ANTENATAL EXAMINATION INVESTIGATION AND PROPHYLACTIC MEDICATIONS
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The document discusses antenatal examination and prophylactic medication. It provides details on the objectives, principles and components of antenatal examination, including maternal history taking, physical examination, abdominal examination, fetal assessment and investigations. It also lists various prophylactic medications recommended during pregnancy to prevent or treat conditions like anemia, nausea, gestational diabetes, thyroid disorders, HIV, and others.
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ANTENATAL EXAMINATION INVESTIGATION AND PROPHYLACTIC MEDICATIONS
- 1. ANTENATAL EXAMINATION INVESTIGATION AND PROPHYLACTIC MEDICATION Presented by:- KHUSHBOO SINGH
- 2. INTRODUCTION
- 3. ANTENATAL CARE /EXAMINATION IT’ S A SYSTEMIC (Examination and advice) of a women during pregnancy Assessment’ MEANS is ‘ to evaluate’i.e. here we gather the information of client status and it identifies the specific needs of a client by which better care can be given to the client and her developing fetus.That means,it is the systematic supervision(examination & advice)of a woman during pregnancy.So,it is the foundation stone for antenatal care.
- 4. Objective • To screen the ‘ high risk’cases • To prevent or to detect and treat at the earilest any complications. • To ensure continued medical surveillence and prophylaxis. • To educate mother about the physiology of pregnancy and labour by demonstration,charts and diagrams so that fear is removed and psychology is improved. • To discuss with the couple about the place,time and mode of delivery and care of newborn. • To motivate the couple about to the need of family planning. • To give appropiate advice to couple seeking MTP.
- 5. GENERAL PRINCIPLES • Always explain to the patient the need and the nature of the proposed examination. Obtain a verbal consent once she has been told what the examination would entail. • The examiner (male or female) should be accompanied by another female • Examination performed in a private side-room, respecting patient's privacy at all times. • Patient should be covered at all times and relevant parts of her anatomy only exposed. • Make sure the room is well lit and comfortably warm.
- 6. • Ensure the patient has emptied her bladder before examining her abdomen. • Patient should lie in the supine position with a pillow under the head and arms by her side. • She is slightly rolled to the left side to prevent compression of the inferior vena cava by the enlarged uterus (inferior venacaval syndrome or supine hypotensive syndrome). • Ask for any tender area before palpating the abdomen.
- 7. MEASURES • MATERNAL MEASURE • FETALMEASURE
- 8. Maternal measures • History Taking Examination • General • Physical • Obstetrical • Abdominal examination • Vaginal examination • Radiological Examination/investigation
- 9. History Taking Vital Statistics • Name: … … … … … … … … … … .. • Date of first examination: … … .. • Address:… … … … … … … … … … • Age:… … … … … … … … … … … … • Gravida:Parity… … … … … … … .. • Duration of marriage: … … … … . • Religion: • Occupation: … … … … … … … … … … … • Period of Gestation: … … … … … … … .. • Chief Complaints: … … … … … … … … .(sleep,appetite,bowel habit,urination) • History Of present illness:… … ........... • History of present pregnancy: … … … First trimester – Hyperemesis gravidarum second trimester-pyelitis, third trimester-anemia,pre- eclampsia and APH also note the no. of antenatal checkups,any exposure to medication or radiation
- 10. • Obstetrics History..No. of children,health status of the baby,immunization, if any miscarriage • Menstrual history: … … … … … … … … ..age of menarche, LMP,Duration,EDD,Amount of blood flow • Past medical history: … … … … … … … . • Past surgical history: • Family History Personal History
- 11. General and Physical Examination: • • Build:Obese/Average/Thin • Nutrition:Good/Average/Poor • Height:Short stature is likely to be associated with small pelvis. • Weight:The total weight gain during the course of singleton pregnancy for a healthy women averges 11 kg(24 Ib) • Pallor:The sites to be noted are lower conjunctiva,dorsum of tongue and nail beds.
- 12. • Jaundice:The sites to be noted are conjunctiva,tongue,skin. • Tongue,teeth,gums and tonsils: • Neck:Neck veins,thyroid gland or lymph nodes should be inspected. • Breast Examination:It should be inspected for pregnancy changes
- 14. Obstetrical Examination : ABDOMINAL EXAMINATION Inspection • Describe the abdominal distension (pyriform). • Previous operative(Caesarean)scars • Striae gravidarum or stretch marks • Linea nigra- a dark vertical line appearing on the abdomen from the pubis to above the umbilicus during pregnancy due to increase melanocyte- stimulating hormone made by the placenta. • Visible foetal movements.
- 15. Palpation • Fundal height (Symphysis-fundal height) • Foetal poles • Foetal lie • Presentation- cephalic(head),breech,etc • Attitude • Level of engagement of presenting part • State of uterine wall/ myometrium • Liquor volume • Estimate foetal weight • Foetal movements
- 16. Auscultation • Auscultation of the foetal heart: • Auscultated with a foetal stethoscope( Pinard's foetal stethoscope) or with a doptone machine. • Best place to listen is over the foetal back, closer to the cephalic pole. • The normal foetal heart rate is btw 110 to 160 beats per minute
- 19. Abdominal Examination: • Palpated using four Leopold's manoeuvres • The fundal grip(foetal poles): • Both hands placed over the fundus and the contents of the fundus determined. • A hard smooth, round pole indicates a fetal head. • A softer triangular pole continuous with the fetal body is the fetal buttocks(breech)
- 20. Lateral grip Symphysis-fundal height(Size and gestational age of the uterus) • More objective, distance from the symphysis pubis to the uterine fundus (top of the uterus) • size of the uterus directly related to the size of the fetus.
- 21. Technique • Palpate down from xiphi-sternum to determine the highest part of the uterus(fundus),may not always be in the midline. • -Mark this point with a pen after obtaining her permission. • -A tape measure turned upsidedown(blinded to avoid bias) is then placed from the mid-point on the uppermost border of the symphysis pubis over the curve of the uterus to the marked highest point of the uterus. • -The tape is then turned and actual measurement in cm is recorded, preferably in graphic form
- 23. Pawlik grip(3rd Leopold) – • The thumb and middle fingers of the right hand are placed wide apart over the suprapubic area to determine the presenting part. • -Presenting part of fetus is the lowest most part of the fetus at the inlet of the pelvis(the lower fetal pole as opposed to the fetal pole in the fundus). • -Cephalic or breech presentation distinguished from each other
- 24. Pelvic grip (Presenting part):
- 25. • -If cephalic prominence on the same side as fetal back, fetal head is extended (abnormal position). • -If examiners hands reach the fetal head equally on both sides, fetal head is deflexed ('Military position, indicating mal-position
- 26. Vaginal Examination: • It should be done by using the left fingers(thumb & index),the character of vaginal discharge,cervix consistency,cystocele,uterine prolapse,rectocele is to be elicited. • Can be done for taking vaginal swabs for investigations
- 28. Investigations
- 30. Investigations • Blood examination (for ABO,Rh,VDRL ) and screening for blood glucose in selected cases • Serological test for Rubella , hepatitis B virus, • Maternal alpha feto protein-at 16-18 weeks is done to detect neural tube defect down syndrome and other chromosomal abnormality • Urine examination • For examining protein, sugar,pus cells
- 32. FETAL MEASURE • Biochemical • MSAFP,Triple test,AChE,) • Cytogenetic • Amniocentesis • Chorion Villus Sampling(CVS) • Cordocentesis • Fluorescence In Situ Hybridisation(FISH) • Biophysical • • Fetal movement count(DFMC) • • Non Stress Test(NST) • • Fetal biophysical profile(BPP) • • Contraction stress test(CST) • • Doppler Ultrasound • •
- 37. Biophysical Profile Biophysical Profile: • It is the screening test for utero-placental insufficiency. • The fetal biophysical activities are initiated,modulated and regulated through fetal nervous system. • The fetal CNS is very much sensitive to diminished oxygenation.
- 39. Non Stress Test(NST) • It is the continuous electronic monitoring of the fetal heart rate along with recording of fetal movements (cardiotocography) is undertaken. • FHR acceleration with fetal movements,which when present,indicates a healthy fetus. • It is used as screening test. • The test is valuable to identify the fetal wellness rather than illness. • Test should be started after 30 weeks and frequency should be twice weekly • • Reactive(Reassuring): When two or more acceleration of more than 15 beats per minute above the base line and longer than 15 sec in duration are present in a 20 min observation. • • Non-Reactive(Non-Reassuring):Absence of any fetal reactivity.
- 40. Fetal movement count(DFMC) • • The patient counts the fetal movements every morning,noon and evening. • • Three counts each of one hour duration are recommended. • • If the no. of kicks are less than 10 in 12 hrs. or 3 in each hour it indicates fetal compromise. • • Increased fetal movements associated with maternal hypoglycemia. • • Decreased FM cause obesity,smoking,hypoxia, anterior placenta,hydramnios,narcotic drugs.
- 41. Ultrasound Indications • • Diagnosis of pregnancy. • • Assessment of gestational age. • • Diagnosis of multiple pregnancy. • • Assessment of IUGR or BPP. • • Uterine size either > dates or < dates. • • Asessment of liquor volume. • • Diagnosis of any abnormality e.g. placenta praevia etc.
- 43. PROPHYLACTIC MEDICATION • Calcium -1000mg • Zinc -15 mg • Protein -60gm • Vitamin A -5000 IU • Vitamin D -400 IU
- 46. Disease Prophylactic drug Anemia prophylaxic Nausea and vomiting Gestational diabetes Hyperthyroid Hypothyroid Thromboembolism HIV 30-60mg of elemental iron Folic 0.4 mg (800 ug) First-line management –Pyridoxine, Doxylamine •Alternatives – Phenothiazines, Metoclopramide (risk of sedation and extrapyramidal effects) – Ondansetron –Corticosteroids (for hyperemesis gravidarum) First-line treatment –Insulin • Alternatives –Glyburide and metformin • Intravenous drip insulin should be used during labor •Propylthiouracil –first trimester • Methimazole –second and third trimesters •Contraindication –Iodine131 – risk of thyroid damage in fetus •Thyroid replacement therapy – Levothyroxine (0.1 mg/day) Warfarin (between 6 and 12 wk) – Unfractionated heparin –Injectable direct thrombin inhibitors Lopinavir-ritonavir –Recommended in pregnant women •Prevention of mother-to-child transmission –Zidovudine with single dose of nevirapine
Editor's Notes
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