Antenatal care screening involves regular checkups during pregnancy to monitor the health of the mother and baby. The goals are to ensure the mother and baby's health, have a good birth outcome, identify high-risk pregnancies, and decrease mortality rates. Checkups include checking weight gain, screening for conditions like anemia, providing dietary advice, and assessing fetal well-being through ultrasounds and monitoring. Women see their provider monthly until 32 weeks, every two weeks until 36 weeks, and weekly after that until delivery.
Antenatal care refers to the care provided to an expectant mother from conception until the start of labor. It aims to ensure the health of the mother and delivery of a healthy infant by detecting and preventing complications through scheduled visits. During visits, the patient's history, physical exam, and tests are conducted to monitor weight, blood pressure, fetal growth and check for signs of issues. Education is also provided on nutrition, self-care, birth planning and danger signs.
Focused antenatal care aims to provide individualized care through a minimum of 4 visits during pregnancy, detecting and treating any complications early. It addresses the most prevalent health issues through evidence-based actions like immunizations, supplements, and preventative treatment. The new approach reduces visits without negatively impacting outcomes, focusing on quality over quantity of care from a skilled provider. Each woman's specific needs, history, and available resources are considered to develop an appropriate birth plan and promote health through discussions of nutrition, hygiene, danger signs, and postpartum care.
Antenatal care involves comprehensive health supervision and guidance for pregnant women from conception through delivery. Its goals are to reduce mortality and morbidity for both mother and baby, and improve their physical and mental health. Regular checkups are recommended to monitor health, detect complications early, and educate on parenting. Screenings are conducted to check for infections, fetal abnormalities, and nutritional deficiencies. Common discomforts of pregnancy are addressed, along with relief measures.
The document outlines the principles of antenatal care, which include predicting and preventing problems in pregnancy through medical history screening, physical exams, and education. It then describes the current approach to antenatal care, which involves prepregnancy counseling, booking and routine visits, and education classes. Finally, it provides details on the processes involved in antenatal visits, including tests, exams, screenings and monitoring the growth and health of the fetus over the course of pregnancy.
Antenatal care involves comprehensive health supervision and guidance for pregnant women from conception through delivery. It aims to reduce maternal and infant mortality and morbidity. Key aspects of antenatal care include detecting and treating complications, educating mothers, and preparing for labor, lactation, and infant care. Pregnant women should have regular checkups including medical history, exams, and tests to monitor health. Care also involves addressing common discomforts of pregnancy through lifestyle and dietary adjustments.
This document outlines important aspects of antenatal care based on NICE/RCOG guidelines. It discusses the aims and timeline of antenatal visits, including initial screening and testing at 10 weeks to check pregnancy and general health. Regular checks are recommended to monitor pregnancy progress and detect any issues. The document also describes screening protocols for common conditions like anemia, gestational diabetes, and infections. Common symptoms are discussed along with lifestyle and treatment recommendations. Interventions not routinely needed are also noted.
Help the medical students to know about the fetal clinical parameters. Very rarely material present in the books. I prepared this for the little bit help from my side.
Antenatal care refers to the care provided to an expectant mother from conception until the start of labor. It aims to ensure the health of the mother and delivery of a healthy infant by detecting and preventing complications through scheduled visits. During visits, the patient's history, physical exam, and tests are conducted to monitor weight, blood pressure, fetal growth and check for signs of issues. Education is also provided on nutrition, self-care, birth planning and danger signs.
Focused antenatal care aims to provide individualized care through a minimum of 4 visits during pregnancy, detecting and treating any complications early. It addresses the most prevalent health issues through evidence-based actions like immunizations, supplements, and preventative treatment. The new approach reduces visits without negatively impacting outcomes, focusing on quality over quantity of care from a skilled provider. Each woman's specific needs, history, and available resources are considered to develop an appropriate birth plan and promote health through discussions of nutrition, hygiene, danger signs, and postpartum care.
Antenatal care involves comprehensive health supervision and guidance for pregnant women from conception through delivery. Its goals are to reduce mortality and morbidity for both mother and baby, and improve their physical and mental health. Regular checkups are recommended to monitor health, detect complications early, and educate on parenting. Screenings are conducted to check for infections, fetal abnormalities, and nutritional deficiencies. Common discomforts of pregnancy are addressed, along with relief measures.
The document outlines the principles of antenatal care, which include predicting and preventing problems in pregnancy through medical history screening, physical exams, and education. It then describes the current approach to antenatal care, which involves prepregnancy counseling, booking and routine visits, and education classes. Finally, it provides details on the processes involved in antenatal visits, including tests, exams, screenings and monitoring the growth and health of the fetus over the course of pregnancy.
Antenatal care involves comprehensive health supervision and guidance for pregnant women from conception through delivery. It aims to reduce maternal and infant mortality and morbidity. Key aspects of antenatal care include detecting and treating complications, educating mothers, and preparing for labor, lactation, and infant care. Pregnant women should have regular checkups including medical history, exams, and tests to monitor health. Care also involves addressing common discomforts of pregnancy through lifestyle and dietary adjustments.
This document outlines important aspects of antenatal care based on NICE/RCOG guidelines. It discusses the aims and timeline of antenatal visits, including initial screening and testing at 10 weeks to check pregnancy and general health. Regular checks are recommended to monitor pregnancy progress and detect any issues. The document also describes screening protocols for common conditions like anemia, gestational diabetes, and infections. Common symptoms are discussed along with lifestyle and treatment recommendations. Interventions not routinely needed are also noted.
Help the medical students to know about the fetal clinical parameters. Very rarely material present in the books. I prepared this for the little bit help from my side.
Ante Natal, Intra Natal AND Post Natal Care of Asian WomenSharda University
This document provides information on maternal and child health (MCH). It begins by introducing MCH and noting that mothers and children are vulnerable groups. MCH refers to promotive, preventive, curative and rehabilitative healthcare for mothers and children, including maternal health, child health, family planning, and more. The objectives of MCH are to reduce mortality and morbidity in mothers, newborns, infants and children, promote reproductive health, and promote physical and psychological development of children. The document then discusses various aspects of MCH including preconceptional care, antenatal care, the maternity cycle, and health education topics for expectant mothers.
Focused approach to antenatal care - First trimester screeningBharti Gahtori
This document discusses focused antenatal care and first trimester screening. It describes the essential elements of antenatal care including targeted assessments based on individual risk factors. First trimester screening aims to detect conditions like aneuploidy through measuring the nuchal translucency, analyzing maternal serum markers, and assessing fetal heart rate between 11-13 weeks of gestation. Screening tests are evaluated based on their sensitivity, specificity, and rates of false positives and negatives.
This document provides guidance on important aspects of antenatal care. It discusses the aims of antenatal care including monitoring pregnancy progress with minimal interference, providing guidance to expectant mothers, and allowing for early detection and treatment of deviations from normal pregnancy. It outlines recommendations for initial visits, screening tests, vaccinations, and management of common symptoms during pregnancy. The guidance is based on standards from NICE and RCOG and aims to ensure healthy outcomes for both mother and baby.
This document discusses anemia in pregnancy. It defines anemia and provides prevalence rates. It describes physiological changes in blood during pregnancy. It discusses severity of anemia and classifications. Iron deficiency anemia is the most common type and the document outlines iron absorption, requirements, and prevention. Signs, effects, diagnosis and treatment of anemia in pregnancy are also summarized.
This document outlines antenatal care (ANC), including its objectives to reduce maternal and infant morbidity and mortality through early detection of complications, health education, and preventive interventions. It describes traditional and focused ANC models, with the focused model recommending 4 routine visits and evidence-based activities. The initial ANC visit includes a detailed history, exam, and diagnostic workup to identify risks and plan care. Subsequent visits monitor progress and new issues. Strategies to assure fetal well-being include assessing growth, movements, and tests after 28 weeks. Health interventions emphasize education, nutrition, and psychological support.
1. Preterm premature rupture of membranes (PPROM) is the rupture of membranes before 37 weeks of gestation. Antibiotics and corticosteroids should be administered between 24-34 weeks to prolong the latent period, improve outcomes, and decrease risks of complications.
2. Diagnosis of PPROM involves checking the pH and slides of amniotic fluid for signs of rupture. Ultrasound can also assess fluid levels. Expectant management is recommended and includes antibiotics, corticosteroids, and monitoring for infection or other complications.
3. Risk factors for peripartum hysterectomy include placenta accreta with prior c-section, uterine atony, or uterine rupture which
This document provides an overview of preconception care. It discusses that preconception care starts before conception and aims to promote the health of women of childbearing age. The goals are to improve maternal health, support healthy fetal development, and encourage emotional well-being by modifying risk factors. Key aspects of preconception care include risk assessment, health education, medical and psychosocial care, controlling diseases and health conditions, avoiding certain exposures, and addressing nutritional, genetic, and environmental factors that could impact a healthy pregnancy. The benefits of preconception care are improved pregnancy outcomes and decreased risks of fetal, infant, and maternal mortality and morbidity.
The document discusses antenatal care and provides information on:
- The aims of antenatal care including screening for high-risk cases, preventing/treating complications, educating mothers, and ensuring continued medical supervision.
- Components of antenatal care including history taking, physical examination, routine investigations, and advice on nutrition, hygiene, immunization, and warning signs.
- Advice given to mothers on diet, rest, exercise, hygiene, immunization, and mental preparation for childbirth.
- The importance of preconceptional care to ensure women enter pregnancy with optimal health.
The document discusses antenatal care and advice for pregnant women. It provides definitions for different types of pregnancies and deliveries. It describes the objectives of antenatal care which include maintaining the health of the mother and fetus, screening for complications, and educating mothers. The process involves collecting patient information, examinations, investigations, and providing advice regarding diet, exercise, hygiene and minor disorders that may occur during pregnancy. The overall aim is to deliver a healthy baby and support the goals of the mother.
Antenatal care involves educating pregnant women, screening for health issues, monitoring the mother and fetus, and promoting well-being. The goal is to help women stay healthy and address any problems early. Focused antenatal care emphasizes quality over quantity by scheduling fewer visits and targeting screening and tests to high-risk women. It follows principles of being woman-friendly, convenient, and providing basic yet effective care through four scheduled visits between 8-38 weeks of pregnancy.
The document summarizes antenatal care, which aims to achieve a healthy pregnancy and delivery. Key points include:
- Antenatal care promotes and protects the health of the mother and baby, detects high-risk cases, and reduces mortality and morbidity.
- Visits are usually monthly until 28 weeks, then two weekly until 34 weeks, and weekly thereafter. High-risk cases have more frequent visits.
- The booking visit establishes gestational age and date through examinations and baseline investigations like blood tests and urine analysis.
- Subsequent visits include monitoring weight, blood pressure, urine, and fundal height. Scans are performed to check fetal development.
- Health education covers diet,
1. Breech presentation occurs in 3-4% of full term deliveries and is when the fetus presents buttocks, feet or knees first instead of head first.
2. It can increase risks for both mother and baby due to difficulties in delivery.
3. Vaginal delivery is considered for multiparous women with adequate pelvis size and average sized fetus, but 85-90% of breech presentations result in c-section.
Anti D is an intramuscular injection that prevents Rh disease by introducing IgG Anti D antibodies to destroy any fetal Rh D positive red blood cells that enter the mother's bloodstream before her immune system can react. It is used after Rh exposure events like miscarriage, abortion, or childbirth to prevent the formation of maternal Rh antibodies. The mechanism is not fully understood but it suppresses the antibody response and formation of anti D antibodies in Rh-D negative people exposed to Rh positive blood. It provides passive protection to the fetus during pregnancy.
- A partograph is a graphic record of labor that plots cervical dilation, fetal descent, uterine contractions, and other variables to evaluate labor progress.
- It was introduced in 1955 and modified in 1972 to add an alert line and action line to indicate abnormal labor progression.
- The partograph records information about the mother, fetus, amniotic fluid, cervical dilation, fetal descent, uterine contractions, and drugs administered during labor.
- An example is given of a woman admitted in active labor whose progress is plotted on the partograph, including spontaneous vaginal delivery.
This document provides guidelines for the use of anti-D immunoglobulin (anti-D Ig) for Rhesus D prophylaxis. It discusses the history and pathogenesis of Rh isoimmunization, appropriate dosing and administration of anti-D Ig, sensitizing events requiring prophylaxis, and the implementation of routine antenatal anti-D prophylaxis programs. The guidelines aim to prevent RhD alloimmunization in RhD-negative women by outlining evidence-based best practices for anti-D Ig administration.
Antenatal care.ppt-by MANOJIT (MS),MALDA MEDICAL COLLEGEDr.Manojit Sarkar
Antenatal care involves comprehensive health supervision and guidance for pregnant women from conception through delivery. Its goals are to reduce maternal and infant mortality and morbidity. Regular checkups are recommended which include physical exams, screening tests, health education, and monitoring for potential complications. Common discomforts of pregnancy like fatigue, back pain, and nausea are discussed along with relief measures. Screening recommendations are provided for conditions like gestational diabetes, anaemia, and infections. Nutritional supplements like folic acid and vitamin D are also addressed.
Intrauterine Fetal Death (IUFD),(Kurdistan)Znar Mzuri
This document provides an overview of intrauterine fetal death (IUFD), also known as stillbirth. It defines IUFD as the death of a baby in the uterus after 20 weeks of gestation. The document discusses the epidemiology, etiology, risk factors, clinical features, diagnosis, treatment and management, and nursing care of IUFD. It also provides references for additional information.
Antenatal care refers to the supervision and care provided to an expectant mother from conception to the start of labor. This presentation discusses the definition, goals, and importance of antenatal care. It outlines the recommended four antenatal visits including what is assessed at each visit. The presentation also covers collecting a medical history, performing a physical examination, and providing health education to mothers on topics like hygiene during pregnancy. The overall aim of antenatal care is to monitor the health of both mother and baby and detect any complications.
This document summarizes information about intrauterine growth restriction (IUGR). It discusses normal fetal growth occurring in three stages: hyperplasia, hyperplasia and hypertrophy, and hypertrophy. Causes of IUGR include maternal, fetal, placental, and environmental factors. Maternal causes include medical conditions, malnutrition, smoking, and infections. Fetal causes include genetic abnormalities and infections. Placental causes include improper placentation and reduced blood flow. Clinical features of IUGR infants include a large head, thin skin, and scaphoid abdomen. Risk prediction methods include ultrasound and Doppler. Problems for IUGR infants include hypoxia, hypoglycemia, and immunological and metabolic issues. Management
Abnormalities of the Placenta, Umbilical Cord and MembranesAladdin Abdrabo
This document discusses abnormalities of the placenta, umbilical cord, and membranes. It covers various placental abnormalities including abnormal shape or implantation, degenerative lesions, circulatory disturbances, hypertrophic lesions, inflammation, and tumors of the placenta. Specific abnormalities are defined such as placenta accreta, placental infarction, and chorioangioma. Complications associated with certain abnormalities like hemorrhage and fetal growth restriction are also noted. The document provides clinical information on evaluating and diagnosing various placental pathologies.
The document discusses antenatal assessment, which involves the systematic supervision of a pregnant woman. It involves determining risk factors through a comprehensive history and physical exam. Regular checkups are recommended, starting with monthly visits until week 28, then twice monthly until week 36, and weekly during the last 4 weeks. The assessments monitor maternal and fetal health and wellbeing through tests, exams, ultrasounds and more. The goal is to promote a healthy pregnancy and delivery.
This document provides information on prenatal care, including initial prenatal evaluation, definitions of common terms, assessment of gestational age, routine prenatal visits, laboratory tests, nutritional counseling, and dietary recommendations. The initial prenatal evaluation involves taking a medical history, physical exam, and laboratory tests to assess the health of the mother and fetus. Routine prenatal visits every 4 weeks until 28 weeks and every 2 weeks until delivery are recommended to monitor the pregnancy. Laboratory tests screen for infections and nutritional deficiencies. Nutritional counseling advises women on healthy diet and weight gain during pregnancy.
Ante Natal, Intra Natal AND Post Natal Care of Asian WomenSharda University
This document provides information on maternal and child health (MCH). It begins by introducing MCH and noting that mothers and children are vulnerable groups. MCH refers to promotive, preventive, curative and rehabilitative healthcare for mothers and children, including maternal health, child health, family planning, and more. The objectives of MCH are to reduce mortality and morbidity in mothers, newborns, infants and children, promote reproductive health, and promote physical and psychological development of children. The document then discusses various aspects of MCH including preconceptional care, antenatal care, the maternity cycle, and health education topics for expectant mothers.
Focused approach to antenatal care - First trimester screeningBharti Gahtori
This document discusses focused antenatal care and first trimester screening. It describes the essential elements of antenatal care including targeted assessments based on individual risk factors. First trimester screening aims to detect conditions like aneuploidy through measuring the nuchal translucency, analyzing maternal serum markers, and assessing fetal heart rate between 11-13 weeks of gestation. Screening tests are evaluated based on their sensitivity, specificity, and rates of false positives and negatives.
This document provides guidance on important aspects of antenatal care. It discusses the aims of antenatal care including monitoring pregnancy progress with minimal interference, providing guidance to expectant mothers, and allowing for early detection and treatment of deviations from normal pregnancy. It outlines recommendations for initial visits, screening tests, vaccinations, and management of common symptoms during pregnancy. The guidance is based on standards from NICE and RCOG and aims to ensure healthy outcomes for both mother and baby.
This document discusses anemia in pregnancy. It defines anemia and provides prevalence rates. It describes physiological changes in blood during pregnancy. It discusses severity of anemia and classifications. Iron deficiency anemia is the most common type and the document outlines iron absorption, requirements, and prevention. Signs, effects, diagnosis and treatment of anemia in pregnancy are also summarized.
This document outlines antenatal care (ANC), including its objectives to reduce maternal and infant morbidity and mortality through early detection of complications, health education, and preventive interventions. It describes traditional and focused ANC models, with the focused model recommending 4 routine visits and evidence-based activities. The initial ANC visit includes a detailed history, exam, and diagnostic workup to identify risks and plan care. Subsequent visits monitor progress and new issues. Strategies to assure fetal well-being include assessing growth, movements, and tests after 28 weeks. Health interventions emphasize education, nutrition, and psychological support.
1. Preterm premature rupture of membranes (PPROM) is the rupture of membranes before 37 weeks of gestation. Antibiotics and corticosteroids should be administered between 24-34 weeks to prolong the latent period, improve outcomes, and decrease risks of complications.
2. Diagnosis of PPROM involves checking the pH and slides of amniotic fluid for signs of rupture. Ultrasound can also assess fluid levels. Expectant management is recommended and includes antibiotics, corticosteroids, and monitoring for infection or other complications.
3. Risk factors for peripartum hysterectomy include placenta accreta with prior c-section, uterine atony, or uterine rupture which
This document provides an overview of preconception care. It discusses that preconception care starts before conception and aims to promote the health of women of childbearing age. The goals are to improve maternal health, support healthy fetal development, and encourage emotional well-being by modifying risk factors. Key aspects of preconception care include risk assessment, health education, medical and psychosocial care, controlling diseases and health conditions, avoiding certain exposures, and addressing nutritional, genetic, and environmental factors that could impact a healthy pregnancy. The benefits of preconception care are improved pregnancy outcomes and decreased risks of fetal, infant, and maternal mortality and morbidity.
The document discusses antenatal care and provides information on:
- The aims of antenatal care including screening for high-risk cases, preventing/treating complications, educating mothers, and ensuring continued medical supervision.
- Components of antenatal care including history taking, physical examination, routine investigations, and advice on nutrition, hygiene, immunization, and warning signs.
- Advice given to mothers on diet, rest, exercise, hygiene, immunization, and mental preparation for childbirth.
- The importance of preconceptional care to ensure women enter pregnancy with optimal health.
The document discusses antenatal care and advice for pregnant women. It provides definitions for different types of pregnancies and deliveries. It describes the objectives of antenatal care which include maintaining the health of the mother and fetus, screening for complications, and educating mothers. The process involves collecting patient information, examinations, investigations, and providing advice regarding diet, exercise, hygiene and minor disorders that may occur during pregnancy. The overall aim is to deliver a healthy baby and support the goals of the mother.
Antenatal care involves educating pregnant women, screening for health issues, monitoring the mother and fetus, and promoting well-being. The goal is to help women stay healthy and address any problems early. Focused antenatal care emphasizes quality over quantity by scheduling fewer visits and targeting screening and tests to high-risk women. It follows principles of being woman-friendly, convenient, and providing basic yet effective care through four scheduled visits between 8-38 weeks of pregnancy.
The document summarizes antenatal care, which aims to achieve a healthy pregnancy and delivery. Key points include:
- Antenatal care promotes and protects the health of the mother and baby, detects high-risk cases, and reduces mortality and morbidity.
- Visits are usually monthly until 28 weeks, then two weekly until 34 weeks, and weekly thereafter. High-risk cases have more frequent visits.
- The booking visit establishes gestational age and date through examinations and baseline investigations like blood tests and urine analysis.
- Subsequent visits include monitoring weight, blood pressure, urine, and fundal height. Scans are performed to check fetal development.
- Health education covers diet,
1. Breech presentation occurs in 3-4% of full term deliveries and is when the fetus presents buttocks, feet or knees first instead of head first.
2. It can increase risks for both mother and baby due to difficulties in delivery.
3. Vaginal delivery is considered for multiparous women with adequate pelvis size and average sized fetus, but 85-90% of breech presentations result in c-section.
Anti D is an intramuscular injection that prevents Rh disease by introducing IgG Anti D antibodies to destroy any fetal Rh D positive red blood cells that enter the mother's bloodstream before her immune system can react. It is used after Rh exposure events like miscarriage, abortion, or childbirth to prevent the formation of maternal Rh antibodies. The mechanism is not fully understood but it suppresses the antibody response and formation of anti D antibodies in Rh-D negative people exposed to Rh positive blood. It provides passive protection to the fetus during pregnancy.
- A partograph is a graphic record of labor that plots cervical dilation, fetal descent, uterine contractions, and other variables to evaluate labor progress.
- It was introduced in 1955 and modified in 1972 to add an alert line and action line to indicate abnormal labor progression.
- The partograph records information about the mother, fetus, amniotic fluid, cervical dilation, fetal descent, uterine contractions, and drugs administered during labor.
- An example is given of a woman admitted in active labor whose progress is plotted on the partograph, including spontaneous vaginal delivery.
This document provides guidelines for the use of anti-D immunoglobulin (anti-D Ig) for Rhesus D prophylaxis. It discusses the history and pathogenesis of Rh isoimmunization, appropriate dosing and administration of anti-D Ig, sensitizing events requiring prophylaxis, and the implementation of routine antenatal anti-D prophylaxis programs. The guidelines aim to prevent RhD alloimmunization in RhD-negative women by outlining evidence-based best practices for anti-D Ig administration.
Antenatal care.ppt-by MANOJIT (MS),MALDA MEDICAL COLLEGEDr.Manojit Sarkar
Antenatal care involves comprehensive health supervision and guidance for pregnant women from conception through delivery. Its goals are to reduce maternal and infant mortality and morbidity. Regular checkups are recommended which include physical exams, screening tests, health education, and monitoring for potential complications. Common discomforts of pregnancy like fatigue, back pain, and nausea are discussed along with relief measures. Screening recommendations are provided for conditions like gestational diabetes, anaemia, and infections. Nutritional supplements like folic acid and vitamin D are also addressed.
Intrauterine Fetal Death (IUFD),(Kurdistan)Znar Mzuri
This document provides an overview of intrauterine fetal death (IUFD), also known as stillbirth. It defines IUFD as the death of a baby in the uterus after 20 weeks of gestation. The document discusses the epidemiology, etiology, risk factors, clinical features, diagnosis, treatment and management, and nursing care of IUFD. It also provides references for additional information.
Antenatal care refers to the supervision and care provided to an expectant mother from conception to the start of labor. This presentation discusses the definition, goals, and importance of antenatal care. It outlines the recommended four antenatal visits including what is assessed at each visit. The presentation also covers collecting a medical history, performing a physical examination, and providing health education to mothers on topics like hygiene during pregnancy. The overall aim of antenatal care is to monitor the health of both mother and baby and detect any complications.
This document summarizes information about intrauterine growth restriction (IUGR). It discusses normal fetal growth occurring in three stages: hyperplasia, hyperplasia and hypertrophy, and hypertrophy. Causes of IUGR include maternal, fetal, placental, and environmental factors. Maternal causes include medical conditions, malnutrition, smoking, and infections. Fetal causes include genetic abnormalities and infections. Placental causes include improper placentation and reduced blood flow. Clinical features of IUGR infants include a large head, thin skin, and scaphoid abdomen. Risk prediction methods include ultrasound and Doppler. Problems for IUGR infants include hypoxia, hypoglycemia, and immunological and metabolic issues. Management
Abnormalities of the Placenta, Umbilical Cord and MembranesAladdin Abdrabo
This document discusses abnormalities of the placenta, umbilical cord, and membranes. It covers various placental abnormalities including abnormal shape or implantation, degenerative lesions, circulatory disturbances, hypertrophic lesions, inflammation, and tumors of the placenta. Specific abnormalities are defined such as placenta accreta, placental infarction, and chorioangioma. Complications associated with certain abnormalities like hemorrhage and fetal growth restriction are also noted. The document provides clinical information on evaluating and diagnosing various placental pathologies.
The document discusses antenatal assessment, which involves the systematic supervision of a pregnant woman. It involves determining risk factors through a comprehensive history and physical exam. Regular checkups are recommended, starting with monthly visits until week 28, then twice monthly until week 36, and weekly during the last 4 weeks. The assessments monitor maternal and fetal health and wellbeing through tests, exams, ultrasounds and more. The goal is to promote a healthy pregnancy and delivery.
This document provides information on prenatal care, including initial prenatal evaluation, definitions of common terms, assessment of gestational age, routine prenatal visits, laboratory tests, nutritional counseling, and dietary recommendations. The initial prenatal evaluation involves taking a medical history, physical exam, and laboratory tests to assess the health of the mother and fetus. Routine prenatal visits every 4 weeks until 28 weeks and every 2 weeks until delivery are recommended to monitor the pregnancy. Laboratory tests screen for infections and nutritional deficiencies. Nutritional counseling advises women on healthy diet and weight gain during pregnancy.
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.
Mternal death review lecture by dr. evelina r. castro 102413Jesart De Vera
The document provides information on maternal death reviews and prenatal care. It discusses how to determine true labor contractions from false contractions. It outlines the schedule of prenatal visits and assessments that should be done at each visit, including medical history, physical exams, lab tests, fetal monitoring, and growth assessments. The summary also reviews guidelines for screening and testing for conditions like gestational diabetes, anemia, STDs, and Group B Strep during each trimester of pregnancy.
E. Atypical HUS (aHUS)
1. Epidemiology. aHUS is much less common than STEC-HUS.
2. Etiology
a. Drugs (e.g., oral contraceptives, cyclosporine, tacrolimus) or pregnancy may cause
aHUS.
b. Inherited aHUS occurs with both autosomal dominant and autosomal recessive
inheritance patterns, although not all patients have identifiable mutations. These
genetic mutations cause chronic, excessive activation of complement, which also
leads to platelet activation, endothelial cell damage, and systemic thrombotic
microangiopathy.
3. Clinical features. Clinical findings are similar to those of STEC-HUS. Diarrhea may also
be present, and severe proteinuria and hypertension are more consistently found. The
clinical course is generally more severe with multiorgan damage.
4. Management. Treatment is supportive. Inciting medications, if any, must be stopped
immediately.
5. Prognosis. Some patients have a chronic relapsing course (recurrent HUS). All patients
with aHUS have a higher risk of progression to ESRD than patients with STEC-HUS.
This document provides guidance on antenatal care during the second trimester of pregnancy. It discusses the goals and aims of antenatal care, the timing and frequency of visits, assessments and screenings to be performed, common discomforts experienced and their management, and counseling of patients. The key aspects covered are initial evaluation if the first visit is in the second trimester, ongoing assessments at follow-up visits, screening tests and their timing, and identifying and managing high-risk pregnancies.
Second Trimester work up and Algorithms by Dr Pratima Mittal NARENDRA C MALHOTRA
The document provides guidance on antenatal care in the second trimester. It recommends ongoing assessments of the health of the mother and fetus between 14 to 28 weeks of gestation, including accurate dating, screening tests, and monitoring for potential complications. Regular visits allow for early detection and treatment of issues. Common discomforts of pregnancy like back pain, nausea, and constipation are also addressed.
SCREENING OF HIGH RISK PREGNANCY NEWER MODALITIES OF_110313.pptxRDiJ1
This document discusses screening methods for high-risk pregnancies. It defines screening as identifying apparently healthy individuals at increased disease risk. High-risk pregnancies are those with increased maternal, fetal, or newborn morbidity/mortality risks due to complicating factors. Screening assessments evaluate medical histories and examine for risk factors like young/elderly primigravidas, medical conditions, obstetric histories, and other maternal conditions. Newer screening modalities include biochemical tests, cytogenetic tests, non-invasive methods like ultrasound and NSTs, and invasive methods like CVS and amniocentesis.
This document provides information on prenatal care, including definitions of common terms, how to diagnose and date a pregnancy, components of routine prenatal care visits, nutritional counseling recommendations, and recommended dietary allowances during pregnancy. Key points covered include determining parity, diagnosing pregnancy through presumptive, probable and positive signs and tests, estimating gestational age using various methods, components of initial and subsequent prenatal visits, weight gain recommendations, nutrition guidelines, and dietary allowances for vitamins, minerals, protein and calories during pregnancy.
Antenatal care involves comprehensive health supervision and guidance for pregnant women from conception through delivery. Its goals are to reduce mortality and morbidity for both mother and baby, and improve their physical and mental health. Regular checkups are recommended to monitor health, detect complications, provide education, and prepare for labor. Appointments are typically more frequent in the third trimester. Examinations include medical history, physical exam, and screening tests. Nutritional supplements like folic acid and vitamin D are also advised.
1) Antenatal care involves educating, supervising, and treating pregnant women in order to ensure healthy pregnancies and deliveries for both mother and baby.
2) The WHO recommends a minimum of four antenatal care visits: the first upon confirmation of pregnancy, the second at 20-28 weeks, the third at 34-36 weeks, and the fourth before the expected delivery date.
3) Each antenatal care visit includes assessing the health of the mother and fetus, providing health education, monitoring weight and blood pressure, checking for signs of complications, and discussing delivery plans. Regular antenatal care aims to promote healthy pregnancies and identify risks early.
This document provides an overview of prenatal care, including when it should begin, what is assessed at prenatal visits, common tests and screenings, risk factors, and how high-risk pregnancies are managed. Prenatal care aims to monitor the health of the mother and fetus, identify potential complications, educate the patient, and promote a healthy pregnancy outcome. Key components of prenatal visits include assessment of gestational age, physical exam, labs, history, abdominal exam checking fundal height and fetal heart tone.
This document provides an overview of a presentation on maternal and child health care programs in developing countries. It discusses key concerns like malnutrition, infection, and uncontrolled reproduction. It then outlines components of antenatal care like checkups, nutrition advice, immunizations and preparing for delivery. Maternal health issues like anemia and infections are addressed. The importance of family planning, neonatal care, and reducing mortality rates is also highlighted. Overall the document covers maternal and child health issues and programs in developing nations.
This document provides guidance on prenatal care for pregnant women. It discusses terminology related to pregnancy, common symptoms and conditions, recommended prenatal visits and assessments. The goals of prenatal care are to establish an estimated due date, diagnose and treat any issues, and promote a healthy pregnancy through nutrition, lifestyle recommendations and monitoring for potential complications. Regular visits include checking vital signs, fetal positioning, and screening tests. The document emphasizes establishing a diagnosis and care plan tailored to each woman's individual risk factors and needs.
Antenatal care and high risk assessment1Pave Medicine
This document contains definitions, guidelines, and recommendations for various aspects of antenatal care. It discusses routine tests and screenings recommended during pregnancy including blood tests, ultrasounds, GBS screening, and tests for conditions like anemia, gestational diabetes, syphilis and HIV. The frequency of antenatal visits is outlined with tests typically done at each visit. Details are provided on assessing gestational age, fetal growth, position and heart rate at appointments.
The document summarizes antenatal care, which aims to achieve a healthy pregnancy and delivery. Key points include:
- Antenatal care promotes mother and baby's health, detects high-risk cases, educates on childcare and reduces mortality.
- Visits are usually monthly until 28 weeks, then two weekly until 34 weeks, and weekly after. High-risk cases have more frequent visits.
- The booking visit establishes gestational age and performs baseline tests. Routine investigations and examinations are done at each visit.
- Health education covers diet, weight gain, symptoms, warning signs, and lifestyle factors. Immunizations like tetanus toxoid are given according to schedule.
The document summarizes antenatal care, which aims to achieve a healthy pregnancy and delivery. Key points include:
- Antenatal care promotes mother and baby's health, detects high-risk cases, educates on childcare and reduces mortality.
- Visits are usually monthly until 28 weeks, then two weekly until 34 weeks, and weekly after. High-risk cases have more frequent visits.
- The booking visit establishes gestational age, provides information, and performs baseline tests like blood tests and urine analysis.
- Subsequent visits include history, exams, investigations and health education on diet, exercise, symptoms and warning signs.
- Ultrasounds are performed for dating, anomalies
High-risk approach with screening and assessmentAnamika Ramawat
High risk pregnancies require screening and assessment to identify risks and provide extra care. Around 20-30% of pregnancies are considered high risk due to factors that could adversely affect the pregnancy outcome for the mother or baby. Assessment involves evaluating the health history and risk factors, while screening identifies apparently healthy people who may be at increased risk. Various diagnostic tests can then be used to further evaluate any risks found during screening. These include noninvasive tests like ultrasound, CTG, NST and CST as well as invasive tests like CVS and amniocentesis. Proper screening, assessment and diagnosis of high risk pregnancies allows for improved monitoring and outcomes.
This document discusses the history and evolution of antenatal care (ANC), current practices, limitations, and ways to improve ANC. It notes that while ANC has significantly reduced maternal and infant mortality rates, the maternal mortality rate in India remains high. It identifies limitations like low coverage, inadequate home care, and an overreliance on predicting risks rather than detecting current issues. The document recommends strengthening continuity of care, screening for common diseases, universal ultrasound screening, and developing birth preparedness plans to ensure earlier access to emergency care. The goal is to make pregnancy a normal physiological event and further reduce mortality rates.
management priorities in high energy trauma
Define the terms of fracture, dislocation and Subluxation
Identify the clinical and radiological pictures of fractures
Classify the different types of fractures
general principles of fracture management
Principles of open fracture management
This document discusses dyslipidemia, including its definition, epidemiology, classifications, diagnosis, screening, and management. Dyslipidemia is defined as abnormal lipid levels and is a major risk factor for cardiovascular disease. The prevalence of dyslipidemia in Saudi Arabia ranges from 20-44% according to recent studies. It can be caused by genetic or secondary lifestyle factors such as obesity, diabetes, and smoking. Screening and treatment focuses on reducing ASCVD risk using statin drugs according to new guidelines that classify patients into groups based on their clinical risk factors and lipid levels. Management involves lifestyle changes and drug therapy using low, moderate, or high intensity statins while monitoring for side effects like muscle symptoms.
This document provides guidance on approaching and managing adult patients with asthma. It defines asthma as a chronic inflammatory airway disease and notes that over 2 million Saudis are affected. When assessing a patient, providers should take a detailed history, perform a physical exam including lung function tests, and rule out alternative diagnoses. Treatment involves education, controlling triggers, pharmacotherapy including inhaled corticosteroids and bronchodilators, and referral for severe or uncontrolled cases. Providers are advised to continuously monitor symptoms and lung function and adjust treatment accordingly.
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The diabetic foot is a serious complication that can lead to amputation. It occurs when neuropathy, poor circulation, and foot trauma combine to cause wounds and infection. The overall prevalence of foot complications among diabetics is around 3%, increasing with age and diabetes duration. A multidisciplinary approach is needed to manage the diabetic foot, focusing on wound care, infection treatment, improving circulation, metabolic control, pressure relief to promote healing, and patient education to prevent future complications. Regular foot screening and early treatment of wounds or infections can help reduce the risk of amputation among those with diabetes.
This document discusses dyslipidemia, including its epidemiology, classification, diagnosis, screening, and management. Some key points:
- Dyslipidemia is characterized by abnormal lipid levels and contributes to atherosclerosis. It can be primary or secondary.
- The prevalence of dyslipidemia in Saudi Arabia ranges from 20-44% according to studies.
- Diagnosis involves measuring lipid levels through a serum profile. Treatment involves lifestyle changes and lipid-lowering drugs like statins.
- Statins are beneficial for both primary and secondary prevention of cardiovascular disease according to clinical trials. Guidelines recommend statin use for those with specific risk factors.
The document discusses road traffic accidents in Saudi Arabia. It notes that Saudi Arabia has one of the highest rates of death due to road traffic accidents in the world at 25.33 per 100,000 people. The ratio of accidents to deaths in Saudi Arabia is also high at 32:1 compared to 283:1 in the US. The most common cause of road traffic accidents in Saudi Arabia is excessive speeding. Family physicians can play an important role by raising awareness, coordinating with other groups, and establishing road safety committees.
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2. ANC goals
•To ensure the woman and her child are as healthy as
possible during pregnancy.
•Good birth outcome.
•Identify high risk pregnancy/ possible complications.
•Decrease infant and maternal mortality rate.
3. Recommended WT
gain
Rate of WT gain in
2nd &3rd
trimester
Recommended
total WT gain
KG/W Total KG
<18.5 0.5 12.5-18 KG
18.5-24.9 0.4 11.5-16KG
25-29.9 0.3 7-11.5KG
> 30 or equal 0.2 5-9 KG
THE RECOMMENDED WT GAIN IN PREGNANCY
4. Daily dietary requirements for common nutrients
Calories: increase 100 kcal/day in the first trimester
and 300 kcal/d in second and third trimester (15%), or
about 2200 cal/day
Protein: an additional 10 to 30 gm /day (about 75
gm/day) Calcium: 1200 mg / day
Float: 400 mcg/day Iron : 30 to 60 mg (300 mg
ferrous sulfate heptahydrate, 180 mg ferrous fumarate or
500 mg of ferrous gluconate.)
5. ANC visits
Monthly up to 32 weeks
Every two weeks until 36 weeks
weekly after 36 weeks till delivery.
6. Focused ANC 4 visits model out lined in WHO clinical
guidelines with additional 2 visits as needed
1st visit
8-12 weeks
2nd visit
24-26 weeks
3rd visit
32 weeks
4th visit
36-38 week
Confirm
pregnancy and
EDD, classify for
basic ANC 4 visits
or more
specialized care.
Screen , treat and
give preventive
measures
Develop a birth
and emergency
plan.
Advice and
counsel.
Assess maternal
and fetal well
being.
Exclude PIH and
anemia .
Preventive
measures.
Review and modify
birth and
emergency plan .
Advice and
counsel.
Assess maternal
and fetal well
being.
Exclude PIH and
anemia, multiple
pregnancies .
Preventive
measures.
Review and modify
birth and
emergency plan .
Advice and
counsel.
Assess maternal
and fetal well
being.
Exclude PIH and
anemia multiple
pregnancies ,
malpresentation .
Preventive
measures.
Review and modify
birth and
emergency plan .
Advice and
counsel.
7. 1st visit
8-12 weeks
2nd visit
24-26 weeks
3rd visit
32 weeks
4th visit
36-38 week
History
( ask ,
check ,
records)
Assess significant
symptoms.
Take psychosocial,
medical and OB hx.
Confirm pregnancy
and calculate EDD.
Classify all women
(in some cases after
test results)
Assess significant
symptoms.
Check record for
previous
complications
and treatment
during the
pregnancy. Re-
classification if
needed
Assess significant
symptoms.
Check record for
previous
complications
and treatment
during the
pregnancy. Re-
classification if
needed
Assess
significant
symptoms.
Check record for
previous
complications
and treatment
during the
pregnancy. Re-
classification if
needed
Ex.
(look,
listen,
feel)
Complete general
and Ob examination
,BP,(weight)
(pelvic examination)
(fundal height
>20w) ,
BP,(weight)
,fetal growth and
movements
Anemia
Anemia ,
BP,(weight fundal
ht),
,fetal growth and
multiple
pregnancies
Anemia ,BP,(wt
,fundal ht)
,fetal growth .
Movements
multiple
pregnancies,
(fetal lie by Abd
palpation)
8. Elements ANC visit
Accurate GA .
Identification of high risk pregnancy.
Deal with common complaints.
Screen for :
Anemia
GDM, STI, Genetic, TORCH
Co-morbidies
Monitoring Fetal well-being
Counseling and prevention
Referral
Screening
Treatment
Education &
Counseling
Psychological
support
11. =
General examination
● Vital signs ● Breast ● Thyroid:
Current guidelines recommend targeted screening by
TSH measurement for women at high risk ?????
-History of thyroid disease
-Type 1 DM
-Current or past use of thyroid therapy
-Family history of autoimmune thyroid disease
-Symptoms of disease in pregnancy
● there is no evidence that universal testing during
pregnancy improves outcomes (not recommended)
● If the TSH level is abnormal, a free thyroxin test may
be useful
12.
13. Physical examination
● Abdominal exam: scars? enlarged uterus? masses?
● LL edema / varicosities
● Dental assessment
● Pelvic exam :Routine antenatal pelvic examination
does not accurately assess gestational age, nor does it
accurately predict preterm birth or cephalopelvic
disproportion. It is not recommended. [B]
15. Investigations
• Urine dipstick
• ABO / rhesus D status
• Screening for anemia & Hbopathies
• Rubella susceptibility
• FBS
• HBV*
• Toxoplasmosis / VDRL
• Early US for GA
•Screening for asymptomatic bacteriuria.
16. ASYMPTOMATIC BACTERIURIA
Asymptomatic bacteriuria complicates 2% to 7% of pregnancies.
All pregnant women should be screened between 11 and 16
weeks’ gestation and treated, if positive, to reduce the risk of
recurrent urinary tract infection, pyelonephritis, and preterm
labor
17. Infectious Diseases
BACTERIAL VAGINOSIS
Universal screening is not supported by current evidence.
A recent systematic review found that screening and
subsequent treatment of infection does not prevent
delivery before 37 weeks’ gestation, but decreases the
risk of low birth weight and premature rupture of
membranes (AAFP 2014)
18. RUBELLA
Women should be screened for rubella immunity during
the first prenatal visit and before conception when
vaccination is safe.
All women who are nonimmune should be offered
vaccination postpartum to prevent congenital rubella
syndrome in subsequent pregnancies.
Vaccination should not be given during pregnancy, but
may be given during lactation
Infectious Diseases
19. VARICELLA
Maternal varicella (chickenpox) can have significant fetal effects,
including congenital varicella syndrome (low birth weight and limb,
ophthalmologic, and neurologic abnormalities)
Neonatal varicella; infection can occur from approximately five days
before to two days after birth
Infectious Diseases
20. Women who test negative for immunoglobulin G should avoid
exposure to varicella during pregnancy and be offered
vaccination postpartum.
After a significant exposure, varicella-zoster immune globulin
therapy may be considered
Infectious Diseases
21. INFLUENZA
Physicians should recommend that all pregnant women receive
vaccination for influenza.
Pregnant women may be at higher risk of influenza complications
than the general population.
Household contacts of pregnant women should also be offered
vaccination
22. TETANUS AND PERTUSSIS
Women should receive a diphtheria, tetanus, and pertussis
(Tdap) vaccine during each pregnancy. (CDC adult immunization
2014& AAFP 2014)
The best time for vaccination is between 27 and 36 weeks’
gestation (CDC adult immunization 2014& AAFP 2014)
23. (AAFP)Routine screening for
other infections, including
toxoplasmosis,
cytomegalovirus, and
parvovirus, Trichomonas ,
Gonorrhea and Herpes is not
recommended during
pregnancy.
24. Ultra
sound
It is the standard of care in most U.S.
communities to offer a single
ultrasound examination at 18 to 20
weeks' gestation, even if dating
confirmation is not needed.11 This is the
optimal time for fetal anatomic
screening.
A randomized trial comparing routine
screening ultrasonography (between 15
and 22 weeks and again at 31 to 35
weeks) performed only for medical
indications showed no difference in
perinatal outcomes (e.g., fetal or
neonatal death, neonatal morbidity).
25. Ultra
sound A recent Cochrane review, however,
showed that ultrasonography before
24 weeks reduces missed multiple
gestation and inductions for
postterm pregnancies.
In our hospital maximum 3 us visits
1-at 8 – 12 wk screening, confirm
date,intra extra uterine.
2-after 20 w fetal anatomy ,multiple
gestation .
3-for lei presentation.
26. Psychosocial screening
•The U.S. Preventive
Services Task Force
(USPSTF) recommends
screen women of
childbearing age for
intimate partner violence,
such as domestic violence,
and provide intervention
services or a referral if a
woman screens positive.
•(ACOG) supports depression
screening during pregnancy.
Complications include
prematurity, low birth
weight, neurodevelopmental
delays, maternal/ infant
bonding.
27. Second visit at 26 gestational age
● Wt/BP/urine for proteinuria.
● Measure fundal height /correlate with calc GA
● Fetal movement
● GDM screening*
● Offer 2nd screening for anemia*
● Investigate Hb level below 10.5 g/100 ml and consider iron
supplements.
●Offer anti-D prophylaxis to women who are rhesus D-negative
28. Third visit at 32 weeks
Review, discuss and record the results of screening tests undertaken at 26 W.
Fetal movement
BP/urine for proteinuria.
Measure fundal height /correlate with calc GA
Give specific information on:
preparation for labour and birth, including the birth plan, recognizing active
labour and coping with pain.
Screening for G B streptococcal infection
29. GROUP B STREPTOCOCCUS
All pregnant women should be offered screening at 35
to 37 weeks’ gestation
Treatment with intrapartum antibiotic prophylaxis
(penicillin, or clindamycin if allergic)
30. Fourth visit at 38 weeks
BP /urine for proteinuria.
Measure fundal height
Fetal movement
Give specific information on:
options for management of prolonged pregnancy
Preparation for labor.
Importance of post natal care and arrange for home visits.
Role of the husband
31. At 41 weeks
BP /urine for proteinuria.
Measure fundal height
Fetal movement
Further discussion of management of prolonged
pregnancy
35. ● Risk of developing alloimmunization in RhD-negative woman
carrying RhD-positive fetus
● Testing for ABO blood group and RhD antibodies performed
early in pregnancy
● Rho(D) immune globulin, 300 mcg, is recommended for
nonsensitized women at 28 weeks’ gestation, and again within 72
hours of delivery if the infant has RhD-positive blood.
Alloimmunization
36. Rho(D) immune globulin administered if the risk of fetal-to-
maternal transfusion is increased in
● Chorionic villus sampling
● Amniocentesis
● Abdominal trauma
● Bleeding in the second or third trimester
Alloimmunization is uncommon before 12 weeks’ gestation so
women with a threatened early spontaneous abortion may be
offered Rho(D) immune globulin, 50 mcg
Alloimmunization
37. Anemia
● IDA associated with
Increased risk of preterm labor
intrauterine growth retardation
perinatal depression.
● All pregnant women should be screened for anemia
early in pregnancy and treated with supplemental iron
if indicated.
● USPSTF found insufficient evidence to recommend
for or against routine iron supplementation.
38. ● Multivitamins alone have no benefit over iron and folate
supplementation.
● Pregnant women with anemia other than IDA or who do not
respond to iron supplementation within four to six weeks should
be evaluated for other conditions, including malabsorption,
ongoing blood loss, thalassemia, or other chronic diseases
Anemia
39. Thyroid disease
Women with overt hypothyroidism, are at increased risk
of
pregnancy loss
Preeclampsia
low birth weight and fetal demise or stillbirth.
placental abruption, hypertensive disorders& IUGR
Levothyroxine 2.33 µg/kg/day for overt hypothyroidism
to achieve a goal TSH level less than 2.5 mIU per L.
Diagnosed before pregnancy The levothyroxine dosage is typically
increased in the first (and sometimes in the second) trimester of
pregnancy, with a possible total increase of 30% to 50%
40. Case
A 31 year old pregnant in 10 weeks
referred to your clinic for evaluation
of her lab and management .
T4 15 (9 –24)
TSH 6.2 (0.5 – 5)
What you will do ?
levothyroxine doses:
TSH < 4.2 mIU/L 1.20 µg/kg/day
TSH > 4.2 to 10 1.42 µg/kg/day
41. Thyroid disease
Hyperthyroidism is associated with pregnancy loss,
preeclampsia, low birth weight, thyroid storm,
prematurity, and congestive heart failure
Treated with propyl thiouracil (PTU) 100 450 mg/d in the
first trimester only in the second and third trimester
treated with methimozol 10-40mg/d
42. All psychotropic medications cross the
placenta, are present in amniotic fluid, and
can enter breast milk.
Studies have shown a relapse rate of 68
percent in women who discontinue
antidepressant therapy during pregnancy..
Psychotic disorder
43. Untreated maternal depression is associated
with increased rates of adverse outcomes
(e.g., premature birth, low birth weight,
fetal growth restriction, postnatal
complications), especially when depression
occurs in the late second to early third
trimesters.
However, the potential risks associated with
SSRI use must be weighed against the risk of
relapse if treatment is discontinued. SSRI
should be individualized.
44. •At present, FDA does not find sufficient evidence to
conclude that SSRI use in pregnancy causes PPHN,
and therefore recommends that health care
providers treat depression during pregnancy as
clinically appropriate.( rare heart and lung condition
known as persistent pulmonary hypertension of the
newborn (PPHN).
45. ACOG Releases Guideline on
Gestational Diabetes 2015
Insulin is the preferred medication for pregestational type 1
and type 2 diabetes not adequately controlled with diet,
exercise, and metformin.
46.
47. Chronic Hypertension
•BP ≥ 140 /90
mmHg one of
them or both .
•Present before
20th week of
pregnancy or
persists longer
then 12 weeks
postpartum.
Avoid treatment in women with
uncomplicated mild essential HTN as
blood pressure may decrease as
pregnancy progresses.
initiate therapy for persistent 150/100
mmHg, or signs of hypertensive end-
organ damage.
Medication choices = Oral
methyldopa and labetalol.
Time of delivery < 160/110 mmHg
after 37 weeks.
48. < 150100 no ttt
> 150100 With oral labetalol† as first-line treatment
to goal less than 150 80–100 mmHg
Preeclampsia
–New onset of HTN and
proteinuria after 20
weeks
–Proteinuria of 0.3 g or
greater in a 24-hour urine
specimen
–Preeclampsia before 20
weeks, think MOLAR
PREGNANCY!
–Time of delivery mild or
moderate HTN at 34+0
to 36+6 weeks
depending on maternal
and fetal condition.
–Sever before 34 w
Gestational Hypertension
Mild hypertension
without proteinuria.
Develops in late
pregnancy, after 20 weeks
gestation.
Resolves by 12 weeks
postpartum.
Can progress onto
preeclampsia. Time of
delivery < 160/110 mmHg
after 37 weeks.
49. HYPERTENSION IN PREGNANCY
Preeclampsia in a previous pregnancy , chronic hypertension, low
dietary calcium (less than 700 mg) increase risk of preeclampsia
. Calcium supplementation for women with low dietary calcium
reduces the risk of preeclampsia by 30% to 50%.
Low-dose aspirin from 12 to 36 weeks’ gestation reduces
preeclampsia by 20% in women with a history of preeclampsia
50. Common questions for which you will need
to have an answer
Activity and exercise: moderation
Sexual activity: no problem if pregnancy progresses normally
Diet: balanced diet
Bathing and swimming: no high speed sports or jet skis
Dentition: a dental check-up is recommended, any work is OK
Immunizations: avoid live virus vaccines MMR V
Travel: frequent stops to stretch
Employment: no contraindication if pregnancy is normal
Consequences of over weight and obesity :Increase risk of DM &GDM which leads to
macrosomia, shoulder dystocia, operative delivery, congenital anomalies, IUGR, spontaneous abortion, stillbirth, preeclampsia, & eclampsia
WHO recommends only 4 essential visits in special time with additional 2 visit as needed
1st visit at 16 week.
2nd visit at 26 week.
3rd visit at 32 week
4th visit 36-38 week
With special protocol to be followed in each visit.