This document discusses antenatal screening guidelines from various expert groups. It recommends screening in the first, second, and third trimesters to monitor fetal development and maternal health. Screening in the first trimester includes tests to check for chromosomal abnormalities and assess risk of conditions like preeclampsia. Second trimester screening involves additional tests and an anatomy scan. Third trimester screening monitors fetal growth, movement, heart rate and includes infection screening before delivery. The goal is early detection of high-risk pregnancies so risks can be managed to prevent complications and ensure safe delivery.
Adbhut matratva is a unique modification of the normal antenatal care.............we now propogate care from PRECONCEPTION to POST PARTUM including a HOLISTIC APPROACH
Antenatal care is the routine health control of presumed healthy pregnant women without symptoms (screening), in order to diagnose diseases or complicating obstetric conditions without symptoms and to provide information about lifestyle, pregnancy and delivery.
Baseline serum chemistry in 1st trimesterRohit Jain
ppt on "baseline serum chemistry in 1st trimester" by Dr.Rohit Jain,Assistant Professor,Obstetrics and Gynecology Department,Civil Hospital,BJ Medical College,Ahmedabad
Adbhut matratva is a unique modification of the normal antenatal care.............we now propogate care from PRECONCEPTION to POST PARTUM including a HOLISTIC APPROACH
Antenatal care is the routine health control of presumed healthy pregnant women without symptoms (screening), in order to diagnose diseases or complicating obstetric conditions without symptoms and to provide information about lifestyle, pregnancy and delivery.
Baseline serum chemistry in 1st trimesterRohit Jain
ppt on "baseline serum chemistry in 1st trimester" by Dr.Rohit Jain,Assistant Professor,Obstetrics and Gynecology Department,Civil Hospital,BJ Medical College,Ahmedabad
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BH...Lifecare Centre
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKAR
WHY THIS PPT ??
One of our of patient’s was discharged home with presumed COMPLETE miscarriage.
Subsequently returned with pain abdomen , bleeding & ruptured EP
…We thought of reviewing
PRENANCY OF UNKNOWN LOCATION
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BH...Lifecare Centre
PREGNANCY OF UNKNOWN LOCATION DR. SHARDA JAIN DR. JYOTI AGARWAL DR. JYOTI BHASKAR
WHY THIS PPT ??
One of our of patient’s was discharged home with presumed COMPLETE miscarriage.
Subsequently returned with pain abdomen , bleeding & ruptured EP
…We thought of reviewing
PRENANCY OF UNKNOWN LOCATION
Prenatal Testing, deteksi kelainan bawaan sejak dalam kandunganHendrik Sutopo
Pengenalan mengenai prenatal diagnosis.
Memberikan gambaran sekilas mengenai cara-cara untuk mengetahui kelainan bawaan sejak janin dalam kandungan.
lebih ditujukan untuk kalangan medis.
Non Invasive Prenatal Testing (NIPT)
Common Lab Investigations in pregnancy specific to each TrimesterDrNisheethOza
There are no standardized guidelines/protocols for conducting common laboratory investigations during pregnancy. Here is an attempt to educate Pregnant ladies in this important aspect of their healthcare.
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
Similar to Maternal screening in pregnancy final (20)
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The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
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Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
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Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
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Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
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Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
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2. EXPERT GROUP
DR NARENDRA MALHOTRA
DR MALA ARORA
DR RANJANA KHANNA
DR ABHA RANI SINHA
DR PRAGYA MISHRA
DR NAVNEET MAGON
DR GANPAT SAWANTA
3. Reference Material
• New WHO guidelines on antenatal care –
Systematic review BJOG 2016;123:519-28
• Guidelines by Government of western
Australia
• SOGC guideline on Prenatal Screening
• RCOG / NICE Guidelines
5. Why Screen ?
1.Triage mothers to High Risk & Low Risk
2.Prevent Maternal Complications
3.Screen the fetus for
• Chromosomal errors
• Structural Defects
• Growth abnormalities
4.Decide the time and mode of safe
delivery
6. ADD SCREENING FOR N.C.D.HERE
THE PYRAMID OF ANTENATAL CARE
Post delivery continued screening
7. Routine Antenatal Care 1990s…….
Early scan to diagnose
pregnancy & dating
Fetal defects
22-24 wks
Anomaly scan
8. Routine Antenatal Care 2005
11-14 wks
Fetal defects
20-23 wks
P I P I P
The great
Ob syndrome
9. Routine Antenatal Care 2010
11-13+6 wks
Fetal defects
Chemical markers Major
Cardiac defects
Uterine artery Doppler
20-23 wks
Anomaly scan
10. FOGSI OLD CHECK LIST OF 2009,MODIFIED IN 2017 AT FOGSI T.O.G.
15. Body Mass Index – If high
•Prevent further weight gain
•Institute Life style modifications
•Medical Therapy – Metformin
•Nutrition Therapy – High fibre diet
•Daily Exercise
•Prepare for safe delivery
16. General Examination
• Heart – Murmurs
• Lungs – Rhonchi
• Breast – Lumps / Nipples
• Abdomen – Scars / Lumps
• Per Speculum – Discharge / Polyp / Erosion
LBC / HPV
• Anus – Sentinel Pile
17. Blood Pressure
• Hypertension – BP in both arms
Sitting position
Dissappearance of korotkov
• Hypotension – increase sodium/ potassium intake
• Screening test for PIH
Placental Growth Factor (PlGF)
S Flt
s endoglin
Uterine artery doppler flow indices
18. Screening for Anaemia
• Complete Blood count
• Peripheral Smear
• If Microcytic Hypochromic
Iron studies – Ferritin / Total Iron / TIBC
Haemoglobin Electrophoresis
• If Normocytic / Macrocytic
Serum Vitamin B12
Serum / Red cell Folate
Reticulocyte count
19. Blood group & Rhesus Antibodies
• If Rhesus Negative
• Partners Blood group – If negative –
• If positive – Indirect Coombs test
• If positive – Cordocentesis & fetal blood
transfusion with Rh negative blood at
periodic intervals
• Deliver at 34 weeks
20. Endocrine Screening
• Thyroid function test
• If abnormal, thyroid antibodies
• In PCO – screen for GDM early (HbA1C)
• If galactorrhea – Prolactin
• Serum Vitamin D
• Relaxin ?
21. Infection Screen
• Complete blood count /ESR
• Rubella antibodies
• Urine routine & microscopy
• Mid stream urine culture
• High Vaginal / Endo cervical swab /Wet Prep /
Vaginal pH / Chlamydia antibodies
(SOLVS + FVU PCR)
• HIV / Hep B / Hep C / VDRL
29. Screening in the 1st trimester
• Time window: 8 - 14 weeks
• Ultrasound Marker:
• NT
• Biochemical markers:
• PAPP-A
• Fb-hCG
• Marker combination:
• Combined test: NT, PAPP-A, Fb hCG
30. Screening for Trisomy 21 at 11- 14 weeks
2-stage (contingency) screening- UK system
USG (N.T.) AND DUAL MARKER FOR ALL
Fetal NT and
free BhCG and
PAPP-A at 12 wks
Very high risk
Very low risk
CVS
Reassure
Borderline
risk
Further
screening
Nasal bone
DV, TR
31. Screening for Trisomy 21 at 11- 14 weeks for
India
2-stage (contingency) screening proposed
RISK ESTIMATE BY ONLY USG N.T. AND OTHER MARKERS
Fetal NT
Nasal bone and
ductus venosus
tricuspid
regurgitation at 12
wks
Very high risk
Very low risk
CVS
Reassure
Borderline
risk
Further
screening
Free B hCG
PAPP-A
THIS WILL SAVE
TIME
MONEY
OPTIMUM USE OF OUR
SKILL
DOUBLE MARKER
TEST
Scan 20w NIPT
32. • MA + NIPT(OPTIONAL)
• Dual Marker
• NT + NB + TR + DV
First
trimester
• Quad Marker
• Genetic Sonogram
Second
trimester
Integrated 1st and 2nd trimester screening
DR – 97%
FPR – 2.5%
33. SO PROPOSAL IS INDIAN
CONTINGENT SCREEN
OR
INTEGRATED FIRST AND
SECOND TRIMESTER
SCREEN
COMBINED FIRST TRIMESTER SCREEN
FOR RISK ESTIMATE…….
FOLLOWED BY COMBINED 2ND
TRIMESTER RISK SCREENING
37. 1LOW LEVELS PREDICT PRE ECCLAMPSIA
2 LOW RISK NO FURTHER TEST (1 : 1000)
INTERMEDIATE RISK (100 : 999) TO PROCEED TO SECOND TRIMESTER SCREENING VS NIPT
HIGH RISK (1 : 99) TO GO FOR CVS / NIPT
ANTENATAL CHECKLIST
First Trimester Recommended Preferable
weight BMI
Blood pressure Mean Arterial Pressure
Haemoglobin Complete blood count/ Peripheral smear /
Hb Electrophoresis / HPLC
Blood group ABO & Rh (both partners)
Urine routine MSU culture
VDRL/ Hep B / HIV HCV / Rubella IgG
TSH Thyroid function test / Thyroid Antibodies
Vitamin D
DIPSI test 75gms 2 hours blood sugar Hb A1C / OGTT/ 6 point blood sugar test
Dating scan + NT
Double marker (free beta
HCG + PAPP A1 )
(Contingent Screen2
Cervical length
Uterine artery Doppler
NIPT
Placental Growth Factor
(PLGF)
Per speculum exam Pap Smear, Bacterial vaginosis &
Chlamydia screen
40. CERVICAL LENGTH SCREENING
ROUTINE TO PREVENT PRETERM
LABOUR AND FOR GUIDELINE FOR
CX STITCH
• ASYMPTOMATIC SINGLETON PREGNANCY A TVS CL <25
MM IN SECOND TRIMESTER
• SCREEN AT 11-13 WEEKS AND THEN AT 22-22 WEEKS
RECENT EVIDENCE SAYS CX STITCH DOES NOT HELP AND
PROGESTERONE MAY BE THE ONLY TREATMENT OPTION
HERE.ROUTINE MCDONALD STITCH PRACTISE SHOULD BE
INDIVIDUALISED
46. Screening for GDM
• HbA1C
• DIPSI one step screen 75 gms 2
hour
• Cut off of 140 mg/dl
• At 24 to 28 weeks
• Repeat at 32 weeks in high risk
women i.e Polyhydramnios /
previous GDM / Parents &
siblings diabetic
47. Screening for PIH
• Blood Pressure
• Water Retention – edema / rapid
weight gain
• Micro albuminuria
• Spot test – Urine Protein /Creatinine
ratio
• Ratio of PlGF / sFlt
• LDH raised in HELLP Syndrome
• Renal artery doppler
48. Vaccination
• Tetanus Toxoid – ONE DOSE
• Tdap –SECOND DOSE AT 24 WEEKS
• Influenza vaccine 24 weeks onwards
• hpB can be given if not immunised
• Targetted Vaccine in case of travel to
endemic areas
• Post partum – HPV vaccine
53. INFECTION SCREEN
• GBS – Is routine screening required prior to
delivery ?
• Pelvic assessment – Does it improve your
decision for normal delivery ?
• Pelvic relaxation techniques / exercises like
walking / squatting / butterfly
56. Cardiotocography
• Non Stress test vs Oxytocin Stress test
• When to start ? Post viability period 30
weeks
• How often to do ? Once a week
• What are the omnious signs –
Lack of BTB variation
Variable deaccelerations of cord
compression
Late deacceleration of fetal hypoxia
• Supplement with ST waveform analysis
• Fetal cord blood pH during labour
58. Recording
•Every kick / roll is 1 movement
•Count 10 movements everyday
•Should be around 6 in 1 hour
•If < 6 movements in 2 hours
•Call doctor & come for CTG / USS
assessment
59. About baby’s movements
An active baby is usually a healthy baby. You
will feel your baby stretch, kick, roll and turn
every day. Some babies are more active than
others. All babies have periods of sleep during
which they are not as active. You will get to
know your baby’s pattern of movements and
when your baby is most active.
You should feel your baby’s movements
throughout the day, each day from 28 weeks of
pregnancy until the baby is born.
When during my pregnancy should I count
my baby’s movements?
Your health care provider may ask you
to count your baby’s movements once
every day.
If you think there is a decrease in your
baby’s movements this is an important sign that
your baby may not be well. Count your baby’s
movements to be sure that you feel at least 6
movements in 2 hours.
Reference:
Society of Obstetricians and Gynaecologists of Canada (2007).
Fetal Health Surveillance : Antepartum and Intrapartum Consensus
Guideline. Journal of Obstetrics and Gynaecology Canada. 29(9).
FETAL MOVEMENT
COUNT CHART
PLEASE BRING THIS CHART WITH YOU EACH
TIME YOU SEE THE DOCTOR/MIDWIFE
IMPORTANT PHONE NUMBERS:
DOCTOR:
MIDWIFE:
HOSPITAL:
DUE DATE:
OTHER INSTRUCTIONS:
For 24-hour nurse advice and health information call
Health Link Alberta:
1-866-408- LINK (5465)– Toll Free
In Calgary call 403-943- LINK (5465)
In Edmonton call 780-408-LINK (5465)
ADDRESS:
NAME:
HS0001-132 (2012/11)
How do I count my baby’s movements?
• Get into a comfortable position – lying on
your side or sitting. Place one or both of your
hands on your abdomen.
• Count each time that you feel your baby
move. If you feel many movements all at
once, count each movement that you feel.
• Write down the date and the time that you
start counting on the fetal movement chart.
• Make a mark on the chart each time your baby
moves.
• Stop counting when you have counted 6
movements.
• Write down the time you stopped counting.
• Do not count for more than 2 hours
What if I don’t feel 6 movements in 2 hours?
Count your baby’s movements once a day. You
should feel 6 or more movements in 2 hours.
If you count fewer than 6 movements in 2 hours
do not wait. Go to the hospital or birthing unit.
Your baby’s heart rate and movements will be
checked using a fetal monitor. This is called a
non-stress test or NST.
If you live too far from a hospital or birthing
unit, immediately contact your health care
provider for advice.
60. TWEAK Screening for alcoholism
• T – Tolerance (No of drinks one can hold)
• W- Worry about drinking
• E – Eye opener
• A - Amnesia
• K/C – Cut down on drinking
• To screen for fetal alcohol syndrome
61. • Antepartum fetal surveillance is the assessment of
fetal well being in utero before the onset of labor
• Early detection of fetus at risk so that timely
management to prevent further deterioration
• Also find out normal fetuses and avoid unnecessary
interventions
• Very high negative predictive value
• Very low positive predictive value
62. FETUS AT RISK
• PRE TERM
• POST TERM
• IUGR
• THICK MECONIUM
WITH SCANTY
FLUID
• INTRAUTERINE
INFECTION
• INTRAPARTUM
BLEEDING
INJUDICIOUS USE OF
OXYTOCIN
EPIDURAL IN A CASE WITH
SOME COMPROMISE
DIFFICULT INSTRUMENTAL
DELIVERY/ MACROSOMIA/
MALPRESENTATION
ACUTE EVENTS (CORD
PROLAPSE, ABRUPTION,
SCAR RUPTURE)
SUSPICIOUS/ ABNORMAL
ADMISSION TEST
FETUS AT
RELATIVE RISK
66. • Hydrops fetalis
• Fetal infections
• PREGNANCY RELATED CONDITIONS
• Preeclampsia
• Multiple pregnancy
• Post term pregnancy
• Decreased fetal movements
• Abnormal placentation
• Placental abruption
67. • Oligohydramnios
• Polyhydramnios
• Unexplained stillbirth in a previous pregnancy
• Cholestasis of pregnancy
• PROM
• Poorly controlled Gestational Diabetes mellitus
68. The Various Methods of Antepartum
Fetal Surveillance
1) Clinical assessment by uterine growth
2) Fetal movement count by the mother
3) Ultrasound for fetal growth
4) Non stress test and cardiotocography
5) Vibroacoustic stimulation test
6) Contraction stress test
7) Nipple stimulation test
8) Biophysical profile
9) Modified biophysical profile
10) Doppler studies
11) Fetal lung maturation studies
12) Placental grading
70. SCREENING IN PREGNANCY
At booking (Recommended 3ANC) [Preferable 5]
General Physical exam Heart / Lungs / Breast /
Abdomen
In all trimesters
• Maternal weight /BMI
• Blood Pressure / Mean Arterial Pressure
• Urine dipstick (albumin sugar)
71. 1LOW LEVELS PREDICT PRE ECCLAMPSIA
2 LOW RISK NO FURTHER TEST (1 : 1000)
INTERMEDIATE RISK (100 : 999) TO PROCEED TO SECOND TRIMESTER SCREENING VS NIPT
HIGH RISK (1 : 99) TO GO FOR CVS / NIPT
ANTENATAL CHECKLIST
First Trimester Recommended Preferable
weight BMI
Blood pressure Mean Arterial Pressure
Haemoglobin Complete blood count/ Peripheral smear /
Hb Electrophoresis / HPLC
Blood group ABO & Rh (both partners)
Urine routine MSU culture
VDRL/ Hep B / HIV HCV / Rubella IgG
TSH Thyroid function test / Thyroid Antibodies
Vitamin D
DIPSI test 75gms 2 hours blood sugar Hb A1C / OGTT/ 6 point blood sugar test
Dating scan + NT
Double marker (free beta
HCG + PAPP A1 )
(Contingent Screen2
Cervical length
Uterine artery Doppler
NIPT
Placental Growth Factor
(PLGF)
Per speculum exam Pap Smear, Bacterial vaginosis &
Chlamydia screen