A "conservative" approach to iron supplementation during pregnancy.

A review of current knowledge about iron metabolism during pregnancy and the evidence from various studies on the effects of iron supplementation in pregnancy on maternal, fetal, and infant outcomes suggest that the implicit goal of current recommendations regarding iron supplementation may be to achieve the highest hemoglobin concentration possible. This goal is only weakly related to improved maternal and infant outcomes in the current pregnancy or to improved maternal iron stores long-term. Indeed, the claim that iron supplementation is universally innocuous is shown to be controversial. For women in developed countries who are generally clinically healthy and have access to adequate nutrition, the benefits of iron supplementation are unclear, and there may be risks. Thus, a better "conservative" approach may be that such women do not require routine iron supplementation during pregnancy. The midwifery philosophy of individualizing care based on a woman's history and health status is one that should be taken in approaching the issue of iron supplementation in pregnancy.

Midwifery triage of first trimester bleeding.

Approximately one of five pregnant women will experience bleeding during the first trimester of pregnancy. Of these women, about half will go on to have a spontaneous abortion. Comfort with triaging this common problem assists the midwife in providing quality, cost-effective care without eliminating continuity. This article reviews the causes of early pregnancy bleeding, offers strategies to differentiate between these causes, and identifies emergent from nonemergent presentations. Triage and management strategies for women with an impending or threatened spontaneous abortion are reviewed, exploring the alternative of expectant management.

Hematocrit values during pregnancy in a nurse-midwifery caseload.

This article reviews the normal hematologic changes in pregnancy and the kinetics of iron metabolism. The differences between iron depletion and anemia are described. The hematocrit levels of a nurse-midwifery caseload in a tertiary-care setting are described and compared with recently published population norms. Hematocrits of the sample compared favorably to the population hematocrits until 24 weeks' gestation, when the sample hematocrit mean became statistically lower and remained that way throughout pregnancy. Further analysis was done on the sample hematocrits, comparing differences in parity, age, pregnancy spacing, and AS versus AA hemoglobin. Parous women with a pregnancy interval > 12 months had a higher mean hematocrit than nulliparous women. Mean hematocrits of age groups varied significantly only at the 29-32-week interval, with women younger than 18 having lower mean hematocrits than those > or = 18. A trend of women with AS hemoglobin having higher hematocrits than women with AA hemoglobin was identified, reaching statistical significance at the 29-32-week interval.

Differential diagnosis of respiratory distress.

Although nurse-midwives care for essentially normal women, even healthy pregnant women at term may deliver babies with respiratory distress. Nurse-midwives need the knowledge to decide whether an infant with respiratory distress needs immediate evaluation by a pediatrician or neonatal specialist or can be safely observed for a while to see if the respiratory distress resolves. This paper reviews the developmental anatomy and physiology of the respiratory system and the pathophysiology of the most common causes of immediate respiratory distress in the newborn. This information will aid nurse-midwives in making appropriate differential diagnoses and management plans for the newborns in their care.

Newborn resuscitation revisited.

The techniques for assessing and resuscitating newborns at birth have become well established over the last 10 years. Standardization of this procedure lagged far behind the standardization of adult and child resuscitation. In 1987, the American Heart Association and the American Academy of Pediatrics published the combined recommendations of the Working Group on Pediatric Resuscitation and the National Task Force on Neonatal Resuscitation of the Section on Perinatal Pediatrics of the American Academy of Pediatrics. This article summarizes those recommendations and suggests means for nurse-midwives to become certified in neonatal resuscitation.

The incidence of meconium-stained amniotic fluid from 1980 through 1986, by year and gestational age.

The annual incidence of meconium-stained amniotic fluid was analyzed for changes in a total obstetric sample of 45,115 singleton, vertex, liveborn infants over a 7-year study period. The incidence of meconium-stained amniotic fluid for the total obstetric population was calculated for each year of the study period. The sample was then stratified by estimated gestational age, and the incidence of meconium-stained amniotic fluid was calculated for each gestational age group. The incidence of meconium-stained amniotic fluid increased 40.9% over the study period, from 18.8% in 1980 to 26.5% in 1986 (P less than .001). This increase was found to be in a consistent linear trend (P less than .05). The incidence of meconium-stained amniotic fluid was also found to increase significantly in a linear trend as gestational age of the fetus increased. These findings lend support to both the maturational theory and the stress theory of meconium passage in utero.