Antenatal care warda [compatibility mode]

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  • 1. ByOsama M. Warda MDOsama M. Warda MDProfessor of OB/GYNMansoura UniversityThursday, May 09, 2013 O Warda
  • 2. DefinitionAntenatal care is the program ofpreventive obstetrics in whichregular visits are used to detect andregular visits are used to detect andmanage any health problems andcomplications during pregnancy.Thursday, May 09, 2013 O Warda
  • 3. The Objectives of Prenatal CareHealthy baby & healthy mother.Promotion of medical, physical & mentalhealth .Avoid and treat medical or obstetricconditions that are dangerous to the motheror fetus.Ensure adequate dietary intake .Instructions for the hygiene of pregnancy.Preparation for breast feeding.Thursday, May 09, 2013 O Warda
  • 4. 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 laborThursday, May 09, 2013 O Warda
  • 5. Preconception careShould be an integral part ofprenatal care because healthprenatal care because healthduring pregnancy depends onhealth before pregnancy.Thursday, May 09, 2013 O Warda
  • 6. Frequency of VisitsDuring 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 isincreased according to circumstances.Thursday, May 09, 2013 O Warda
  • 7. 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 andfetus.4. Initiate a plan for continued care untildelivery.Thursday, May 09, 2013 O Warda
  • 8. The Initial Visit; componentsA. 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 thepathologicpathologicpathologicpathologic changes that may develop duringpregnancy.Thursday, May 09, 2013 O Warda
  • 9. 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 athigh risk for preterm labor (Hx)high risk for preterm labor (Hx)No treatment for increased vaginal discharge unlessdiagnosis of specific infection is madec. Cervix:Pap. smear and culture for gonorrhea routinely inareas where sexually transmitted diseases (STD) areprevalent.Clamydia culture performed in high risk population.Thursday, May 09, 2013 O Warda
  • 10. 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 ifneededHBV surface antigen and test for syphilis.Rubella titer.Other investigation according to the case.Thursday, May 09, 2013 O Warda
  • 11. 2. Specialized screening tests :HIV infection for high risk group.HB electrophoresis.Urine or blood toxicology screen.Only when indicatedThursday, May 09, 2013 O Warda
  • 12. 3. Mid trimester screening tests:Maternal serum Alfa-fetoprotein (AFP)between 16-18 weeks. NTD1 hour glucose screening between 24 & 28weeks. Value equal to or greater than 140mg/dl is evaluated by 3 hours oral glucosetolerance.Thursday, May 09, 2013 O Warda
  • 13. Repeated testsHb% and Hct 26 to 30 weeks.Serology of syphilis at 28 to 32 weeks forhigh risk group.Antibody screen in Rh-ve women betweenAntibody screen in Rh-ve women between28-30 weeks and(Rh D Ig) is administered ifneeded.3rd trimester screening for gonorrhea andchlamydia is recommended in high riskgroup.Thursday, May 09, 2013 O Warda
  • 14. Risk FactorsPre-existing medical disease.Previous pregnancy complications:Perinatal mortality, prematrity, IUGR,congenital fetal malformation and obstetric hge.Evidence of poor nutrition.Thursday, May 09, 2013 O Warda
  • 15. Risk FactorsGenetic counseling is indicated in thefollowing conditionsMaternal age >35 years at the time ofbirth.birth.Family history of congenital anomaliesor inherited disorders.Abnormal development or mentalretardation of previous child.Exposure to teratogens.Habitual 1ST trimester abortionThursday, May 09, 2013 O Warda
  • 16. Education of the Pregnant Mother1. DIET:A. Calories:The requirements increase from 2200 toThe requirements increase from 2200 to2500 Kilocalories (Kcal). The additionalenergy required is more than 300 Kcalbut is reduced by reduced physicalactivity.Thursday, May 09, 2013 O Warda
  • 17. Education of the Pregnant Mother-DIET-B. Proteins:Increased protein demands are needed for fetal,uterine, placental and breast growth and increasedblood volume.blood volume.During the last 6 months of pregnancy 1 kg of proteinis deposited amounting to 5-6 grams per day.The majority is required as animal proteins (meat,milk, eggs). Milk is the ideal source. Lactoseintolerance can be prevented by eating yoghurt andcheese.Thursday, May 09, 2013 O Warda
  • 18. Education of the Pregnant MotherC. Fats and Carbohydrates:Fried food, cream, sweets, chocolates andsugar should be consumed sensibly to avoidexcess weight gain.excess weight gain.Jams, cakes, pastries, biscuits and largequantities of bread and potatoes should alsobe restricted.Thursday, May 09, 2013 O Warda
  • 19. Education of the Pregnant MotherD. Vitamins and Minerals:Iron is the only nutrient for which requirementsare not met by diet alone.Daily requirement is 30-60 mg of which only 30%are absorbed. Daily elemental iron requirement isare absorbed. Daily elemental iron requirement is7mg.Total requirement allover pregnancy is 1GRAM.Iron should NOT be prescribed before 14th weekThursday, May 09, 2013 O Warda
  • 20. Education of the Pregnant MotherD. Vitamins and Minerals:Calcium: Two glasses of milk every day aresufficient.Multivitamin routine prescription is notMultivitamin routine prescription is notrecommended. Balanced diet is sufficient.Sodium: Salting food to taste givessufficient salt.Iodine: Deficiency may lead to congenitalgoiter and maternal goiter.Thursday, May 09, 2013 O Warda
  • 21. Education of the Pregnant MotherD. Vitamins and Minerals:Vitamin A: Daily requirement in pregnancyis 5000 I.U. over-dosage is teratogenicVitamin B6: Deficiency may causevomiting. It is only found in animal proteinsvomiting. It is only found in animal proteinsFolic acid: About 1 mg provides veryeffective prophylaxis against megaloblasticanemia. Folic acid supplementation beforepregnancy significantly reduces the risk ofneural tube defects (NTD).Thursday, May 09, 2013 O Warda
  • 22. Education of the Pregnant MotherE. Coffee and Tea:There is no association with birth defects orlow birth weight but excess consumption canincrease irritability and disturb sleep. Caffeineincrease irritability and disturb sleep. Caffeinepresent in coffee, tea and chocolate reducesiron absorption.Thursday, May 09, 2013 O Warda
  • 23. Education of the Pregnant MotherF. General dietary instructions1. Advise mothers to eat what she wants in theamounts she desires and salted to taste.2. Ensure she is gaining ample weight. Weight gainduring pregnancy: About 12 kg.during pregnancy: About 12 kg.Recommended Daily DietProtein: 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 fruitsThursday, May 09, 2013 O Warda
  • 24. Sleep:Adequate rest of about 8 hours at night and 2 hours inthe afternoon is recommended.Exercise:Exercise:Regular exercise improves metabolic deficiency.Exercise does not increase the rate of spontaneousabortion, it shortens active labor and is associated withfewer C.S.Exercise is avoided in women with twin pregnancies,pregnancy-induced hypertension, growth restrictedfetuses and severe heart and lung diseases.Thursday, May 09, 2013 O Warda
  • 25. Education of the Pregnant MotherWork:Birth weights of women who work during the thirdtrimester are 150-400 gm less than those who do notwork.work.Standing was also associated with increase in pretermbirths. Any occupation that causes severe physicalstrain 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
  • 26. Education of the Pregnant MotherTraveling:This has no harmful effect. Air travel is also safe but inlong trips of more than 6 hours the woman shouldwalk about every 2 hours to prevent deep venouswalk about every 2 hours to prevent deep venousthrombosis. The greatest risk is to travel away fromproper medical facilities.Thursday, May 09, 2013 O Warda
  • 27. Education of the Pregnant MotherCoitus:There is no restriction for the patientwithout complication. It is contraindicatedwithout complication. It is contraindicatedwhen pregnancy complication occurs asundiagnosed pPROM or known placentapreviaThursday, May 09, 2013 O Warda
  • 28. Education of the Pregnant MotherClothing:It should he practical and non-restricting. High heelsare avoided to prevent loss of balance and preventincreased lordosis.increased lordosis.Thursday, May 09, 2013 O Warda
  • 29. Education of the Pregnant MotherCare of Teeth:Pregnancy is not a contraindication for any dentaltreatment. The concept that pregnancy aggravatesdental caries is not true.dental caries is not true.Thursday, May 09, 2013 O Warda
  • 30. Education of the Pregnant MotherBreasts:Well fitting supporting brassieres are required asbreasts become heavy and pendulous.Crusts or dried secretion over the nipples areCrusts or dried secretion over the nipples arewashed by warm water or boric acid.The nipples are drawn for a short time daily by thethumb and fingers and painted with a lubricantstarting at the 36th week.Thursday, May 09, 2013 O Warda
  • 31. Education of the Pregnant MotherBowels:Bowel habits become irregular due to relaxation of thebowel smooth muscles and compression of the lowerbowel by the pregnant uterus.bowel by the pregnant uterus.Hemorrhoids are common.Prevention of constipation is by drinking sufficientamounts of fluid, daily exercise, food containingroughage as fruit and salad.Strong laxatives and enemas are avoidedThursday, May 09, 2013 O Warda
  • 32. Education of the Pregnant MotherBathing:There are no restrictions but the mother should becareful not to slip. Showers are safer.Douching:Douching:Douching is condemned either in pregnant (risk ofascending infection and persistent vaginitis) or non-pregnant (risk of PID and ectopic pregnancy) and justthe ordinary vulvar washing with good gentle drynessis recommendedThursday, May 09, 2013 O Warda
  • 33. Education of the Pregnant MotherSmoking:Should be discontinued during pregnancy.More than 10 cigarettes/day can have a pronouncedaffect on birth weight. Low birth weights, IUGR,affect on birth weight. Low birth weights, IUGR,increased peri-natal deaths and preterm labors arehigher in smokers.Thursday, May 09, 2013 O Warda
  • 34. Education of the Pregnant MotherImmunization:Live attenuated virus vaccines as measles, rubella,mumps, poliomyelitis are contraindicated.Inactivated virus vaccines as influenza, and rabies areInactivated virus vaccines as influenza, and rabies aresafe.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 canbe given whenever needed..Thursday, May 09, 2013 O Warda
  • 35. Education of the Pregnant MotherWarning Signs:Swelling of the face, fingersand limbs.Vaginal bleeding.Persistent vomiting.Chills and Fever.Escape of fluid from theSevere headache.Blurring of vision.Abdominal pain.Escape of fluid from thevagina.Preterm labor.
  • 36. THANK YOU