ANTENATAL CARE 2022.pptx slide for nicu care

A slides to elobrate on antenatal care

1. Preconception care

2. OBJECTIVE At the end of this lecture, the student should: Understand the concept of preconception care and The conduct of preconception care

3. INTRODUCTION Ideally all prospective mothers should be evaluated before getting pregnant. Necessary in those with: Chronic medical condition – Diabetes, hypertension, heart disease, renal disease and others (HIV). To control or counsel against pregnancy. Genetic disorders, eg . Sickle cell – for genetic counseling and selection of partners. Family history of diabetes .

4. 3 . Recurrent pregnancy loss: to evaluate and treat any treatable cause 4. Counsel on whether to embark on pregnancy or not: HIV / AIDS, severe heart disease, end stage diabetes, severe hypertension with retinopathy, severe renal disease 5. Unhealthy life style – smoking, excessive alcohol, obesity, poor hygiene, no exercise.

5. Conduct of preconception care: History, examination, investigations. Appropriate treatment. Health education on: life style, hygiene. Avoidance of harmful agents to the fetus. .

6. ANTENATAL CARE

7. Learning objectives At the end of this lesson, the student must be able to: Define antenatal care(ANC) Know the OBJECTIVES and IMPORTANCE of ANC Be able to CONDUCT NORMAL ANC

8. ANTENATAL CARE DEFINITION: Healthcare and education given to a pregnant woman from conception to onset of labour . (excluding abortion care) It is a form of preventive, promotive and therapeutic health care OBJECTIVES AIM: To have a wanted pregnancy result in a healthy mother delivering a healthy baby.

9. SPECIFIC OBJECTIVES: Assessing the health status of the mother through thorough history, examination and investigations. Identifying any risk factors that may affect the outcome of the pregnancy. Prompt intervention of complications .

10. Specific Objectives d. Education on healthy life style (+ ITN use),danger signs, normal physiological changes in pregnancy, common disorders or complaints, what to expect in labour, birth preparedness , puerperium breastfeeding, and immunization E Planning the time, place and mode of delivery. f. Contraceptive counseling and service.

11. IMPORTANCE OF ANC Promotion of maternal,fetal and neonatal health. Reduction of maternal and neonatal morbidity and mortality Through the implementation of the objectives of ANC i.e. detection of abnormalities, interventions, and education

12. THE CONDUCT OF NORMAL ANTENATAL CARE: Antenatal visits: Typically visit 4 weekly till 28 weeks, 2 weekly till 36 weeks, and weekly till delivery. Average of 6 – 7 visits have been shown to give the same outcome. Minimum of 4 visits required by WHO, first-by 16wks, 2 nd -24-28wks, 3 rd -32wks, last at 36 weeks gestation. This applies to low-risk cases.

13. Focus antenatal care[ individualized care]: - A skilled attendant offering all the necessary care (education, history and exam, treatment) to a client at one sitting place. - Client - friendly and interactive .

14. FIRST ANTENATAL VISIT Ξ booking visit (name in ANC book) Demography Full history Examination + pelvic examination if indicated: nulligravida , STI, recurrent miscarriage. Investigations. - Pregnancy test, Ultrasound - Haematology and MPS - Sickling , grouping and Rh factor, G.6.P.D. - Diabetes screen - FBS, 2 hr RBS, OGTT if indicated - Infection screen - VDRL / RPR, HBsAg , HIV(opt out approach) - Urine analysis. - stool examination.

15. - Others where indicated eg . LFT, RFT, funduscopy . Identify any risk factors and manage / advise accordingly. Treatment: Iron, Folic acid, multivite . Education on: i . Need to come for subsequent visits. ii. Need to take all prescribed medications.

16. iii. Education on Common disorders of pregnancy: * Nausea and vomiting, ptyalin. * breast changes * backache and ligament pain (postural and hormonal) * headache (stress, fatigue, emotional) * constipation, heartburns

17. * increased vaginal discharge ( endocervical glandular hyperplasia ) * Oedema of lower extremeties . Acroparaesthesia Dyspnoea at 34 – 38 weeks Physiological skin changes ( chloasma , acne, striae gravidam , linea nigra . Dmotional instability .

18. Education on danger symptoms / signs Pelvic: * Bleeding P. V. * Fluid loss P. V. Offensive discharge Abdominal: * Epigastric pain - severe pre eclampsia imminent eclampsia * Uterine cramps – preterm labour * Decreased fetal movement – fetal jeopardy. * hyperemesis gravidarum

19. Cerebral disturbances. * Dizziness, visual disturbance (blurred, double vision). * Persistent severe headache – severe pre eclampsia. Facial and hand swellings . Urinary symptoms – dysuria, decreased output. Fever and chills. Jaundice. Pallor, easy fatiguability

20. Education on Life style: - diet, clothes and shoes, exercise, sexual concerns, personal hygiene, ITN. Birth preparedness Contraception.

21. Risk assessment Increased risk of adverse pregnancy outcome is associated with: - extremes of age: < 18 yrs, > 35 yrs. - grandmultiparity , nulliparity - low socioeconomic status - single motherhood - smoking, alcohol - previous pregnancy loss or neonatal loss - previous C/S or uterine surgery - previous or current SGA, LGA, anomalous fetus . - previous or current hypertension, diabetes, other medical condition. - multiple pregnancy, polyhydramnios .

22. - bleeding in current or previous pregnancy. - family history of medical condition affecting pregnancy. - maternal obesity. - short stature (≤ 1.5m) - Rh negative status. - Any previous obstetric problem - Reduced fetal movement - Maternal anaemia - Poor weight gain - Reduced liquor volume - Malpresentation - Uterine abnormalities .

23. These cases are designated high risk and require care in tertiary centres and a more detailed evaluation and monitoring and some may require more frequent ANC . Subsequent care. After risk assessment, low risk cases may be attended to at lower centres and by skilled midwives or general doctors and referred to tertiary centres if any risk arise. This is called shared antenatal care

24. For routine care the following are done at he specified times . I.M. tetanol ( tetanus toxoid ) at booking,preferably in 2 nd trimester,4wks later [then 6months,1 year, 1 year=5doses] SP for IPT:at 16wks or quickening,3 doses at 4wks interval .Supply and ensure it has been taken [DOT]. R/o G6PD Hb / PCV repeat at 30 – 32 weeks and 36 weeks

25. At each subsequent visit, review the previous notes. Take history, perform physical examination, Do urine dipstick for protein and sugar, and request for any indicated investigation. Ensure that: - client perceives fetal movements - weight gain is appropriate[not >0.5kg/ wk from 20wks and gain a minimum of .5kg/month] - Symphysiofundal height is compatible with gestational age. - fetal heart tones are present and normal - danger signs, if present, are appropriately evaluated and managed. - emphasize on the previous education given. - emphasize on delivery by skilled trained healthcare personnel .

26. Delivery plan: If all is well allow pregnancy to go to term . Do clinical pelvimetry if infdicated [short stature ,pelvic deformity ,in nulliparous client], at 36 – 37 weeks, otherwise best done in labour. Decide on mode and place of delivery at 36 – 37 weeks, based on current findings .

27. Delivery plan Supply list of items required for delivery. Repeat education on what to expect in labour. Repeat education on puerperium and breast feeding Allow spontaneous onset of labour. Ensure clients Hb is ≥ 10g/dl before 37 completed weeks. Let relatives donate 2 units of blood.

28. Pelvic Rock (Helps relieve backache and pressure in the abdomen, and strengthens muscles in abdomen)

29. Head and Shoulder Lift (Strengthens muscles in abdomen)

30. Squat (Strengthens leg muscles)

31. Rib Cage Lift ( Strengthens chest muscles and makes it easier to breath)

32. CONCLUSION Antenatal care is a very important means of preventing maternal and neonatal mortality and morbidity, and should be encouraged for all pregnant women THANK YOU