Antenatal care warda [compatibility mode]

By

Osama M. Warda MDOsama M. Warda MDProfessor of OB/GYN

Mansoura University

Thursday, May 09, 2013 O Warda

Definition

�Antenatal care is the program of preventive obstetrics in which regular visits are used to detect and regular visits are used to detect and manage any health problems and complications during pregnancy.


The Objectives of Prenatal Care

� Healthy baby & healthy mother.

�Promotion of medical, physical & mental health .

�Avoid and treat medical or obstetric conditions that are dangerous to the mother or fetus.

�Ensure adequate dietary intake .

� Instructions for the hygiene of pregnancy.

�Preparation for breast feeding.Thursday, May 09, 2013 O Warda

COMPONENTS OF A.N. CARE

�-Pre-conception care

�-Frequency of antenatal visits

�-The initial visit�-The initial visit

�-Follow-up visits

�-Health education; diet-hygiene-

physiology of pregnancy and labor


Preconception care

�Should be an integral part of

prenatal care because health prenatal care because health

during pregnancy depends on

health before pregnancy.


Frequency of Visits

� During the first 7 months: Every month.

� During the 8th month : Every 2 weeks.

� During the 9th month : Weekly.During the 9th month : Weekly.

� The median number of visits made by women is 13.

� In cases of high-risk pregnancy ; frequency is increased according to circumstances.


The Initial VisitThe goals:

1. Detection of high risk pregnancy.

2. Determine the GA and EDD. (HOW??)2. Determine the GA and EDD. (HOW??)

3. To define the health status of the mother and

fetus.

4. Initiate a plan for continued care until

delivery.


The Initial Visit; components

A. Diagnosis of pregnancy and accuratedatingB. Obstetric case taking [History taking+ Clinical exam + Bedside tests]Clinical exam + Bedside tests]

Certain points should be put in mind;

� The examiner must be aware of the normalnormalnormalnormalchanges found in pregnancy as well as the pathologicpathologicpathologicpathologic changes that may develop during pregnancy.


The Initial Visit; SPECIAL NOTE S:

� a. External genitalia : Evidence of previous obstetric injury.

� b. Vagina:

� Screening for bacterial vaginosis is done only for women at high risk for preterm labor (Hx) high risk for preterm labor (Hx)

� No treatment for increased vaginal discharge unless diagnosis of specific infection is made

c. Cervix:

� Pap. smear and culture for gonorrhea routinely in areas where sexually transmitted diseases (STD) are prevalent.

� Clamydia culture performed in high risk population.


Investigations Done at First Visit:

1. Routine initial screen:

�Complete blood picture CBC.

�ABO/Rh typing.

�Complete urine analysis for bacteriuria, �Complete urine analysis for bacteriuria, glucosuria, proteinuria and culture if needed

�HBV surface antigen and test for syphilis.

�Rubella titer.

�Other investigation according to the case.


2. Specialized screening tests :

�HIV infection for high risk group.

�HB electrophoresis.

�Urine or blood toxicology screen.

Only when indicated


3. Mid trimester screening tests:

�Maternal serum Alfa-fetoprotein (AFP) between 16-18 weeks. NTD

� 1 hour glucose screening between 24 & 28 weeks. Value equal to or greater than 140 mg/dl is evaluated by 3 hours oral glucose tolerance.


Repeated tests� Hb% and Hct 26 to 30 weeks. � Serology of syphilis at 28 to 32 weeks for

high risk group. �Antibody screen in Rh-ve women between �Antibody screen in Rh-ve women between

28-30 weeks and(Rh D Ig) is administered if needed.

� 3rd trimester screening for gonorrhea and chlamydia is recommended in high risk group.


Risk Factors

�Pre-existing medical disease. �Previous pregnancy complications:

Perinatal mortality, prematrity, IUGR,

congenital fetal malformation and obstetric hge. �Evidence of poor nutrition.


Risk FactorsGenetic counseling is indicated in the

following conditions

� Maternal age >35 years at the time of birth. birth.

� Family history of congenital anomalies or inherited disorders.

� Abnormal development or mental retardation of previous child.

� Exposure to teratogens.

�Habitual 1ST trimester abortion Thursday, May 09, 2013 O Warda

Education of the Pregnant Mother

1. DIET:

A. Calories:

The requirements increase from 2200 to The requirements increase from 2200 to 2500 Kilocalories (Kcal). The additional energy required is more than 300 Kcal but is reduced by reduced physical activity.



-DIET-

B. Proteins:

� Increased protein demands are needed for fetal, uterine, placental and breast growth and increased blood volume. blood volume.

� During the last 6 months of pregnancy 1 kg of protein is deposited amounting to 5-6 grams per day.

� The majority is required as animal proteins (meat, milk, eggs). Milk is the ideal source. Lactose intolerance can be prevented by eating yoghurt and cheese.



C. Fats and Carbohydrates:

�Fried food, cream, sweets, chocolates and sugar should be consumed sensibly to avoid excess weight gain. excess weight gain.

� Jams, cakes, pastries, biscuits and large quantities of bread and potatoes should also be restricted.



D. Vitamins and Minerals:

� Iron is the only nutrient for which requirements are not met by diet alone.

� Daily requirement is 30-60 mg of which only 30% are absorbed. Daily elemental iron requirement is are absorbed. Daily elemental iron requirement is 7mg.

� Total requirement allover pregnancy is 1GRAM.

� Iron should NOT be prescribed before 14th week




�Calcium: Two glasses of milk every day are sufficient.

�Multivitamin routine prescription is not�Multivitamin routine prescription is notrecommended. Balanced diet is sufficient.

�Sodium: Salting food to taste gives sufficient salt.

� Iodine: Deficiency may lead to congenital goiter and maternal goiter.




�Vitamin A: Daily requirement in pregnancy is 5000 I.U. over-dosage is teratogenic

�Vitamin B6: Deficiency may cause vomiting. It is only found in animal proteinsvomiting. It is only found in animal proteins

�Folic acid: About 1 mg provides very effective prophylaxis against megaloblastic anemia. Folic acid supplementation before pregnancy significantly reduces the risk of neural tube defects (NTD).



E. Coffee and Tea:

� There is no association with birth defects or

low birth weight but excess consumption can

increase irritability and disturb sleep. Caffeine increase irritability and disturb sleep. Caffeine

present in coffee, tea and chocolate reduces

iron absorption.



F. General dietary instructions

� 1. Advise mothers to eat what she wants in the amounts she desires and salted to taste.

� 2. Ensure she is gaining ample weight. Weight gain during pregnancy: About 12 kg. during pregnancy: About 12 kg.

� Recommended Daily Diet

� Protein: meat or fish 120 gm / day.

� Milk: 0.75 Liter / day. Egg: 1 / day.

� Bread: 2 - 3 slices. Potato or rice 2/ day.

� + Fresh vegetables and fruits


Sleep:

Adequate rest of about 8 hours at night and 2 hours in the afternoon is recommended.

Exercise: Exercise:

� Regular exercise improves metabolic deficiency. Exercise does not increase the rate of spontaneous abortion, it shortens active labor and is associated with fewer C.S.

� Exercise is avoided in women with twin pregnancies, pregnancy-induced hypertension, growth restricted fetuses and severe heart and lung diseases.



Work:

� Birth weights of women who work during the third trimester are 150-400 gm less than those who do not work. work.

� Standing was also associated with increase in preterm births. Any occupation that causes severe physical strain is avoided.

Pregnant women who should properly not work include: � History of two preterm deliveries.

� Incompetent cervix.

� Fetal loss secondary to uterine abnormalities.

� Cardiac disease greater than class II. Thursday, May 09, 2013 O Warda


Traveling:

� This has no harmful effect. Air travel is also safe but in long trips of more than 6 hours the woman should walk about every 2 hours to prevent deep venous walk about every 2 hours to prevent deep venous thrombosis. The greatest risk is to travel away from proper medical facilities.



Coitus:

�There is no restriction for the patient without complication. It is contraindicated without complication. It is contraindicated when pregnancy complication occurs as undiagnosed pPROM or known placenta previa



Clothing:

� It should he practical and non-restricting. High heels are avoided to prevent loss of balance and prevent increased lordosis.increased lordosis.



Care of Teeth:

� Pregnancy is not a contraindication for any dental treatment. The concept that pregnancy aggravates dental caries is not true.dental caries is not true.



Breasts:

� Well fitting supporting brassieres are required as breasts become heavy and pendulous.

Crusts or dried secretion over the nipples are � Crusts or dried secretion over the nipples are washed by warm water or boric acid.

� The nipples are drawn for a short time daily by the thumb and fingers and painted with a lubricant starting at the 36th week.



Bowels:

� Bowel habits become irregular due to relaxation of' the bowel smooth muscles and compression of the lower bowel by the pregnant uterus.bowel by the pregnant uterus.

� Hemorrhoids are common.

� Prevention of constipation is by drinking sufficient amounts of fluid, daily exercise, food containing roughage as fruit and salad.

� Strong laxatives and enemas are avoided



Bathing:

� There are no restrictions but the mother should be careful not to slip. Showers are safer.

Douching:Douching:

� Douching is condemned either in pregnant (risk of ascending infection and persistent vaginitis) or non-pregnant (risk of PID and ectopic pregnancy) and just the ordinary vulvar washing with good gentle dryness is recommended



Smoking:

� Should be discontinued during pregnancy.

� More than 10 cigarettes/day can have a pronounced affect on birth weight. Low birth weights, IUGR, affect on birth weight. Low birth weights, IUGR, increased peri-natal deaths and preterm labors are higher in smokers.



Immunization:

� Live attenuated virus vaccines as measles, rubella, mumps, poliomyelitis are contraindicated.

� Inactivated virus vaccines as influenza, and rabies are � Inactivated virus vaccines as influenza, and rabies are safe.

� Inactivated bacterial vaccines as cholera, meningococcus, and typhoid are safe.

� Toxoids as tetanus and diphtheria toxoid are safe.

� Immuneglobulins as for hepatitis, tetanus and rabies can be given whenever needed..



Warning Signs:

� Swelling of the face, fingers and limbs.

� Vaginal bleeding.

� Persistent vomiting.

� Chills and Fever.

Escape of fluid from the � Severe headache.

� Blurring of vision.

� Abdominal pain.

� Escape of fluid from the vagina.

� Preterm labor.

THANK YOU

Documents

Antenatal care warda [compatibility mode]