Prenatal care Dr Nawal Al Sinani

Objective To assure that each pregnancy ended by delivery of a healthy baby without impairing the health of the mother To assure that each pregnancy ended by delivery of a healthy baby without impairing the health of the mother

Significance Appropriate antepartum care has proven of great value in prevention of catastrophes such as : Appropriate antepartum care has proven of great value in prevention of catastrophes such as : Preeclamptic fetes. Preeclamptic fetes. Pylonephritis Pylonephritis Macrocosmic baby Macrocosmic baby IUFD IUFD

General health care Systemic health care before pregnancy prove quite beneficial to the mother and her child. Systemic health care before pregnancy prove quite beneficial to the mother and her child. E.g. IDDM has to have strict blood sugar control at least 3months before pregnancy E.g. IDDM has to have strict blood sugar control at least 3months before pregnancy supplement of folic acid to the mother with h/o NTD should be started before conception. supplement of folic acid to the mother with h/o NTD should be started before conception.

Terminology Nulligravida :women who is not now & never has been pregnant Nulligravida :women who is not now & never has been pregnant Gravida :who is pregnant now Gravida :who is pregnant now Primigravida Primigravida Multigravida Multigravida Nullipara :how has never completed pregnancy beyond an abortion Nullipara :how has never completed pregnancy beyond an abortion

Primipara :how has been delivered once of the fetus how reached the stage of viability Primipara :how has been delivered once of the fetus how reached the stage of viability Multipara :who completed two or mre pregnancy to stage of viability Multipara :who completed two or mre pregnancy to stage of viability Parturicnt :is a woman in labor Parturicnt :is a woman in labor A puerpera : is a woman has just given birth A puerpera : is a woman has just given birth

Normal duration of pregnancy Mean duration of pregnancy calculated from the 1 st day of last normal menstrual period (LMP) Mean duration of pregnancy calculated from the 1 st day of last normal menstrual period (LMP) 280 days or 40 weeks 280 days or 40 weeks

How to calculate EDD Expected Day of Delivery Expected Day of Delivery Add 7 days to the date of 1st day of LMP Add 7 days to the date of 1st day of LMP Counting back 3 months Counting back 3 months Ex :LMP 10 September Ex :LMP 10 September EDD 17 Jun EDD 17 Jun

What is trimesters Pregnancy divided into 3 equal parts Pregnancy divided into 3 equal parts Each trimester 13 weeks or 3 calender months Each trimester 13 weeks or 3 calender months 1 st trimester … most of the abortion 1 st trimester … most of the abortion 3 rd trimester … pregnancy induced hypertension 3 rd trimester … pregnancy induced hypertension

Initial care Prenatal care should be initiated as soon as likely hood of pregnancy Prenatal care should be initiated as soon as likely hood of pregnancy Goals : Goals : To define the health status of the mother & fetus To define the health status of the mother & fetus To determine the gestational age To determine the gestational age To initiate a plan for continuing obstetric care To initiate a plan for continuing obstetric care

History Menstrual history (regularity,pill, lactating) Menstrual history (regularity,pill, lactating) Current health problem Current health problem Previous major illness Previous major illness Previous pregnancies Previous pregnancies Medication Medication Allergy Allergy Family history Family history

Examination General General –Signs of medical disease (anemia,hyperthyroidism) –Teeth Vital sign Vital sign Breast Breast

Examination Abdomen : Abdomen : Fubdal height Fubdal height –If uterus > date ?wrong date ?wrong date ?multiple gestation ?multiple gestation ?polyhydramenous ?polyhydramenous ?macrocosmic baby ?macrocosmic baby ?fibroid ?fibroid –If uterus < date ?Wrong date ?Wrong date ?IUGR ?IUGR ?oligohyramenous ?oligohyramenous

Examination Lower limps Lower limps Genital examination Genital examination

Investigation CBC CBC Blood Group Blood Group Serology Serology –Hepatitis –Rubella –VDR(TPHA) –Toxo –HIV Urine Urine

Categorization of pregnancy High risk High risk Low risk Low risk Further instruction: Further instruction: (bleeding, edema, headache, vomiting, abd pain, fever, disuria, escape fluid from the vagina, fetal movement )

Subsequent prenatal care Subsequent prenatal care Return visit : Return visit : Each 4 weeks throw out the first 7 months Each 4 weeks throw out the first 7 months Each 2 weeks till 9 th month Each 2 weeks till 9 th month Weekly Weekly Each visit : Each visit : –Calculate the gestational age –Review lab result –Check blood pressure –Weight –Urinary protein –Fundal height –Fetal heart

Nutrition Wight gain 9-12 kg Wight gain 9-12 kg Birth weight parallel to maternal weight gain Birth weight parallel to maternal weight gain

Recommended dietary allowances Calories :Increase by 300 K cal. above the non pregnant Calories :Increase by 300 K cal. above the non pregnant Protein :Increase by 30g /day Protein :Increase by 30g /day Minerals :Pt require 7mg/day Minerals :Pt require 7mg/day Calcium :Increase by 400mg above the normal Calcium :Increase by 400mg above the normal Zinc Zinc Iodine Iodine

Vitamin Folic acid : Folic acid : Protection from – NTD –Abruptio placenta –? Toximia of pregnancy B complex B complex Daily requirement 2.6 mg /day Vitamin C: Vitamin C: Daily 80 mg /day

General Exercise : Exercise : Must be limited in patient with –Pregnancy induced hypertension –Multiple pregnancy –IUGR Employment Employment Heavy work in 3 rd trimester can affect birth weigh Travel : Travel : allowed in non complicated pregnancy

Coitus : Coitus : To be avoided in threaten abortion and premature labor Smoking Lead to Smoking Lead to –prenatal death –Small for date –Anti partum hemorrhage –Premature labor Alcohol  fetal mal formation Alcohol  fetal mal formation Medication : Advantage to be gained clearly out weight any risk inherent in it use Medication : Advantage to be gained clearly out weight any risk inherent in it use

Immunization There has been some concern over the safety of various immunization during pregnancy Cholera :only in traveling to endemic area Cholera :only in traveling to endemic area Hepatitis A-B: better to avoid it Hepatitis A-B: better to avoid it Influenza :evolution of immunity status according to criteria applied to others Influenza :evolution of immunity status according to criteria applied to others Measles :contra indicated (live virus) Measles :contra indicated (live virus) Mumps : contra indicated (live virus) Mumps : contra indicated (live virus) Poliomyelitis :not recommended but mandatory in epidimic or traveling to endemic area Poliomyelitis :not recommended but mandatory in epidimic or traveling to endemic area Rabies : same as non pregnant Rabies : same as non pregnant Tetanus :toxoid can be given Tetanus :toxoid can be given Yellow fever not recommended but mandatory in epidimic or traveling to endemic area Yellow fever not recommended but mandatory in epidimic or traveling to endemic area

Common complaints during pregnancy Nausea & vomiting Nausea & vomiting Pica Pica Backache Backache Varicosities Varicosities Hemorrhoids Hemorrhoids Heart burn Heart burn Ptyalism (profuse salivation ) Ptyalism (profuse salivation ) Fatigue Fatigue Headache Headache Candida Candida