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PRE-CONCEPTIONALCARE &PRE-CONCEPTIONALCOUNSELLING
GUIDED BY:MRS.VINITHA SURESHMISS SUSHMA
PRESENTED BYDEEPA KUSHWAHADIVYA MATHEW
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INTRODUCTION
Concept of preconceptioncare has evolved over thelast several decadesJ.W. Ballantyne -
originated concept of pre-conception care andcounseling.
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CONTu
Ideally a pregnancy should be by choice and not by chance and by
appointment and not by accident.Preparing for pregnancy is a positivestep towards enhancing pregnancyoutcome and provides prospective
parents with options that may not beavailable once a pregnancy is confirmed.
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DEFINITIONPre-conception counselling (also
called pre-conceptual counselling)
is based on the medical theory thatall women of child-bearing yearsshould be pre-screened for healthand risk potentials before
attempting to become pregnant.Pre-conceptional counselling ispreventive medicine for obstetrics.
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THE VISION OF PRE-
CONCEPTION CARE All pregnancies areplanned
All risks areidentified A comprehensiveplan is available toassist women inmaking healthylifestyle choices topromote a healthypregnancy
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Cont.
A team of physicians, healthcare coordinators, mental health
specialists and nutritionists canguide a woman along thecontinuum
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OBJECTIVE To ensure that a woman enterspregnancy with an optimal state
of health which would be safe bothto herself and the fetus
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GOAL OF PRECONCEPTION
COUNSELLING AND CARETo identify pre-existing conditions
that may affect an anticipated
pregnancyTo Identify processes involving
mother and fetus
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Cont. To Screen for conditions which may
impact fertility, fetal development ormothers ability to adapt to pregnancy
Institute preventative measures beforepregnancy
Educate couples regarding risks of
pregnancy and strategies to minimizethe risks
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COMPONENTS OF
PRECONCEPTION CAREIt begins with attitudes andpractices that value pregnant
women children and families.It encourages women and men toprepare actively for pregnancy.
It focuses on environmentinfluencing the family.
It respects the diversity of peopleslives and experiences.
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ContIt incorporates informed choice.It enables women and men to be as
healthy as possible helping them torecognize actual and potentialproblems.
It attempts to identify parents with
increased genetic risk.It helps to provide them sufficientknowledge about reproductiveoptions.
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STATISTICS
Worldwide maternal mortalityapproximately one million women
annuallyMaternal mortality rate in India
is 460 deaths/1 lakh live birthpopulationOrissa has the highest rate of
MMR i.e. 781/1000 live birthKerala has least 76/1000 live birth
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WHY PRE-CONCEPTION C&C
Increased utilization of prenatalcare, no decrease in MM, LBW.
1stprenatal visit maybe too late Limits of prenatal care recognizede.g.
- Organogenesis begins early. NTclosure- 6 weeks(28 days post
conception) Too late for folic acidbenefit- Placental dev. (7 days post
conception) Poor placental dev.- pre-eclampsia, preterm labor
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PLACE OF PRE-CONCEPTION
CARE WORK PLACE SCHOOL
MEDIA PRIMARY CARE COMMUNITY SETTING
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RISK ASSESSMENT AND
EDUCATIONIdentification of high risk factors forpregnancy.
Counseling for patient with bad
pregnancy history.Risk from the environment.DietFolic acid
Body weightExerciseSmoking
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Cont
Alcohol use Medication review Illicit drug use Cervical screening
Chronic diseases Infections
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IDENTIFICATION OF HIGH
RISK FACTORS FORPREGNANCY A detailed interview should be taken. Basic health status should be
assessed. Immunization should be taken by
women. Fear should be removed by
counseling.
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Cont.
Verify if the women has takenany drug and educateaccordingly.
They should be urged to stopsmoking.Start taking folic acid 4 weeks
prior to conceptions.
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COUNSELING FOR PATIENT
WITH BOH.
Discuss the importance of prenatal diagnosis of chromosomal diseases.
A couple having previous history of
abortion or fetal loss should beconvinced and counseled. Identify-
- existing or emerging illness whichmay have gone undetected before.
- existing risk for the woman whomay become pregnant.
- existing risk which may affect afetus if the woman become pregnant.
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RISK FROM ENVIRONMENT
Consider potential hazards at home or at work place.
Advice to wash hands after gardening or to avoid cleaningcow dung during pregnancy to avoid toxoplasmosis.
Advice the woman to avoid for exposure to any hazardous substances radiation etc. who is planning to become pregnant.
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DIET Advice to take a balanced diet along
with eating five portions of fruits andvegetables per day.(paneer, curd, softcheese).
Consuming dairy products to raisedstores of vitamin, iron and calcium.
Vitamin D should be
included in the diet(10 mcg/day) along
with folic acid and
vitamin C.
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Cont
She should be advised toavoid
- uncooked meat, fish
and eggs.- unpasteurized milk.- soft cheese.
- unwashed fruits andvegetables.- caffeine and heavy
soft drinks.
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FOLIC ACID
All women should takeatleast 400 mcg per
day, if she is planningto become pregnant and for atleast the 1st
three months of
pregnancy to reducethe risk of NTD.
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BODY WEIGHT
Women with overweight should beadviced to lose weight.
Women who are underweight should beadviced to gain weightbefore getting
pregnant. Consultation with the
dietician may behelpful.
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Exercise
Advice the women toexercise regularly.
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ALCOHOL USE
High level of alcohol usecauses fetal alcohol syndrome(FAS).
Advice women to avoidalcohol completely. When a women is
unable to reduce her
alcohol consumption with support in primary care, offer specialist referal.
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MEDICATION REVIEW
Minimize exposure to all drugs including those bought over the
counter. Avoid all herbal preparations
during pregnancy. Advice not to exceed 10,000 IU of
vitA.
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ILLICIT DRUG USE
Avoid coccaine. Opiate use should be avoided.
Effect of Cannabis is harmful for thefetus.
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CERVICAL SCREENING
Encourage the women to go forcervical screening before
pregnancy.
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CHRONIC DISEASES
Women should have theoppurtunity to discuss the risk ofchronic diseases on the pregnancyand make a choice how to optimizetheir health , disease control andmedications prior to conceptions.
Encourage the women to usecontraceptives regularly until theyhave a full review with thespecialist team.
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Cont
Asthma Diabetes
Chronic hypertension Heart diseases Epilepsy
Thyroid diseases Mental health problems
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INFECTIONS
Rubella Viral hepatitis
Varicella TORCHES
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AGE RELATED RISKS
As the maternal age increase therisk for fetal abnormality
increases. E.g. down syndrome. 1 in 1500 risk at 20 years 1 in 270 at 35 years 1 in 100 at 40 years
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PRE-CONCEPTIONAL
COUNSELING
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PRE-CONCEPTIONAL
COUNSELLINGCounseling: It is a process that focuses
on helping a person understand theirissues and make effective decisionsaffecting their life.
Pre conception counseling : it is amethod that is based on the medical
theory that all women of child-bearing years should be pre-screenedfor health and risk potentials beforeattempting to become pregnant.
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Pre conception counseling
includesGeneral CareGenetic Counseling
-Aneuploidy Risk-Steps of counseling
Preconception Assessment,
counseling & support- Specificissues
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GENERAL CARE-:
Identification of high risk factors forpregnancy.Counseling for patient with badpregnancy history.
Risk from the environment.DietFolic acid
Body weightExerciseSmoking
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Cont
Alcohol use Medication review
Illicit drug use Cervical screening Chronic diseases
Infections
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GENETIC COUNSELING
Genetic counseling is theprocess of:
evaluating family history
and medical recordsordering genetic testevaluating the result of thisinvestigation helpingparents understand andreach decisions about whatto do next.
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Cont
CYSTIC FIBROSIS -CaucasiansBETA-THALASSEMIAALPHA-THALASSEMIASICKLE CEL DISEASEDowns Syndrome
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Cont
Offer genetic counseling to at-riskcouples
Testing includes carrier screeningand available antenatal diagnosticmodalities
Review possible options/mayconsider neonatal consultation
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ANEUPLOIDY RISK
Risk of any type of aneuploidyincreases with maternal age
Offer genetics consultation
Important to obtain familypedigree
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Cont
It has three steps -:1) PERSONAL INTERVIEW-: To
gather information aboutfamily, pedigree chart, mode ofinheritence, then initialdiagnosis is confirmed.
2)2ndAPPOINMENT-: Test ofother family members , andclarifies out come.
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Cont
LAST INTERACTIVE PHASE-:After having intervention
option for having child shouldgiven to the proband. If thecouple is not convinced thesecond session is repeated untilthe proband get convinced.
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Preconception Assessment,
Counselling, and Support Social Support Stress
Quality of Relationships Abuse and Violence
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LIMITATIONS OF
PRECONCEPTIONALCOUNSELLING
Lack of public awareness
Late consultations with doctorUnplanned pregnancies
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THE WOMANS ROLE
A woman may need to adjust certainaspects of her health & well beingwhich are in her control. In addition,she may need to discontinue certainherbs or over-the-counter medicationsas recommended by the physician.Many physicians will alsorecommend pre-natal vitamins beforea woman actually conceives in orderto boost her overall health.
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ROLE OF NURSE
Nurses have aresponsibility to involvethemselves in providing
preconception care toindividual women andfamily.
Nurse should work as
advocates to create healthy,supportive communities forwomen and men in thechild bearing age.
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Cont
Nurses should enterinto a collaborativepartnership with the
couples, enablingthem to examine theirown health and itsinfluence on the
health of baby
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Cont
Nurses role is to provide accurateinformation; translate couplesdecision making process; and offerthem and refer them to relevantservices when appropriate.
Community health nurse often work
closely with other communityleaders, including teachers andreligious leaders in the pre-conceptioncounseling and care.
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ROLE OF PRECONCEPTIONAL
COUNSELORS Practitioners providing routine
health maintenance for reproductive-aged women have the best
opportunity to provide preventivecounseling. Gynecologists, internists, familypractitioners, and pediatricians can
do so at annual examination. According to survey conducted on
1995 almost 95% of women reportedatleast
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Cont
One could affect a future pregnancy. These included Medical or
reproductive problem (52%), Family
history of geneticdiseases(50%),Increasing risk ofcontracting HIV(30%), Increased riskof contracting hepatitis B(25%), Druguse(25%), Alcohol use(17%),
Nutritional risk(54%). Basic pre-conceptional advice and
can be provided by primary careprovider.
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Cont
Medical record should be obtainedand reviewed.
Counselors should be knowledgeableabout relevant diseases, priorsurgery, reproductive disorders, or
genetic conditions.
The practitioners who isuncomfortable providing counselingshould refer the women or couple to acounselor with special exercise.
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Conclusion
Thorough history takingComplete physical exam
Necessary consultationsCounselingInstruct on accurate menstrual
history and on contraceptionNecessary laboratory evaluation
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Cont
Adequate preconceptioncounseling can decrease risk ofpregnancy complicationsEducation can lead to healthy
habits and realistic expectationsCan lead to more efficient and less
costly pregnancy care
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Every Woman, Every Time
Preconception health promotion iswellness for life
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Discussions/Questions
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THANK
YOU