THE PRINCIPLES OF ANTENATAL CARE.pptx

For MBBS and Gynae and Obstetrics Postgrad Students

1. THE PRINCIPLES OF ANTENATAL CARE (Including PA& Teratogenic Drugs) PROF. DR. IRAM CHAUDHRY FCPS(OBS. & GYNAE) MHPE. BAHAWALPUR.

2. Definition ‘A planned program of observation, education, and medical management of pregnant women directed toward making pregnancy and delivery a safe and satisfying experience.’ (American college of O&G)

3. WHAT I S ANTE NATA L CARE Care of women during pregnancy Or “ Periodic and regular supervision including examination and advice of a woman during pregnancy is called Antenatal care”

4. Objec t ives To ensure a normal pregnancy with delivery of a healthy baby from a healthy mother

5. Prin c ip l es To predict problems on the basis of history and physical examination. To prevent or reduce the severity of problems by prophylactic measures To detect and treat conditions having harmful effects on the mother or fetus. To provide education, information and reassurance for mother and partner.

6. Current Approach Prepregnancy counselling Booking visit Routine antenatal visits Antenatal education classes Inpatient care

7. Prepregnancy Counselling Conditions requiring referral Maternal- Diabetes , other endocrine disorders , HTN , Infections; herpes, HIV . Genetic disease Age Drug exposure Abnormal nutrition-obese/skinny Previous adverse obstetric history ( preg . loss, preterm delivery, IUGR, congenital defects) Tab. Folic Acid

8. Prepregnancy Counselling General principles. Folic Acid. Avoid smoking and drugs. Exercise and BMI Folic acid supple m ents : 6 wks prior to concept io n and continue till 14 wks.

9. Antenatal care comprises - Registration of pregnancy History taking Antenatal examinations [general and obstetrical] Laboratory investigations Health education

10. Booking Visit- history Ideally at 10-12 wks Includes Detailed History Clinical Examination Investigations.

11. History Particulars of the patient Chief complaints with duration Past history Obstetric history Menstrual history Family history Drug History History of immunization Socio-economic history Contracepti ve history History of allergy

12. Complete Examination Weight, height, BMI BP Full CVS and resp exam Breast check- inverted nipples Abdom inal Examination: SFH : Palpable after 12 wks F undus at umbilicus - 20 wks X iphisternum - 36 wks.

13. Investigations Booking- blood tests: FBC Blood group and antibody screen Hep B & C, syphilis, rubella, HIV serology Triple test at some cent er s For at risk; sickle test, Hb electrophoresis Urine dip- protein and glucose

14. Genetic Risk Maternal age > 35yrs Afro-Caribbean- sickle cell Mediterranean or Asian- thalassemia Previous child with abnormality Inherited diseases- hemophilia

15. Screening Tests 10-12 weeks booking scan Confirm IU preg, foetal HR 11-13 wks nuchal translucency Together with age, estimates likelihood of Downs (normally 1/500) 14-20 wks. serum screening for Downs (triple test not used at PRH; CVS or amniocentesis instead)

16. Screening Tests anomaly scan: 18-20 wks . x 20-22 wks. Accurate assessment of gestation al age. Multiple pregnancy detection . Placental site localization Detection of congenital abnormalities: all 4 chambers of heart

17. Timing variable but traditionally - Every 4 wks until 28wks 2 wks until 36wks Weekly thereafter BP and urine checked at each visit Abd . presentation assessed from 32wks af t e r 36 w k s b r eech nee d s m ana g ing fe t al head engages at 36-38wks in primi gravida Subsequent Visits

18. Subsequent Visits Patient complains & Identification of problem General examination Gestational Age Foetal movement SFH measurement Health education Prophylaxis & treatment of anemia Developing individualized birth plan

19. Subsequent Visits Blood tests: - Rhesus neg women have titres measured at 30 and 36wks. Anti-D given at 28 and 34 wks ?

20. 50% IUGR remain undetected Clinical assessment Fetal movements Ultrasound Assessment , used in series Biophysical profile Limb and body movements, breathing, tone, amniotic fluid vol, HR variability on CTG Fetoplacental Blood Flow ( Doppler Studies) Cordocentesis , for blood transfusions too Assessment of fetal Growth and Wellbeing

21. Models of ANC Focused ANC- also called “new” or “WHO” models E vidence based interventions and visit patterns that benefited mothers and their fetus and were cost effective as well 4 routine visits , with a few evidence based diagnostic and intervention modalitie s. at 16,28,32 and 36 weeks Additional visits on individual basis

22. Visit First Visit Second visit Third visit Fourth visit G es t a t i onal age <16 weeks 28 weeks 32 weeks 3 6 weeks Activities Classification to either the basic or specialized component Clinical exam Hgb test G es t a t i ona l A ge determination Blood pressure Weight/Height Syphilis/STIs Urinalysis ABO/RH TT administration Iron supp l e m e n t a t i on D ocu m e nt on ANC Clinical exam for anemia Gestational age; FH; FHB exam Blood p r e s su r e Weight- only if underweight at initial visit Urinalysis- for nullipara or pr. pre-eclampsia Iron supplement Complete on ANC card Hgb test TT second dose Instructions for birth planned Re c o m m enda t i o n s for lactation/contrace ption Document on ANC card Examine for breech presentation Document on ANC card

23. Elderly primi (30 yr. and above) Short statured primi (140 cm and below) Mal presentations APH, threatened abortion Pre – eclampsia, eclampsia Risk Appr o ach

24. Risk Appr o ach Anaemia Twins, hydramnios IUFD, Still birth Elderly grand multiparas Prolonged pregnancy H/o past caesarean or instrumental delivery Treatment for infertility

25. Warning sign Headache Blurring of vision Convulsion Vaginal bleeding Fever

26. Fundal height at different gestational period

27. Measurement of distance between upper limit of uterus and superior border of symphysis pubis

28. Fundal grip

29. Umbilical / Lateral grip

30. Obstetrical grips

31. Location of fetal heart in different presentations

32. Different fetal presentations

33. FDA CLASSIFICATION OF DRUGS IN PREGNANCY

34. Fetal alcohol syndrome is the most severe  fetal alcohol spectrum disorder. These are a group of  birth defects  that can happen when a  pregnant  woman drinks alcohol.  Other fetal alcohol syndrome disorders (FASDs) include: Partial fetal alcohol syndrome Alcohol-related birth defects Alcohol-related neurodevelopment disorder Neurobehavioral disorder associated with prenatal alcohol exposure