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Antenatal care for undergraduate

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Undergraduate course lectuers in Obstetrics&Gynecology,Obstetrics and Gynecology Departement ,Faculty of Medicine,Zagazig University,Egypt – PowerPoint PPT presentation

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Title: Antenatal care for undergraduate


1
ANTENATAL CARE
  • DR MANAL BEHERY
  • Zagazig University , Egypt

2
Definition
  • Antenatal care refers to the care that is given
    to an expected mother from time of conception is
    confirmed until the beginning of labor
  • It is a preventative cost effective service

3
GOALS
  • 1-Ensure mother health.
  • 2- Ensure delivery of a healthy infant.
  • 3-Anticipate problem
  • 4- Diagnose problem early.

4
Objectives
  • 1-Early detection and if possible, prevention of
    complications of pregnancy.
  • 2-Educate women on danger and emergency signs
    symptoms.
  • 3-Prepare the woman and her family for childbirth
  • 4- Give education counseling on
    family planning

5
Schedual of antenatal care
Medical check up every four weeks up to 28 weeks
gestation Every 2 weeks until 36 weeks of
gestation Every week until delivery An
average 7-11 antenatal visits/pregnancy More
frequent visits may be required if complications
arise.
6
On first antenatal visit
  • 1-First Confirm pregnancy by pregnancy test or
    US.
  • 2-History
  • 3-Physical examination
  • 4-investigation

7
History
  • Personal history
  • Menstrual history
  • Obstetrical history
  • Family history
  • Medical and surgical history
  • History of present pregnancy

8
Menstrual history
  • Ask about
  • 1-Last menstrual period (LMP).
  • 2-Regularity and frequency of menstrual cycle.
  • 3-Contraception method used .
  • 4-Calculate expected date of delivery (EDD) as
  • 1st day of LMP -3 months 7 days, and change the
    year.

9
Obstetric History
  • Gravidity? Parity? abortion, and living children.
  • Weight of infant at birth length of gestation.
  • Type of delivery, location of birth, and type of
    anesthesia.
  • Maternal or infant complications.

10
Medical and surgical history
  • 1-Chronic conditions as diabetes mellitus,
    hypertension, and renal disease ,cardiac disease.
  • 2-Prior operation as cesarean section, genital
    repair, and cervical cerclag.
  • 3-Allergies, and medications.
  • 4-Accidents involving injury of the bony pelvis

11
History of present pregnancy
  • History suggesting e.g. Diabetes,
    hypertension and ante partum hemorrhage.
  • Ask about episodes of fever or chills
  • Ask about pain or burning sensation on urination.
  • Abnormal vaginal discharge, itching at the vulva
    or if partner has a urinary problem.

12
IMMEDIATE ASSESSMENT for emergency signs.
  • Vaginal bleeding
  • Severe abdominal or pelvic pain
  • Severe headache with visual disturbance
  • Persistent vomiting
  • Unconscious/Convulsion
  • Severe difficulty in breathing
  • High grade Fever
  • Looks very ill

13
Assessment and physical examination
14
Weight measurement
  • Maternal height and weight measurements to
    determine body mass index(BMI).
  • Maternal weight should be
  • measured at each
  • antenatal visit

15
Check for pallor or anemia.
  • 1-Look for palmar pallor.
  • 2-Look for conjunctival pallor
  • 3-Count respiratory rate in one minute.

16
Blood pressure measurement
  • Measure BP in sitting position.
  • If diastolic BP is 90 mm Hg or higher repeat
    measurement after 6 hour rest.
  • If diastolic BP is still 90 mm Hg or higher ask
    the woman if she has
  • Severe headache
  • Blurred vision
  • Epigastric pain
  • Check urine for protein.

17
Investigations
  • Get baseline on the first or following the first
    visit.
  • Hemoglobin, blood type
  • Urine analysis
  • VDRL or RPR to screen for syphilis
  • Hepatitis B surface antigen To detect carrier
    status or active disease

18
At each visit
19
At each visit
  • 1-Questions about fetal movement
  • 2-Ask for danger signs during this pregnancy
  • 3-Ask patient if she has any other concerns

20
Symphysis Fundal hieght
  • LMP plus 280 days
  • Add 7 days, subtract 3 months
  • MacDonald's Rule (cm weeks)

21
At third trimester
  • Do
  • Leopolds exam

22
  • Provide advice on
  1. Diet and weight gain
  2. Medication
  3. Avoid Radiation exposure
  4. Self-care during pregnancy
  5. Minor complaints.
  6. Family planning Breastfeeding
  7. Birth place preparation and anticipation of
    complication Emergency situations.

23
Diet in pregnancy
  •  
  • Total caloric intake increase to 300 kcal /day
    due to 15 increase in BMR .
  • Diet show contain 20Protein(better from animal
    source), 30 fat ,and 50 carbohydrates .
  • Sufficient fluids should be available.

24
Supplementation
  • 1-Folic acid 0.4 mg tab daily
  • 2- iron (ferrous sulphate or gluconate )300
    mg/daily
  • 3- Ca 1200mg /daily
  • 4-
  • -Those with a normal balanced diet
  • probably dont need extra vitamins

25
Weight gain in pregnancy
  • There is a slight loss of pounds during early
    pregnancy if the patient experiences much nausea
    and vomiting.
  • Weight gain of 2 to 4 lbs(0,5-1 kg) by the end of
    the first trimester.
  • Gain of 1 lb(0.5)/ per wk is expected during the
    second and third trimesters.
  • Monitoring of weight gain should be done in
    conjunction with close monitoring of BP.

26
Medications During Pregnancy
  • Antibiotics - some OK, some not
  • Local anesthetics - OK
  • Local with epinephrine - not OK
  • Aspirin - not OK
  • Immunizations - some are OK, some are not
  • Antimalarial - some OK, some are not
  • Narcotics - OK except for addiction issue

27
  • Case Study

28
Case Study
  • A 35-year-old G2 P10 woman is seen for her first
    prenatal visit.
  • Based on her LMP, she is at 15 weeks gestation.
  • She has no complaints, and no significant medical
    history.
  • She denies dysuria or urinary urgency.
  • Her surgical history is remarkable
  • Her last delivery was a vaginal delivery and was
    uncomplicated

29
On examination
  • Her blood pressure (BP) is 100/65 mm Hg
  • heart rate (HR)90 (bpm),
  • respiratory rate (RR) 12,temperature 98F
    (36.6C),
  • weight 70KG.
  • general physical examination is normal

30
Abdominal examination
  • Her abdomen is non tender
  • Fundal height is at the level ofthe umbilicus.
  • Fetal heart tones are 140 bpm.
  • Her extremities are without edema.

31
Prenatal laboratories
  • CBC Hgb 10.0 g/dL ,Plt 150,000 WBC 8,000
  • Rubella nonimmune
  • Hepatitis B surface antigen positive
  • Blood type O, Rh negative
  • UCS 10,000 cfu/mL of group Bstreptococcus
  • Gonorrhea assay negative Chlamydia assay
    negative

32
Questions
  • ? What items should be listed on the problems
    list?
  • ? What is your next step for the problems listed?
  • ? What other testing should be recommended to the
    patient?

33
Problem List
  • Advanced maternal age 35 Y or greater at EDD
  • fundal height at umbilicus corresponds to 20
    weeks)
  • Mild microcytic anemia (Hgb lt 10.5)
  • Hepatitis B surface antigen (HBsAg) positive
  • Rh-negative blood type
  • Urine culture with GBS 10,000 cfu/mL,
  • Rubella nonimmune

34
Next Steps
  • 1. AMAgenetic counseling
  • 2. Size/datesfetal ultrasound to assess GA,
    multiple gestation
  • 3. Anemiatherapeutic trial of iron
  • 4. HBsAg positivecheck liver function tests, and
    hepatitis B serology toassess for active
    hepatitis versus chronic carrier status

35
Next step
  • 5. Rh negative Rhogam at 28 weeks and at delivery
    if the baby proves to be Rh positive
  • 6. Urine culture with GBStreat with ampicillin
    and re-culture urine, peni-cillin IV prophylaxis
    in labor
  • 7. Rubella statusvaccinate postpartum

36
Other tests recommended to patient
  • consider early diabetic screen

37
  • Thank you
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