Midwife Licensure Exam Normal Pregnancy, Labor & Postpartum — Prenatal Care & Maternal NutritionConcept Map

Concept

Goals and Schedule of Antenatal Care

Sub Concepts

• DOH minimum 4 ANC visits
• WHO 2016 model: 8 contacts
• Visit frequency schedule (every 4 weeks until 28 weeks, every 2 weeks 28-36 weeks, weekly after 36 weeks)
• First (booking) visit comprehensive assessment
• Every-visit ongoing assessments
• High-risk pregnancy monitoring

Relationship To Central

Foundational framework for organizing prenatal interventions

Concept

First (Booking) Visit Assessment

Sub Concepts

• Full menstrual history
• GTPAL obstetric history
• Medical and family history
• Social risk screening
• EDD calculation by Naegele's rule
• Complete physical examination
• Pelvic examination
• Baseline laboratory work (blood type, Rh, CBC, glucose, urinalysis, VDRL, HIV, HBsAg)
• Rh-negative identification and anti-D planning

Relationship To Central

Comprehensive baseline data collection for risk stratification

Concept

Every-Visit Ongoing Assessments

Sub Concepts

• Weight measurement and trend analysis
• Blood pressure monitoring (screen for hypertension)
• Urine dipstick (protein and glucose detection)
• Fundal height measurement and tracking
• Fetal heart rate auscultation (normal 110-160 bpm)
• Leopold's manoeuvres for fetal position
• Fetal movement counts (kick counts)
• Danger signs review and reinforcement

Relationship To Central

Continuous monitoring for maternal-fetal well-being and early problem detection

Concept

Tetanus Immunisation (Td Schedule)

Sub Concepts

• Td1: first visit, early pregnancy
• Td2: ≥4 weeks after Td1, ≥2 weeks before delivery (protects newborn)
• Td3: ≥6 months after Td2
• Td4: ≥1 year after Td3
• Td5: ≥1 year after Td4 (lifetime protection)
• Child Protected at Birth (CPAB) concept
• Administration: 0.5 mL IM (deltoid muscle)
• Duration of neonatal protection

Relationship To Central

Prevention of maternal and neonatal tetanus through immunisation

Concept

Iron and Folic Acid Supplementation

Sub Concepts

• Recommended dose: 60 mg elemental iron + 400 mcg folic acid daily
• Timing: throughout pregnancy and postpartum
• Iron functions: prevention and treatment of anaemia
• Folic acid functions: neural tube defect prevention, RBC formation
• Pre-conception folic acid initiation
• Absorption enhancement (vitamin C, empty stomach)
• Absorption inhibitors (milk, tea, coffee, antacids)
• Expected side effects (dark/black stools, constipation)
• Management of GI side effects
• Adherence counselling and troubleshooting

Relationship To Central

Prevention of anaemia and neural tube defects

Concept

Other Essential Micronutrient Supplements

Sub Concepts

• Calcium supplementation (fetal skeleton development, pre-eclampsia reduction)
• Iodine (fetal brain development, iodised salt via ASIN Law RA 8172)
• Vitamin A (needed for development; avoid megadoses and isotretinoin as teratogenic)
• Dietary sources versus supplementation
• Safe supplementation levels

Relationship To Central

Support for fetal development and maternal health

Concept

Maternal Weight Gain and Nutritional Requirements

Sub Concepts

• Recommended total weight gain by pre-pregnancy BMI (IOM guidance)
• Underweight: 12.5-18 kg
• Normal weight: 11.5-16 kg
• Overweight: 7-11.5 kg
• Obese: 5-9 kg
• Pattern of gain (minimal 1st trimester, ~0.4 kg/week 2nd-3rd trimester)
• Excessive gain with oedema as pre-eclampsia indicator
• Extra energy needs: +340 kcal 2nd trimester, +450 kcal 3rd trimester
• Protein requirements: +25 g/day for fetal and placental growth
• Carbohydrate adequacy for protein sparing and ketosis prevention

Relationship To Central

Optimize fetal growth and maternal-fetal health

Concept

Key Micronutrients and Food Sources

Sub Concepts

• Iron sources (meat, fish, dark leafy greens, malunggay, dried beans)
• Folate sources (dark green vegetables, legumes, fortified grains, citrus)
• Calcium sources (milk, small fish with bones, dilis, tofu, dark greens)
• Iodine sources (iodised salt, seafood)
• Vitamin C sources (citrus, guava, tomatoes) for iron absorption
• Malunggay as iron and vitamin-rich food supporting lactation
• Locally available, affordable, culturally acceptable foods
• Dried beans and monggo as protein and legume sources

Relationship To Central

Evidence-based nutritional counselling using culturally appropriate Filipino foods

Concept

Foods and Substances to Limit or Avoid

Sub Concepts

• Alcohol: no safe amount (fetal alcohol syndrome risk)
• Smoking and secondhand smoke (low birth weight, prematurity)
• Caffeine: limit to ≤200 mg/day (~1-2 cups coffee)
• High-mercury fish (methylmercury toxicity)
• Raw or undercooked meat, fish, and eggs (Listeria, Toxoplasma)
• Unpasteurised dairy products (Listeria risk)
• Unapproved medications, herbal products, supplements

Relationship To Central

Prevention of teratogenic and infectious risks to fetus

Concept

Management of Common Pregnancy-Related Nutrition Issues

Sub Concepts

• Nausea management (small frequent meals, dry crackers, odour avoidance)
• Constipation management (fibre, fluids, activity; worsened by iron)
• Pica assessment and counselling (may indicate iron deficiency)
• Adolescent pregnancy nutrition (higher needs, extra support)
• Closely spaced pregnancies (nutritional depletion concerns)

Relationship To Central

Practical strategies for maternal comfort and adequate nutrition

Concept

Health Teaching Across Pregnancy

Sub Concepts

• Danger signs recognition and reporting (bleeding, fluid leakage, severe headache, visual changes, facial/hand swelling, epigastric pain, fever, dysuria, decreased fetal movement, preterm contractions, convulsions)
• Activity and rest recommendations (moderate exercise, left-lateral rest, avoid overheating)
• Sexuality in normal pregnancy (avoid if bleeding, ruptured membranes, preterm labour risk)
• Substance and medication safety (verify all medicines)
• Immunisation safety (inactivated flu vaccine safe; live vaccines MMR, varicella contraindicated)
• Preparation for birth and newborn care (birth plan, breastfeeding intent, newborn care knowledge)
• Oral health during pregnancy (safe and important)
• Seatbelt use in pregnancy (lap belt below belly, shoulder strap between breasts)

Relationship To Central

Comprehensive maternal education for safe pregnancy, birth, and newborn transition

Concept

Common Problems Screened in Prenatal Care

Sub Concepts

• Anaemia (Hgb screening at booking and 3rd trimester, iron-folic acid management)
• Gestational hypertension and pre-eclampsia (BP, proteinuria, oedema screening)
• Gestational diabetes (screening 24-28 weeks, diet and insulin management)
• Infections (asymptomatic bacteriuria, UTI, syphilis, HIV, Hepatitis B screening and prophylaxis)
• Rh incompatibility (anti-D immunoglobulin for prevention)
• Abnormal fetal growth and lie (fundal height, Leopold's manoeuvres, ultrasound referral)

Relationship To Central

Early detection and management of conditions threatening mother and fetus

Concept

Nursing Role and Health-Teaching Priorities

Sub Concepts

• Building rapport and continuity of care
• Supplement adherence reinforcement and troubleshooting
• Danger-sign recognition teaching at every visit
• Addressing social determinants (nutrition on budget, safe home, IPV screening, support systems)
• Referral to social services and DOH programs
• Preparation for facility-based delivery
• Alignment with DOH maternal and newborn health programs
• Documentation and RA 9173 professional standards

Relationship To Central

Professional nursing practice in antenatal care delivery

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First (Booking) Visit Assessment

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Goals and Schedule of Antenatal Care

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Relationship

Booking visit is the foundation establishing the baseline for subsequent visits; comprehensive history and labs determine risk stratification

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Every-Visit Ongoing Assessments

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First (Booking) Visit Assessment

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Baseline data from booking visit provides comparison point for ongoing assessments; abnormalities detected at follow-up visits are compared to booking baseline

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Common Problems Screened in Prenatal Care

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Every-Visit Ongoing Assessments

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Each component of ongoing assessment (BP, urine, weight) screens for specific complications like pre-eclampsia, gestational diabetes, and anaemia

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Goals and Schedule of Antenatal Care

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Tetanus Immunisation (Td Schedule)

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Td immunisation is integrated into the antenatal care schedule; timing of Td doses is coordinated with pregnancy weeks and delivery preparation

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Maternal Weight Gain and Nutritional Requirements

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Iron and Folic Acid Supplementation

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Iron-folic acid supplements are part of comprehensive maternal nutrition; supplementation supports adequate weight gain and fetal development

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Common Problems Screened in Prenatal Care

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Iron and Folic Acid Supplementation

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Supplementation addresses anaemia prevention; haemoglobin monitoring at booking and third trimester assesses effectiveness of iron-folic acid therapy

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Maternal Weight Gain and Nutritional Requirements

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Other Essential Micronutrient Supplements

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moderate

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Calcium, iodine, and vitamin A supplements support specific aspects of fetal development and maternal health; integrated into overall nutritional plan

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Maternal Weight Gain and Nutritional Requirements

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Key Micronutrients and Food Sources

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Food sources provide the micronutrients needed for fetal growth and maternal health; dietary counselling complements supplementation

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Health Teaching Across Pregnancy

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Foods and Substances to Limit or Avoid

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Avoidance of teratogenic substances and unsafe foods is a critical health-teaching priority; reinforced at every visit

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Maternal Weight Gain and Nutritional Requirements

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Management of Common Pregnancy-Related Nutrition Issues

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moderate

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Managing nausea, constipation, and pica ensures mother maintains adequate nutrition and appropriate weight gain despite pregnancy symptoms

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Nursing Role and Health-Teaching Priorities

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Health Teaching Across Pregnancy

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Health teaching is a core nursing responsibility; repetition of danger signs and nutrition teaching at every contact is the nurse's primary intervention

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Health Teaching Across Pregnancy

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Common Problems Screened in Prenatal Care

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Health teaching addresses prevention and early recognition of screened conditions; danger-sign teaching is the most critical protective intervention

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Every-Visit Ongoing Assessments

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Nursing Role and Health-Teaching Priorities

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Nurses conduct the ongoing assessments, document findings, and use assessment data to guide individualised teaching and referrals

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Key Micronutrients and Food Sources

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Maternal Weight Gain and Nutritional Requirements

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Recommended weight gain and energy are achieved through balanced intake of macronutrients and micronutrients from appropriate food sources

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Management of Common Pregnancy-Related Nutrition Issues

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Key Micronutrients and Food Sources

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moderate

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Food choice adjustments (e.g., smaller, frequent meals for nausea; fibre-rich foods for constipation) address pregnancy-related nutrition challenges while maintaining micronutrient intake

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Maternal Weight Gain and Nutritional Requirements

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Every-Visit Ongoing Assessments

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Weight measurement at every visit tracks progress toward recommended gain; excessive gain with oedema signals nutritional and metabolic concerns

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Iron and Folic Acid Supplementation

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First (Booking) Visit Assessment

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Relationship

Baseline labs (haemoglobin, blood type) at booking determine supplementation needs; Rh-negative status identified at booking guides anti-D prophylaxis

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Common Problems Screened in Prenatal Care

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First (Booking) Visit Assessment

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Relationship

Comprehensive booking assessment includes screening for anaemia, infections, hypertension risk, and gestational diabetes; baseline labs establish normal values

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Health Teaching Across Pregnancy

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Tetanus Immunisation (Td Schedule)

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moderate

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Td immunisation is explained during health teaching; woman is counselled on schedule and importance of Td2 for Child Protected at Birth