Guidelines for Nurse Practitioners in Ambulatory Obstetric Settings

363 Pages·2022·5.426 MB·English

by  Kelly D. Rosenberger, Nancy Cibulka, Mary Lee Barron

6 × 9
Third Edition
Third Edition
Guidelines Nurse Practitioners
for
Ambulatory Obstetric Settings
in
Guidelines
for
Kelly D. Rosenberger, DNP, APRN, CNM, WHNP-BC, FAANP
Nancy J. Cibulka, PhD, WHNP, FNP-BC, FAANP
Mary Lee Barron, PhD, APRN, FNP-BC, FAANP
Nurse Practitioners
Praise for the First Edition:
“This is a concise, yet comprehensive book. I would recommend that any advanced practice
nurse working in obstetrics have it on the bookshelf. It could also be used as a protocol manual
for small practices.” Score: 100, 5 Stars
Ambulatory
—Doody’s Medical Reviews in
Now in its third edition, this remains the only comprehensive source of current, evidence-based
information for busy nurse practitioners and related professionals who provide preconception,
prenatal, and postpartum care in outpatient settings. This resource encompasses essential
clinical topics and practice standards in an easy-to-read outline format. The third edition presents Obstetric Settings
important new information on thyroid disorders in pregnancy, COVID-19 during pregnancy and
lactation, rural maternity services, utilization of telehealth services in pregnancy, adverse child
experiences, LGBTQIA+ considerations, genetic counseling, and more. Additionally, unique topics
of emerging clinical relevance address the complex and evolving nature of prenatal care in the
21st century, such as the latest trends in preterm labor prevention, disaster planning, managing
exposure to the Zika virus, obesity, dermatoses, and HIV in pregnancy. Purchase includes digital
access for use on most mobile devices or computers.
New to the Third Edition:
n New chapters on Thyroid Disorders in Pregnancy and COVID-19 During Pregnancy and
Postpartum
n Updated sections on rural maternity services, telehealth services, adverse childhood
experiences, nutrition, and LGBTQIA+ considerations
n Clinical updates on genetic screening and testing, nausea and vomiting, use of low-dose
aspirin to prevent complications, HIV prevention, using PrEP, breastfeeding, avoidance of
non–medically indicated early-term delivery, and use of marijuana and heroin
n Greatly expanded section on options for noninvasive prenatal testing for aneuploidy
n New information from the FDA on drug labeling
n New recommendations on anemia screening in pregnancy
n Updated imaging recommendations
n New and updated guidelines from Association of Women’s Health, Obstetric and Neonatal
Nurses; American Congress of Obstetricians and Gynecologists; American Academy of
Pediatricians;
American College of Nurse Midwives; National Certification Corporation; National
Association of Nurse Practitioners in Women’s Health; the Centers for Disease Control and
Prevention; and the U.S. Preventive Services Task Force
n Two new appendices covering Telehealth Resources and Best Practice Guides and
LGBTQIA+ Resources
Kelly D. Rosenberger
ISBN 978-0-8261-4845-2
Nancy J. Cibulka
11 W. 42nd Street
Mary Lee Barron
New York, NY 10036-8002
www.springerpub.com 9 780826 148452
Guidelines for
Nurse Practitioners in
Ambulatory Obstetric
Settings
Kelly D. Rosenberger, DNP, APRN, CNM, WHNP-BC, FAANP, is a women’s health nurse
practitioner (NP) and certified nurse midwife with more than 25 years of experience providing high-
quality, patient-centered OB/GYN care. Her clinical service initially began at the Cleveland Clinic
Foundation in the 1990s, and she currently has a robust clinical practice at the University of Illinois
Chicago (UIC) Mile Square L.P. Johnson FQHC in Rockford, Illinois. Dr. Rosenberger is also a Clinical
Assistant Professor at UIC in the Department of Human Developmental Nursing Science in the College
of Nursing and in the Department of Family and Community Medicine in the College of Medicine.
At UIC, Dr. Rosenberger taught the Clinical Skills course to medical students from 2007 to 2014
at the Rockford Campus. Dr. Rosenberger has also taught numerous advanced practice clinical
and DNP courses for the College of Nursing in addition to precepting numerous NP and medical
students since 1997. In 2016, Dr. Rosenberger was honored with the Preceptor of the Year Award.
Dr. Rosenberger has served as a manuscript reviewer and guest editor as invited for her expertise
in OB/GYN. She is well published and has numerous presentations on many topics.
Dr. Rosenberger has been a member of many professional organizations, including the American
College of Nurse-Midwives and the American Association of Nurse Practitioners (AANP). In
2018, she received AANP’s highest honor with induction as a Fellow. In 2021, Dr. Rosenberger
received the I-TEAM Award from the UIC for her excellence in interprofessional clinical practice
and development of teaching innovations with the National Center for Rural Health Professions.
Nancy J. Cibulka, PhD, WHNP, FNP-BC, FAANP, is a women’s health and family nurse
practitioner (NP) with extensive practice experience providing prenatal, postpartal, and well
woman care to inner city women at Barnes–Jewish Hospital and at Washington University’s
OB/GYN clinic. She is also an Associate Professor in Nursing at Saint Louis University teaching
in the DNP program. Dr. Cibulka’s experience as an NP spans more than 40 years, including with
the OB/GYN clinic (Barnes-Jewish Hospital), Health Resources Center (Saint Louis University
free clinic), Vista Staffing Solutions (Milwaukee, Wisconsin), Take-Care Health Systems (St. Louis),
Unity Corporate Health Services, and private practice Perinatal Group at Washington University
School of Medicine (St. Louis) and Gratiot Community Hospital private practice (Alma, Michigan).
In addition to her current teaching position at Saint Louis University, Dr. Cibulka was an
associate professor of nursing at Maryville University (St. Louis, Missouri) and an instructor at the
University of Iowa College of Nursing. Dr. Cibulka has taught undergraduate courses in maternal–
child nursing and taught advanced graduate clinical courses in advanced health assessment; care of
the adolescent, adult, and older adult; care of childbearing and childrearing families; professional
role development; and advanced clinical practicum. Additional clinical experience includes being
an NP, Planned Parenthood of East Central Ohio; nurse consultant, Maternal & Child Health
Bureau, Iowa Department of Public Health; and clinical consultant, March of Dimes Perinatal
Project, Wisconsin Vocational Studies Center, University of Wisconsin. She has published articles
in the Journal of Obstetric, Gynecologic, & Neonatal Nursing; American Journal of Nursing; Journal of the
Association of Nurses in AIDS Care; The Journal for Nurse Practitioners; Journal of Nursing Education;
and Journal of the American Association of Nurse Practitioners; among others. She has presented papers
at national conferences, including the Association of Women’s Health, Obstetric, and Neonatal
Nurses; National Organization of Nurse Practitioner Faculties (NONPF); Midwest Nursing
Research Society; Sigma Theta Tau International (STTI); and the annual evidence-based practice
conferences. Honors and awards include the Research Abstract Award (American Association of
Nurse Practitioners [AANP] in 2008), research poster (STTI in 2005), School of Health Professions
Distinguished Faculty Award (2005), the scholarship/fellowship award (Abbott Labs in 2005), and
the Maryville University President’s Faculty Award for Exemplary Service for Scholarship (2005),
among others. She is a member of the AANP and, in June 2012, she was inducted into the Fellows.
Mary Lee Barron, PhD, APRN, FNP-BC, FAANP, is an associate professor, School of Nursing,
Southern Illinois University Edwardsville (SIUE). Additionally, she is the Director of Marquette
Fertility Education, offering direct patient care services and research in natural family planning.
Formerly, she taught at Saint Louis University in the FNP program and served as Director of the
Master’s and DNP Programs. With more than 40 years of nursing experience, her nurse practitioner
(NP) clinical experience has focused on OB/GYN at the OB/GYN clinic (Barnes–Jewish Hospital)
and affiliated with Washington University School of Medicine and Saint Louis University. She has
taught the Marquette Method as a Natural Family Planning Instructor and has been trained by the
Pope Paul VI Institute, Omaha, Nebraska, as a Medical Consultant and Fertility Care Practitioner. She
also served in the U.S. Naval Reserve, where she advanced to the rank of Lieutenant Commander.
At SIUE, Dr. Barron teaches graduate Advanced Management of Women’s Health with
Practicum, Nursing Research, Theory-Guided Practice, and Emerging Roles in Advanced Nursing
Practice. She has published 23 peer-reviewed articles in a variety of journals. Dr. Barron has
authored the March of Dimes module on Antepartum Care and Laboratory Examination since
1998 and served as a visiting professor presenting “Born Too Soon” for the Los Angeles chapter.
She has authored 10 book chapters and presents widely on topics related to the health benefits
of breastfeeding, natural family planning, obesity and pregnancy, and hormone replacement
therapy. Dr. Barron is the recipient of several awards, including March of Dimes Nurse of the Year
(Advanced Practice) in 2017, Leadership Academy Fellow (American Association of Colleges of
Nursing [AACN]), and Alpha Sigma Nu (Jesuit Honor Society). She is a member of the American
Association of Nurse Practitioners (AANP) and in June 2014 she was inducted into the Fellows.
Additionally, she has held membership in Sigma Theta Tau International (STTI), Association of
Women’s Health, Obstetric, and Neonatal Nurses (AWHONN), National Organization of Nurse
Practitioner Faculties (NONPF), and serves as a manuscript reviewer for a number of journals,
including Clinical Nursing Research, MCN: The American Journal of Maternal Child Nursing and
Biological Research for Nursing.
Guidelines for
Nurse Practitioners in
Ambulatory Obstetric
Settings
Third Edition
Kelly D. Rosenberger,
DNP, APRN, CNM,
WHNP-BC, FAANP
Nancy J. Cibulka,
PhD, WHNP, FNP-BC, FAANP
Mary Lee Barron,
PhD, APRN, FNP-BC, FAANP
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Contents
Contributors ix
Preface xi
I. Guidelines for Preparation for Pregnancy
1. PRECONCEPTION COUNSELING AND CARE 3
Mary Lee Barron and Kelly D. Rosenberger
2. SCREENING FOR GENETIC DISORDERS AND GENETIC
COUNSELING—PRECONCEPTION AND EARLY
PREGNANCY 13
Nancy J. Cibulka, Lisa Hickman, and Kelly D. Rosenberger
II. Guidelines for Routine Prenatal and Postpartum Care
3. THE FIRST PRENATAL VISIT 33
Mary Lee Barron, Kelly D. Rosenberger, and Janet Thorlton
4. ONGOING PRENATAL CARE 69
Mary Lee Barron and Kelly D. Rosenberger
5. MEDICATION USE IN PREGNANCY 95
Mary Lee Barron and Kelly D. Rosenberger
6. ANTENATAL FETAL SURVEILLANCE 103
Nancy J. Cibulka and Kelly D. Rosenberger
7. POSTPARTUM CARE IN THE AMBULATORY SETTING 109
Nancy J. Cibulka and Kelly D. Rosenberger
8. POSTPARTUM COMPLICATIONS 127
Nancy J. Cibulka and Kelly D. Rosenberger
III. Guidelines for Management of Common Problems of Pregnancy
9. ORAL HEALTH AND ORAL HEALTH PROBLEMS IN
PREGNANCY 149
Nancy J. Cibulka and Kelly D. Rosenberger
10. ANEMIA IN PREGNANCY 155
Nancy J. Cibulka, Kelly D. Rosenberger, and Michael P. Rosenberger
11. RESPIRATORY ILLNESS DURING PREGNANCY: UPPER
RESPIRATORY INFECTION, INFLUENZA, AND ASTHMA 161
Nancy J. Cibulka and Kelly D. Rosenberger
12. ASYMPTOMATIC BACTERIURIA AND URINARY TRACT
INFECTION IN PREGNANCY 175
Mary Lee Barron, Kelly D. Rosenberger, and Amy M. Seibert
vii
viii 13. VAGINITIS AND SEXUALLY TRANSMITTED INFECTIONS 183
Kelly D. Rosenberger, Mary Lee Barron, and Amy M. Seibert
S
T
N 14. DERMATOSES OF PREGNANCY 203
E Nancy J. Cibulka and Kelly D. Rosenberger
T
N
O
C IV. Guidelines for Management of Selected Complications of
Pregnancy
15. BLEEDING AND PREGNANCY LOSS 215
Mary Lee Barron and Kelly D. Rosenberger
16. GESTATIONAL DIABETES MELLITUS 235
Mary Lee Barron and Kelly D. Rosenberger
17. OBESITY AND PREGNANCY 245
Mary Lee Barron and Kelly D. Rosenberger
18. HYPERTENSIVE DISORDERS OF PREGNANCY 253
Nancy J. Cibulka and Kelly D. Rosenberger
19. PRETERM LABOR 261
Kelly D. Rosenberger and Nancy J. Cibulka
20. HIV-1 AND PREGNANCY: SCREENING, DIAGNOSIS, AND
MANAGEMENT 271
Nancy J. Cibulka, Karen Cotler, and Kelly D. Rosenberger
21. ZIKA VIRUS AND PREGNANCY 279
Nancy J. Cibulka and Kelly D. Rosenberger
22. DISASTER PLANNING FOR PREGNANCY AND
POSTPARTUM 285
Nancy J. Cibulka, Anna J. Fischer Colby, and Kelly D. Rosenberger
23. THYROID DISORDERS IN PREGNANCY AND
POSTPARTUM 293
Kelly D. Rosenberger and Michael P. Rosenberger
24. COVID-19 DURING PREGNANCY AND POSTPARTUM 299
Amy M. Seibert and Kelly D. Rosenberger
Appendices
A. Patient Resources and Instructions 309
B. Screening Tools 319
C. Common Approach to HIV Testing in Pregnancy for Barnes-Jewish Hospital: A
Consensus of the HIV Perinatal Working Group of Washington University School
of Medicine 324
D. Federal Employment Laws on Work Break 327
E. Telehealth Resources and Best Practice Guides 330
F. LGBTQIA+ Resources 333
Index 337
Contributors
Karen Cotler, DNP, FNP-BC, FAANP
Dr. Cotler is a faculty member of the University of Illinois Chicago (UIC) College
of Nursing, where she teaches and directs the FNP program. She also has a
robust FNP clinical practice caring for individuals with HIV. Dr. Cotler contrib-
uted to Chapter 20.
Anna J. Fischer Colby, BFA, MS, MPP
Anna Colby is a senior research associate at Public Policy Associates (PPA) in
Lansing, Michigan. She has extensive experience in public policy, development,
research, and evaluation in food systems, healthcare, education, and other areas.
Prior to joining PPA in 2019, Ms. Colby worked as a policy advocate for California
Food Policy Advocates (CFPA) and was assistant director of the Tomas Rivera
Policy Institute (TRPI) of the University of Southern California. Ms. Colby con-
tributed the graphics in Figure 2.1 and created Table 19.1.
Lisa Hickman, BSN, RNC-OB
Ms. Hickman is a current student of Dr. Rosenberger in the NMW/WHNP
Program at the University of Illinois Chicago (UIC) College of Nursing. She is a
certified OB RN with many years of labor and delivery experience. She contrib-
uted to Chapter 2.
Michael P. Rosenberger, BSc, MPH
Mr. Rosenberger is currently completing his third year as a medical student.
With a bachelor’s in chemistry, a master’s in public health, and interest in endo-
crinology, he has presented on several topics related to women’s healthcare. He
contributed to Chapters 10 and 23.
Amy M. Seibert, DNP, WHNP-BC
Dr. Seibert is a former student of Dr. Rosenberger’s and has published with Dr.
Rosenberger on OB/GYN topics, such as asymptomatic GBS bacteriuria. She
has a robust clinical practice as a WHNP-BC at the Midwest Center for Women’s
Healthcare. She contributed to Chapters 12, 13, and 24.
Janet Thorlton, PhD, MS, RN, CNE
Dr. Thorlton is a faculty member of the University of Illinois Chicago (UIC)
College of Nursing, where she teaches DNP students and conducts a program of
research surrounding consumer use of performance enhancing ingredients con-
tained in dietary supplements and energy drinks. She contributed to Chapter 3.
ix

Preface
The third edition of Guidelines for Nurse Practitioners in Ambulatory Obstetric
Settings is designed for nurse practitioners, nurse midwives, clinical nurse spe-
cialists, physician assistants, students in these areas, and other health profes-
sionals who provide prenatal and postpartum care in outpatient settings. The
initial decision to write this book was prompted by our mutual desire to incor-
porate more than 100 years of combined practice experience caring for women
and newborns with the best evidence currently available to positively impact
pregnancy outcomes. Since the first edition was published, practice knowledge
has changed in many areas, and we were aware of the importance of updating
the information. The extensive revisions in this edition reflect new guidelines for
practice endorsed by professional organizations and/or the government. Each
chapter has been updated with new references and contains new management
strategies. Throughout history, quality care before, during, and after childbirth
has played an important role in reducing maternal and fetal death, preventing
birth defects, and decreasing the incidence of other preventable health problems.
Healthcare providers have a remarkable opportunity to provide health educa-
tion, assessment, and early problem identification and management during the
preconception and childbearing years. To help achieve these goals, the third edi-
tion of this book presents the best available practice evidence for providing pre-
conception, prenatal, and postpartum care in one easy-to-use publication.
This book is organized into four sections. Part I, “Guidelines for Preparation
for Pregnancy,” comprehensively covers preconception counseling and care, as
well as the latest guidelines on screening for genetic disorders before and dur-
ing pregnancy. Part II, “Guidelines for Routine Prenatal and Postpartum Care,”
provides a wealth of information on key assessments, including laboratory and
ultrasound diagnostics for the initial prenatal visit and for subsequent visits.
Management of uncomplicated pregnancies and the discomforts that commonly
occur are addressed, along with safe medication use and antenatal surveillance
recommendations. The continuum of obstetric care does not end with the deliv-
ery of the infant; thus, in-depth recommendations are provided for postpartum
care in the ambulatory setting. Topics such as general care and health promo-
tion, early parenting issues, breastfeeding for success, and assessment and
management of selected postpartum complications are offered, so that the cli-
nician can guide patients as they make the transition from childbearing to par-
enting. Throughout the book, we have presented topics using a problem-based
schema that highlights history, physical examination, laboratory and diagnos-
tic testing, differential diagnosis, management, indications for consultation
and/or referral, and follow-up care. This format is particularly evident in Parts
III and IV, “Guidelines for Management of Common Problems of Pregnancy”
and “Guidelines for Management of Selected Complications of Pregnancy.”
Several unique topics are included in these sections to address the complex
and evolving nature of prenatal care in the 21st century. For example, the latest
trends in preterm labor prevention, disaster planning, managing exposure to the
Zika virus, obesity, dermatoses, and HIV in pregnancy are important contem-
porary topics that we have included because they are highly relevant to today’s
xi
clinicians.