This document provides information on antenatal care including definitions, diagnosis of pregnancy, history taking, physical examination, investigations, nutrition advice, and identification of high-risk pregnancies. Prenatal care aims to ensure an uncomplicated pregnancy and delivery of a healthy infant by identifying risks early. Nutrition, weight gain, fetal growth, and maternal/fetal well-being are closely monitored at regular prenatal visits. Certain medical conditions and obstetric histories require consultation with maternal-fetal medicine specialists.
Globally the incidence of unwed mothers is rising.Unwed mothers remain a challenge in obstetric practice due to a complex interplay of obstetric,medical,social and psychological complications associated with them.so ,it is important to know who are unwed mothers,causes and nurses role.
baby born before 37 weeks of gestation calculating from the first day of last menstural period is defined as preterm baby/ premature baby.
These babies are known as preemies
Postnatal care (PNC) for the mother should respond to her special needs, starting within an hour after the delivery of the placenta and extending through the following six weeks. The care includes the prevention, early detection and treatment of complications, and the provision of counselling on breastfeeding, birth spacing, immunization and maternal nutrition. To standardise the PNC service, you are advised to use the screening, counselling and postnatal care cards. These cards ensure that you have covered all the essential steps in every home visit.
this ppt is beneficial for nursing and obstetric and gynaecology students.
This Lesson Plan is regarding Breast Feeding-Introduction, Definition, Anatomy of Breast, Physiology of Lactation, Hormones, Reflexes in the baby, Advantages, Contraindications, composition of Human Milk, the types of milk,Breast Feeding Positions,Breast Feeding Pattern, Good and Poor attachment of the baby.
BREAST CARE(PRECEDURE)
PRESENTED BY – M. MANJOT KAUR GILL
DEFINITION
Breast care is the process of cleaning the breast of mother that helps in maintaining hygiene and prevent from cross infection during feeding .
PURPOSES
To clean the breast.
To detect any abnormalities.
To stimulate milk ejection .
To prevent local infection.
To prevent breast complications.
INDICATIONS
Postnatal mothers.
Before and after breastfeeding.
Cracked nipple.
Pt. who are not able to take self care.
Nipple with unhygienic conditions.
PREPRATION OF ARTICLES
Screen
Mackintosh with towel.
A bowel with 2-3 cottons.
A bowel with boiled and cool cotton swabs.(12-15)
A bowel with dry gauze pieces.(12-15)
Kidney tray/Paper bag
Nursing records.
STEPS OF PROCEDURES.
Arrange all articles .
Explain the procedure to the mother about benefit of breast care.
Provide screen for privacy.
Provide comfortable position to the mother preferable sitting position.
Spread the mackintosh with towel over the lap of the mother.
Wash hand
Stand on the right side of the mother whole giving care.
Expose both the Brest firth and check symmetry.
Inspect the Breast for size and any abnormality.
-Inverted nipple
-Cracked nipple.
-Retracted nipples
-Any sign of infection
Palpate the breast from superficial to deep for tenderness, pain, tumors, exaggerated lymph nodes, etc
Squeeze the breast and observe the secretions.
Clean the secretion with the pad and throw In paper bag.
Take the cotton swab and squeeze excess water holding the tail and keeping above the hand.
Clean the breast in the following order—nipple-primary areola-secondary areola- total breast –lower crease-axilla.
Dry the breast with gauze pieces following the same order.
Cover the further breast exposing the near one.
Inspect, palpate and squeeze in the previous manner.
Assist the mother to do hand wash for return demonstration.
Assist the mother to clean the breast in same manner.
Put the baby on to the breast.
Make the mother and baby comfortable after care.
Record any abnormal findings.
SUMMARIZATION
Definition
Purposes
Indications
Articles
Steps of procedure
BIBLIOGRAPHY
Ghai, sandhya .(2018) clinical nursing procedures. New Delhi: satish kumar. Pp.613-616.
Dharitri, swain.(2017) obstetrics nursing procedure manual. New Delhi: jappee brothers. Pp. 158--159.
THANKS
eenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female under the age of 20. Pregnancy can occur with sexual intercourse after the start of ovulation, which can be before the first menstrual period (menarche) but usually occurs after the onset of periods.
Globally the incidence of unwed mothers is rising.Unwed mothers remain a challenge in obstetric practice due to a complex interplay of obstetric,medical,social and psychological complications associated with them.so ,it is important to know who are unwed mothers,causes and nurses role.
baby born before 37 weeks of gestation calculating from the first day of last menstural period is defined as preterm baby/ premature baby.
These babies are known as preemies
Postnatal care (PNC) for the mother should respond to her special needs, starting within an hour after the delivery of the placenta and extending through the following six weeks. The care includes the prevention, early detection and treatment of complications, and the provision of counselling on breastfeeding, birth spacing, immunization and maternal nutrition. To standardise the PNC service, you are advised to use the screening, counselling and postnatal care cards. These cards ensure that you have covered all the essential steps in every home visit.
this ppt is beneficial for nursing and obstetric and gynaecology students.
This Lesson Plan is regarding Breast Feeding-Introduction, Definition, Anatomy of Breast, Physiology of Lactation, Hormones, Reflexes in the baby, Advantages, Contraindications, composition of Human Milk, the types of milk,Breast Feeding Positions,Breast Feeding Pattern, Good and Poor attachment of the baby.
BREAST CARE(PRECEDURE)
PRESENTED BY – M. MANJOT KAUR GILL
DEFINITION
Breast care is the process of cleaning the breast of mother that helps in maintaining hygiene and prevent from cross infection during feeding .
PURPOSES
To clean the breast.
To detect any abnormalities.
To stimulate milk ejection .
To prevent local infection.
To prevent breast complications.
INDICATIONS
Postnatal mothers.
Before and after breastfeeding.
Cracked nipple.
Pt. who are not able to take self care.
Nipple with unhygienic conditions.
PREPRATION OF ARTICLES
Screen
Mackintosh with towel.
A bowel with 2-3 cottons.
A bowel with boiled and cool cotton swabs.(12-15)
A bowel with dry gauze pieces.(12-15)
Kidney tray/Paper bag
Nursing records.
STEPS OF PROCEDURES.
Arrange all articles .
Explain the procedure to the mother about benefit of breast care.
Provide screen for privacy.
Provide comfortable position to the mother preferable sitting position.
Spread the mackintosh with towel over the lap of the mother.
Wash hand
Stand on the right side of the mother whole giving care.
Expose both the Brest firth and check symmetry.
Inspect the Breast for size and any abnormality.
-Inverted nipple
-Cracked nipple.
-Retracted nipples
-Any sign of infection
Palpate the breast from superficial to deep for tenderness, pain, tumors, exaggerated lymph nodes, etc
Squeeze the breast and observe the secretions.
Clean the secretion with the pad and throw In paper bag.
Take the cotton swab and squeeze excess water holding the tail and keeping above the hand.
Clean the breast in the following order—nipple-primary areola-secondary areola- total breast –lower crease-axilla.
Dry the breast with gauze pieces following the same order.
Cover the further breast exposing the near one.
Inspect, palpate and squeeze in the previous manner.
Assist the mother to do hand wash for return demonstration.
Assist the mother to clean the breast in same manner.
Put the baby on to the breast.
Make the mother and baby comfortable after care.
Record any abnormal findings.
SUMMARIZATION
Definition
Purposes
Indications
Articles
Steps of procedure
BIBLIOGRAPHY
Ghai, sandhya .(2018) clinical nursing procedures. New Delhi: satish kumar. Pp.613-616.
Dharitri, swain.(2017) obstetrics nursing procedure manual. New Delhi: jappee brothers. Pp. 158--159.
THANKS
eenage pregnancy, also known as adolescent pregnancy, is pregnancy in a female under the age of 20. Pregnancy can occur with sexual intercourse after the start of ovulation, which can be before the first menstrual period (menarche) but usually occurs after the onset of periods.
According to the International Federation of Gynaecology and Obstetrics (FIGO), prolonged pregnancy is defined as any pregnancy that exceeds 42wks (294 days) from the first day of the LMP in a woman with regular 28-day cycles.
A complete overview of pregnancy for student nurses, paramedics, and ancillary healthcare. Covers the major disorders and emergencies of pregnancy.
Brought to you by Tentance.
2. Introduction Embryo – upto 8 weeks Fetus –from 8 weeks upto delivery Getational age—is expressed in completed weeks and calculated from the lmp Fetal age– is from the day of implantation Gravida– total number of pregnancies Parity- number of pregnancies that as passed the period of viaility excluding the present pregnancy
3. Live birth-complete expulsion of products of conception from mother regardless of the gestational age which after such separation shows signs of life Preterm infant-one born prior to 37 weeks
4. Prenatal care Pregnancy is normal physiological event Complication is seen only in 5-20% Prenatal care aim is to identify and special care for the high risk pregnancy So as to ensure uncomplicated pregnancy and delivery of healthy infant Remember that mother emotional state during pregnancy effects the fetal outcome
5. Conclusion Importance of antenatal care is to identify high risk cases during preconceptional period at earliest and during antenatal period not the least so as to provide a healthy baby to the mother if she is at risk
6. Preconceptionalcounscelling is necessary Physician should establish history, physical examination and lab tests during this period Remember healthy women will bear a healthy child Stress regarding avoidance of cigarette smoking, drug abuse and teratogenic drug should be advised
7. PRENATAL CARE Prenatal care should be initiated as soon as there is a reasonable likelihood of pregnancy. The major goals are. To define the health status of the mother and fetus. To estimate the gestational age of the fetus. To initiate a plan for continuing obstetrical care
8. Reasons for inadequate prenatal care varied by social and ethnic group, age, and method of payment. woman did not know she was pregnant. lack of money or insurance for such care. inability to obtain an appointment. Fear or lack of confidence in health care profession
9. population-based study from North Carolina, Harper and co-workers (2003) found that the risk of pregnancy-related maternal death was decreased fivefold among recipients of prenatal care.
10. DEFINITION OF ANTENATAL CARE "A comprehensive antepartum care program that involves a coordinated approach to medical care and psychosocial support that optimally begins before conception and extends throughout the antepartum period." The content of such a comprehensive program includes (1) preconceptional care, (2) prompt diagnosis of pregnancy, (3) initial presentation for pregnancy care, and (4) follow-up prenatal visits. Health during pregnancy depends on health before pregnancy, preconceptional care should logically be an integral part of prenatal care.
11. Diagnosis of Pregnancy Signs and Symptoms Cessation of Menses---- Uterine bleeding somewhat suggestive of menstruation occurs occasionally after conception. One or two episodes of bloody discharge, somewhat reminiscent of and sometimes mistaken for menstruation, are not uncommon during the first half of pregnancy. Such episodes are interpreted to be physiological, and likely the consequence of blastocyst implantation.
12. Diagnosis of pregnancy Changes in Cervical Mucus cervical mucus is relatively rich in sodium chloride when estrogen, but not progesterone, is being produced. Progesterone secretion—even without a reduction in estrogen secretion—acts promptly to lower sodium chloride concentration to levels at which ferning will not occur. During pregnancy, progesterone usually exerts a similar effect, even though the amount of estrogen produced is enormous. .
13. Diagnosis of pregnancy Thus, if copious thin mucus is present and if a fern pattern develops on drying, early pregnancy is unlikely. From about the 7th to the 18th day of the menstrual cycle, a fernlike pattern of dried cervical mucus is seen After approximately the 21st day, a different pattern forms that gives a beaded or cellular appearance This beaded pattern also is usually encountered during pregnancy
14. Diagnosis of pregnancy Changes in the Breasts= the anatomical changes in the breasts that accompany pregnancy are quite characteristic during the first pregnancy Discoloration of the Vaginal Mucosa the vaginal mucosa usually appears dark bluish or purplish-red and congested—the so-called Chadwick sign (Chadwick, 1886). This appearance is presumptive evidence of pregnancy, but it is not conclusive
15. Diagnosis of pregnancy URINE PREGNANCY TEST Trophoblast cells produce hCG in amounts that increase exponentially following implantation. With a sensitive test, the hormone can be detected in maternal plasma or urine by 8 to 9 days after ovulation. The doubling time of plasma hCG concentration is 1.4 to 2.0 days. Levels increase from the day of implantation and reach peak levels at about 60 to 70 days. Thereafter, the concentration declines slowly until a nadir is reached at about 14 to 16 weeks
16. Diagnosis of pregnancy The sensitivity for the laboratory detection of hCG in serum is as low as 1.0 mIU/mL using this technique. With extremely sensitive immunoradiometric assays, the detection limit is even lower (Wilcox and associates, 2001). False-positive hCG test results are rare (Braunstein, 2002). However, some women have circulating factors in their serum that may interact with the hCG antibody. The most common are heterophilic antibodies, which are human antibodies directed against animal-derived antigens used in immunoassays
17. Diagnosis of pregnancy Transvaginal sonography imaging of early pregnancy and its growth and development. A gestational sac may be demonstrated by abdominal sonography after only 4 to 5 weeks' menstrual age By 35 days, all normal sacs should be visible, after 6 weeks, a heartbeat should be detectable. Up to 12 weeks, the crown-rump length is predictive of gestational age within 4 days
18. History Present pregnancy- symptoms, LMP to calculate the EDD Previous pregnancy-outcome, length of gestation, fetal presentation, type of delivery, length of labor, complications. If cesarean was done type of uterine incision Medical history- CVS ,GIT and endocrine disorder require carefull evaluation and councselling concerning possible deleterious effect on mother Current infection if present should be treated to avoid deleterious effect on fetus
19. Surgical history- ceaserean details, prior history of multiple induced abortions or mid trimester loss may suggest incompetant cervix Family history – diabetes, previous still birth and anomalous babies, twins
20. Nausea and vomiting-50% of pregnancies 2-12 weeks If excess suspect multiple pregnancy or molar pregnancy Protracted vomiting causes dehydration and ketonuria Rapidly rising HCG levels is the cause
21. Breast Mastodynia hormonal response of mammary ducts and alevolar system Enlargment of subceous glands of areola Colustrumsecetion begin at 16 weeks Quickening -18-20 weeks in primi and 14-16 weeks in multi
22. Urinary tract Increased frequency because of pressure of growing uterus Urinary tract infections to be detected and treated asympomaticbacteruria to be treated as it increases risk of miscarriage, preterm and iud
23. signs Increased body temperature for a period of 3 weeks suspect pregnancy Skin – chloasma mask of pregnancy skin on forehead bridge of nose or cheek bones Linea nigra—increased MSH stimulating the melanocytes Palmarerthyma and spider telengectasiaalso present Strech marks seperation of underlying collagen and appear as irregular scars
24. Physical examination Maternal height and weight rate of weight gain is important . Bmi to be calculated in the preconceptional period if wt is <45 kg one should encourage them to gain weight upto 11-15 kg Indequate weight gain reflects nutritional deficiency , materanl illness ,iugr
26. Fundal Height Between 20 and 34 weeks, the height of the uterine fundus, measured in centimeters, correlates closely with gestational age in weeks Obesity, however, may distort this relationship. T he fundal height should be measured as the distance over the abdominal wall from the top of the symphysis pubis to the top of the fundus. The bladder must be emptied before making the measurment, fundal height was 3 cm higher with a full bladder.
27. Fundal height Just above symphisis pubis 12 weeks In between umblicus and symphysis 16 weeks Umblicus 22 weeks Just above umblicus 24 -26 weeks At xiphi 36 weeks Subsequent in between umblicus and xiphi can be divided into 3 parts four finger appart corresponding to 28, 32 and 36 weeks Orange line represents 40 weeks
28. subsequent prenatal visits has been scheduled at intervals of 4 weeks until 28 weeks, and then every 2 weeks until 36 weeks, and weekly thereafter. Women with complicated pregnancies often require return visits at 1- to 2-week intervals
29. At each return visit, steps are taken to determine the well-being of mother and fetus (see Table 8–3). Certain information—for example, assessment of gestational age and accurate measurement of blood pressure (Jones and associates, 2003)—is especially important. Fetal Heart rate(s) Size—current and rate of change Amount of amnionic fluid Presenting part and station (late in pregnancy) Activity
30. Pelvic examination Pelvic soft tissue any pelvic mass should be described accurately with help of scan Bony pelvis Pelvic inlet one as to measure diagonal conjugate from which obstetric conjugate can be calculated Mid pelvis note any prominence of ischial spine and distance between them curve of sacrum and side walls Outlet sub pubic angle and bi tuberous diameter Cervical length average around 3-4 cm tvs as upper hand over digital examination
31. Maternal Blood pressure— current and extent of change Weight— current and amount of change Symptoms—including headache, altered vision, abdominal pain, nausea and vomiting, bleeding, vaginal fluid leakage, and dysuria Height in centimeters of uterine fundus from symphysis Vaginal examination late in pregnancy often provides valuable information: Confirmation of the presenting part. Station of the presenting part Clinical estimation of pelvic capacity and its general configuration Consistency, effacement, and dilatation of the cervix.
32.
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35. INVESTIGATION Blood tests HB , blood group and typing , VDRL, HBSAG, HIV Women belonging to high risk group for GDM should get GCT done with 50 gm of glucose if that is positive one should do GTT with 100 gm of glucose Maternal HCG, alfafeto protein, inhibin, and unconjugatedestriol to be estimated as a part of quardaple test to look for fetal anomaly( 16 -18 weeks) First trimester test with PAPPA and free BHCG and nuchaltranslucany by scan is helpful to detect certain chromosomal anomaly
36. Genetic test should be offered for all women over 35 years of age and with abnormal pedigree chart and family history of inherited disease CVS at 10-14 weeks and amniocentesis at 16 -20 weeks can be offered
37. Urine for protein and culture Culture if asymptomatic bacteriuria treat accordingly Protein> 300 mg/dl of 24 hr is significant think preeclampsia Glucose in urine may be due to decreased renal threshold or because of GDM differentiated by blood glucose levels
38. Psychosocial Screening For barriers to care includes transportation facilities Child care Family support Unstable housing Unintended pregnancy Communication barriers Nutritional problems Ciggarate smoking Substance abuse
39. Cigarette Smoking spontaneous abortion, low birthweight due to either preterm delivery or fetal growth restriction, infant and fetal deaths, and placental abruption Suggested pathophysiological mechanisms for these adverse pregnancy effects include increased fetal carboxyhemoglobin, reduced uteroplacental blood flow, and fetal hypoxia Perinatal mortality reduces by 5 % if smoking is left
40. Drug abuse . Fetal distress, low birthweight, and drug withdrawal soon after birth are well documented
41. Domestic Violence Screening the majority of abused women continue to be victimized during pregnancy. With the possible exception of preeclampsia, domestic violence is more prevalent than any major medical condition detectable through routine prenatal screening
42. Recommended Consultation for Risk Factors Identified in Early Pregnancya Risk Factor Asthma Symptomatic on medication Severe (multiple hospitalizations) MFM Cardiac disease Cyanotic, prior myocardial infarction, aortic stenosis, pulmonary hypertension, Marfan syndrome, prosthetic valve, American Heart Association class II or greater MFM Other OBG Diabetes mellitus Class A–C OBG Class D or greater MFM Drug and alcohol use
43. High risk pregnancy MFM Epilepsy (on medication) OBG Family history of genetic problems (Down syndrome, Tay-Sachs disease, phenylketonuria) MFM Hemoglobinopathy (SS, SC, S-thalassemia) MFM Hypertension Chronic, with renal or heart disease MFM Chronic, without renal or heart disease OBG
44. High risk pregnancy Prior pulmonary embolus or deep vein thrombosis OBG Psychiatric illness OBG Pulmonary disease Severe obstructive or restrictive MFM Moderate OBG Renal disease Chronic, creatinine 3 mg/dL, ± hypertension MFM Chronic, other OBG Requirement for prolonged anticoagulation MFM Severe systemic disease MFM Obstetrical History and Conditions Age 35 years at delivery OBG Cesarean delivery, prior classical or vertical incision
45. High risk pregnancy Incompetent cervix Prior fetal structural or chromosomal abnormality MFM Prior neonatal death Prior fetal death Prior preterm delivery or preterm ruptured membranes Prior low birthweight (< 2500 g)
46. High risk pregnancy Second-trimester pregnancy loss Uterine leiomyomata or malformation Condylomata (extensive, covering vulva or vaginal opening) Initial Laboratory Tests Human immunodeficiency virus (HIV) Symptomatic or low CD4 count MFM CDE (Rh) or other blood group isoimmunization (excluding ABO, Lewis)
47. Advice regarding nutrition Certain prenatal vitamin–mineral supplements may lead to intakes well in excess of the recommended allowances. Moreover, the use of excessive supplements—for example, 10 times the recommended daily allowances—which often are self-prescribed, has led to concern about nutrient toxicities during pregnancy. Nutrients that can potentially exert toxic effects include iron, zinc, selenium, and vitamins A, B6, C, and D. Vitamin
48. CALORIE REQUIRMENT pregnancy requires an additional 80,000 kcal, which are accumulated primarily in the last 20 weeks. To meet this demand, a caloric increase of 100 to 300 kcal per day is recommended during pregnancy
49. PROTEIN protein should be supplied from animal sources, such as meat, milk, eggs, cheese, poultry, and fish, because they furnish amino acids in optimal combinations. 15 gram extra protein to be added diet Milk and dairy products have long been considered nearly ideal sources of nutrients, especially protein and calcium, for pregnant or lactating women.
52. IRON approximately 300 mg of iron transferred to the fetus and placenta and the 500 mg incorporated, if available, into the expanding maternal hemoglobin mass, nearly all is used after midpregnancy. During that time, iron requirements imposed by pregnancy and maternal excretion total about 7 mg per day
53. Scott and co-workers (1970) established that as little as 30 mg of elemental iron, supplied as ferrous gluconate, sulfate, or fumarate and taken daily throughout the latter half of pregnancy, provided sufficient iron to meet the requirements of pregnancy and to protect any preexisting iron stores The woman who is overtly anemic from iron deficiency responds well to oral supplementation with iron salts
54. Electrolyte and Mineral Metabolism), the pregnant woman retains about 30 g of calcium, most of which is deposited in the fetus late in pregnancy (Pitkin, 1985). This amount of calcium represents only about 2.5 percent of total maternal calcium, most of which is in bone, and which can readily be mobilized for fetal growth.
55. ZINC zinc deficiency may lead to poor appetite, suboptimal growth, and impaired wound healing. Profound zinc deficiency may cause dwarfism and hypogonadism. It may also lead to a specific skin disorder, acrodermatitisenteropathica, as the result of a rare, severe congenital zinc deficiency. zinc supplementation was not found to confer any benefits on developmental outcome (Hamadani and co-workers,
56. IODINE use of iodized salt and bread products is recommended during pregnancy to offset the increased fetal requirements and maternal renal losses. Despite this, iodine intake has declined substantially in the past 15 years, and it is probably inadequate for some populations
57. Trace elements Important role in enzyme functions. Deficiency of selinium manifests as cardiomyopathy
58. Vitamins The increased requirements for vitamins during pregnancy usually are supplied by any general diet that provides adequate calories and protein. The exception is folic acid during times of unusual requirements, such as pregnancy complicated by protracted vomiting, hemolytic anemia, or multiple fetuses. Supplementation with multivitamins reduce inidence of lbw and iugr
59. Vitamins more than half of these defects could be prevented with daily intake of 400 g of folic acid throughout the periconceptional nutritional sources alone are insufficient, however, folic acid supplementation is still recommended A woman with a prior pregnancy complicated by a neural-tube defect can reduce the 3-percent recurrence risk by more than 70 percent if she supplements her daily diet with 4 mg of folic acid for the month before conception and for the first trimester of pregnancy
60. Vitamins A small number of case reports suggest an association of birth defects with very high doses during pregnancy—10,000 to 50,000 IU daily. These malformations are similar to those produced by the vitamin A derivative isotretinoin (Accutane), which is a potent teratogen in humans Vitamin A deficiency, whether overt or subclinical, was associated with a significantly increased risk of both maternal anemia and spontaneous preterm birth. The former likely reflected the need for vitamin A to facilitate iron absorption, and the latter possibly reflected increased susceptibility to infection associated with vitamin A deficiency.
61. Vitamins Vit b 12– deficiency in first trimester increases risk of ntd Vit b6 –combined with doxylamine reduces incidence of nausea and vomiting of pregnancy The recommended dietary allowance for vitamin C during pregnancy is 80 to 85 mg/day, or about 20 percent more than when nonpregnant
62. Pragmatic Nutritional Surveillance Although the science of nutrition continues in its perpetual struggle to identify the ideal amounts of protein, calories, vitamins, and minerals for the pregnant woman and her fetus, those directly responsible for their care may best discharge their duties as follows. In general, advise the pregnant woman to eat what she wants in amounts she desires and salted to taste. Make sure that there is ample food to eat in the case of socioeconomically deprived women.
63. Pragmatic Nutritional Surveillance Monitor weight gain, with a goal of about 25 to 35 pounds in women with a normal BMI. Periodically explore food intake by dietary recall to discover the occasional nutritionally absurd diet. Give tablets of simple iron salts that provide at least 27 mg of iron daily. Give folate supplementation before and in the early weeks of pregnancy. Recheck the hematocrit or hemoglobin concentration at 28 to 32 weeks to detect any significant decrease
64. Common Complaints during Pregnancy Ptylaism --xcessive salivation cause unknown strongly associated with nausea and vomiting Pica ingestion of substance with no food value for eg clay and starch educating patient is important as they may neglect their nutrition as these substance substitute their food Excessive urination is due to pressure of gravid uterus and hormonal changes and vascular enlargement in the pelvis
65. INFECTIONS HSV topical acyclovir can be used oraly to be use dif pregnancy> 36 weeks If active lesion at time of delivery section to be done HIV viral load to be calculated by measuring cd4 count art to be started depending n viral load . If viral load > 1000 copies /ml section is to be done
66. Employment confirmed a 20- to 60-percent increase in preterm birth, fetal growth restriction, or hypertension associated with physically demanding work. In a prospective study of more than 900 healthy primigravida, Higgins and associates (2002) found that women who worked were about fivefold more likely to develop preeclampsia. Newman and colleagues (2001) reported the relationship between occupational fatigue and preterm birth in 2929 women with singleton pregnancies studied by the Maternal–Fetal Medicine Units Network.
67. Employment They found that 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 preterm membrane rupture. For those women reporting the highest degrees of fatigue, the risk was 7.4 percent.
68. EXCERISE pregnant woman to severe physical strain should be avoided. Ideally, no work or play should be continued to the extent that undue fatigue develops. Adequate periods of rest should be provided during the work period. Women with previous pregnancy complications that are likely to be repetitive, such as low-birthweight infants, probably should minimize physical work
69. Common ConcernsExercise no exercise or to weight-bearing exercise beginning at 8 weeks. Exercise consisted of treadmill running, step aerobics, or stair stepper use for 20 minutes three to five times each week placental size and birthweight were significantly greater in the exercise group.
70. Absolute Contraindications FOR EXCERISE Hemodynamically significant heart disease Restrictive lung disease Incompetent cervix or cerclage Multifetal gestation at risk for preterm labor Persistent second- or third-trimester bleeding Placenta previa after 26 weeks of gestation Preterm labor during the current pregnancy Ruptured membranes Preeclampsia or gestational hypertension
71. Relative Contraindications Severe anemia Unevaluated maternal cardiac arrhythmia Chronic bronchitis Poorly controlled type 1 diabetes mellitus Extreme morbid obesity Extreme underweight (BMI < 12) History of extremely sedentary lifestyle Fetal growth restriction in current pregnancy Poorly controlled hypertension Orthopedic limitations Poorly controlled seizure disorder Poorly controlled hyperthyroidism Heavy smoker
72. EXCERSISE pregnant women should be encouraged to engage in regular, moderate-intensity physical activity 30 minutes or more a day. Each activity should be reviewed individually for its potential risk. Activities with a high risk of falling or abdominal trauma should be avoided. Similarly, scuba diving should be avoided because the fetus is at an increased risk for decompression sickness.
73. Travel pregnant women should be encouraged to wear properly positioned three-point restraints throughout pregnancy while riding in automobiles. The lap belt portion of the restraining belt should be placed under the woman's abdomen and across her upper thighs. The belt should be as snug as comfortably possible. The shoulder belt also should be snugly applied and positioned between the breasts the American College of Obstetricians and Gynecologists has concluded that pregnant women can safely fly up to 36 weeks.
74. Fish consumption Pregnant ladies are asked to avoid fish containing higher level of methyl mercury levels
75. Varicose Veins Varicosities may develop in the legs or in the vulva. A family history of varicosities is often present. Pressure by the enlarging uterus on the venous return from the legs is a major factor in the development of varicosities. The physician should warn the patient early in pregnancy of the need for elastic stockings and elevation of the legs if varices develop. Specific therapy (injection or surgical correction) usually is contraindicated during pregnancy. Superficial varicosities may rarely signal deeper venous disease. These patients should be examined carefully for signs of deep vein thrombosis.
76. Joint Pain, Backache, & Pelvic Pressure Although the main bony components of the pelvis consist of 3 separate bones, the symphysial and sacroiliac articulations permit practically no motion in the nonpregnant state. In pregnancy, however, endocrine relaxation of these joints permits some movement. The pregnant patient may develop an unstable pelvis, which produces pain. A tight girdle or a belt worn about the hips, together with frequent bed rest, may relieve the pain; however, hospitalization is sometimes necessary.
77. Improvement in posture often relieves backache. The increasingly protuberant abdomen causes the patient to throw her shoulders back to maintain her balance; this causes her to thrust her head forward to remain erect. Thus, she increases the curvature of both the lumbar spine and the cervicothoracic spine. A maternity girdle to support the abdominal protuberance and shoes with 2-inch heels, which tend to keep the shoulders forward, may reduce the lumbar lordosis and thus relieve backache. Local heat and back rubs may relax the muscles and ease discomfort. Exercises to strengthen the back are most rewarding.
78. Leg Cramps The cause of leg cramps in pregnancy is unknown but may be the result of a reduced level of diffusible serum calcium or elevation of serum phosphorus. Treatment for this includes curtailment of phosphate intake (less milk and nutritional supplements containing calcium phosphate) and an increase of calcium intake (without phosphorus) in the form of calcium carbonate or calcium lactate tablets. Alternatively, a randomized trial showed that magnesium citrate, 300 mg/d, reduces leg cramps. Symptomatic treatment consists of leg massage, gentle flexing of the feet, and local heat. Tell the patient to avoid pointing toes when she stretches her legs (eg, on awakening in the morning) as this triggers a gastrocnemius cramp. She should also practice "leading with the heel" in walking.
79. BREAST Soreness Physiologic breast engorgement may cause discomfort, especially during early and late pregnancy. A well-fitting brassiere worn 24 hours a day affords relief. Ice bags are temporarily effective. Hormone therapy is of no value
80. Discomfort in the Hands Acrodysesthesia of the hands consists of periodic numbness and tingling of the fingers (the feet are never involved). It affects at least 5% of pregnant women. In some cases it is thought to be a brachial plexus traction syndrome caused by drooping of the shoulders during pregnancy; carpal tunnel syndrome is a common cause of a similar symptom complex. The discomfort is most common at night and early in the morning. It may progress to partial anesthesia and impairment of manual proprioception. The condition is apparently not serious, but it may persist after delivery as a consequence of lifting and carrying the baby
81. Bathing Bath water does not enter the vagina. Even swimming is not contraindicated during normal pregnancy. Diving should be avoided because of possible trauma. A woman in the last trimester of pregnancy may have impaired balance. For this reason, she should be cautioned about slipping and falling in the tub or shower.
82. Immunization Killed virus, toxoid, or recombinant vaccines may be safely administered during pregnancy, and patients should be vaccinated appropriately for both maternal and fetal benefit. The American College of Obstetricians and Gynecologists recommends that all women who are pregnant in the second or third trimester during the flu season (October to March) should receive the influenza vaccination. Diphtheria and tetanus toxoid may be administered in pregnancy if a woman has not received a booster in 10 years, or if no primary series had been received. The hepatitis B vaccine series and killed polio vaccine may be given during pregnancy to women at risk.
83. IMMUNIZATION Live, attenuated vaccines, including those for varicella, measles, mumps, polio, and rubella, should be given 3 months prior to pregnancy or immediately postpartum. These vaccines are contraindicated in pregnancy secondary to the potential of fetal infection. Viral shedding occurs in children receiving vaccination, but they do not transmit the virus; consequently, vaccination may be safely given to the children of pregnant women. Secondary prophylaxis with specific immune globulin is recommended for pregnant women exposed to measles, hepatitis A, hepatitis B, tetanus, chickenpox
85. Dental Care There may be generalized gum hypertrophy and bleeding during pregnancy. Interdental papillae (epulis) may also form in the upper gingivae, and these rarely resorb and must be excised. Normal dental procedures under local anesthesia (ie, drilling and filling) may be carried out at any time during gestation. Lengthy procedures should be postponed until the second trimester. Antibiotics are given for dental abscesses and in cases of rheumatic heart disease and mitral valve prolapse. Periodontal disease has been associated with an increased risk of preterm birth but there have been no trials of treatment during pregnancy.
86. coitus Can be practised Few condition in which abstience is advised r If cramps or spotting following intercoures Late in pregnancy in women with previous history of preterm delivery or in present pregnancy with pv bleeding
87. Conclusion Importance of antenatal care is to identify high risk cases during preconceptional period at earliest and during antenatal period not the least so as to provide a healthy baby to the mother if she is at risk