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Antenatal Care

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Antenatal Care Dr. NUSRAT NOOR Obstetrics/Gynecology * Everyday Pregnancy Issues! * Supplements: Should I be taking anything? When to start and stop! – PowerPoint PPT presentation

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Title: Antenatal Care


1
Antenatal Care
  • Dr. NUSRAT NOOR
  • Obstetrics/Gynecology

2
Background
Antenatal period presents opportunities for
reaching pregnant women with interventions that
may be vital to their health and well-being and
that of their infants, for example
  • detect potential complications of pregnancy and
    delivery
  • promote good nutrition, hygiene and rest
  • provide family planning information
  • management of STIs
  • tetanus immunization
  • HIV counseling and ART prophylaxis
  • malaria prophylaxis

3
Aims Of Antenatal Care
  • To prevent, detect and manage those factors that
    adversely affect the health of the baby
  • To provide advice, reassurance, education and
    support for the woman and her family
  • To deal with the minor ailments of pregnancy
  • To provide general health screening

4
Classification Of Antenatal Care
  • Shared Care
  • Hospital Maternity Team
  • General Practitioner (GP)
  • Community Midwives

5
Community-Base Care
6
Hospital-Based Care
7
Advice, Reassurance Education
  • Reassurance explanation on pregnancy symptoms
  • Nausea
  • Heartburn
  • Constipation
  • Shortness Of Breath
  • Dizziness
  • Swelling
  • Back-ache
  • Abdominal Discomfort
  • Headaches

8
  • Information regarding
  • Smoking
  • Alcohol Consumption
  • Drugs (Both LEGAL and ILLEGAL)

9
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10
  • 2nd trimester - (BPD, HC, AC, FL 10 days).
  • 3rd trimester - Much less accurate.

11
Confirmation of the pregnancy
  • The symptom of the pregnancy
  • Breast tenderness
  • Nausea
  • Amenorrhea
  • Urinary Frequency
  • Positive urinary or serum pregnancy test are
    usually sufficient confirmation of a pregnancy.
  • Dating Pregnancy, confirms the pregnancy and
    accurately dates it.

12
Dating Pregnancy
  • Menstrual EDD
  • Dating by ultrasound
  • Benefits of a dating scan
  • Accurate dating women with irregular menstrual
    cycles or poor recollection of LMP.
  • Reduced incidence in induction of labor for
    prolonged pregnancy
  • Maximizing the potential for serum screening to
    detect fetal abnormalities
  • Early detection of multiple pregnancies
  • Detection of otherwise asymptomatic failed
    intrauterine pregnancy

13
Booking History
  1. Past Medial History
  2. Past Obstetric History
  3. Previous Gynaecological History
  4. Family History
  5. Social History

14
Booking Examination
  • Full Physical Examination
  • Cardiovascular
  • Respiratory Systems
  • Abdominal
  • Pelvic Examination
  • Breast Examination

15
  • Examination for most
  • healthy women
  • Accurate measurement of blood pressure
  • Abdominal examination to record the size of the
    uterus
  • Recognition of any abdominal scars indicative of
    previous surgery

16
  • Measurement of height and weight for calculation
    of the BMI.
  • Women with a low BMI are at greater risk
  • of fetal growth restriction and obese women
  • are at greater risk of fetal growth restriction
  • and obese women are at significantly greater
  • risk of most obstetric complications, including
  • gestitational diabetes, pre-eclampsia, need for
  • emergency caesarean section and anaesthetic
  • difficulties.

17
  • Urine examaniation asymptomatic bacteriuria is
    more likely to ascend and cause pyelonephritis in
    pregnancy.
  • This causes significant maternal morbidity, but
    also predisposes to pregnancy loss and preterm
    labour.
  • All women at booking should have a midstream
    urine sent for culture or be tested with a
    dipstick which recognizes nitrates, the presence
    of which sensitivity predicts the presence of
    significant bacteria.

18
Booking Investigation
  • Full Blood Count
  • Blood Group Red Cell Antibodies
  • Women found to be rhesus negative will be offered
    prophylactic anti-D administration at 28 and 34
    weeks gestation to prevent rhesus
    iso-immunization and future HDN.
  • Other possible iso-immunization events, such as
    threatened miscarriage after 12 weeks gestation,
    antepartum haemorrhage and delivery of the baby,
    may require additional anti-D prophylaxis in
    rhesus-negative women.

19
  • Rubella
  • Women who are found to be rubella non-immune
    should be strongly advised to avoid infectious
    contacts and should undergo rubella immunization
    after the current pregnancy to protect themselves
    for the future.
  • Hepatitis B
  • Vertical transmission to the fetus may occur,
    mostly during labour, and horizontal transmission
    to staff or the newborn infant can follow contact
    with body fluids.
  • A baby born to a hepatitis B carrier should be
    actively and passively immunized at delivery.

20
  • Human Immunodeficiency Virus
  • In known HIV-positive mothers, the use of
    antiretroviral agents, elective Caesarean section
    and avoidance of breastfeeding reduces vertical
    transmission rates from approximately 30 to less
    than 5.
  • The Department of Health guidelines now recommend
    that all pregnant women should be offered an HIV
    test at booking.
  • Syphilis

21
  • Haemoglobin Studies
  • Tests for thalassaemia and sickle cell disease
    are usually reserved for women who have an ethnic
    background and those from the Middle East.

22
  • Gestational Diabetes
  • Random Blood Sugar
  • Fasting Blood Sugar
  • Formal Oral Glucose Tolerance

23
Background
WHO recommends a minimum of four antenatal visits
based on a review of the effectiveness of
different models of antenatal care. WHO
guidelines are specific on the content of
antenatal care visits, which should include -
blood pressure measurement - urine testing for
bacteriuria proteinuria - blood testing to
detect syphilis severe anemia - weight/height
measurement (optional)
24
International Goals Targets
Special emphasis must be placed on prenatal and
postnatal care and care for newborns,
particularly for those living in areas without
access to services
25
Antenatal Care (ROSA)
26
  • Pattern Of Follow Up Visits
  • 4 weekly appointments from 20 weeks until 32
    weeks
  • Followed by fortnightly visits 32 weeks to 36
    weeks and weekly visits.
  • The minimum number of visits recommended by the
    Royal College of Obstetricians and Gynaecologists
    is 5, occurring at 12, 20, 28-32, 36 and 40-41
    weeks.

27
  • Content Of Follow Up Visits
  • General questions regarding maternal well-being.
  • Enquiry regarding fetal movements (24 weeks).
  • Measurement of blood pressure (a screen for
    pregnancy-related hypertensive disorders).
  • Urinalysis, particularly for protein, blood and
    glucose this is used to help detect infection,
    pre-eclampsia and gestational diabetes.

28
  • Examination for oedema
  • Oedema is common in pregnancy and is mostly an
    insensitive marker of pre-eclempsia. Oedema of
    the hands and face is somewhat more important as
    a warning feature of pre-eclampsia.
  • Abdominal palpation for fundal height
  • If repeated symphysisfundal height measurement
    are made throughout a pregnancy, the detection of
    fetal growth problems and abnormalities of
    liquor volume increased.

29
  • Auscultation of the fetal heart
  • There is no evidence that this practice is of
    any benefit in a woman confident in the movements
    of her baby however, it provides considerable
    reassurance and will occasionally detect an
    otherwise unrecognized intrauterine fetal death.
  • A full blood count and red cell antibody screen
    is repeated at 28 and 36 weeks.
  • Depending on the screening policy of the
    particular unit, women at 28 weeks may be tested
    for gestational diabetes.

30
  • From 36 weeks, the lie of the fetus
    (longitudinal, transverse or oblique), its
    presentation (cephalic or breech) and the degree
    of engagement of the presenting part should be
    assessed and recorded.
  • It is often at this appointment that a decision
    is made regarding the mode of delivery (i.e.
    vaginal delivery or planned Caeserean section).

31
  • At 41 weeks gestation, a discussion regarding
    the merits of induction of labour for prolonged
    pregnancy should occur.
  • An association between prolonged pregnancy and
    increased perinatal morbidity and mortality means
    that women are usually advised that delivery of
    the baby should occur by 42 completed weeks
    gestation.
  • This will usually mean organizing a date for
    induction of labour at approximately 12 days past
    the EDD.

32
  • Antenatal complications
  • dealt with in
  • customized antenatal clinics

33
  • Endocrine (diabetes, thyroid, prolactin and other
    endocrinopathies)
  • Miscellaneous medical disorders (e.g. secondary
    hypertension, autoimmune disease)
  • Haematology (thrombophilias, bleeding disorder)
  • Substance Misuse
  • Preterm labour
  • Multiple gestation
  • Teenage pregnancy

34
  • Everyday Pregnancy Issues!

35
Supplements Should I be taking anything?
  • When to start and stop!
  • Trace elements
  • Folate, calcium,
  • Iron ( vit.C), multivitamins.
  • Dietary supplements
  • Protein drinks.

36
Listeria
  • Avoid chilled, ready -to-eat foods
  • Soft cheeses.
  • Takeaway chicken sandwiches.
  • Cold meats.
  • Pre-prepared or stored salads.
  • Raw seafood.
  • Smoked salmon smoked oysters (can OK).

37
EXERCISE
  • Reduced weight gain.
  • More rapid weight loss after pregnancy.
  • Improved mood.
  • Improved sleep patterns.

38
Some studies have shown
  • Faster labour.
  • Less need for induction.
  • Less likely to need epidural.
  • Fewer operative births.
  • Exercise does NOT increase risk of miscarriage.

39
Exercise commonsense
  • Take frequent breaks.
  • Avoid exercise in extremely hot weather.
  • Avoid unstable ground (joints more lax).
  • Avoid contact sports.
  • Avoid lifting weights over head.
  • And weights that strain lower back muscles.

40
Air Travel
  • Travel must be completed by 36th week.
  • Medical clearance needed for twins complicated
    pregnancy.

41
Preventing DVT
  • Support stockings.
  • Hydration.
  • Ankle rolls, walks around plane.
  • Baby aspirin.

42
Stretch marks
  • Related to type of collagen ie genetic.
  • May have link with pelvic floor perineal
    stretchiness
  • Goanna oil, emu oil, olive oil,vitamin E and
    other expensive topicals..

43
Fetal movements - what is normal?
44
Vaginal Discharge
  • Normally increases with gestation.
  • Exclude rupture of membranes.
  • Canesten pessaries OK for thrush.

45
Uncomfortables
  • Cant sleep!
  • Swollen feet!
  • Backache!
  • sick of being pregnant!

46
Shoes wont fit, rings too tight...
  • 85 of pregnancies have oedema.
  • Rest and elevate!
  • Carpal tunnel.

47
My back hurts...
  • Posture
  • Dont slouch!, do not bend from waist.
  • Choose chair with back support.
  • Bra with support.
  • Hot pack panadol.
  • Elastic brace supports.
  • Physiotherapy review.

48
Is my baby too big?!
  • Fundal height gestation /- 2 cm.
  • Engagement of fetal head.
  • Liquor vs EFW.
  • Assessing fetal size at term.

49
I AM SICK OF BEING PREGNANT!!!!!
  • Check CTG AFI when 7 days post EDD.
  • Post dates IOL 10 days after EDD.
  • Natural IOL - does it work?
  • Curry, chilli, castor oil, etc..
  • Warm bath!
  • Cervical sweep!

50
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52
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