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Antenatal care

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  • 1. Antenatal Care
    www.freelivedoctor.com
  • 2. Objectives
    * Prevention, early detection and treatment of pregnancy
    related complications as pre-eclampsia, eclampsia and haemorrhage.
    * Prevention, early detection and treatment of medical disorders as anaemia and diabetes.
    * Detection of malpresentations, malpositions and disproportion that may influence the decision of labour.
    * Instruct the pregnant woman about hygiene, diet and warning symptoms.
    * Laboratory studies of parameters may affect the foetus as blood group, Rh typing, toxoplasmosis and syphilis.
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  • 3. Frequency of antenatal visits
    >Every month during the first 6 months.
    >Every 2 weeks during the 7th and 8th months.
    >Every week during the last month.
    >More frequent visits are indicated in high risk pregnancy.
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  • 4. The first visit
    * History.
    * Examination: general, abdominal and local.
    * Laboratory investigations:
    o Blood grouping.
    o Rh typing.
    o Haemoglobin.
    o Toxoplasma and / or VDRL if needed.
    o Urine analysis particularly for albumin and sugar.
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  • 5. Return visits
    History: ask the patient about any complaint.
    Examination:
    o Blood pressure.
    o Weight.
    o Oedema.
    o Abdominal examination.
    Investigation: urine for albumin and sugar.
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  • 6. INSTRUCTIONS TO THE PREGNANT WOMAN
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  • 7. Diet
    The daily requirements are:
    * Calories: 2500 Kcal.
    * Proteins: 60 gm.
    * Carbohydrates: 200- 400 gm.
    * Lipids: should be restricted.
    * Vitamins:
    o Vitamin A: 5000 IU.
    o Vitamin B1 (Thiamine): 1mg.
    o Vitamin B2 (Riboflavin): 1.5 mg.
    o Nicotinic acid: 15mg.
    o Ascorbic acid (vit. C): 50mg.
    o Vitamin D: 400 IU.
    o Folic acid: 0.5 mg.
    * Minerals:
    o Iron: 15 mg.
    o Calcium: 1000 mg.
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  • 8. So the suggested daily diet should include:
    * One litre of milk or its derivatives,
    * 1-2 eggs,
    * fresh vegetables and fruits.
    * 2 pieces of red meat replaced once weekly by sea fish and once by calf ’s liver.
    * Cereals and bread are recommended also.
    Coffee and tea: should be restricted.
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  • 9. Smoking: should be avoided as it may cause intrauterine growth retardation or premature labour.
    Rest and sleep: 2 hours in the midday and 8 hours at night.
    Exercises: violent exercises as diving and water sports should be avoided. House work short of fatigue and walking are encouraged.
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  • 10. Clothing
    * Lighter and looser clothes of non synthetic materials are more comfortable due to increased BMR and sweating.
    * Clothes which hang from the shoulders are more comfortable than that requiring waste bands.
    *Breast support is required.
    * Avoid tight elastic hosiery or its bands.
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  • 11. Bathing: Shower bathing is preferable than tube or sea bathing for fear of ascending infection. Vaginal douching should be avoided.
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  • 12. Shoes: High - heeled shoes should be discouraged as they increase lumbar lordosis, back strain and risk of falling.
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  • 13. Breasts: to reduce the incidence of retracted and/ or cracked nipples postpartum, the patient is instructed to massage them with a mixture of glycerine and alcohol during the last 6 weeks of pregnancy.
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  • 14. Bowels: Constipation is avoided by increasing vegetables, fluids and milk intake and mild exercise. Liquid paraffin should not be used for long period as it interferes with absorption of fat- soluble vitamins (A and D).
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  • 15. Coitus: Whenever abortion or preterm labour is a threat, coitus should be avoided. Otherwise, it is allowed with less frequency and violence. Some obstetricians advise abstinence in the last 4 weeksof pregnancy for fear of ascending infection.
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  • 16. Travelling: long and tiring journeys should be avoided particularly ifthe woman is prone to abortion or preterm labour. Flying is not contraindicated but not the long ones and near term.
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  • 17. Medications: not to be taken without obstetrician advice due to risk of teratogenicity
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  • 18. Exposure to infections: is to be avoided particularly those of documented teratogenicity e.g. rubella, cytomegalovirus, herpes hominis and varicella zoster viruses.
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  • 19. Exposure to irradiation: is to be avoided whether diagnostic or therapeutic.
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  • 20. The warning symptoms: which indicate immediate contact to the obstetrician are:
    * vaginal bleeding,
    * gush of fluid per vagina,
    * abdominal pain,
    * persistent headache,
    * blurring of vision,
    * oedema of lower limbs or face,
    * persistent vomiting.
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