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PRECONCEPTIONAL COUNSELLING A NEED OF THE HOUR in India DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Jyoti Bhaskar

PRECONCEPTIONAL COUNSELLING DEFINITION
Pre-counselling is a meeting with health care professional (generally a doctor or nurse) by the couple before attempting to become pregnant.

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PRECONCEPTIONAL COUNSELLING A NEED OF THE HOUR in India DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Jyoti Bhaskar

  1. 1. PRECONCEPTIONAL COUNSELLING: A NEED OF THE HOUR in India …Caring hearts, healing hands DR. SHARDA JAIN Dr. Jyoti Agarwal Dr. Jyoti Bhaskar
  2. 2. Over 200 ppts are available on slideshare.net ***for use of public/Doctors www.slideshare.net / Lifecarecentre
  3. 3. PRECONCEPTIONAL COUNSELLING DEFINITION Pre-counselling is a meeting with health care professional (generally a doctor or nurse) by the couple before attempting to become pregnant. …Caring hearts, healing hands
  4. 4. As per Centre for Disease Control and Prevention (CDC, 2006) of USA, Pre - Conceptional care is a set of interventions that aim to identify biomedical, behavioural and social risks to a woman’s health or pregnancy outcome through prevention and management. …Caring hearts, healing hands
  5. 5. LIMITATIONS of PRE-CONCEPTIONAL COUNSELLING IN INDIA While preconception Counselling is routine in western countries, they are still in infancy in India. The Indian women usually visit their doctors only when they are already pregnant ignoring the basic concept of pre-conception care & counselling. …Caring hearts, healing hands
  6. 6. OBSTACLES TO PRE CONCEPTIONAL COUNSELLING Globally 38% pregnancies unplanned & unintended. In India the Number crosses over 50% For this reason many gynaecologist recommend that all women of childbearing age be offered preconception care & counselling regardless of intent to become pregnant …Caring hearts, healing hands
  7. 7. OBJECTIVE Objective is to ensure that a woman enters pregnancy with an optimal state of health which would be safe both to herself and the baby. Preconception counselling is a part of preventive medicine. It includes risk assessment and education. It is hoped it becomes done thing in INDIA too. …Caring hearts, healing hands
  8. 8. COMPONENTS & PRECONCEPTIONAL COUNSELLING …Caring hearts, healing hands
  9. 9. Pre – Conceptional Counselling in the United States Recommends the following • Height and weight to calculate BMI • Blood pressure • Medical history • Abdominal and pelvic examination • Rubella screening • Varicella screening • Domestic violence screening • Depression screening • Testing for Gonorrhea and Chlamydia for women at high risk for STDs …Caring hearts, healing hands
  10. 10. PRE-CONCEPTION RISK ASSESSMENT It generally includes a pre-conception risk assessment for any potential complications of pregnancy as well as modifications of risk factors, such as increasing folic acid intake to reduce the risk of neural tube defects and counselling on smoking cessation, alcohol cessation, and alter medications for various medical conditions that may compromise fetal development. …Caring hearts, healing hands
  11. 11. Folic Acid Supplementation Preconception folate supplementation • 0.4mg/day in low risk women, • 5 mg per day in high risk women • Beginning 6 weeks prior to pregnancy & continued up to 3 months of pregnancy reduces neural tube defects. …Caring hearts, healing hands
  12. 12. Routine testing for rubella IgG antibodies & Hepatitis B prior to planning pregnancy is recommended. All susceptible patients should be immunized and advised against attempting pregnancy for subsequent one month. VACCINE AGAINST RUBELLA & HEPATITIS B VIRUS …Caring hearts, healing hands
  13. 13. Examination & Pre – Pregnancy Counselling • Blood Pressure is checked & cardiovascular examination is performed. • To reduce weight in an obese women. • To stop smoking , alcohol & illicit drug use …Caring hearts, healing hands
  14. 14. • To rule out reproductive tract infections including HIV. • To avoid teratogenic drugs . • Fear of pregnancy is removed by education Examination & Pre – Pregnancy Counselling …Caring hearts, healing hands
  15. 15. Use of iodized salt and practice of screening all patients for thyroid disorders is recommended. TSH should be kept below 2.5 in ladies who want to become pregnant. HYPOTHYROIDISM need to be controlled before starting pregnancy EXCLUDE HYPOTHYRODISM …Caring hearts, healing hands
  16. 16. • ↓ Fertility • ↑ Risk of spontaneous abortion • ↑ Risk of Impaired fetal brain development bcz of Hypothyroidism Uncontrolled Hypothyroidism Why Thyroid function assessment?
  17. 17. Pre-existing chronic disease like hypertension, diabetes, epilepsy are stabilized in optimal state by intervention. …Caring hearts, healing hands
  18. 18. Type 2 Diabetes mellitus (T2DM) • Is a common condition that is increasingly diagnosed in younger patients. • End-organ effects, particularly micro-and macro vascular complication during pregnancy may impact both mother and fetus directly and in the longer term. • T2DM is associated with increased perinatal mortality, congenital malformations, preeclampsia, birth trauma, and operative delivery.
  19. 19. DIABETES AND PREGNANCY : ES GUIDELINES PRECONCEPTION COUNSELLING TO ALL DIABETIC WOMEN • Sufficient glycaemic control • Assessment of comorbidities • Discontinuing unsafe medications • Smoking cessation Preconception counselling and active management of women with T2DM has been reported to reduce significantly the risk of major congenital malformations. …Caring hearts, healing hands
  20. 20. PRECONCEPTION CARE OF WOMEN WITH DIABETES Achieve blood glucose and HbA1c close to normal that is 6.5 …Caring hearts, healing hands
  21. 21. Diabetes and Pregnancy : ES Guidelines on Insulin therapy Multiple daily doses of insulin or, Continuous sc insulin infusion Split-dose, premixed insulin therapy 1.More likely to achieve target levels 2.Flexibility vs …Caring hearts, healing hands
  22. 22. PRECONCEPTION CARE OF WOMEN WITH DIABETES FIRST TREAT RETINOPATHY CONCEIVE ONLY WHEN IT IS STABILIZED DETAILED OCULAR ASSESSMENTRETINOPATHY PRESENT PATIENT COUNSELLING FOR RISK OF WORSENING Retinopathy needing therapy OCULAR CARE
  23. 23. ↑ Risk of Adverse outcomes (e.g. preeclampsia) Satisfactory BP Control <130/80 mm Hg Preconceptional Uncontrolled HTN Management of Hypertension
  24. 24. What antihypertensive agent should be used? A Cochrane review of antihypertensive treatment in pregnancy failed to find that any particular drug was superior to any other. Consensus guidelines have been published in the United Kingdom, Canada, United States, Australia, and New Zealand. The three most commonly used antihypertensive drugs used in pregnancy are labetalol, methyldopa, and nifedipine.
  25. 25. SAFER ALTERNATIVES : 1.Methyldopa 2.Labetalol 3. Diltiazem 4.Clonidine 5. Prazosin ACE Inhibitors or Angiotensin- receptor blockers Management of Hypertension
  26. 26. WOMEN WITH HYPERTENSION Women with hypertension on ACE inhibitors should switch on to safer drugs like * Methyldopa, ** Labetalol, etc. Women with systemic lupus erythematosis (SLE) should conceive when in remission
  27. 27. Irreversible worsening Renal dysfunction ↑ Risk of Adverse Maternal & Fetal outcomes (e.g. preeclampsia) Mild Preconceptional Renal dysfunction Mod-Severe Preconceptional Renal dysfunction Reversible worsening PRECONCEPTION CARE OF WOMEN WITH C.K.D RENAL FUNCTION
  28. 28. Anti – Hypertension drugs Medical Review for CKD- a new insight The key drugs are angiotensin – converting enzyme (ACE) inhibitors and angiotensin II receptor blockers, which are widely utilized • to delay progression of CKD, • **minimizing proteinuria • *** treating hypertension , particularly in diabetic nephropathy …Caring hearts, healing hands
  29. 29. THUMB RULE for Anti Hypertensive drugs to be used even in CKD patients when they are planning a pregnancy It is currently recommended that these drugs be stopped in pregnancy , as exposure in the second & third trimester is associated with growth restriction, oligo-hydramnios, renal dysplasia , fetal renal failure death. However ceasing these drugs in pregnancy may lead to loss of their anti- proteinuric effects ACE Inhibitors or Angiotensin- receptor blockers
  30. 30. If vascular risk factors present Screen for CAD before conceiving Elevated Vascular Risk …Caring hearts, healing hands
  31. 31. 1. Dyslipidaemia seldom poses threat during pregnancy 2. Unproven safety of statins, fibrates and niacin during pregnancy DO NOT use Statins DO NOT use Fibrates or Niacin Bile acid-binding resins may be used to treat hypercholesterolemia MANAGEMENT OF DYSLIPIDEMIA
  32. 32. Women should be seizures free for 2 years – than one can stop drugs to decrease chances of congenital malformation or Should be managed on mono therapy& folic acid 5 mg is must for woman on VALPROATE AND CARBAMAZEPINE Epileptic Women …Caring hearts, healing hands
  33. 33. Epileptic women should take high dose of folic acid (5 mg) starting 6 weeks prior to pregnancy • should control their epilepsy by safer drugs (e.g. carbamazepine)..after consulting Neurologist DICTUM for Epileptic Women …Caring hearts, healing hands
  34. 34. In India 90 to 95% have RHEUMATIC HEART DISEASE They have to be assessed well before they are given GO HEAD signal. Should be advised to have DELIVERY in Tertiary care Hospital Women with Cardiac Disease …Caring hearts, healing hands
  35. 35. Who had valve replacement surgery should take heparin in first trimester instead of warfarin, which can cause teratogenicity Women with Cardiac Disease …Caring hearts, healing hands
  36. 36. Couple with history of recurrent pregnancy loss or with family history of congenital abnormality are investigated and counselled properly. …Caring hearts, healing hands RECURRENT PREGNANCY LOSS
  37. 37. Thalassemia, Sickle cell disease are screened before conception and risk of passing the condition to offspring is discussed & also told what to do to find out whether the baby is effected or not . …Caring hearts, healing hands GENETIC counselling for INHERITABLE Disease
  38. 38. Recurrent miscarriage & bad obstetric history: the women should be screened for inherited & acquired Thrombophilia's & anti-phospholipid antibody syndrome & should be started heparin therapy in pregnancy • parental karyotyping for balanced translocation is performed if karyotype of POC is Abnormal Recurrent Miscarriage
  39. 39. Uterine septum should be resected hysteroscopically prior to conception. The counselling should be done by the obstetrician genetic depending upon the condition ‘Not all cases require SURGERY UTERINE SEPTUM
  40. 40. Pre- Conceptional Care is very crucial during which detailed obstetric history, past medical or surgical history & family history plus systemic examination, evaluation & supervision of many disease & counselling is done. It is wishful thinking that it becomes routine in India. …Caring hearts, healing hands TAKE HOME MESSAGE
  41. 41. ADDRESS 11 Gagan Vihar, Near Karkari Morh Flyover, Delhi - 51 CONTACT US 9650588339 9599044257 011-22414049 WEBSITE : www.lifecareivf.in www.lifecarecentre.in www.lifecareabs.in ISO 14001:2004 (EMS) …..Caring hearts, healing hands ISO 9001:2008 Helpline : 9599044257 Web.www.lifecareivf.in Helpline : 9910081484

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PRECONCEPTIONAL COUNSELLING DEFINITION Pre-counselling is a meeting with health care professional (generally a doctor or nurse) by the couple before attempting to become pregnant.

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