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.
Preparation for delivery of mother, baby and midwife and equipmentsDR MUKESH SAH
In addition to their delivery bags, midwives “carry” many other invaluable tools ... family planning, delivery preparation, postnatal counseling and breastfeeding. ... With this equipment, we can recover 80% of newborns. ... “Midwifery feels good when both the mother and baby come out of the labor ward alive.
Preparation for delivery of mother, baby and midwife and equipmentsDR MUKESH SAH
In addition to their delivery bags, midwives “carry” many other invaluable tools ... family planning, delivery preparation, postnatal counseling and breastfeeding. ... With this equipment, we can recover 80% of newborns. ... “Midwifery feels good when both the mother and baby come out of the labor ward alive.
An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
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.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
Taking-In Phase
It takes 2-3 days, during which time the mother’s first concern is with her own needs (sleep and food).
The woman reacts passively, mostly dependent on others to meet her needs.
She is quite talkative during this phase about every detail of her labor and delivery experience
Taking-Hold Phase (Taking Responsibility as a Mother)
It starts the 3rd day postpartum
She progresses from the passive individual to the one who is in command of the situation.
This phase lasts about 10 days.
Once the mother has taken control of her physical being and accepted her role as a mother, she is able to extend her energies to her mate and other children.
Letting-go Phase
This generally occurs when the mother returns home.
In this phase there are two separations that the mother must accomplish.
One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
Letting-go Phase
This generally occurs when the mother returns home.
In this phase there are two separations that the mother must accomplish.
One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
Physical Assessment is necessary to identify individual needs or potential problems
Explain to pt purposes of the examination.
Obtain her consent.
Record your findings and report results to the mother.
Ensure privacy and environment where the mother can lie on her back with her head supported.
Ensure bladder is empty & lay patient supine with legs flexed.
The midwives hands should be clean and warm
An episiotomy is a cut (incision) through the area between your vaginal opening and your anus. This area is called the perineum. This procedure is done to make your vaginal opening larger for childbirth.
This topic contains definition, instruments, indications, contraindications, prerequisites, advantages, procedure, complications and hazards of ventouse or vaccum delivery.
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.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
Taking-In Phase
It takes 2-3 days, during which time the mother’s first concern is with her own needs (sleep and food).
The woman reacts passively, mostly dependent on others to meet her needs.
She is quite talkative during this phase about every detail of her labor and delivery experience
Taking-Hold Phase (Taking Responsibility as a Mother)
It starts the 3rd day postpartum
She progresses from the passive individual to the one who is in command of the situation.
This phase lasts about 10 days.
Once the mother has taken control of her physical being and accepted her role as a mother, she is able to extend her energies to her mate and other children.
Letting-go Phase
This generally occurs when the mother returns home.
In this phase there are two separations that the mother must accomplish.
One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
Letting-go Phase
This generally occurs when the mother returns home.
In this phase there are two separations that the mother must accomplish.
One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
Physical Assessment is necessary to identify individual needs or potential problems
Explain to pt purposes of the examination.
Obtain her consent.
Record your findings and report results to the mother.
Ensure privacy and environment where the mother can lie on her back with her head supported.
Ensure bladder is empty & lay patient supine with legs flexed.
The midwives hands should be clean and warm
Musculoskeletal system – movements of the lower limb technologiesKareem Magar
A teaching resource I created for an assessment for university. It lists all the main movements of the lower limb (hip joint, leg/knee and leg/foot), the muscles associated with each movement and any other relevant information. At the end is a table summarizing all the information in depth, including origin and insertion. Included within the presentation are pictures of every movement and muscle involved, as well as links to useful resources such as a 3D anatomy model.
Introduction
Pregnancy is a normal physiological process and any intervention that is offered to the pregnant or expectant mother should have known benefits and should be acceptable to the woman
Screening in pregnancy is the process of surveying a population of women with markers and defined screening cut-off levels, to identify those at higher risk for a particular disorder
All pregnant women, regardless of age, should be offered, through an informed counselling process, the option of a prenatal screening test for the most common clinically significant fetal aneuploidies
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.
Hello everyone
This presentation will give a insight into the recent advances in fetal therapy. Hope it might help you
Thanking you
Dr Ankit gupta
MD Pediatrics
Kims karad
This is a discussion of hepatitis B, hepatitis C and HIV in pregnancy, the optimal screening for these infections and the integration of management approach based on evidence. Lecture given during the 2018 PIDSOG post-graduate course "High-Yield OBGYN Infections 2.0: From Confusion to Clarity" at the Conrad Manila on November 12, 2018.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
2. 13/12/200
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Definition:
Embryo:
Fetus:
Gravidity
Parity
Abortion:
Immature infant:
Preterm/premature infant:
Term:
Post term
Date/Post date
Birth rate
Fertility rate
Neonatal period:
I, II & III
Perinatal period:
Perinatal mortality rate:
Maternal mortality rate:
3. Sign & symptoms of PRESUMPTIVE /PROBABLE manifestations
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Pregnancy test:
Biological
Immunological
Radioimmunoassay for HCG
Serum vs urine
4. “”Antenatal care is the clinical assessment of mother and fetus
during pregnancy, for the purpose of obtaining the best possible
outcome for both the mother and the fetus”
The aims of antenatal care:
Assessment and management of maternal risk and symptoms
Assessment and management of fetal risk
Prenatal diagnosis and management of fetal abnormalities
Diagnosis and management of perinatal complications
Decision regarding timing and mode of delivery
Education regarding pregnancy and childbirth
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5. Frequency of antenatal visits
12 weeks –booking + viability uss
16 weeks-blood screening (MW)
18 weeks-dating &detailed uss
24 weeks-
28 weeks- FBS, auto ab
30 weeks
32 weeks- growth uss
34 weeks
36 weeks –
38 weeks
40 weeks
41 weeks -
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booking visit (first visit):
The aim:
obtain a comprehensive history and physical examination
establish the gestational age
identify the maternal and foetal risk factors
History:
A FULL obstetric history particularly:
LMP (last menstrual period)
EDD (estimated delivery date)
Past obstetric, gynaecological, medical and surgical history
Family history
Social history ( inquire about smoking, alcohol, drugs)
Identify factors and categories which make patient high or low risk.
7. Assessment of gestational age:
Nagel’s rule (EDD) :
Subtract 3 months from the date of the last menstrual period and add
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7 days( 14 days in Arabic months).
If the cycle was longer than 28 days, the number of additional days
are added to the days used in the rule
Do the opposite if the cycle is shorter
Biparietal diameter: accurate +/- 3 weeks ( useful between wks 7-12)
Crown rump length: accurate +/- 1 week (useful between wks 7-12)
Fundal height: correspond to gestational age in weeks
.
9. Measurement Symphyseal
Fundal height
Evidence supports either palpation or S- F measurement
at every AN visit to monitor fetal growth
measurement should start at the variable point (F) and
continue to the fixed point (S)
SF measurement should be recorded in a consistent
manner (therefore cms at RWH)
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10. Fetal Presentation and
Descent
Check presenting part beginning around 30 weeks
Descent of presenting part is important as term
approaches
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11. Auscultation of fetal heart
Listening to fetal heart is of no known clinical benefit,
but may be of psychological benefit to mother
(Consensus opinion)
Should be offered at each visit after about 20 weeks
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12. Routine BP measurement
HT is defined when systolic BP is 140mmHg +/or DBP is
90 mmHg or there is an incremental rise of 30 systolic
or 15 diastolic
Automated devices & ambulatory devices should not be
used (Mercury devises seem best)
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13. Urinalysis by dipstick for
proteinuria - evidence
high incidence of false +ve and - ve using dipsticks cf 24
hr urine collection
reliable in detecting highly variable elevations in
protein in pre-eclampsia
Gribble et al AJOG 1995; 173: 214-7
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14. Urinalysis by dipstick forn
proteinuria - evidence
no statistical differences in rates of PAH, fetal distress,
abruptio placentae, neonatal outcome in those with
absent, mild or marked proteinuria by dipstick
US and Canadian Guidelines recommend screening for
pre-eclampsia by BP measurement rather than dipstick
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15. Urinalysis by dipstick for
proteinuria - guidelines
Routine screening for proteinuria in low risk pregnant
women not recommended IV
assessment hypertensive pregnancies requires
estimation of total protein in 24-hr collection IV
If detect hypertension then use dipstick for testing
proteinuria
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16. Routine weighing at A/N
visits - evidence
weighing at every antenatal visit
routine practice for many years
No conclusive evidence for weighing at
each visit. Maternal weight not
clinically useful screening tool for
detection of IUGR, macrosomia or pre-eclampsia
IV
Weighing at booking or other times
may be indicated eg anaesthetic risk
assessment (done BIV at RWH) or
maternal weight concerns
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18. Initial recommended tests
FBE
MCHC/MCV (Thal screen. Ferritin and
Hb electrophoresis if low)
Blood group/Ab screen
HIV (level 1 evidence)
Hep B
Syphilis (ideally prior 16 weeks)
Rubella Abs
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19. Urine testing- either 2 step or
MSU+dipstick
PAP if due
Consider
Hep C
Ferritin
Vit D levels - common in patients at RWH
addit Thal screen
dating US
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20. Hepatitis C screening
Should be offered to all at increased risk
history of injecting drugs
partner who injected drugs
tattoo or piercing
been in prison
blood t/f later positive for Hep C
long-term dialysis or organ transplant before 7/92
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21. Prenatal testing
Down screening
Screening - : early US, 15-17 week MSST, Early
combined screening(first trimester MSST and early US)
diagnostic testing - CVS, amniocentesis
Other testing according to history eg for CF, Fragile X,
Thalassaemia, Huntington's disease
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22. Prenatal screening for Down’s
syndrome
All women should be offered screening irrespective of
age III/IV
counselling given by appropriately trained staff and
specific to age of each woman III/IV
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23. Down syndrome screening
Screening should
include accurate dating by 1st T u/s IV
either by 2nd T biochem, or nuchal translucency alone or
combination III
notify result irrespective of risk in understandable format
II
if increased risk should be offered further counselling and
diagnostic testing within 72 hrs or ASAP IV
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24. Down’s syndrome screening
Quality of counselling is of primary importance, non-directional,
if chooses screening, should be single-step
III
Nuchal translucency should be performed at 11-14
weeks by trained operators and risks derived in
conjunction with gestation and maternal age IV
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25. Other recommended tests
26 weeks (at hospital)
Gestational diabetes screening -
AB screen on all women
36 weeks
GBS screen
(Ab if RH -ve has been ceased)
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26. Screening for GDM
In absence of high level evidence to either support or
abandon screening reasonable to
not offer screening
selectively offer screening to all with risk factors
offer screening to all
if screening do so between 24-28 weeks
RWH screen all women at 26 weeks
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27. Prevention of Early Onset GBS
Swabs should be taken between 35-37 weeks’ III
Intrapartum antibiotics recommended if
<37 weeks’
ruptured membranes >18 before delivery
maternal temperature ³38 C
previous GBS colonisation, bacteruria or infant with GBS III
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28. Antenatal anti-D prophylaxis
Prophylactic Anti-D at 28 and 34
weeks’ gestation
No level I evidence
Level II and III evidence would suggest
that the 1.5 percent immunisation
rate could be reduced to 0.1-0.2%
through antenatal prophylaxis (Huchet
et al, 1987;Bowman and Pollock, 1978;
Hermann et al, 1974)
www.health.gov.au/nhmrc/publicatio
ns/pdf/wh27.pdf
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29. 13/12/200
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Investigation:
routine test:
Blood group and Rh type ( if positive, appropriate management)
CBC
Urine analysis- to prevent UTI affecting pregnancy)
MSU
HBs Ag ( if a mother has it, 70-90% chance of foetus getting it,
90% chance of being chronic carrier. Prevent by treating newborn
of HBs AG+ve mother with B immune globulin and hep B
vaccine)
Rubella
Syphilis
U/S:
Determine foetal crown rump length and thus gestational age
Identify multiple gestation
Identify gross abnormalities/ markers of genetic disease.
Cervical cytology
30. 2-Screening tests:
Anaemia
Gestational DM (best carried out between 24 and 28 weeks, observe 1 hr
after 50g glucose solution. A reading of 126 mg/dl or greater is abnormal,
according to the amended WHO recommendations 1999 regarding DM,
as is HbAlc of greater than 90%. In these cases proceed to glucose
tolerance test)
Antibodies
Triple test: Alpha feto protein in normal serum, oestriol, HGG
( to detect neural tube defect or chromosomal defect, 16-18 weeks)
Hb electrophoresis
Tuberculin skin testing
Urine culture- for glucose, ketones and protein, bacilli
Cervical culture: N gonorrhoea, group B streptococci,
Chlamydia trachomatis, Mycoplasma hominis
Toxoplasma antibody test
HIV
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31. HIV: Voluntary Counseling
and Testing
Voluntary HIV counseling and testing should be
available to every pregnant woman--for public health
reasons as well as for the benefit to the individual
woman.
Pre and post-test counseling is an essential part of
managing HIV in pregnancy.
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Source: WHO and UNAIDS 1999.
32. Benefits of Voluntary HIV
Counseling and Testing
1) If the HIV test is positive, the woman can
get early counseling and treatment
2)Allows appropriate follow-up and treatment
of child
3)Enables a woman to make decisions
regarding continuation of the pregnancy
and future fertility
4)May allow the institution of anti-retroviral
(ARV) therapy
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Source: WHO and UNAIDS 1999.
33. Benefits of Voluntary HIV Counseling and
Testing continued
5) Provides the opportunity to
implement strategies that attempt
to prevent transmission to the child
6) Can inform partner and enable him
to get counseling and testing
7) Women can take precautions to
prevent transmission to partners
8) If the HIV test is negative, the
woman can be guided in
appropriate HIV prevention
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Source: WHO and UNAIDS 1999.
34. Syphilis
Maternal-fetal transmission may
be as high as 80%.
Incidence of adverse effects on
the fetus/infant due to untreated
maternal syphilis reported in some
studies was:
Spontaneous abortion – 20%
Perinatal death – 30%
Congenital syphilis – 25%
Source: WHO 1991.
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35. Syphilis continued
A study in Zambia found syphilis to be the
single most common cause of fetal wastage.
The adverse outcomes of syphilis were
halved by a fairly incomplete program of
screening and treatment.
Sources: Hira et al 1990; Tinker and Koblinsky 1993.
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36. Syphilis continued
Even where prevalance is relatively low
(i.e., as in most industrialized countries) an
antenatal syphilis screening program is a
cost-effective intervention.
Initiation of treatment should occur at the
same visit as the screening.
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Source: Wang and Smaill 1989.
37. Tuberculosis
Infants born to women with tuberculosis (TB) have an increased risk
of morbidity and mortality in the neonatal period.
Source: Figueroa-Damian and Arredondo-Garcia 2001.
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38. Severe anemia
Mild or moderate anemia is not correlated with adverse
pregnancy outcomes
Severe anemia, however, (hgb <7 g/dL or hct <20%) is
associated with increased preterm delivery, inadequate
intrauterine growth, increased perinatal mortality and
increased maternal mortality.
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39. Severe anemia continued
Providers can screen for anemia by
1)Hemoglobin (hgb) by thin film/smear
2)Hematocrat (hct) test
3)Hemoglobin Color Scale, or
4) Clinical observation of the inferior conjunctiva
of the eye, the nail beds and the palm. If any of
these are pale, the woman is severely anemic.
Other symptoms include shortness of breath
and signs of heart failure.
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40. Tetanus Toxoid
Tetanus toxoid is
An effective, stable, cheap toxoid
which has been available for > 50 years
and is produced in many developing
countries.
Effective in preventing neonatal
tetanus (NNT), which causes
approximately half a million
deaths/year) and maternal tetanus,
which is estimated to cause 30,000
deaths annually.
Sources: Fauveau V et al 1993; Bennett JV 2000.
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41. Iron Deficiency
Globally among all populations, iron
deficiency (and its manifestation in anemia)
is the single most prevalent nutrient
deficiency condition. The World Health
Organization (WHO) estimates put anemia
prevalence at 52% among pregnant women.
Source: MotherCare, John Snow, Inc. 2000.
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42. Iron Folate Supplements
The International Nutritional Anemia Consultative
Group, WHO and UNICEF have endorsed the
following guidelines:
1) All women should consume daily iron folate
supplements for 6 months during pregnancy.
2) Where anemia prevalence is <40%, women should
receive supplements of 60 mg iron and 400
micrograms of folate
3) In areas where anemia prevalence is high among
pregnant women (³40%), women should continue
the same dosage for 3 months into postpartum.
Sources: Stoltzfus and Dreyfuss 1998; McDonagh 1996.
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43. 3-Specific nutritional advice:
0.4 mg Folic Acid per day ( it prevents tube defects)
30 mg ferrous iron
60 mg ferrous iron 2 times a day ( anaemic patients)
Supplement copper and zinc in anaemic patients
Avoid Vitamin A in huge amounts as it is teratogenic
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44. Nutrition Requirements
Good antenatal nutrition includes:
Meeting the caloric needs
Eating foods which supply specific micronutrients
Providing micronutrient supplementation
An underweight mother increases the
likelihood of a low birth weight (LBW) baby;
low iron intake contributes to anemia.
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45. Models of antenatal care
At each visit midwives and doctors should offer
information, consistent advice, clear explanations and
provide opportunity to ask questions III/IV
More likely to be satisfied with A/N care when perceive
care givers are kind, supportive, courteous, respectful,
recognise individual needs IV
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47. Complications Cannot Be
Reliably Predicted
No formula or scoring system can reliably distinguish those who will
develop complications from those who will not.
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48. Complication Readiness is
KNeepyal tStou dSyurvival
Less than 50% of families of women who died in
pregnancy, delivery or postpartum, recognized the
problem.
36% decided within 2 hours to seek care and get
transport.
15% decided in 2 to 23 hours to seek care and get
transport.
29% made the decision and arranged transport 1 to
8 or more days after recognition of a life-threatening
complication.
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Source: MOH, Nepal 1998.
49. Complication Readiness is
Key to Survival continued
The interval from onset to death for
antepartum hemorrhage can be
approximately 12 hours.
The interval from onset to death for
postpartum hemorrhage can be two hours.
The hours required for making
arrangements (which could have been
made prior to the emergency) may define
the line between survival and mortality.
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Sources: Maine 1991; MOH, Nepal 1998.
50. Danger Signals
Families of pregnant women need to know how to recognize the signs
of complications as well as what to do and where to get help
In Nepal, less than 50% of families of women who died recognized the
problem.
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Source: MOH, Nepal 1998.
51. On subsequent visits
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Check:
oBp 0 urine analysis 0 weight?
Ask for :
0 FM 0 Maternal complaints
Examine:
0 abdomen/obstetric 0 listen/see FH USS if required
Advice:
Treatment of complaint & health education
63. Assessment of gestational age and fetal growth:
menstrual history unreliable in up to 45% of women
serial fundal height measurement provides a guide to fetal growth
USS: crown-rump length before 14 weeks
USS: BPD serial measurement every 2 weeks for fetal growth.
Unreliable after 28 weeks for dating
USS: head/abd ratio, 2 weeks serial HC & AC for fetal growth .. IUGR
AC< but initially HC ~.
USS: femur length, more precise guide to gestational age than BPD
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64. 13/12/200
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Principles:
the ideal scheme to assess FWB should:
Take account of cycles of normal fetal behavior
detect impending harm accurately and in time to intervene to
prevent it
give reassurance preferably up to 7 days
avoid causing unnecessary anxiety
allow detection of specific causes e.g hypoxia, infection, malf’n
produce measurable benefits in reducing perinatal loss/injury
such system is likely to involve tests which assess several
fetal systems, CVS, NS,, RS and use >1 modality
66. BPP uses FHR monitor and real time USS to assess:
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fetal breathing movement
discrete body or limb movement
fetal tone
FHR
amniotic fluid volume
Amniotic fluid volume is most important
Fetal breathing movement is the first to disappear in asphyxia
7 days reassurance in low risk, only 24 hours in high risk preg
68. Clinical Indications for Doppler Studies
most useful in assessing IUGR
identify only the sub-group which is hypoxemic bec/of
inadequate placental function and may be abnormal for up to 18
weeks before any fetal problem is observed
no proven role in population screening for increased risk of
pre-eclampsia or IUGR
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Source: WHO and UNAIDS. 1999. HIV in Pregnancy: A Review, pp. 27-31. Geneva, Switzerland.
Source: WHO and UNAIDS. 1999. HIV in Pregnancy: A Review, pp. 27-31. Geneva, Switzerland.
Source: WHO and UNAIDS. 1999. HIV in Pregnancy: A Review, pp.27-31. Geneva, Switzerland.
Source: World Health Organization Programme of Maternal and Child Health and Family Planning Unit. 1991. WHO Consultation on Maternal and Perinatal Infections, 28 November – 2 December 1988 report. WHO/MCH/91.10. WHO: Geneva, Switzerland.
Sources: Hira SK et al. 1990. Syphilis intervention in pregnancy: Zambian demonstration project. Genitourinary Medicine 66(3): 159-164;Tinker A and MA Koblinsky. 1993. Making Motherhood Safe, pp. 99-100, World Bank: Washington, DC.
Source: Wang E and F Smaill. 1989. Infection in pregnancy, in Effective Care in Pregnancy and Childbirth. Chalmers I, MW Enkin and MJNC Keirse (eds), pp.534-564. Oxford University Press: Oxford, UK.
Source: Figueroa-Damian R and JL Arredondo-Garcia. 2001. Neonatal outcome of children born to women with tuberculosis. Archives of Medical Research 32(1): 66-69.
Sources: The LINKAGES Project. 2000. Maternal Nutrition: Issues and Interventions. A computer-based slide presentation for advancing maternal nutrition. Academy for Educational Development: Washington, DC; Stoltzfus RJ and ML Dreyfuss. 1998. Guidelines for the Use of Iron Supplements to Prevent and Treat Iron Deficiency Anemia. INACG/WHO/UNICEF: Washington, DC.
Sources: Fauveau V et al. 1993. Maternal tetanus: Magnitude, epidemiology, and potential control measures. International Journal of Gynecology and Obstetrics 40(1): 3-12; Bennett JV. 2000. Memo from author, The role of topical antimicrobials, to persons interested/involved in control of neonatal tetanus (NNT), 14 February.
Source: MotherCare, John Snow, Inc. (JSI). September 2000. Issues in Programming for Maternal Anemia. MotherCare/JSI: Arlington, Virginia.
Sources: Stoltzfus RJ and ML Dreyfuss. 1998. Guidelines for the use of iron supplements to prevent and treat iron deficiency anemia. INACG/WHO/UNICEF: Washington,DC; McDonagh M: 1996. Is antenatal care effective in reducing maternal morbidity and mortality? Health Policy and Planning 11(1): 1-15.
The source listed below discusses the difficulties in implementing an effective risk scoring system.
Source: Rooney C. 1992. Antenatal Care and Maternal Health: How effective is it? A review of the evidence, pp. 12-16. WHO: Geneva, Switzerland.
Note: Optional slides 24 and 25, if used, should always be used together.
In Nepal, a recent study showed that less than 50% of families of women who died in pregnancy, delivery or postpartum, recognized the problem. In rural situations in the developing world, as many as 12 to15 hours may elapse between the decision to seek treatment and the beginning to travel towards that treatment.
Source: Ministry of Health (MOH). His Majesty’s Government of Nepal. 1998. Maternal Mortality and Morbidity Study, p. 29. MOH: Kathmandu, Nepal.
This same study in Nepal found that of those families who did decide to seek care, 36% decided within 2 hours to seek care and get transport; 15% decided in 2 to 23 hours to seek care and get transport; while 29% made the decision and arranged transport 1 to 8 or more days after recognition of a life-threatening complication.
Source: Ministry of Health (MOH). His Majesty’s Government of Nepal. 1998. Maternal Mortality and Morbidity Study, p. 31. MOH: Kathmandu, Nepal.
Note: Optional slides 24 and 25, if used, should always be used together.
Life-depleting hours can be lost from the time a complication that needs treatment is recognized through the time arrangements have been made for all the elements that must be in place for the woman to reach help. Considering that the interval from onset to death for antepartum hemorrhage can be approximately 12 hours, while the interval from onset to death for postpartum hemorrhage can be two hours, the hours required for making arrangements (which could have been made prior to the emergency) may define the line between survival and mortality.
Sources: Maine D. 1991. Safe Motherhood Programs: Options and Issues. Center for Population and Family Health, p. 42. Columbia University: New York; Ministry of Health (MOH), His Majesty’s Government of Nepal. 1998. Maternal Mortality and Morbidity Study, pp. 27-28. Kathmandu, Nepal.
Birth planning and complication readiness prior to the development of a complication is key to survival.
Source: Ministry of Health (MOH). His Majesty’s Government of Nepal. 1998. Maternal Mortality and Morbidity Study, p. 29. MOH: Kathmandu, Nepal.