Prenatal care smeniar


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  • Antenatal record:On the first visit to her obstetrician or midwife, the pregnant woman is asked to carry out the antenatal record, which constitutes a medical history and physical examination. On subsequent visits, the gestational age (GA) is rechecked with each visit.Symphysis-fundal height (SFH; in cm) should equal gestational age after 20 weeks of gestation, and the fetal growth should be plotted on a curve during the antenatal visits. The fetus is palpated by the midwife or obstetrician using Leopold maneuver to determine the position of the baby. Blood pressure should also be monitored, and may be up to 140/90 in normal pregnancies. High blood pressure indicates hypertension and possibly pre-eclampsia, if severe swelling (edema) and spilled protein in the urine are also present.Fetal screening is also used to help assess the viability of the fetus, as well as congenital problems. Genetic counseling is often offered for families who may be at an increased risk to have a child with a genetic condition. Amniocentesis at around the 20th week is sometimes done for women 35 or older to check for Down's Syndrome and other chromosome abnormalities in the fetus.Even earlier than amniocentesis is performed, the mother may undergo the triple test, nuchal screening, nasal bone, alpha-fetoprotein screening and Chorionic villus sampling, also to check for disorders such as Down Syndrome. Amniocentesis is a prenatal genetic screening of the fetus, which involves inserting a needle through the mother's abdominal wall and uterine wall, to extract fetal DNA from the amniotic fluid. There is a risk of miscarriage and fetal injury with amniocentesis because it involves penetrating the uterus with the baby still in utero
  • First trimesterComplete blood count (CBC)Blood typeGeneral antibody screen (indirect Coombs test) for HDNRh D negative antenatal patients should receive RhoGam at 28 weeks to prevent Rh disease.Rapid plasma reagent (RPR)[1] which screens for syphilisRubella antibody screenHepatitis B surface antigenGonorrhea and Chlamydia culturePPD for tuberculosisPap smearUrinalysis and cultureHIV screenGroup B Streptococcus screen – will receive IV penicillin or ampicillin (it is much cheaper and has a wider coverage)if positive (if mother is allergic, alternative therapies include IV clindamycin or IV vancomycin)genetic screening for downs syndrome (trisomy 21) and trisomy 18 the national standard in the United States is rapidly evolving away from the AFP-Quad screen for downs syndrome- done typically in the second trimester at 16–18 weeks. The newer integrated screen (formerly called F.A.S.T.E.R for First And Second Trimester Early Results) can be done at 10 plus weeks to 13 plus weeks with an ultrasound of the fetal neck (thick skin is bad) and two chemicals (analytes) Papp-a and bhcg (pregnancy hormone level itself). It gives an accurate risk profile very early. There is a second blood screen at 15 to 20 weeks which refines the risk more accurately. The cost is higher than an "AFP-quad" screen due to the ultrasound and second blood test but it is quoted to have a 93% pick up rate as opposed to 88% for the standard AFP/QS. This is an evolving standard of care in the United States
  • Second trimesterMSAFP/quad. screen (four simultaneous blood tests) (maternal serum alpha-fetoprotein; inhibin; estriol; bhcg or free bhcg) - elevations, low numbers or odd patterns correlate with neural tube defect risk and increased risks of trisomy 18 or trisomy 21Ultrasound either abdominal or trannsvaginal to assess cervix, placenta, fluid and babyAmniocentesis is the national standard for women over 35 or who reach 35 by mid pregnancy or who are at increased risk by family history or prior birth history
  • Third trimester:Hematocrit (if low, mother will receive iron supplementation)Glucose loading test (GLT) - screens for gestational diabetes; if > 140 mg/dL, a glucose tolerance test (GTT) is administered; a fasting glucose > 105 mg/dL suggests gestational diabetes.Most doctors do a sugar load in a drink form of 50 grams of glucose in cola, lime or orange and draw blood an hour later (plus or minus 5 minutes) ; the standard modified criteria have been lowered to 135 since the late 1980s
  • Imaging:Imaging is another important way to monitor a pregnancy. The mother and fetus are also usually imaged in the first trimester of pregnancy. This is done to predict problems with the mother; confirm that a pregnancy is present inside the uterus; estimate the gestational age; determine the number of fetuses and placentae; evaluate for an ectopic pregnancy and first trimester bleeding; and assess for early signs of anomalies.X-rays and computerized tomography (CT) are not used, especially in the first trimester, due to the ionizing radiation, which has teratogenic effects on the fetus. No effects of magnetic resonance imaging (MRI) on the fetus have been demonstrated,[2] but this technique is too expensive for routine observation. Instead, ultrasound is the imaging method of choice in the first trimester and throughout the pregnancy, because it emits no radiation, is portable, and allows for realtime imaging.Ultrasound imaging may be done at any time throughout the pregnancy, but usually happens at the 12th week (dating scan) and the 20th week (detailed scan).A normal gestation would reveal a gestational sac, yolk sac, and fetal pole. The gestational age can be assessed by evaluating the mean gestational sac diameter (MGD) before week 6, and the crown-rump length after week 6. Multiple gestation is evaluated by the number of placentae and amniotic sacs present.
  • Fetal assessments:Ultrasound is routinely used for dating the gestational age of a pregnancy from the size of the fetus, the most accurate dating being in first trimester before the growth of the fetus has been significantly influenced by other factors. Ultrasound is also used for detecting congenital anomalies (or other fetal anomalies) and determining the biophysical profiles (BPP), which are generally easier to detect in the second trimester when the fetal structures are larger and more developed. Specialised ultrasound equipment can also evaluate the blood flow velocity in the umbilical cord, looking to detect a decrease/absence/reversal or diastolic blood flow in the umbilical artery.Other tools used for assessment include:Fetal karyotype can be used for the screening of genetic diseases. This can be obtained via amniocentesis or chorionic villus sampling (CVS)Fetal hematocrit for the assessment of fetal anemia, Rh isoimmunization, or hydrops can be determined by percutaneous umbilical blood sampling (PUBS) which is done by placing a needle through the abdomen into the uterus and taking a portion of the umbilical cord.Fetal lung maturity is associated with how much surfactant the fetus is producing. Reduced production of surfactant indicates decreased lung maturity and is a high risk factor for infant respiratory distress syndrome. Typically a lecithin:sphingomyelin ratio greater than 1.5 is associated with increased lung maturity.Nonstress test (NST) for fetal heart rateOxytocin challenge test
  • Complications and emergencies:The main emergencies include:Ectopic pregnancy is when an embryo implants in the Fallopian tube or (rarely) on the ovary or inside the peritoneal cavity. This may cause massive internal bleeding.Pre-eclampsia is a disease which is defined by a combination of signs and symptoms that are related to maternal hypertension. The cause is unknown, and markers are being sought to predict its development from the earliest stages of pregnancy. Some unknown factors cause vascular damage in the endothelium, causing hypertension. If severe, it progresses to eclampsia, where a convulsions occur, which can be fatal. Preeclamptic patients with the HELLP syndrome show liver failure and Disseminated intravascular coagulation (DIC).Placental abruption where the patient can bleed to death if not managed appropriately.Fetal distress where the fetus is getting compromised in the uterine environment.Shoulder dystocia where one of the fetus' shoulders becomes stuck during vaginal birth, especially in macrosomic babies of diabetic mothers.Uterine rupture can occur during obstructed labor and endangered fetal and maternal life.Prolapsed cord refers to the prolapse of the fetal cord during labor with the risk of fetal suffocation.Obstetrical hemorrhage may be due to a number of factors such as placenta previa, uterine rupture of tears, uterine atony, retained placenta or placental fragments, or bleeding disorders.Puerperal sepsis is a progressed infection of the uterus during or after labor.
  • Prenatal care smeniar

    1. 1. UMM AL-QURA UNIVERSITY<br />College of Medicine<br />Prenatal Care and Identification of Risk<br />Submitted by:<br /><ul><li>Waleed Al-Qurashi
    2. 2. Husam Al-Sohaimi
    3. 3. Ahmed Abeed
    4. 4. Meshary Al-hazmi
    5. 5. Omar Al-Ghamdi
    6. 6. AbdulWaheed Al-Ghamdi</li></ul>To Be Presented to:<br /><ul><li> Associate Professor: Ahmed Malibary
    7. 7. Associate Professor: TimoorKhattab</li></li></ul><li>2<br />Seminar Title:<br />Prenatal Care and Identification of Risk<br />Date & Time :<br />Sunday 25/09/2011 - 11:00 AM to 12:00 PM<br />Place :<br />UMM AL-QURA UNIVERSITY - College of Medicine<br />Submitted by :<br />Waleed Al-QurashiMeshary Al-hazmi<br />Husam Al-Sohaimi Ahmed Abeed<br /> Omar Al-GhamdiAbdulWaheed Al-Ghamdi<br />Index :<br />Case History<br /> Presentation<br /> Researches & Evidences<br />
    8. 8. :: Antenatal Care ::<br />1 - Case History<br />3<br />
    9. 9. 4<br />Salma is a 20 years old pregnant gravida2 para1 at 40 weeks gestational age came to ER in Friday 25-10-1432 complaning of abdominal pain. <br />Case History<br />
    10. 10. 5<br />Present obestatric history:<br />LMP: 14-1-1432 sure preceded by regular periods with no contraception used. The pregnancy test was confirmed at the 6th week , she did not have any antenatal care visit . she did not do any ultrasound imaging .first kick movement felt at 20th week after that she felt fetal movement regularly. She reported no complication during her pregnancy until last night she started to have abdominal pain which is on and off , progressive , sever , last for 2-3 minutes .<br />Case History<br />
    11. 11. 6<br />6<br />Physical exam:<br />- Vital sign: BP105/64 RR:26 PULS:103 TEMP:36C.<br />- In general she was in labor, conscious, well oriented.<br /><ul><li>The abdomen was soft, not tender, normal liquor, the fundal height was 37cm, the uterus was REGULAR NOT TENDER, with one longitudinal fetus, breech , engaged , the back in right side with normal fetal heart.
    12. 12. Past obestatric history:</li></ul>Gravida 2 para1<br />Case History<br />
    13. 13. 7<br />7<br />Gynecological history:<br />Menarch at age of 14 years old with regular menses and that last 4 days with out pain.<br />Medical and surgical history :<br /> No DM, HTN, cardiac disease or any chronic disease . no surgical history.<br />Case History<br />
    14. 14. 8<br />8<br />Allergy and medication:<br /> She is not taking any corticosteroids or broad spectrum antibiotics or any medication. she has no allergy to any medication.<br />Social history:<br /> A nonsmoker Saudi housewive married once for two year living in azizai.<br />She delivered a normal healthy boy by through SVD.<br />The baby's weight is height is head circumference<br />Case History<br />
    15. 15. :: Prenatal Care ::<br />2- Presentation<br />9<br />
    16. 16. Prenatal Care Embraces:<br />10<br /><ul><li> Maternal health care
    17. 17. Evolution of fetal health and development
    18. 18. Disease screening
    19. 19. Analysis the risk for development of complication
    20. 20. Provision of advice and education</li></li></ul><li>Prenatal Care Components:<br />11<br /><ul><li> 2.1 - Antenatal record
    21. 21. 2.2 - First trimester
    22. 22. 2.3 - Second trimester
    23. 23. 2.4 - Third trimester
    24. 24. 2.5 - Imaging
    25. 25. 2.6 - Fetal assessments
    26. 26. 2.7 - Complications and emergencies</li></li></ul><li>2.1 - Antenatal record:<br />12<br /><ul><li> Medical history and physical examination
    27. 27. Gestational age (GA)
    28. 28. Symphysis-fundal height (SFH; in cm)
    29. 29. Leopold maneuver
    30. 30. Blood pressure</li></li></ul><li>2.2 - First trimester:<br />13<br /><ul><li> Complete blood count (CBC)
    31. 31. Blood type
    32. 32. Rapid plasma reagent (RPR)
    33. 33. Rubella antibody screen
    34. 34. Hepatitis B surface antigen
    35. 35. Gonorrhea and Chlamydia culture
    36. 36. PPD
    37. 37. Pap smear
    38. 38. Urinalysis and culture
    39. 39. HIV screen
    40. 40. Group B Streptococcus screen</li></li></ul><li>2.3 - Second trimester:<br />14<br /><ul><li> Maternal serum alpha-fetoprotein screen (MSAFP/quad)
    41. 41. Amniocentesis:</li></ul>triple test, nuchal screening, nasal bone, alpha-fetoprotein Chorionic villus sampling<br />
    42. 42. 2.4 - Third trimester:<br />15<br /><ul><li>Hematocrit
    43. 43. Glucose loading test (GLT)
    44. 44. Glucose tolerance test (GTT)</li></li></ul><li>2.5 - Imaging:<br />16<br /><ul><li> Ultrasound 12th week (dating scan) and the 20th week (detailed scan):</li></ul> Gestational age<br /> Multiple gestation<br /> Ectopic pregnancy <br /> Evaluated of placentae and amniotic sacs<br /><ul><li> X-rays and (CT) (MRI) </li></li></ul><li>2.6 - Fetal assessments:<br />17<br /><ul><li> Fetal karyotype
    45. 45. Biophysical profiles (BPP)
    46. 46. Percutaneous umbilical blood sampling (PUBS)
    47. 47. Nonstress test (NST)
    48. 48. Oxytocin challenge test</li></li></ul><li>2.7 - Complications and emergencies:<br />18<br /><ul><li> Ectopic pregnancy
    49. 49. Pre-eclampsia
    50. 50. Placental abruption
    51. 51. Fetal distress
    52. 52. Shoulder dystocia
    53. 53. Uterine rupture
    54. 54. Prolapsed cord
    55. 55. Obstetrical hemorrhage such as placenta previa, uterine rupture of tears, uterine atony, retained placenta or placental fragments, or bleeding disorders
    56. 56. Puerperal sepsis </li></li></ul><li>:: Prenatal Care ::<br />3- Researches & Evidences<br />19<br />
    57. 57. :: Prenatal Care ::<br />3- Researches & Evidences<br />20<br />Does lowering of antenatal care visit’s well increase the risk of pregnancy?!<br />
    58. 58. 3.1 –<br />3.2 -<br />Who systemic review of randomized controlled trials of routine antenatal care<br />Antenatal care in Saudi Arabia - Lifestyle<br />
    59. 59. Background<br />Methods<br />The main hypothesis was: <br /><ul><li> New Model Vs Standard Model</li></ul>There is a lack of evidence of the content, frequency, and timing of visits in standard antenatal-care programmes.<br />The selected outcomes were:<br /><ul><li> Preeclampsia
    60. 60. Urinary-tract infection
    61. 61. Postpartum anaemia
    62. 62. Maternal mortality
    63. 63. Low birthweight
    64. 64. Women’s satisfaction & cost effectiveness.
    65. 65. Standard Model (14 visits):</li></ul>8-28 weeks every 4 weeks<br />28-36 weeks every 2 weeks<br />36 weeks every 1 weeks<br /><ul><li>New Model:</li></ul>Less than 14 visits (4-8 visit)<br />
    66. 66. Findings<br />Interpretation<br /><ul><li> New-mode visits could be introduced into clinical practice
    67. 67. 7 eligible randomised controlled trials
    68. 68. 57 418 women participated :
    69. 69. 30 799 (new-model)
    70. 70. 26 619 (standard-model)
    71. 71. NO risk to mother or baby
    72. 72. Some degree of dissatisfaction by the mother could be expected
    73. 73. No clinically differential effect in reduced number of visit
    74. 74. Lower costs can be achieved
    75. 75. Mortality were similar
    76. 76. Dissatisfaction with care was observed
    77. 77. The cost of the new model was equal to or less than that of the standard model.</li></li></ul><li>Antenatal care in Saudi Arabia has been improved due to:<br /><ul><li> Good planning and strategy
    78. 78. Provide community education & health Facilities
    79. 79. Participate in international research & trial</li></li></ul><li>Ministry of Health <br />متوسط وفيات الأطفال دون الخامسة لكل ألف مولود حي في المملكة ودول منظمة التنمية والتعاون الأقتصادي والأوروبي (1990 – 2009)<br />مؤشر الوفيات<br />
    80. 80. Ministry of Health <br />Best Time To Get Pregnant <br />Pregnancy Due Date Calculate <br />
    81. 81. Saudi Society of Family and Community Medicine<br />
    82. 82. Mobily Telecom Company<br />
    83. 83. “<br />Thank<br />”<br />You<br />The END<br />