PREMARITAL COUNSELING

1. Benha University Hospital, EGYPT
PREMARITAL COUNSELING
Aboubakr Elnashar

2. The concept of premarital counseling is well
recognized in developed countries. However, in
developing countries, PMCC are not yet popular.
Is there a need for premarital counseling
clinics(PMCC)?
Aboubakr Elnashar

3. CONTENTS
I. TARGET POPULATION.
II. MAIN FUNCTIONS.
III. THE PROCEDURE
IV. PREMARITAL SCREENING PROGRAM IN
KSA
Aboubakr Elnashar

4. 1. Couples about to marry.
2. The newly weds.
3. Any individual seeking advise
Aboubakr Elnashar

5. 1. Medical counseling.
2. Genetic counseling.
3. Family planning counseling.
4. Nutritional counseling
5. Sex education
Aboubakr Elnashar

6. 1. MEDICAL COUNSELLING
The aim is diagnosis of diseases
1. Transmitted to the other partner: STD, TB
2. Represent a risk factor during pregnancy:
cardiac disease
chronic renal disease
renal transplantation
Aboubakr Elnashar

7. 3. Affect reproductive function:
Female:
fibroid, genital hypoplasia, anovulation, menstrual
disorders, hirsutism
Male:
undesnded testes, varicocele, azospermia, physical
disability.
Aboubakr Elnashar

8. 2. GENETIC COUNSELLING
Aim:
identify individuals at risk of having a child with genetic
disorder
Aboubakr Elnashar

9. Indications
1. Age > 35:
Down syndrome: 1/2000 at 20 y
1/500 at 40y
1/32 at 45 y.
2. First cousins:
share large groups of identical genes (1/16):
increasing the risk of recessive diseases particularly if
there is family history.
Aboubakr Elnashar

10. 3. Chromosomal abnormality in either partner.
4. Family history of genetic disorders
5. Ehnic groups:
Blacks: Sickle cell anemia.
Mediterranean's: B thalassemia, Glucose 6
phosphate dehydogenase def.
6. Pregnancy loss in those previously married.
Aboubakr Elnashar

11. Steps
1. Establishment of a diagnosis.
2. Estimation of a recurrent risk.
3. Communication of relevant information
4. Provision of long term support.
Aboubakr Elnashar

12. Teratogenic medications:
e.g. Anticonvulsant, antineoplastic,
Oral anticoagulant, isotretinoin
lithium, alcohol, smoking
Effects should be explained.
Aboubakr Elnashar

13. 3. FAMILY PLANNING COUNSELLING
I. Encourage pregnancy
1. > 30 y.
2. A cause of possible impairment of fertility:
fibroid, PCOS, oligomenorrhea, genital hypoplasia.
3. Chronic medical disease which progress with
advancement of age
Aboubakr Elnashar

14. II. Contraception
 Aim
reduction the hazards of:
a. adolescence pregnancy
b. unnecessary resort to induction of abortion
c. birth of unwanted child.
 Explain the hazards of:
a. uncontrolled fertility
b. high risk pregnancy (too early, too many & too
close together)
Aboubakr Elnashar

15. Methods:
a. Natural barrier & chemical:
not good choices.
b. IUCD, injectables & implants:
not suitable.
c. Pills
best choice.
d. Emergency contraception (levonorgestrel)
may be required.
Aboubakr Elnashar

16. 4. Nutritional counseling
 BMI:
preferred indicator of nutritional status
 Eating habits:
fasting, pica, eating disorders, megavitamin
 Preconcetional intake of folic acid
Aboubakr Elnashar

17. 5. SEX EDUCATION
Important
{level of sexual knowledge amongst youth is moderate}.
Aboubakr Elnashar

18. Includes
1. Sensitive sexual sites.
2. Healthy marital relations.
3. Communication skills to
reduce the chance of marital difficulties
increase marital satisfaction.
4. Safe sex & protection against STD.
5. Answers of questions on sexually related issues.
Aboubakr Elnashar

19. Requirements
1. The partners may be counseled separately or
together.
2. The doctor:
.Good knowledge of different aspects of human
reproduction & sexuality.
.Good listening.
.Encourage them to ask questions.
Aboubakr Elnashar

20. A. History
B. Examination
C. Investigations
D. Health education
Aboubakr Elnashar

21. A. History
1. Menstrual.
2. Family.
3. Drug intake
4. Past: STD
Aboubakr Elnashar

22. B. Examination
1. Female:
BMI, SSC, hair distribution, galactorrhea
2. Male:
External genitalia:
undesended testes, varicocele, hydrocele,
hypospadias
Aboubakr Elnashar

23. C. Investigations
I. Routine investigations
Female:
RH typing,
Rubella Ab,
Toxoplasmosis Ab,
Pelvic ultrasonography
Male:
semen analysis
Both:
urine analysis,
CBC,
Bl group,
blood sugar, .
liver function
Aboubakr Elnashar

24. II. Special investigations
1. Hormonal profile:
amenorrhea, oligomenorrhea, galactorhea, PCOS,
hypogonadism.
2. Karyotyping:
at risk cases.
3. Screening for STD:
some cases.
4. Investigations for specific medical diseases:
cardiac ECHO, GTT, kidney function, IVP, CT of skull
in galactorrhea, thyroid function test
Aboubakr Elnashar

25. D. Health education
1.Family planning
2.Nutritional
3.Sex
Aboubakr Elnashar

26. IV. PREMARITAL SCREENING PROGRAM
IN KSA
Genetic disorders and in particular
hemoglobinopathies: sickle cell anemia and
thalassemia are common in Saudi Arabia,
particularly in the Eastern and Southern regions.
2004
Saudi Ministry of Health implemented a mandatory
premarital screening program in order to decrease
the incidence of these genetic disorders in future
generations. This program was named “premarital
medical test”. Aboubakr Elnashar

27. 2008
this test was updated to include mandatory screening
for hepatitis B and C viruses and Human
Immunodeficiency virus (HIV). The new updated
program was given the name of “Program of healthy
marriage”.
By law:
marriage certificate will not be issued unless the test
is performed
Aboubakr Elnashar

28. Where:
Designated Marriage Consultation Centers,
Premarital form:
name, age, gender, national number, address,
and telephone number.
Tests:
CBC
sickle cell test
hemoglobin electrophoresis
screening for HIV, Hepatitis B and C viruses.
Aboubakr Elnashar

29. PREMARITAL SCREENING
Define:
conducting examination for soon-to-be married in
order to identify if there is any injury with
genetic blood diseases: sickle-cell anemia (SCA)
and Thalassemia
some infectious diseases: hepatitis B, C and HIV
How?:
1. Provide medical consultation on the odds of
transmitting these diseases to the other marriage
partner or the children in the future
2. Give options and alternatives before soon-to-be
married with the aim of helping them plan for a
healthy sound family.
Aboubakr Elnashar

30. Objectives
1. Limiting the spread of some genetic blood
diseases: sickle-cell anemia (SCA) and
thalassemia, and some infectious diseases:
hepatitis B, C and AIDS/HIV.
2. Reducing the financial burdens resulting from the
treatment of the injured in terms of the family and
community.
3. Reducing pressure over health institutions and
blood banks.
Aboubakr Elnashar

31. ​
4. Avoiding the social and psychological problems for
families whose children suffer.
5. Making those seeking such an check-up feel at
ease.
6. Disseminating awareness with regard to the
concept of the comprehensive, healthy marriage.
Aboubakr Elnashar

32. Tests:
1. HB electrophoresis
2. Blood Group and RH Factor
3. Semen Examination
4. Random blood Sugar
5. FSH
6. LH
7. Progesterone
8. Toxoplasma (IgM & IgG)
Aboubakr Elnashar

33. Benha University Hospital, EGYPT
Email: elnashar53@hotmail.com
Aboubakr Elnashar