Planned parenthood

1. PLANNED PARENTHOOD
Sharon Treesa Antony
First year M.sc Nursing
Govt. College of nursing
Kottayam

2. Preconception care
Set of interventions that aims to identify &
modify biomedical, behavioural & social
risks to
a woman’s health or pregnancy outcome
through prevention & management.

3. Components
 Early detection & prevention of health risks
 Management high risks before conception
 Active management of fertility
 Creation of awareness among women about
contraception

4. Objectives
 Maximise the health of prospective parents
and hence their babies
 Reduce perinatal mortality& morbidity
 Provide information to prospective parents to
make informed choices & make them ready
to be parents
 Evaluate need for genetic counselling
 Reduce unplanned pregnancies
 Inform about maternity services

5. EVERYWOMAN
EVERYVISIT

6. Preconception health assessment
 Health status
 Sexual history
 Family history-genetic,consanguinous marriage
 Medical/surgical history
 Psychological history
Substance use , occupation
 History of infections
 Obstetric & gynaecological history
 Nutritional history

7. Screening Tests
 BP,Weight,Urinalysis,Full blood count
 Cardiac &Thyroid function
 Respiratory function
 Sexual health status
 Cervical smear
 Serum screening –
rubella,haemoglobinopathies,TB
 Vitamin,Zn,lead levels
 Hair analysis
 Karyotyping

8. Preconception classes

9. 1. Nutrition
 Folic acid supplementation-400mcg/day
 Vitamin D(1000 IU/day) & calcium if low intake

10. DAILY CALORIE REQUIREMENT
 Weight in lb * 10 = calories for BMR A
 A * 30% = calories for average activity B
 A+B * 10% =calories for specific dynamic
action C
 TOTALCALORIES
A+B+C

11. RECOMMENDED DAILY INTAKE
 Protein – 0.8 g /kg
 Iron -18 mg
 Calcium -500mg
 Zinc -12 mg
 Iodine -150 micro gram
 Vitamin A -5000 IU
 Vitamin D- 200IU

12.  Thiamine – 1.1 mg
 Riboflavin – 1.1 mg
 Nicotinic acid = 15 mg
 Vitamin C -60 mg
 Folic acid – 200 micro gram
 Vitamin B 12 – 2 microgram

13. BODY MASS INDEX
BMI=
weight in
kg /height
in( meter)2

14. Classification based on BMI
< 18.5
kg/ m 2
- under
weight
18.5-
24.9
kg/m 2
–
normal
25 –
29.9
kg/m 2
–
overwei
ght
>30.0
kg/m 2
- obese

15. OBESITY
 Risks
 Neural tube defects
 Preterm delivery
 Fetal macrosomia
 Hypertension
 Diabetes mellitus
ACHIEVE NORMAL BMI BEFORE CONCEPTION

16. EATING DISORDERS
 Anorexia nervosa
 Risks
 Abortion
 Low birth weight
 Post partum depression
• Bulimia improves during pregnancy
ACHIEVE NORMAL BMI BEFORE
CONCEPTION

17. VITAMIN DEFICIENCIES
 No need of supplements if healthy diet
 Vitamin A is teratogenic
 Avoid foods high in retinoids

18. FOLIC ACID DEFICIENCY
 Higher dose if epileptic
 Leafy vegetables & whole meat products
 Supplements 2-3 monhs before pregnancy to
end of first trimester
 4mg if epileptic/previous history of neural
tube defect

19. CALCIUM DEFICIENCY
 700mg calcium
 Milk, cheese, egg, yogurt,small fish

20. CAFFIENE
 Reduces implantation
 3 cups/day -27% reduction in conception
 Reduce intake gradually

21. ANAEMIA
 Associated with fetal growth restriction
 Treat before pregnancy
 Diet rich in IFA

22. 2.Infections
 Vaccination if non immune to rubella
 Paternal mumps linked to infertility
 High fever can result in spontaneous abortion
Eg: mumps,measles

23. RUBELLA
 Risks
 Deafness
 Cataract
 Cardiac malformation
 IUGR
 Retinopathy
 Microcephalus
 Cerebral palsy

24.  Avoid contact with infected person 7 days
before&5 days after rash appears
 Vaccinate prior to conception
 Avoid pregnancy for 3 months after
vaccination
 Higher fetal risk in first trimster

25. Erythema Infectiosum
 Avoid children with disease
 Infectious period is 1week before& 1 week
after symptoms

26. Toxoplasmosis
 Low risk for congenital infecion
 Wash hands after contact with soil, meat,
fruits & vegetables
 Wear gloves while dealing with cat litter box

27. Tuberculosis
 Treat before conception
 Use barrier methods during treatment

28. HIV/AIDS
Maintenance of low viral load & high CD4 count
prior to conception
 Treated with zidovudine
 No further unprotected sex

29. Varicella zoster
 Prior maternal infection protects baby during
pregnancy
 Test for vz antibody
 Vaccinate if needed
 No pregnancy for 3 months after vaccination
 Can lead to spontaneous abortion

30. Hepatitis B
 Vaccinate before conception if at high risk
 LFT to assess severity of disease
 Vaccination to uninfected family members

31. Group B streptococcus
 If present in vagina antibiotic therapy in
labour/following ROM

32. Cyto megalo virus
 May be asymptomatic
 Wash hands before preparing meals

33. Tetanus
 Wash hands after contact with soil
 TT before /during pregnancy

34. Syphilis
• Risks
 Still birth
 Abortion
 Infected baby
 Antibiotic therapy during pregnancy

35. Gonorrhoea
 Risks
 Ophthalmia neonatoram
 Arthritis
• Diagnosed with cervical swabs
• Treated with penicillin during pregnancy

36. 3.MEDICAL CONDITIONS

37. Diabetes mellitus
 Risks
 Macrosomia
 Malformations
• Control preconception glycemia
• Measure HbA1C

38. Epilepsy
 Anticonvulsants are teratogenic
 Take folic acid

39. Phenylketonuria
 Maintain blood phenylalanine level
120-360 micromol/L
 Restrict milk, meat, fish , cheese & eggs

40. Hypertension
 Control BP
 Increase risk for preeclampsia,
fetal growth retardation
 ACE inhiibitors & angiotensin 2 receptor
blockers cause fetal malformation

41. Systemic Lupus Erythematosus
 Control associated kidney disease 6 months
prior to conception
 Pregnancy contraindicated in active nervous
system involvement

42. Thyroid disorders
 Hyperthyroidism leads to
 Hypertension,
 Fetal anomalies
 IUGR
 Preterm birth
 Hypothyroidism leads to
 Dwarfism
 Intellectual impairement
SURVEILLANCE OFTHYROID LEVELS ARE
NEEDED

43. Cancer
 Cervical smear prior to conception
 Store sperms/ova before chemotherapy

44. Dental caries , ginguvitis
 Increased chance of preterm labour

45. 4.Genetics
 Screen for genetic disease among high risk
group
 Genetic counselling

46. GENETIC COUNSELLING
 A communication process that deals with
human
problems associated with occurence or
recurrence of a genetic disorder in a family or
individual at increased risk for a condition that
has a genetic component

47. Indications
 Parents of affected child
 Positive family history
 Women >35 years
 Risky ethnic group
 Consanguinous marriage
 Affected couple
 Concern about genetic disorder

48. TESTS
 Biochemical testing-enzyme levels & activity
• DNA testing for mutation
• Chromosomal testing
 Genetic pedigree
 Testing cells of embryo after in vitro
fertilization
 Karyotyping

49. Ethnicity & Genetic conditions
 Asian –Thalassemia
Asian:southeast/chinese-alpha thalassemia
Asian :Indian-beta thalassemia
• African:sickle cell disease/trait,thalassemia
• Ashkenazi Jewish:cystic fibrosis,Tay sachs
disease,Gaucher’s disease,Niemann-pick
disease,canavan disease,Fanconi anaemia,Blorm
syndrome,

50.  European,whitish: cystic fibrosis
 Mediterranean : thalassemia

51. • Autosomal dominant diseases: cystic fibrosis,
sickle cell anaemia , thalassemia
• Autosomal recessive disease:Tay sach’s
disease
Child will have the disease /Will be carrier

52. 5.Environment & lifestyle
 AVOID JOBS INVOLVING:
 Vibrating machines
 Toxic substances
 Excessive cold/heat
 Heavy lifting
 Long travelling times
 Exposure to pesticides / phthalates
 Prolonged standing

53.  Chronic stress preterm birth
 Exercise
 No new exercise in pregnancy
 Increased core body temperature
spontaneous abortion
 No contact sports

54.  Smoking
 Reduces sperm count
 Stop smoking 4 months before conception
:both
 Away from smoky environment

55. • Alcohol
 Reduces sperm count
 Affect ovulation
 Crosses placenta
 Cause fetal alcohol syndrome
 Result in abortion,growth restriction
 Stop alcoholism 4 months prior to conception

56.  Hazardous substances
 Have organically grown foods
 Wash all foods
 No contact with pesticides /insecticides
 No radiation exposure from 3 months prior to
conception

57.  Lead
 From drinking water,soil ,exhaust
fumes,utensils,battery,paint
 Wear protective clothing
 Mineral analysis before conception
>10mcg/dl : toxicity
 Filter water
 High levels in men : infertility
 Lead content in mother moves to fetus

58.  Cadmium
 High levels in men : infertility
 Reduce smoking, alcoholism , contact with
plumbing alloys, paint , batteries ,fertilizers
 Filter water
 Mineral analysis prior to conception

59. • Zinc
 Found in red meat,cereals ,cheese,nuts.
 Levels reduced in alcohol drinkers
 Low levels in men : infertility
 Mineral analysis prior to conception

60.  Aluminium
 Mineral analysis prior to conception
 Derived from utensils while cooking ,antacids
 Filter water
 Use stainless steel / glassware

61.  Mercurry
 Derived from tinned tuna,large fishes,weed
killers,dental amalgam
 Do dental procedures before
conception/involve non mercurry based
amalgam
 Filter water
 Mineral analysis prior to conception

62. Exercise
 Swimming is the best
 To maintain ideal weight

63. 5.Reproductive sexual
health
 Barrier methods during preparation phase of
pregnancy
 Oral contraception
 Cervical screening
 Cease the use 3 months prior to conception
 Reduces Zn,Mn,vitamin A&B
 Intrauterine contraceptive device
 Discontinue 3 months prior to conception
 May increase copper levels

64. Interpregnancy interval
 Ideally at least 18 months
 Short interval causes preterm birth,LBW

65. Advice for men
 Wear loose fitting shorts,trousers
 Cold showers preferred than hot baths
 No smoking and alcoholism
 Ideal weight
 No exposure to chemicals

66. PHYSICAL PREPARATION
AGE :>18 years for girls
>21 years in boys
 Diet: balanced diet,not anaemic not
malnourished
 No exposure to hazardous substances
 Free of infections
 Stop OCP 3 months before
GENETIC CONSELLING

67. PSYCHOLOGICAL PREPARATION
 Mentally prepared
 Away from violence
 Mature

68. FINANCIAL PREPARATION
 Ready to meet increasing demands
 Plan for maternity leave & benefits

69. BENEFITS
 Increased fertility
 Healthy conception,pregnancy,birth
 Reduced risk of abortion ,premature birth
,abnormality
 Reduced morning sickness
 Improved success rate of IVF
 More chance of natural,intervention free birth
 Low risk for postpartum depression
 Suceessful and long term breast feeding
 Healthy children

70. Preparation of family
 Sibling education classes
 Grand parent preparation
 Preparing fathers