Ante Natal Care - PowerPoint PPT Presentation

1 / 39
About This Presentation
Title:

Ante Natal Care

Description:

Ante Natal Care Prof. Fawzia Ahmed Habib Professor Consultant Obstetrics & Gynecology – PowerPoint PPT presentation

Number of Views:259
Avg rating:3.0/5.0
Slides: 40
Provided by: rurb
Category:

less

Transcript and Presenter's Notes

Title: Ante Natal Care


1
Ante Natal Care
  • Prof. Fawzia Ahmed Habib
  • Professor
  • Consultant Obstetrics Gynecology

2
(No Transcript)
3
Objectives
  • To have knowledge of ante partum care
  • Be able to give advise on health education
  • Some practical obstetrics skill
  • Manage minor pregnancy problems

4
Introduction Ante natal care is intended to
facilitate preparation for child birth, and to
some extent, subsequent child care.
  • Ante natal care embraces
  • Maternal health checks
  • Evaluation of fetal health development
  • Disease screening
  • Analysis of risk for the development of
    complications
  • Provision of advise and education

5
All maternity services should be centered on the
woman her needs. Each woman should be given
sufficient help and information to enable her to
make an informed decision about her care.
  • Communication has become a key factor between
    different health professionals and the woman for
    an effective team working to provide continuity
    of care.

6
Organization of ante natal care
  • Pre conceptional visit
    prenatal advise education
  • First visit
    idealy before 12 weeks
  • A minimum of monthly check-ups until 28
    weeks
  • Fort nightly check-ups
    until 36 weeks
  • Weekly visits
    until labor
  • Subsequent care would be according to risk
    evaluation at the booking clinic

Full hospital care
Shared care (hospital GP)
7
Maternal health
  • Improvements in the standard of living for
    most of the pregnant ladies, raises some habits
    which was known in the society e.g. smoking.
  • So maternal advise education is important in
    the first ante natal visit.

8
Supplements Vitamins
  • Folate supplementation 400 microgram up to
  • 3 months before conception is recommended
  • and to be continued up to 3 months after
  • conception on the basis of strong evidence that
  • the incidence of Neutral tube defect is
  • reduced.
  • Vitamin A supplements should be avoided
  • Iron Calcium only if indicated.

9
(No Transcript)
10
Food HygieneAttention to food hygiene is
advised in order to avoid food poisoning and
specific effects of some micro-organisms as the
pregnancy.
  • Listeria
    avoid soft cheese, unbasterurized

  • milk
  • Toxo plasma undercooked
    meat
  • Raw eggs
    salmonella

11
Physical extortionPhysically demanding work has
been associated with poor outcomes, such as
preterm birth, pre eclampsia low birth weight.
  • It is better to stop employment after 33 weeks of
    pregnancy
  • Normal, mild exercise is encouraged during
    pregnancy
  • Sexual intercourse has not been found to be
    associated with increased risk of preterm
    delivery.

12
SmokingThe association between maternal
smoking and low birth weight is well known.If
women cease smoking, fewer complications develop
during pregnancy. There is less chance of
placental abruption, preterm, labor fetal cleft
lip/palate.
13
(No Transcript)
14
First ante natal visit
  • Confirm pregnancy urine or blood
  • Document LMP
  • Calculate EDD
  • Calculate gestational age
  • Booking history and risk assessment

15
Common risk factors at booking and arising during
pregnancy which needed referral to maternity
services.
Risk Suggested actions
Pre existing medical condition e.g. DM, high Bp Epilepsy, asthma Refer to specialist obstetric clinic
Family history of genetic disorder Down Syndrome multiple congenital anomalies Refer to perinatology clinic
Previous genital tract surgery e.g. myomectomy Refer to specialist obstetric clinic for opinion about delivery
Cervical cone biopsy- late termination previous ,cervical cerclage Refer by 12 weeks to specialist obstetric clinic for cervical cerclage if considered
Anal sphincter surgery Consider elective caesarian section
16
Post obstetrics history Post obstetrics history
Five or more previous births Three or more miscarriages Serious complications during pregnancy Preterm labor-Ante Partum haemorrhage hypertension still birth etc. Delivery caesarian section third degree tear Post partum haemorrhage infection large baby shoulder dystocia neonatal admission neonatal death Refer to obstetrics units Refer to obstetrics units
17
Present pregnancy urgent referral to maternity services Present pregnancy urgent referral to maternity services
Multiple pregnancy Refer to obstetrics unit
Anemia lt Hb less than 8 gm/dL Refer to obstetrics unit
BPgt 140/90 mmHg Admit to obstetrics unit
Haemorrhage after 24 weeks Admit to obstetrics unit

Transverse lie after 36 weeks Admit to obstetrics unit
Concern about fetal movement Refer to obstetrics unit
Not delivered at 41 weeks Refer to obstetrics unit
18
Maternal Examination Maternal Examination
Maternal height (short stature less than 150 cm.
Maternal Weight Each visit
BMI More than 29 weeks is an indication for dietary advise
BP recording each visit Identify hypertension/PET
Auscultation of the heart lungs. First visit
Breast examination 1st visit masses
Abdominal examination scars Symphysis fundal height regularly from 20-40 weeks fetal lie presentation from 36 weeks
19
(No Transcript)
20
(No Transcript)
21
Investigations Investigations
Full blood count at booking then at 28 weeks -36 weeks Would Health Organization Definition lt 11 gl dL Severe anemia lt 7 gl dL
Platelet count Levels lt 100 x 109 L should be referred to obstetrics and hematology unit
Blood group red cell antibodies at booking visit Rhesus status, blood group red blood cell antibodies Rh-negative urgent refer Postive red cell antibodies to Atypical red cell antibodies Obstetric un
22
Maternal infection screening Maternal infection screening
Rubella Ig G antibodies positive Rubella I g G antibodies negative Rubella I g M antibodies - positive Indicate immunity Needs post natal vaccination Infection congenital rubella syndrome
Hepatitis B negative Hepatitis Bs Ag - positive No intervention Urgent refer to obstetric unit
Syphilis VDRL positive TPHA - negative Urgent referral to obstetric unit
Toxoplasmosis Ig M positive Ig G positive Ig M - negative urgent referral to obstetric unit Previous infection
23
Ultrasound scans
  • Dating scan multiple pregnancy Before
    12 weeks
  • Congenital abnormally 18-22 weeks
  • scan
  • Growth scan 32 weeks

24
(No Transcript)
25
Glucose challenge test Glucose challenge test
All patients 24-28 weeks 50 gm glucose to non fasting mothers then BL sugar after one hour upper limit (7.8 m mole/L)
Oral glucose tolerance test 75 gm 100 g Fasting results (5.3 5.8 mmol/L) Cut-off values at 2 hours 8.6 mmole/L 9.2 mmol/L
26
Urinalysis for protein uria each visit whenever Bp is checked Microscopic urine examination urine culture and sensitivity for all pregnant women Protein is an indication for urgent referral to obstetrics unit Rule out A symptomatic Bactiruria
27
Evaluation of fetal health
  • Fetal movements
  • Normal fetal activity during the third trimeter
    is an indication of adequate fetal oxygenation
  • Biological variations in fetal activity,
    including fetal rest activity need to be taken
    into account when interpreting concerns about
    fetal activity
  • Woman who are concerned about reduction of fetal
    movements should be reported fro further
    investigation

28
Fetal growth monitoring clinical palpation of
the abdomen and measurement of symphysis fundal
distance
  • Identify fetus is small or large
  • - smaller fetus carries risk of hypoxia in
    labor
  • - large fetus carries risk of shoulder
    dystocia
  • Refer to obstetric unit for further investigation

29
  • Fetal growth by ultrasound for low risk
    pregnancies
  • Scan at 32 weeks
  • Biophysical profile Doppler ultrasound
    examination only to be ordered by obstetrician is
    high risk pregnancies
  • Fetal cardiotocography - GTG
  • If indicated due to concern about fetal
    activity urgent to obstetric units.
  • Prenatal Diagnosis Needs urgent referral to
    perinatal clinic
  • Indicated for detecting abnormalities in the
    fetus when suspected by ultrasound.
  • Indications 1. chromosomal abnormalities
    (trisomies)
  • 2. congenital
    abnormalities
  • 3. metabolic
    diseases
  • 4. rhesus
    incompatibility
  • 5. fetal infection

30
(No Transcript)
31
(No Transcript)
32
Minor Symptoms of Pregnancy
  • A minor and physiological changes to
  • body functions occur during pregnancy
  • need to be dealt by general practitioner.

33
Gastro interstinal Gastro interstinal
Nausea vomiting hyperemesis gravidarum (severe) gastric reflux oesophagitis Constipation Antihistamines Admit to obstetric unit Antacids --small meal Fibre supplements and osmotic laxatives lactulose-
34
Cardio Vascular Cardio Vascular
Headache and occasional Fainting in early pregnancy Explain physiological changes
Short episode palpitation Persistence headache in the third trimester Varicose veins Posture change Could be pre eclampsia Support tights Pregnancy periods of rest
35
Respiratory Respiratory
Dyspnoea breathlessness Rest Exlude infection, asthma-heart failure pulmonary emboli
36
Musculoskeletal Musculoskeletal
Carpal tunnel syndrome ulner nerve compression Backache Pubic symphysis diastasis Leg cramps Oedema of lower legs Analgesia Advise on posture Advise on posture Analgesia Common avoid over heating of the legs at night common
37
Genitourinary Genitourinary
frequency of micturition Mucoid vaginal discharge Watery vaginal leakage Vulval irritation itching Common Common ??liquor Refer to obstetric unit to exclude SROM Candida albicans Miconazol pessaries or cream
38
Routine Induction of labor
  • By 40 weeks gestation, less than 60 percent of
  • woman have delivered --- If not delivered by 40
    weeks do
  • ultrasonography for
  • amount of amniotic fluid and growth to be done
  • if both satisfactory keep
  • till 41 weeks.
  • Induction of labor by 42 weeks refer to
    obstetric
  • unit

39
  • Wish you uncomplicated
  • delivery
Write a Comment
User Comments (0)
About PowerShow.com