit/Avoid vs. Safe Alternatives in Pregnancy

Rows

Columns

• Vaccine Type
• Vaccines
• Pregnancy Safety
• Timing

Table Title

Immunisation Safety in Pregnancy: Live vs. Inactivated Vaccines