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Prenatal care

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Prenatal care Dr Nawal Al Sinani – PowerPoint PPT presentation

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Title: Prenatal care


1
Prenatal care
  • Dr Nawal Al Sinani

2
Objective
  • To assure that each pregnancy ended by delivery
    of a healthy baby without impairing the health of
    the mother

3
Significance
  • Appropriate antepartum care has proven of great
    value in prevention of catastrophes such as
  • Preeclamptic fetes .
  • Pylonephritis
  • Macrocosmic baby
  • IUFD

4
General health care
  • Systemic health care before pregnancy prove quite
    beneficial to the mother and her child .
  • E.g. IDDM has to have strict blood sugar control
    at least 3months before pregnancy
  • supplement of folic acid to the mother with h/o
    NTD should be started before conception .

5
Terminology
  • Nulligravida women who is not now never has
    been pregnant
  • Gravida who is pregnant now
  • Primigravida
  • Multigravida
  • Nullipara how has never completed pregnancy
    beyond an abortion

6
  • Primipara how has been delivered once of the
    fetus how reached the stage of viability
  • Multipara who completed two or mre pregnancy to
    stage of viability
  • Parturicnt is a woman in labor
  • A puerpera is a woman has just given birth

7
Normal duration of pregnancy
  • Mean duration of pregnancy calculated from the
    1st day of last normal menstrual period (LMP)
  • 280 days or 40 weeks

8
How to calculate EDD
  • Expected Day of Delivery
  • Add 7 days to the date of 1st day of LMP
  • Counting back 3 months
  • Ex LMP 10 September
  • EDD 17 Jun

9
What is trimesters
  • Pregnancy divided into 3 equal parts
  • Each trimester 13 weeks or 3 calender months
  • 1st trimester most of the abortion
  • 3rd trimester pregnancy induced
    hypertension

10
Initial care
  • Prenatal care should be initiated as soon as
    likely hood of pregnancy
  • Goals
  • To define the health status of the mother fetus
  • To determine the gestational age
  • To initiate a plan for continuing obstetric care

11
History
  • Menstrual history (regularity ,pill, lactating)
  • Current health problem
  • Previous major illness
  • Previous pregnancies
  • Medication
  • Allergy
  • Family history

12
Examination
  • General
  • Signs of medical disease (anemia,hyperthyroidism)
  • Teeth
  • Vital sign
  • Breast

13
Examination
  • Abdomen
  • Fubdal height
  • If uterus gt date
  • ?wrong date
  • ?multiple gestation
  • ?polyhydramenous
  • ?macrocosmic baby
  • ?fibroid
  • If uterus lt date
  • ?Wrong date
  • ?IUGR
  • ?oligohyramenous

14
Examination
  • Lower limps
  • Genital examination

15
Investigation
  • CBC
  • Blood Group
  • Serology
  • Hepatitis
  • Rubella
  • VDR(TPHA)
  • Toxo
  • HIV
  • Urine

16
Categorization of pregnancy
  • High risk
  • Low risk
  • Further instruction
  • (bleeding , edema , headache , vomiting, abd pain
    , fever , disuria , escape fluid from the vagina
    , fetal movement )

17
Subsequent prenatal care
  • Return visit
  • Each 4 weeks throw out the first 7 months
  • Each 2 weeks till 9th month
  • Weekly
  • Each visit
  • Calculate the gestational age
  • Review lab result
  • Check blood pressure
  • Weight
  • Urinary protein
  • Fundal height
  • Fetal heart

18
Nutrition
  • Wight gain 9-12 kg
  • Birth weight parallel to maternal weight gain

19
Recommended dietary allowances
  • Calories Increase by 300 K cal. above the non
    pregnant
  • Protein Increase by 30g /day
  • Minerals Pt require 7mg/day
  • Calcium Increase by 400mg above the normal
  • Zinc
  • Iodine

20
Vitamin
  • Folic acid
  • Protection from
  • NTD
  • Abruptio placenta
  • ? Toximia of pregnancy
  • B complex
  • Daily requirement 2.6 mg /day
  • Vitamin C
  • Daily 80 mg /day

21
General
  • Exercise
  • Must be limited in patient with
  • Pregnancy induced hypertension
  • Multiple pregnancy
  • IUGR
  • Employment
  • Heavy work in 3rd trimester can affect birth
    weigh
  • Travel
  • allowed in non complicated pregnancy

22
  • Coitus
  • To be avoided in threaten abortion and premature
    labor
  • Smoking Lead to
  • prenatal death
  • Small for date
  • Anti partum hemorrhage
  • Premature labor
  • Alcohol ? fetal mal formation
  • Medication Advantage to be gained clearly out
    weight any risk inherent in it use

23
Immunization
  • There has been some concern over the safety of
    various immunization during pregnancy
  • Cholera only in traveling to endemic area
  • Hepatitis A-B better to avoid it
  • Influenza evolution of immunity status
    according to criteria applied to others
  • Measles contra indicated (live virus)
  • Mumps contra indicated (live virus)
  • Poliomyelitis not recommended but mandatory in
    epidimic or traveling to endemic area
  • Rabies same as non pregnant
  • Tetanus toxoid can be given
  • Yellow fever not recommended but mandatory in
    epidimic or traveling to endemic area

24
Common complaints during pregnancy
  • Nausea vomiting
  • Pica
  • Backache
  • Varicosities
  • Hemorrhoids
  • Heart burn
  • Ptyalism (profuse salivation )
  • Fatigue
  • Headache
  • Candida

25
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