6Hl007 Research For Health Project: Assessment Answers

The lifespan of an unfertilized ovum is 12-24 hours. Within this time, the sperm should fertilize it (Soon et al, 2014). Failure to fertilize the ovum within the stated time, it will die and be absorbed in the fallopian tube by the cells lining it. The life span of a sperm in the female reproductive tract is 72 hours; the best time for sexual intercourse in order to conceive is between the 11^th and the 14^th day of a regular 28-day cycle (Verma et al, 2017). Age is also a major factor in pregnancy. A woman is very fertile between 13- 35 years of age and her fertility reduces with time up to 45 years. It is therefore, advisable to try and get pregnant before the specified years elapse for them.

Keeping a temperature chart or the use of an ovulation kit as Jane and John do is advised for a couple who find it difficult to conceive. After ovulation, the body temperature always rises slightly, usually around 0.2?C (Soon et al, 2014). Therefore, monitoring of the body temperature is key in determining the occurrence of ovulation. An ovulation kit can also be used to measure the level of hormones of the menstrual cycle in the urine and thus can help predict ovulation (Friedman, 2017). A couple that is undergoing fertility investigation should avoid smoking in order to conceive a healthy baby. Nicotine is a major factor in infertility and thus it is advisable to give up the intake of any substance with nicotine when planning to get pregnant.

The frequency of sexual intercourse is also a determinant of the ease to conceive. If sexual intercourse takes place 3 to 4 times a week, there will always be presence of live sperms in the fallopian tube (Lum et al, 2017). This increases the chances of fertilization when ovulation occurs. On the other hand, having sexual intercourse once a week lowers the chances of fertilization since ovulation may be missed. Further, emotional factors also take the toll on fertility especially for the female. These factors include stress, overwork, strain, pressure in work. The production of adrenalin during stress inhibits the utilization of the progesterone hormone, which is significant in fertility (Verma et al, 2017). The presence of adrenalin also causes the release of high levels of prolactin by the pituitary gland which is also a cause of infertility. It is therefore, advisable for John and Jane like any other couple to avoid stressful situations in their attempt to have a baby.

Blood tests for assessment of maternal wellbeing

Low Hemoglobin in Pregnancy

An expecting mother usually faces challenges that they have to overcome during pregnancy. Some of these challenges are health issues among which there is the issue of the level of hemoglobin of the blood. Hemoglobin is the protein found in the red blood cells (RBCs) that carries oxygen from the lungs to other tissues of the body and also carbon dioxide from other body tissues to the lungs (Jwa et al, 2015).  The normal level of hemoglobin for women is between 12 to 16 g/dl.

Causes

During pregnancy, it is normal for the hemoglobin level to drop. This is due to increase in blood volume by 50% in order to provide essential nutrients for the fetus. Increase in the blood volume begins in the 8^th week of pregnancy (Jwa et al, 2015). The drop of hemoglobin can always go up to 10.5g/dl causing mild anemia. Low hemoglobin can cause dizziness, shortness of breath at rest, pale lips and skin, increased heart rate and brittle nails. Further drop in the level of hemoglobin below 6d/dl in an expectant mother according to Shinar & Maslovitz (2017) may result to angina due to low supply of blood to the heart.

Treatment and Management

Screening for hemoglobin level should be done at first antenatal visit to determine the levels and also the concentration of ferritin (Shinar & Maslovitz, 2017). During pregnancy, low hemoglobin can easily be treated by adding iron and vitamin supplements on a daily routine. However, in severe cases which are usually rare, there may be need for blood transfusion. Screening of hemoglobin and ferritin should be continued in the second and the third trimester visit and treated appropriately.

Serum ferritin of women with known hemoglobinopathy should be checked and if low, they should be given iron supplements. Women whose iron-deficiency has been established should be offered 100-200 mg of iron element daily (Shinar & Maslovitz, 2017). They should be advised on how to correctly administer to optimize absorption. Vitamin C increases the rate of absorption and thus the pregnant women are advised to take foods rich in it. These foods include citrus fruits and juices, oranges, tomatoes, strawberries and kiwis. Preventing low hemoglobin during pregnancy is possible and necessary. One can do this through making changes in the diet. It is recommended that a pregnant woman eat at least 30mg of iron every day. The foods rich in iron include lean, red meats, eggs, leafy green vegetables; spinach, broccoli, beans and lentils and nuts.

Activity 2: Antenatal screening

Antenatal screening is done for pregnant mothers in order to identify those at high risk of disorders. Screening helps determine those at high risk in order to offer prenatal diagnosis. Screening is not replaced with diagnosis but rather helps in making informed decisions (Harcombe & Armstrong, 2008). These decisions include whether or not to be screened, the specific disorders to be screened, after screening and identified to be at high risk whether to go for prenatal diagnosis and if the pregnancy is affected, the further decisions that should be made; termination of pregnancy(Pilnick & Zayts, 2011). Antenatal screening tests that can be done today are for Down’s syndrome, fragile X syndrome, cystic fibrosis and spinal muscular atrophy.

Down’s syndrome Screening

Down’s syndrome commonly causes intellectual disability which varies in degree. People with Down’s syndrome present medical conditions like poor tongue control, dry skin, sinuses infection and slow feeding (Habib, 2011). Some may have heart defects though many people with the syndrome enjoy a healthy life. Down’s syndrome results from chromosomal anomaly where there is, an extra number of chromosomes; instead of being 46 they are 47 (Cuckle at la, 2013). This is due to an error in cell division egg production. In the past, identifying a high risk group was through advanced maternal age or if there is a previous case of Down’s syndrome during pregnancy. Currently, a blood test or ultrasound examination is done and are more effective. It involves measuring chemicals in the blood of the mother or structures viewed on ultrasound. These are referred to as ‘markers’ (Davis et al, 2014). These markers include nuchal translucency, free-beta HCG, HCG, Inhibin A, nuchal skinfold, Alpha-fetoprotein, nasal bone length, nasal bone absence, pregnancy associated plasma protein and prenasal translucency.

Among the advantages of screening for Down’s syndrome is that it helps assess the chances of the baby having the condition (Habib, 2011). This can help decide on having invasive diagnostic tests to give assurance of the baby’s condition and also prepare the parents if they want to keep the baby and if so to prepare on raising the child (Cuckle at la, 2013). In regard to disadvantages first, the screening is does not indicate specifically the presence of Down’s syndrome but rather calculates the likelihood. Further, the diagnostic tests are more definitive but pose a risk to the mother and the baby during the pregnancy because they are invasive.

Main issues from the analysis

• To perform the screening there has to be informed consent. The woman should be well informed of the screening test in terms of the procedures, the requirements, the possible outcomes, the next steps depending on the outcome, the advantages and the risks that come with the screening and further diagnosis. This will help the mother to make informed decisions in taking up the screening tests.   
• The midwife has to ensure confidentiality. The midwife should always keep private the information of the patient concerning health matters.
• The test should be carried out in every trimester of the pregnancy. This helps in monitoring the pregnancy to be able to detect any disorders before the baby is born. 

Activity 3: Urine Dipstick Test Analysis

This is a rapid pregnancy test done during every prenatal visit. It is convenient as it ascertains results in a few minutes after collecting the urine sample. The urine sample is collected in a sterile container. Using a fresh sterile syringe, a small volume of urine from the container is removed and placed on the dipstick which is then held horizontally before reading (Asadzadeh, 2017). Common color outcomes are brown, green, blue, orange, red and yellow. It is taken to check on the sugar level, protein, ketones and blood cells or bacteria.

Sugar levels are monitored during pregnancy in this test. Low sugar level in the urine is considered normal during pregnancy. When the level rises during the prenatal visits, it is likely to be a sign of gestational diabetes and further glucose tests are likely to be done (Cho, et al, 2014). During pregnancy, the body naturally becomes resistant to insulin to provide more glucose to nourish the baby. When insulin production cannot keep up with the demand by the glucose in the mother’s body, the blood sugar level goes high causing gestational diabetes. The condition is not permanent as it is likely to end as soon as the baby is born. To reduce the chances of having gestational diabetes, one should adopt a healthy lifestyle like maintaining a balanced diet and doing regular physical exercise.

Presence of excess proteins in the blood could be a sign of urinary tract infection or kidney damage. If the mother has high blood pressure too during the pregnancy, chances are that it could be preeclampsia (Asadzadeh, 2017). If the blood pressure is normal, the sample could be taken to the laboratory for further analysis. Preeclampsia happens mostly after the 20^th week of pregnancy. If it is mild, it could be managed by getting bed rest, reducing salt intake, drinking a lot of water and regularly visiting the doctor (Yeung & Wong, 2009). If serious, one can be admitted for thorough monitoring to reduce the blood pressure or give steroid injections to help quick development of the baby’s lungs.   

Ketones can also be found in the urine in the dipstick test. When there are not enough carbohydrates in the body, the body begins to breakdown stored fat in the body to provide energy (Cho, et al, 2014). This maybe accompanied with nausea, weight loss, vomiting. Urine test may indicate the presence of ketones in the urine. If high sugar is found as well, it could be a sign of diabetes. The presence of ketones in the urine is referred to as acetonuria. This leads to dehydration in the body and also metabolic disturbance which can provoke miscarriage or cause premature birth (Asadzadeh, 2017). Treatment of acetonuria depends on the cause to determine its management. Necessary medication and intravenous fluids will be given and healthy eating recommended. Sorbents can also be prescribed to reduce intoxication.   

The white blood cells produce certain enzymes while certain bacteria produce nitrites in the presence of an infection (Yeung & Wong, 2009). When these chemicals are found in a urine sample, it could be a sign of urinary tract infection (UTI) and further tests can be done in the lab to confirm the infection (Cho, et al, 2014). UTI occurs when a bacteria infects the urethra and is more common in females due their anatomy. It is characterized by frequent urination, burning urination, feeling the urge to urinate frequently, pelvic pain and fever. UTI during pregnancy are treated by administering antibiotics as prescribed by a physician. To prevent UTI, it is important for a woman to empty her bladder before and after sex, wearing only cotton underwear, drinking plenty of water to prevent dehydration and avoid washing the genitalia with harsh soaps.  

References

Asadzadeh, L. (2017). Compare Urine Culture and Urinalysis Test (Microscopic, Nitrite and Leukocyte Esterase Dipstick Test) In the Diagnosis of Urinary Tract Infection. World Journal of Pharmaceutical Research, 1-11.

Cho, M., Ji, M., Kim, S., Choe, W., Lee, W., Chun, S., & Min, W. (2014). Evaluation of the URiSCAN Super Cassette ACR Semiquantitative Urine Dipstick for Microalbuminuria Screening. Journal Of Clinical Laboratory Analysis, 28(4), 281-286.

Cuckle, H., Benn, P., & Pergament, E. (2013). Maternal cfDNA screening for Down syndrome - a cost sensitivity analysis. Prenatal Diagnosis, 33(7), 636-642.

Davis, C., Cuckle, H., & Yaron, Y. (2014). Screening for Down syndrome - incidental diagnosis of other aneuploidies. Prenatal Diagnosis, 34(11), 1044-1048.

Friedman, S. (2017). Pregnancy and IBD: Timing Is Everything. Digestive Diseases And Sciences, 62(8), 1847-1849.

Habib, F. (2011). Antenatal Screening Strategies for Down Syndrome: Analysis of Existing Protocols and Implications in the Kingdom of Saudi Arabia. British Journal Of Medicine And Medical Research, 1(3), 105-121.

Harcombe, J., & Armstrong, V. (2008). Antenatal Screening. The UK NHS Antenatal Screening Programmes: Policy and Practice. Innovait: Education And Inspiration For General Practice, 1(8), 579-588.

Jwa, S., Fujiwara, T., Yamanobe, Y., Kozuka, K., & Sago, H. (2015). Changes in maternal hemoglobin during pregnancy and birth outcomes. BMC Pregnancy And Childbirth, 15(1).

Lum, K., Sundaram, R., Barr, D., Louis, T., & Buck Louis, G. (2017). Perfluoroalkyl Chemicals, Menstrual Cycle Length, and Fecundity. Epidemiology, 28(1), 90-98.

Mechery, J., Abidogun, K., Crosfill, F., & Jip, J. (2012). Hyperhemolysis Syndrome Complicating Pregnancy in Homozygous δβ-Thalassemia. Hemoglobin, 36(2), 183-185.

Naik, D. (2017). A Study of Dipstick and Microscopic Analysis of Formed Elements in Urine. Journal Of Medical Science And Clinical Research, 05(04), 20485-20488.

Pilnick, A., & Zayts, O. (2011). ‘Let’s have it tested first’: choice and circumstances in decision-making following positive antenatal screening in Hong Kong. Sociology Of Health & Illness, 34(2), 266-282.

Shinar, S., & Maslovitz, S. (2017). 638: Is low hemoglobin consistent with anemia in pregnancy?. American Journal Of Obstetrics And Gynecology, 216(1), S373.

Soon, R., Elia, J., Beckwith, N., Kaneshiro, B., & Dye, T. (2014). Cultural factors affecting attitudes toward pregnancy and pregnancy planning among native Hawaiians. Contraception, 90(3),342.

Verma, P., Singh, K., & Singh, A. (2017). Pregnancy risk during menstrual cycle: misconceptions among urban men in India. Reproductive Health, 14(1).

Yeung, K., & Wong, T. (2009). Value of the urine dipstick test for leukocytes in screening for urinary tract infection. Emergency Medicine, 4(2), 73-75.