2. INITIAL PRENATAL EVALUATION
• GOALS:
1) Define the health status of the mother and
fetus
2) Estimate the gestational age
3) Initiate a plan for continuing obstetrical
care
3. PREGNANCY DURATION
• The mean duration of pregnancy calculated
from the first day of the last normal
menstrual period is very close to 280 days
or 40 weeks
• EDD = adding 7 days to the date of the first
day of the last normal menstrual period and
counting back 3 months—Naegele rule
5. PREVIOUS AND CURRENT HEALTH
STATUS
• Past Medical History
• Menstrual history
• Psychosocial Screening
• Smoking cessation
• Alcohol
• Illicit Drugs
• Intimate Partner Violence
6. SMOKING
• Twofold risk of placenta previa, placental
abruption and premature membrane
rupture compared with nonsmokers
• Neonates born to women who smoke are
more likely to be preterm and have lower
birthweights than infants born to
nonsmokers
7. ALCOHOL
• Ethyl alcohol or ethanol is a potent
teratogen that causes a fetal syndrome
characterized by growth restriction, facial
abnormalities, and central nervous system
dysfunction
8. ILLICIT DRUG USE
• Include heroin and other opiates, cocaine,
amphetamines, barbiturates and marijuana
• Well-documented sequelae include fetal-
growth restriction, low birthweight and drug
withdrawal soon after birth
10. CLINICAL EVALUATION
• Thorough general physical examination should
be completed at the initial prenatal encounter
• Pelvic examination
• Pap smear
• Specimens for identification of Chlamydia
trachomatis and Neisseria gonorrhoeae are also
obtained when indicated
12. PRENATAL VISITS
• 4-week intervals until 28 weeks,
• then every 2 weeks until 36 weeks,
• then weekly thereafter
• Women with complicated pregnancies
often require return visits at 1 to 2 week
intervals.
13. PRENATAL SURVEILLANCE
• Each return visit
- the well-being of mother and fetus are
assessed
- Fetal heart rate, growth, amnionic fluid
volume, and activity are evaluated
• - Maternal blood pressure, weight and
their extent of change are assessed
14. PRENATAL SURVEILLANCE
• Danger Signs in Pregnancy
- severe or persistent headache
- altered/disturbed vision
- abdominal pain
- severe nausea and vomiting
- bleeding/ vaginal fluid leakage
- decline on baby’s activity level
17. FOLIC ACID
• Daily intake of 400 μg throughout the
periconceptional period
• 4 mg folic acid supplements the month
before conception and during the first
trimester if with previous child with NTD
(reduce 2-5% recurrence risk by 70%)
18. PROTEIN
• Second half of pregnancy, approximately
1000 g of protein are deposited, amounting
to 5 to 6 g/day
• Sources: Meat, milk, eggs, cheese, poultry,
and fish
19. IRON
• 300 mg of transferred to the fetus and
placenta
• 500 mg incorporated into the expanding
maternal hemoglobin mass
• Requirements imposed by pregnancy and
maternal excretion total approximately
27 mg of elemental iron supplement daily
20. IODINE AND ZINC
IODINE
• recommended daily allowance is 220 μg
ZINC
• recommended daily allowance is 12
mg/day
21. CALCIUM
• In one recent metaanalysis, Patrelli and
coworkers (2012) reported that increased
calcium intake lowered the risk for
preeclampsia in high-risk women
• In aggregate, most of these trials have
shown that unless women are calcium
deficient, supplementation has no salutary
effects (Staff, 2014)
22. OTHER MINERALS AND VITAMINS
• Magnesium
• Trace metals (Copper, selenium, chromium,
and manganese)
• Potassium
• Fluoride
• Vitamins A, B6, B12, C
• Vitamin D- 15 μg per day or 600 IU per day
24. EXERCISE
• Regular, moderate-intensity physical
activity for 30 minutes or more
• Refrain from activities with a high risk of
falling or abdominal trauma
25. EMPLOYMENT
• Physically-demanding work: 20 to 60% increase in
rates of preterm birth, fetal-growth restriction or
gestational hypertension
• Work is associated with fivefold risk of preeclampsia
• Occupational fatigue—estimated by the number of
hours standing, intensity of physical and mental
demands, and environmental stressors—was
associated with an increased risk of PPROM
26. AIR TRAVEL
• Pregnant women can safely fly up to 36
weeks
• Include seatbelt use while seated and
periodic lower extremity movement and at
least hourly ambulation to lower venous
thrombo-embolism risks
27. COITUS
• AVOIDED if with threat of abortion,
placenta previa, or preterm labor
28. DENTAL CARE
• Dental evaluation should be included in
prenatal care
• Periodontal disease has been linked to
preterm labor
• Pregnancy is not a contraindication to
dental treatment including dental
radiographs
29. IMMUNIZATION
• One dose of Tdap be given to women during
each pregnancy, optimally between 27 and
36 weeks (CDC, ACOG)
- 3 doses of Td should be received by
pregnant patient 1 month apart. 3rd dose
can be given postpartum
30. CAFFEINE INTAKE
• Moderate consumption of caffeine—less
than 200 mg per day—does not appear to
be associated with miscarriage or preterm
birth, but that the relationship between
caffeine consumption and fetal-growth
restriction remains unsettled (ACOG)
• Recommendation: Less than 300 mg daily,
or approximately three 5-oz cups
31. NAUSEA AND VOMITING
• Eating small meals at more frequent
intervals but stopping short of satiation is
valuable
32. BACKACHE
• Reported by nearly 70% of pregnant women
• Reduced by squatting rather than bending
when reaching down, by using a pillow
back support when sitting, and by avoiding
high-heeled shoes.
33. VARICOSITIES
• Venous leg varicosities have a congenital
predisposition and accrue with advancing
age
• Treatment is generally limited to periodic
rest with leg elevation, elastic stockings, or
both
34. HEMORRHOIDS
• Hemorrhoids: rectal vein varicosities, may
first appear during pregnancy as pelvic
venous pressures increase
• Pain and swelling usually are relieved by
topically applied anesthetics, warm soaks,
and stool-softening agents
35. HEARTBURN
• Upward displacement and compression of
the stomach by the uterus, combined with
relaxation of the lower esophageal sphincter
• May give Aluminum hydroxide, magnesium
trisilicate, or magnesium hydroxide alone or
in combination
36. SLEEPING AND FATIGUE
• Soporific effect of progesterone
• Sleep efficiency appears to progressively
diminish as pregnancy advances
• Daytime naps and mild sedatives at
bedtime such as diphenhydramine
(Benadryl) can be helpful
37. LEUKORRHEA
• Increased mucus secretion by cervical
glands in response to hyper-estrogenemia is
undoubtedly a contributing factor
• Rule out vulvovaginal infection
PSYCHOSOCIAL SCREEN: American Academy of Pediatrics and the American College
of Obstetricians and Gynecologists (2012) define psychosocial
issues as nonbiomedical factors that affect mental and physical
well-beinG; barriers to care, communication obstacles, nutritional status,
unstable housing, desire for pregnancy, safety concerns that
include intimate partner violence, depression, stress, and use
of substances such as tobacco, alcohol, and illicit drugs. This
screening should be performed on a regular basis, at least once
per trimester, to identify important issues and reduce adverse
pregnancy outcomes
