The primary aim of preconception and interconception care is to improve maternal health and birth outcome for mother, infant and family through prevention and interventions.
Antenatal care which is just the care given to a pregnant woman through out pregnancy from the time of conception until the time the woman goes into labor.
Antenatal care which is just the care given to a pregnant woman through out pregnancy from the time of conception until the time the woman goes into labor.
To have the mother and child Healthy during the 9 months of pregnancy, Antenatal Care is must. This nine month is very crucial and intensive care should be provided to the mother.
Every woman should be thinking about her health whether or not she is planning pregnancy. One reason is that about half of all pregnancies are not planned. Unplanned pregnancies are at greater risk of preterm birth and low birth weight babies. Another reason is that, despite important advances in medicine and prenatal care, about 1 in 8 babies is born too early. Researchers are trying to find out why and how to prevent preterm birth. But experts agree that women need to be healthier before becoming pregnant. By taking action on health issues and risks before pregnancy, you can prevent problems that might affect you or your baby later.
Discover the essential steps and expert advice for optimal pre-conception care. Learn how to enhance your fertility, ensure a healthy pregnancy, and lay the foundation for your baby's lifelong well-being
I am a student who graduated with bachelor of science in midwifery from Lira University and a master degree in microbiology from Kampala International University
Community Wellness Through Improved Maternity Practices By Drs Jose Gorrin and Ana Parilla. Given at the Puerto Rican Cultural Center in September of 2003
To have the mother and child Healthy during the 9 months of pregnancy, Antenatal Care is must. This nine month is very crucial and intensive care should be provided to the mother.
Every woman should be thinking about her health whether or not she is planning pregnancy. One reason is that about half of all pregnancies are not planned. Unplanned pregnancies are at greater risk of preterm birth and low birth weight babies. Another reason is that, despite important advances in medicine and prenatal care, about 1 in 8 babies is born too early. Researchers are trying to find out why and how to prevent preterm birth. But experts agree that women need to be healthier before becoming pregnant. By taking action on health issues and risks before pregnancy, you can prevent problems that might affect you or your baby later.
Discover the essential steps and expert advice for optimal pre-conception care. Learn how to enhance your fertility, ensure a healthy pregnancy, and lay the foundation for your baby's lifelong well-being
I am a student who graduated with bachelor of science in midwifery from Lira University and a master degree in microbiology from Kampala International University
Community Wellness Through Improved Maternity Practices By Drs Jose Gorrin and Ana Parilla. Given at the Puerto Rican Cultural Center in September of 2003
History and Examination in OBGYN Skill lab.pdfElhadi Miskeen
By the end of this presentation, students :
1. Should be able to refine communication and clinical care skills in taking a pertinent comprehensive medical history
2. Assessing risk and patient adherence to health care recommendations.
3. Should be able to use this information to formulate a diagnosis and management plan while communicating important findings and recommendations to the patient
incorporating her socioeconomic and cultural context
Screening and Preventive Care in OBGN .pdfElhadi Miskeen
SLOs:
By the successful completion of this presentation, you are expected to:
1. Counsel patients on important preventive medicine and health maintenance topics, such as immunization, diet and exercise.
2.Describe appropriate screening protocols for cancer, cardiovascular disease, and osteoporosis
3.Describe the importance of history and physical examination in Screening and Preventive Care.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
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.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Triangles of Neck and Clinical Correlation by Dr. RIG.pptx
Preconception care and ANC Miskeen IL.pdf
1. Preconception, Antenatal and
Antepartum Care
(IL)
„Dr. Elhadi Miskeen, MBBS, MD
„Head Department of Obstetrics and
Gynecology
„College of Medicine, University of Bisha, KSA
2. SLOs
Communicate
• Communicate the patients on appropriate interventions to optimize
preconception health
Describe
• Describe typical care of the pregnant patient, including accurate
diagnosis of pregnancy, medication safety, risk factors for poor
outcome
Discuss
• Discuss the assessments for fetal well-being, and nutritional needs
Discuss
• Discuss the antepartum patient education including employment,
exercise, nutrition and weight gain, breast feeding, sexual activity,
travel and teratogens
List
• List the common symptoms of pregnancy
3. Clinical Case
A 36-year-old nulliparous woman presents to your office for her
first prenatal visit. She is unsure of her last menstrual period as
she recently discontinued her birth control pills, but thinks it
was 2 months ago.
In addition to worrying about her baby having abnormalities
related to her age, she is an early elementary school teacher
and is concerned about exposure to childhood illnesses.
Since she is“older,” she is concerned that she may not have
other children and really wants to optimize the outcome of this
pregnancy.
What will you do during her first obstetric visit? What screening
will you offer her? How will you counsel her regarding her goal
for a healthy pregnancy?
4. INTRODUCTION
The primary aim of preconception and
interconception care is to improve maternal health
and birth outcome for mother, infant and family
through prevention and interventions.
Preconception care is defined by interventions that
aim to identify and modify biomedical, behavioral,
and social risks to a woman’s health through
prevention and management.
These interventions focus on risk factors that can be
modified and/or eliminated prior to conception or
in early pregnancy in order to impact overall
pregnancy health and birth outcome.
5. The essential elements of preconception
health promotion
and intervention
1. Screening for medical and social risk factors
2. Counseling based on age, race, medical,
and/or genetic history
3. Providing appropriate immunizations such
as rubella and varicella
4. Prescribing intervention aimed at improving
overall pregnancy outcome and adult health
such as achieving a healthy weight, diabetes
control, eliminating inappropriate
prescription and non-prescription
medications and habits (smoking)
5. General health education
6. The CDC
Preconception
Health and Health
Care
Recommendations
Each woman, man, and couple should be encouraged
to have a reproductive life plan.
Increase public awareness of the importance of
preconception health behaviors and services by using
information that is relevant across various age groups,
literacy levels, and cultural/ethnic groups.
As a part of primary care visits, provide risk assessment
and educational and health promotion counseling to all
women of childbearing age to reduce reproductive
risks and improve pregnancy outcome.
7. The CDC Preconception Recommendations
4. Increase the proportion of women who receive interventions as follow-up to
preconception risk screening, focusing on high priority interventions (i.e. those
with evidence of effectiveness and greatest potential impact).
5. Use the interconception period to provide additional intensive interventions to
women who have had a previous pregnancy that ended in an adverse outcome
(i.e. infant death, fetal losses, birth defects, low birth weight, or preterm birth).
6. Offer, as a component of maternity care, one prepregnancy visit for couples and
persons planning a pregnancy.
8. The CDC
Preconception
Recommendation
s
Increase public and private health insurance coveragefor women with low
incomes to improve access to preventive women’s health and preconception
and interconception care.
Increase
Integrate components of preconception health into existing local public
health and related programs, including an emphasis on interconception
interventions for women with previous adverse outcomes.
Integrate
Increase the evidence base and promote the use of the evidence to improve
preconception health.
Increase
Maximize public health surveillance.
Maximize
11. A 37-year-old P0 has Type
II diabetes for five years
that is under fair control
with Metformin.
She has a body mass index
(BMI) of 35 cmm−3 and is
considering infertility
treatment because of
ovulatory dysfunction.
• Key components to be considered in
her preconception care include the
following:
a. Maternal age
b. Pregestational diabetes
c. Obesity
d. Medications
CLINICAL
12. A 24-year-old G2 P1102
recently delivered a term
female
infant with an open neural
tube defect (NTD) that was
diagnosed late in pregnancy.
A prior delivery three years
ago was delivered at 33
weeks after preterm
premature
rupture of membranes.
Key components of interconception
counseling should include the following:
a. Recurrence risk for NTDs
b. Folic acid recommendations
c. Recurrence risk for preterm delivery
d. Progesterone recommendations
13. A number of other
tests can be
performed for
specific indications:
• All health encounters during a woman’s
reproductive years, particularly those that
are a part of preconception care, should
include counseling about appropriate
medical care and behaviors to optimize
pregnancy outcomes.
14. Screening for STDs Testing
for maternal diseases based
on medical or reproductive
history
Mantoux test with purified
protein derivative for
tuberculosis by epidermal
injection technique and not
by use of “tine” instruments
Screening for genetic
disorders based on racial and
ethnic background.
15. Patients should
be counseled
regarding the
benefits of the
following
activities:
Maintaining good control of any preexisting medical conditions
Taking 0.4 mg of folic acid daily while attempting pregnancy and
during the first trimester of pregnancy for prevention of NTDs;
Determining the time of conception by an accurate menstrual
history
Reducing weight before pregnancy, if obese; increasing weight, if
underweight
Exercise
Avoiding food faddism
Avoiding pregnancy within 1 month of receiving a live attenuated
vaccine (e.g., rubella)
Preventing HIV infection
Abstaining from tobacco, alcohol, and illicit drug use before and
during pregnancy
16. ANTEnatal
CARE
The goals of obstetric care are to
1)provide easy access to care,
2) promote patient involvement, and
3) provide a team approach to ongoing
surveillance and education for the patient and
about her fetus.
17. Complete antenatal
care includes the
following:
Diagnosing pregnancy and determining gestational age
Diagnosing
Monitoring the progress of the pregnancy with periodic
examinations and appropriate screening tests
Monitoring
Assessing the well-being of the woman and her fetus
Assessing
Providing patient education that addresses all aspects of
pregnancy
Providing
Preparing the patient and her family for her management
during labor, delivery, and the postpartum period
Preparing
Detecting medical and psychosocial complications and
instituting indicated interventions
Detecting
18. DIAGNOSIS
OF
PREGNANCY
• For a woman with regular menstrual cycles, a
history of one or more missed periods
following a time of sexual activity without
effective contraception strongly suggests early
pregnancy.
• Symptoms” Fatigue, nausea/vomiting, and
breast tenderness
• On physical examination, softening and
enlargement of the pregnant uterus becomes
apparent 6 or more weeks after the last
normal menstrual period.
• The patient’s initial perception of fetal
movement (called quickening) is not usually
reported before 16 to 18 weeks of gestation
and often as late as 20 weeks in first-time
mothers.
19. Investigations
• A pregnancy test
• Serum pregnancy tests
Human chorionic gonadotropin (hcG)
Detection of fetal heart activity (fetal heart tones)
20. THE INITIAL PRENATAL VISIT
At the initial prenatal appointment, a
comprehensive history, focusing on:
• past pregnancies, gynecologic history,
medical history with attention to chronic
medical issues and infections,
• information pertinent to genetic screening,
and information about the course of the
current pregnancy.
social circumstances
21. Patients should be questioned
about the following aspects of their lifestyle that could pose a risk and receive appropriate
counseling, if indicated:
Nutrition and weight
gain counseling
Sexual activity Exercise Smoking
Environmental and
work hazards
Alcohol
Traditional and home
medications; OTC
medications (for
example, cough
medications)
Illicit/recreational
drugs
Domestic violence Sexual abuse Seat belt use
22. Initial Assessment of Gestational Age: Estimated Date of Delivery
Gestational age is the number of weeks that have
elapsed between the first day of the LMP (not the
presumed time of conception) and the date of delivery
Ultrasound examination can detect pregnancy early in
gestation. (TVS)
24. Clinical
Follow-Up
The patient is 8 weeks pregnant based on your bedside vaginal
sonogram.
You perform a thorough history and physical examination, obtaining
the appropriate prenatal screening blood work and cervico-vaginal
cultures.
You discuss available screening for genetic conditions, including fetal
chromosome abnormalities, as well as screening for immunity to
more common infectious diseases. The patient is educated on the
importance of regular prenatal care, appropriate exercise, nutrition,
and weight gain, and how to manage common complaints in
pregnancy.
25. Which is a common symptom of pregnancy?
Symptoms of early pregnancy include:
missed periods, nausea and vomiting, breast changes, tiredness
and frequent urination.
Many of these symptoms can also be caused by other factors such as
stress or illness.
If pregnancy suspect advice for seeking medical care ASP.
26. Antenatal care (ANC)
• ANC is defined as the complex of interventions that a pregnant woman receives
from organized health care services.
• The purpose of ANC is to prevent, identify and treat conditions as well as help a
woman approach pregnancy and birth as a positive experiences.
• The care should be appropriate, cost-effective and based on individual needs of
the mother.
• Antenatal care is a key entry point for pregnant women to receive a broad range of
health promotion and preventive health services.
27. Focused antenatal care
• Focused antenatal care (FANC) is personalized care provided to a pregnant
woman which emphasizes on the women's overall health status, her preparation
for child-birth and readiness for complications or it is timely, friendly, simple safe
services to pregnant women.
28. Impoertance of ANC
• Antenatal care is a key entry point for pregnant women to receive a broad
range of health promotion and preventive health services.
• ANC is an opportunity to advice women and their families on how to
prepare for birth and potential complications and promote the benefit of
skilled attendance at birth and to encourage women to seek postpartum
care for themselves and their newborn.
• It is also ideal time to counsel women about the benefits of family planning
and provide them with options of contraceptives.
• In addition, ANC is an essential link in the house – to – hospital care
continuum and helps assure the link to higher levels of care when needed.
29. Objectives of Focused ANC
• The new approach to ANC emphasizes the quality of care rather than the quantity.
For normal pregnancies WHO recommends only four antenatal visits.
• The major goal of focused antenatal care is to help women maintain normal
pregnancies through:
• Health promotion and disease prevention
• Early detection and treatment of complications and existing diseases
• Birth preparedness and complication readiness planning.
30.
31. The first visit
The first ANC visit should occur in the first trimester, around or
preferably before 16 weeks of gestational age.
Objectives of first visit:
To determine patients’ medical and obstetric history with a view to collect evidence of the woman's eligibility to follow the
basic component or need special
care and/or referral to a specialized hospital (using the classifying form).
To do pregnancy test to those women who come early in pregnancy,
To identify and treat symptomatic STI
To determine gestational age
To provide routine Iron supplementation
Provide advice on signs of pregnancy-related emergencies and how to deal with them
To provide simple written instructions that gives general information about pregnancy and delivery, as well as any
specific answers to the patient’s questions.
To provide routine Provider-initiated HIV counseling and testing using the optout approach
32. Component of the first visit
1. History
2. Examination
3. Laboratory tests
Urine analysis preferably multiple dipstick test for bacteriuria and test for proteinuria
Blood: syphilis (rapid test - RPR if available or VDRL) result while waiting in the clinic.
Blood-group typing (ABO and rhesus).
Hemoglobin (Hb) or hematocrit.
Stool exam
Perform HIV test
Additional investigation that can be considered include: urine culture and sensitivity, ultrasound,
Pap smear, HBsAg.
33. Interventions:
Iron and folate supplements
Iron
If rapid test for syphilis is positive: treat, provide counseling on safer sex, and arrange for her partner’s
treatment and counseling.
Treat
Tetanus toxoid: give first injection.
Give
In malaria endemic areas provide insecticide treated nets (ITN).
Provide
Refer clients that need specialized care, according to diagnosis
Refer
34. The second visit
The second visit should be scheduled at 24-28 Weeks. It is expected to take 20 minutes.
Objectives of the second visit is to:
address complaints and concerns
perform pertinent examination and laboratory investigation
assess fetal well being
design individualized plan
advice on existing social support
decide on the need for referral based on updated risk assessment
address complaints and concerns
35. The third visit
The third visit should take place around 30 – 32 weeks and is expected to take 20 minutes.
The objective of the third visit:
address complaints and concerns
perform pertinent examination and laboratory investigation
review individualized birth plan and complication readiness including advice on skilled attendance at birth
advice on family planning, breastfeeding
decide on the need for referral based on updated risk assessment
36. The fourth visit
• The fourth should be the final visit of the basic component and should take place between
weeks 36 and 38.
• Objectives of the 4th visit:
• review individualized birth plan
• complication readiness
• re-inform women and their families of the benefits of breastfeeding and contraception
• perform relevant examination and investigations
38. Danger Signs During Pregnancy
• Vaginal bleeding
• Sudden gush of fluid or leaking of fluid from vagina
• Severe headache not relieved by simple analgesics
• Dizziness and blurring of vision
• Sustained vomiting
• Swelling (hands, face, etc.)
• Loss of fetal movements
• Convulsions
• Premature onset of contractions (before 37 weeks)
• Severe or unusual abdominal pain
• Chills or fever