preventive obstetric

1. Preventive And Social
Obstetrics
Dr. Ghanshyam Patel
M.D Gynec

2. Latestupdateswithreferenceto:
1. Investigations
2. Clinical examination
3. Non therapeutic mx.
4. Developmental anomaly

3. Social obstetrics
• It is a branch of preventive medicine
• Relation between social and environmental
factors and human reproduction, even in
preconception and premarital period

4.  Social factors
 Age at marriage
 Age at child bearing
 Birth spacing
 Family size
 Fertility pattern
 Level of education
 Economic status
 Role of woman in society

5. Investigations
• UPT
• β-Hcg
• CBC
• BG
• HIV
• Serum creatinine ,
• PT , APTT
• LFT
• HBSAG
• VDRL
• RBS
• URINE-routine and micro
• TSH
• OPTIONAL-Vit. D ,Vit. B12

6.  Clinical examination
history
symptoms
signs

7.  TVS
 TAS
 3D USG AND COLOR DOPPLER
 STUDY
 MRI

8. NON THERAPEUTIC MX.
1. Adolescent health screening
2. Premarital counselling
3. Preconception counselling
4. Good ANC
5. Birth spacing

9. Social factor
1. Age at marriage
2. Age at pregnancy
3. Women empowerment
4. Women education
5. Population Control

10. Anomalies
Past history
Exposure to drug , X’ ray etc.
How to look for it
Chorion villus biopsy,
Amniocentesis
Triple test
Quadruple test
Targeted sonography
3D USG
Cordocentesis

19. The recent development of high-resolution ultrasound equipment has
markedly improved the diagnostic accuracy of ultrasound. In particular
, the introduction of high-frequency vaginal probes has enabled early
diagnosis of certain fetal abnormalities from the 12th to 14th week of
pregnancy. Such early testing is of special importance for women with
a history of pregnancies associated with birth defects

20. • 4D USG detects all structural anomalies while color Doppler detects
• outrightly vascular problems, and both can be done in one sitting
• . For down syndrome nuchal translucence, long bone length, major
• structural defect are to be looked for.

21. • anencephaly
• open spina bifida
• cleft lip
• diaphragmatic hernia
• gastrochisis
• exomphalos
• serious cardiac abnormalities
• bilateral renal agenesis
• lethal skeletal dysplasia
• Edwards' syndrome, or T18
• Patau's syndrome, or T13

22. Frequent or Occasional Features
Syndromes
Meckel-Gruber Encephalocele, cleft palate, polycystic kidney,
polydactyly, IUGR (A/R)
Dubowitz IUGR, hypertelorism, olinodactyly of fifth finger
(A/R)
Robert IUGR, cleft lip, hypertelorism, hypomelia, CHD,
polycystic kidneys, polyhydramnios, hydrocephalus
(A/R)
Seckel IUGR, facial hypoplasia with prominent nose (A/R)
De Lange IUGR, micrognathia, micromelia, CHD, sporadic
etiology
Coffin-Siris IUGR, CHD, Dandy-Walker anomaly, hypoplastic fifth
finger (unknown etiology)
Bloom IUGR A/R

23. Chromosomal Deviations
Trisomy 13 Holoprosencephaly, hydronephrosis, polycystic kidneys,
IUGR, single umbilical artery, CHD
Trisomy 18 Polyhydramnios, hydronephrosis, polycystic kidneys, IUGR,
single umbilical artery, CHD, omphalocele, choroid plexus
cysts
VATER associations Esophageal atresia, radial hypoplasia, renal dysplasia
Del (4p) and Del (5p) Hypertelorism, IUGR, CHD
Del (13 q) Hypertelorism, IUGR,CHD, hydrocephalus, small thumbs
Del (18p) IUGR, holoprosencephaly
Del (18q) Cleft lip, CHD, horseshoe kidney

24. Environmental Factors
Alcohol IUGR, hydrocephalus, CHD
Amniopterin IUGR, hydrocephalus, neural tube defect,
hypoplasia/frontal bone, cleft palate, broad nasal bridge,
hypertelorism, CHD
Hydantoin IUGR, hypertelorism, cleft lip, CHD, duodenal atresia,
single umbilical artery
Maternal phenylketonuria IUGR, CHD
Rubella IUGR, CHD

25. Abnormal Ultrasound
Feature
Skeletal
Dysplasias
Amniotic fluid volume and polyhydramnios Robert S,
VATERS
association
Acromelia Ellis-van
Creveld
dysplasia,
Poland
sequence

43. Gestation (weeks) <10 10–12 12–14 >14
Patients 19 34 65 26
Four chamber - 13 (37) 44 (68) 21 (81)
Head - 13 (37) 43 (66) 16 (62)
Spine - 5 (15) 28 (43) 8 (31)
Stomach 2 (10) 19 (56) 62 (95) 24 (92)
Kidneys - 5 (15) 38 (58) 14 (54)
Bladder 3 (6) 14 (42) 52 (80) 23 (88)

48. Take Home message
• Adolesence health care
• Premarital counselling
• Marriage at approptiate age
• Child bearing at appropriate age
• Good anc
• Good intrapatum care
• Good pnc
• Woman empowerment

49. • Anomaly scan at 18to22k
• Nowdays 3d or 4d usg at 10wk to14
• Cvs
• Amniocentesis
• Cordocentesis
• If require opion of fetal medicine expert

50. THANK YOU