1. In the name of God

2. Obstetrician & Gynecologist Prenatalogist from KCL,England
Dr Solmaz Piri
Obstetrician & Gynecologist
Prenatalogist from KCL,England

3. Prenatal Care
 The major goal of prenatal care is to ensure the birth of a healthy baby with minimal risk for the mother.

4. Main Components Patient education and communication
Early, accurate estimation of gestational age
Identification of the patient at risk for complications
Ongoing evaluation of the health status of both mother and fetus
Anticipation of problems and intervention, if possible, to prevent or minimize morbidity
Patient education and communication

5. Woman-centred care

6. care and that of her baby should be sought and respected at all times
Women, their partners and their families should always be treated with kindness, respect dignity
The views, beliefs and values of the woman, and her family in relation to her
care and that of her baby should be sought and respected at all times

7. booking
(ideally by 10 weeks)

8. Documentation of care

9. Gestational age
Crown–rump length measurement should be used to determinegestational age.
If the crown–rump length is above 84mm, the gestational age should be estimated using head circumference.

10. Immunization

11. Tetanus and diphtheria toxoid vaccine (Td)
Available vaccines
Tetanus and diphtheria toxoid vaccine (Td)
Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap).

12. In 2013, The ACIP recommendations supported by the American College of Obstetricians and Gynecologists
All pregnant women receive vaccination against pertussis with Tdap during each pregnancy, optimally between 27 and 36 weeks of gestation, regardless of prior vaccination status, to better protect their infant

13. tetanus booster If Tdap is given earlier than 27 to 36 weeks
and at any stage of pregnancy if the woman lives in an area with a pertussis epidemic
or required as part of wound management

14. Varicella vaccination
Varicella vaccination is recommended for women without evidence of immunity preconceptionally or postpartum:
Postpartum:The first dose is given while the patient is in the hospital and the second dose is given four to eight weeks later, which typically coincides with the routine postpartum visit. Breastfeeding is not a contraindication

15. History The elements of the patient history include:
Personal and demographic information
Past obstetrical history
Personal and family medical history
Past surgical history
Genetic history
Menstrual and gynecological history
Current pregnancy history
Psychosocial information

16. Physical examination Classic and complete approach
Everything is important
Every mild derangement should be carefully adressed
Keep in mind : Pregnant women is using her body reserve and may not be able to make further compensation

17. Rhesus type and antibody screen — This test will detect antibodies potentially causing hemolytic disease of the newborn.

18. Folic acid

19. The recommended dose is 400 micrograms per day
Dietary supplementation with folic acid, before conception and throughout the first 12 weeks, reduces the risk of having a baby with a neural tube defect
The recommended dose is 400 micrograms per day

20. Vitamin A, be carefull !
Pregnant women should be informed that vitamin A supplementation (intake above 700 micrograms) might be teratogenic and should therefore be avoided.
Pregnant women should be informed that liver and liver products may also contain high levels of vitamin A, and therefore Consumption of these products should also be avoided.

21. vitamin D

22. haematological conditions

23. gestational diabetes

24. fetal anomalies and aneuploidies

26. Air travel

27. Hepatitis B
Testing for HBsAg should be performed on all women at the first prenatal visit and repeated late in pregnancy in those at high risk for HBV infection. The current recommendation is to provide passive-active immunization to newborns of carrier mothers.

28. Antivirals
A meta-analysis of 10 studies concluded that the administration of lamivudine to the mother in late pregnancy in addition to hepatitis B vaccination and hepatitis B immunoglobulin prophylaxis for the infant significantly reduced mother-to-child transmission

29. More data are needed to clarify the HBV DNA cutoff for recommending antiviral therapy to pregnant HBV carriers
At present, we tend to offer antiviral prophylaxis in women who have a high viral load (more than 8 log(10) int. unit/mL). Treatment should be started preferably six to eight weeks before delivery to allow enough time for HBV DNA levels to decline. Of the available oral agents, telbivudine and tenofovir are pregnancy class B drugs

30. With appropriate immunoprophylaxis, breastfeeding of infants of HBV carriers poses no additional risk for the transmission of HBV
Infants who received HBIG and the first dose of vaccine at birth may be breastfed as long as they complete the course of vaccination
but carrier mothers should not participate in donating breast milk.
Mothers with chronic hepatitis B who are breastfeeding should also exercise care to prevent bleeding from cracked nipples

31. Further tests
VDRL
Asymptomatic bactriuria
HIV
Thyroid function tests

32. Not recommended
CMV
Toxoplasmosis
HSV
Bacterial Vaginosis

35. Thank you very much for your attention