Maternal Health and Paediatric Nursing †MyAssignmenthelp.com

Question: Discuss about the Maternal Health and Paediatric Nursing. Answer: Obesity, which is a significant issue related to health of women. It is a recurrent problem among women of during the age of reproduction. Overweight and Obesity involve an excessive and abnormal fat storage that negatively impacts the body and reproduction cycle (Mahmood Arulkumaran, 2013).According to the World Health Organization (WHO), if the body mass index (BMI) equals to or is greater than twenty five kg per meter square, it is premeditated as overweight, whereas if the BMI equals to or is greater than thirty kg per meter square, it is considered obese . Obesity among women is a rising distress across many countries (Chang, Llanes, Gold, Fetters, 2013). Obesity generates several health problems including fertility in women. This report emphasizes on the influence of obesity on the reproduction ability of women, significantly in the process of Oocyte (Forno, Young, Simhan, Celedn, 2014). Data from several infertility clinics and experiments on animals that demonstrates the i mpacts of obesity are existent. Oocyte development is significantly relied upon the cumulus cells, metabolic support and bi directional communication and the affects of obesity have significant roles on pregnancy. Development and metabolism of oocytes are damaged because of the obesity and affect negatively for future development (Choi, Fukuoka, Lee, 2013). Obesity also causes rise in insulin level or glucose and lesser amount of reproductive hormones which are impediment to pregnancy. Secondary research method was followed to create the report. The systematic search procedure was adopted during the making of the report (Forno, Young, Simhan, Celedn, 2014). All the relevant materials related to obesity and its disadvantages were the keywords for the searching scholarly articles on Google scholar. Obesity in Pregnancy, negative factors for reproduction, PCOS were those keywords while searching for respective journals. Limitation rule enforced to the search method was the existence of the key words in the title of the journals as well as in the abstract (Shub, Huning , Campbell , McCarthy, 2013). A comprehensive number of journals were generated based on the titles and abstracts from these explorations. Obesity brings out many problems such as social, psychological, demographic, and health problems. It is related to increased health risks such as diabetes mellitus, hypertension, coronary heart disease, and osteoarthritis and is linked to various malignancies, parti cularly endometrium, breast, and colon cancers. Obesity also plays a significant role in reproductive disorders, particularly in women. It is associated with anovulation, menstrual disorders, infertility, difficulties in assisted reproduction, miscarriage, and adverse pregnancy outcomes.In obese women, gonadotropin secretion is affected because of the increased peripheral aromatization of androgens to estrogens. The insulin resistance and hyperinsulinemia in obese women leads to hyperandrogenemia (Choi, Fukuoka, Lee, 2013). The sex hormone-binding globulin (SHBG), growth hormone (GH), and insulin-like growth factor binding proteins (IGFBP) are decreased and leptin levels are increased. Thus, the neuro-regulation of the hypothalamic-pituitary-gonadal (HPG) axis deteriorates (Morgan et al., 2014).These alterations may explain impaired ovulatory function and so reproductive health. Because of lower implantation and pregnancy rates, higher miscarriage rates, and increased maternal and fetal complications during pregnancy, obese women have a lower chance to give birth to a healthy newborn. In this review, the effects of obesity on fertility and effective management of infertility in obese and overweight women is summarized. A BMI greater than 30 is associated with abnormalities in estrogen metabolism. Fat acts as a steroid reservoir and a precursor for the synthesis of androgens to oestrone and oestradiol and hence to oestriol by enhancement of the 16-hydroxylase pathway.Oestrone, while not a potent steroid, upon sustained exposure, has a significant estrogenic activity particularly on the endometrium known as lining of the womb (Foster and Hirst , 2014). It has been examined the influence of body weight on oestradiol (E2) metabolism. They demonstrated that weight influences the direction of E2 metabolism (Jones et al. , 2016). Also, body weight may play a significant role in anovulation, since obesity is associated with hormonal aberrations, decreased sex hormone binding globulin (SHBG), elevated serum E2, and elevated levels of androgens (Chang, Llanes, Gold, Fetters, 2013). The PCOS is one of the most common endocrine disturbances in women. It accounts for 90% of women with anovulation who attend infertility clinics. It is a heterogeneous disorder, the definition of which has been refined through the years. The syndromes cardinal features are; characteristic ovarian morphology on ultrasound, menstrual irregularity, hyperestrogenism, decreased SHBG, hyperandrogenism, and IR. The latter two disturbances have significant reproductive and metabolic consequences (Haghiac et al, 2014). Abdominal/truncal (increased waist-to-hip ratio) obesity is another important feature of PCOS, which worsens the clinical, endocrine and metabolic features of the syndrome. This type of obesity is associated with more pronounced hyperandrogenism and IR. These two factors lead to chronic anovulation, through mechanisms primarily involving the insulin-mediated overstimulation of ovarian steroidogenesis and decrease in SHBG concentration. The prevalence of obesity in PCOS has been estimated to be around 40% (Mission, Marshall, and Caughey, 2015). However, marked variation has been noted in this frequency, which also varies according to ethnicity and geographic location. The pathogenesis of obesity in PCOS is unclear however. Obesity could be the consequence of genetic factors, or alternatively due to life style factors such as diet and a sedentary existence. More specifically, the role of diet in the genesis of obesity and lipid abnormalities in women with PCOS has not been established. In the general population and in certain ethnic groups, it is well-known that high fat/carbohydrate diet markedly influences the prevalence of obesity and metabolic abnormalities (Heslehurst et al., 2015). Obese women with PCOS are more likely to have menstrual irregularities and anovulation than lean women with PCOS. Furthermore, IR in women with PCOS appears more common than in the general population. Insulin resistance and, thus, secondary hyperinsulinemia may contribute to the hyperandrogenism, anovulation, dyslipidemia, and glucose intolerance in women with PCOS (Mills, Schmied and Dahlen, 2013). The gonadotrophic effects of insulin on ovarian steroid hormone synthesis were shown in vivo and in vitro.The exaggerated insulin action on the ovarian tissue may present the pathogenic mechanism leading to the disturbances of the endocrine profile and menstrual cycles and hence to infertility in some obese women. Several authors have provided that the risk of anovulatory infertility increased in women with increasing BMI values. Weight in pregnancy is composed of both weight gains during pregnancy and pre-pregnancy weight. Pre-pregnancy obesity was associated with poor pregnancy outcome. Maternal obesity in pregnancy carries significant risks for both mother and fetus such as; an increased rate of miscarriage, gestational diabetes, macrocosmia, pre-eclampsia, cesarean section and still birth (Poston, 2017). There is an increase in congenital malformation, especially neural tube defects. It has also been suggested that central compared with peripheral fat is more closely related to birth weight, gestational carbohydrate intolerance, and hypertension (Gaillard, 2015). Further, it has been explained that maternal pre-pregnant BMI predicts infants birth weight, and childhood obesity. This would eventually, establishes a risk profile for the development of subsequent metabolic disease in children.Communication obstacles and difficulties often go unexplored in health care sector and can have substantial impact on the health and safety of patients. Limited literacy skills are one of the vigorous indicators of poor health results for patients. Studies have exhibited that when patients have minor fluency in reading, they tend to understand limited about their diseases and health related problems. Patients with limited literacy rates are poor at handling their care and patients are less likely to care about preventive measures and cautions for their health (Atkinson, French, Mnage, Olander, 2017). The point to which an individual has the ability to acquire, progress, and find out basic health services and data required to make proper health related decisions. Limited health literacy problem is a secret prevalent problem. It can affect health outcomes, status, health care use and related costs also. The integrated health care system depends on the understanding of the patients regarding spoken information and complex written data (Yogev Sheiner, 2013). Patients are presumed to steer through a c omplicated medical system and after that administer more and more of their often complex care at home. If they do not comprehend health information properly then they cannot resort to required actions for their health or make proper health decisions (Kim, Young, Grattan, Jasoni, 2014). There are several symptoms that patients may possess restricted health literacy such as faultily or improper filled out forms, often missed appointments, indigent compliance, incompetence to recognize the purpose, name, or timetable of a medication and not querying any questions. A patients feedback to materials in written format can hike worry about literacy skills. A patient with low to moderate literacy rates might seek to hid problems through excuses. The patient can also state that he or she will carry the materials home to read or to show it to others.If patients display these symptoms, midwives or nurses should be alert that they may require better help in comprehending information related to their health. For better understanding and clarity, written materials should be generated in a patient-friendly manner. It implies using simple words, small sentences in pointed format, and ample of spaces between sentences. Medical jargon must be averted and simple diagrams must be used when it is needed. Emphasis must be based on what the patient must follow, unrelated information should be omitted. Physicians must motivate clear communication with patients. All patients including limited health literacy can get advantages from lucid communication practices. When sharing information verbally, healthcare professionals and staff should converse in key points, averting redundant information. It is required to talk calmly and avert medical jargon. Using analogies for common things, a patient might better understand joint problems if joints are compared with hinges. Reading handouts with the patient, highlighting and circling important parts and motivating the patient to ask questions are also helpful tools. The midwife encourages the core of the healthy relationship with women because it is the essence of midwifery practice (Thangaratinam et al. , 2012). Midwife can establish such relationship communicating efficiently and maintaining partnership during the work. She works with women to assess and plan facilities, care while giving learning options that simplify decision-making of the women (Yu et.al, 2013). The graduate midwife has the skills, attitudes and knowledge to work as a midwife internationally according to the scope and responsibilities of the midwife. It is accredited by other departments such as biological, social, physical and biological, behavioral sciences, healthcare and legal also (Magann, Doherty, Sandlin, Chauhan, Morrison, 2013). The graduate midwifes are also skilled to offer safe and functional care covering the spaces between community clinics and hospital including the home along with the local hospitals, or in any kind of maternity service (Jersey et. al ,2012 ). She is adept to accurately and effectively appraise the demand of women and their babies and to structure the plan, apply and assess care pertaining to midwifery (McParlin, Bell, Robson, Muirhead, Arajo-Soares , 2017). This process involves the antenatal period and the postnatal period along with labor and birth (Mission, Marshall Caughey, 2015). Midwife guides and sometimes practice in, constancy of care models. The graduate midwife is skillful, versatile and able to act in response to a variety of situations inclusive of emergencies. When babies and women both have complicated needs and feel necessity for referral, the accredited midwife will assist midwifery care in association with other professionals in healthcare segment (Biro et al., 2013). The graduate midwife safeguards, promotes and helps breastfeeding while relating each womans choice in breast feeding. She is capable to begin, supply and supervise proper substances of pharmacological in an effective and safe manner w ithin legislation. Conclusion Regular health examinations in periodic intervals and other consultation for gynaecologic care before to pregnancy provide perfect opportunities to understand the challenges of weight loss before getting pregnant. Women should be motivated to select conception with a body mass index generally less than 25 kg per meter square. BMI should be calculated from pre-pregnancy height and weight. Women who are having BMI greater than 30 kg per meter square are assessed as obese. This data can be useful in advising women about threats connected with obesity and pregnancy. Obese women must be guided about weight loss, nutrition and food choices before the pregnancy. Obese women can be subject to medical complications such as gestational hypertension, gestational diabetes, cardiac disease, obstructive sleep apnea and pulmonary disease. Regular exercises pre and post pregnancy may aid to decrease these risks. Women are also needed to do some activities during pregnancy too. Obese women should be given counseling that their fetus is at a high risk of abnormalities related to congenital and proper review must be done. 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