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knowledge regarding antenatal care, develops a right attitude towards antenatal care and apply this knowledge in their professional and personal life.
SPECIFIC OBJECTIVES:
At the end of the seminar, the group
COMMON TERMINOLOGIES:
Nullipara: is one who has never completed a pregnancy to
the stage of viability. She may or may not have aborted previously Primipara: Is one who has delivered one viable child Multigravida: Is one who has previously been pregnant. She may have aborted or have delivered a viable baby Parturient: Is a woman in labour
pregnant Primigravida: Is one who is pregnant for the first time Multipara: Is one who has delivered two or more children Puerpera: Is a woman who has just given birth
ANTENATAL CARE
Definition:
Systematic supervision ( examination and advice ) of a women during pregnancy is called antenatal or prenatal care.
Objective: To ensure a normal pregnancy with a delivery of a healthy baby from a healthy mother.
ANTENATAL VISITS
Services as per WHO recommendation: Atleast 4 visit 1st visit around 16weeks 2nd visit between 24-28 weeks 3rd visit at 32 weeks 4th visit at 36 weeks
Generally At interval of 4 weeks up to 28 weeks At interval of 2 weeks up to 36 weeks At weekly interval up to EDD
Risk Determination
Antenatal Advice
1. History taking
Age Gravida and Parity Duration of marriage Occupation Occupation of Husband Period of Gestation Complaints History of Present illness
Contraceptive History
PHYSICAL EXAMINATION
General Examination
Obstetrical Examination
Obstetrical Examination:
Abominal Examination
Inspection
Palpation
Auscultation Vaginal Examination
INVESTIGATIONS
Examination of Blood:
Urinalysis Cervical Cytology Study
Special Investigations:
Recommended Intervals for Routine and Indicated Tests and Procedures During Prenatal Care
Initial
Hemoglobin Urinalysis, including microscopic examination and infection screen Blood group and D type Antibody screen Rubella antibody titer Syphilis screen Cervical cytology Hepatitis B virus screen
8-18
16-18
26-28
28
Repeat antibody test for un sensitized D-negative patients Prophylactic administration of anti-D immune globulin Repeat hemoglobin
RISK DETERMINATION
Risk factors that may raise during pregnancy are ;
Fetal movement pattern reduced or changed Hb lower than 10g/dl
90mmHg or 15mmhg or more above booking diastolic Uterus large or small for gestational age
ANTENATAL ADVICE
1. DIET: The diet during pregnancy should be adequate to provide (a) the maintenance of maternal health, (b) the needs of the growing fetus, (c) the strength and vitality required during labour and (d) successful lactation.
2. Rest and sleep Bowel Bathing Clothing, shoes and belt Dental care Care of the breasts Coitus Travel Smoking and alcohol Exercise IMMUNISATION
with Hepatitis B vaccine initially, then vaccine alone at 1 and 6 months Rabies: post-exposure prophylaxis Tetanus: post-exposure prophylaxis Varicella: Consider for post exposure (within 96 hours)
Inactive Virus Vaccines Influenza: Underlying Disease Rabies: same as non pregnant Hepatitis B: at high risk and negative for B antigen Toxoids Tetanus: diphtheria - same as non pregnant Pooled immune serum globulins Hepatitis A: post-exposure prophylaxis Measles: post-exposure prophylaxis
SUBSEQUENT VISITS
Maternal weight gain
Blood pressure
Assessment of the size of the uterus and height of
Constipation
Leg cramps Acidity and heartburn
Varicose veins
Ankle oedema Vaginal discharge Pelvic joint pain Incontinence Stretch marks
proper steps are taken to rectify it Pregnancy should be regularly supervised Antenatal care is said to be the strategy, the intranatal care is the tactics in obstetrics Acceptance of advice
childbirth is a physiological process and to boost up the psychology The net effect is marked reduction in maternal mortality (about I/7th) and morbidity
DRAWBACKS
Trifling abnormality may be exaggerated for which
unnecessary medications or risky operative interference is prescribed Quality is not always maintained specially in the developing countries with increasing population. Faulty dietary advice and prescription of harmful drugs produce injurious effects on the mother and/or the baby.
PRECONCEPTIONAL COUNSELLING
When a couple is seen and counselled about
pregnancy, its course and outcome well before the time of actual conception is called preconceptional counselling.
recorded. Rubella and hepalitis immunization in a non-immune woman is offered. Folic acid supplementation (4 mg a day) starting 4 weeks prior to conception upto 12 weeks of pregnancy , is advised Maternal health is optimised preconceptionally
about the effects of the disease on pregnancy and also the effects of pregnancy on the disease. Drugs used before pregnancy are verified and changed if required Woman should be urged to stop smoking, taking alcohol and abusing drugs. Addicted woman is given specialised care. Inheritable genetic diseases (sickle cell disease, cystic fibrosis) are screened before conception and risk of passing on the condition to the offspring is discussed
genetic diseases are discussed Inheritable genetic diseases could be managed either by primary prevention Couples with history of recurrent fetal loss or with family history of congenital abnormalities (genetic, chromosomal or structural) are investigated and counselled appropriately
and families to comprehend the natural history of genetic and congenital conditions, as well as the psychosocial and reproductive implications
and are concerned about the risk for chromosomes problems during pregnancy. Couples in which one or both have a history of birth defects or genetic disease. Couples who have had a child or pregnancy affected with certain birth defects or genetic disease. Individuals interested in carrier screening for genetic disease due to family history or ethnic background.
that they are both carriers of the same genetic condition Pregnant women coping with abnormal genetic test results. Women concerned about a drug, environmental hazard, or other exposure during pregnancy. Couples who have been diagnosed with infertility
pregnancy) This second trimester screening test is a combination of a maternal serum screening test and an ultrasound scan. The maternal serum screening test is optimally performed between 14 and 18 weeks and measures the levels of three products (triple test); estriol, free -hCG and alpha-fetoprotein or four (quadruple test) by including inhibin-A. The ultrasound scan, also called a Fetal Anomaly Scan, is ideally performed between 18 and 23 weeks of pregnancy and is used to measure the nuchal fold, assess structural development of your baby, and detect major and minor structural markers.
determines the risk for your baby to have a birth defect, chromosomal abnormality or genetic condition, compared to your basic age related risk. If the risk is significantly greater than the age related risk then you will be offered a prenatal diagnostic test, such as an amniocentesis. The ultrasound scan can detect structural abnormalities e.g. a neural tube defect
Pregnancies with an increased risk for a birth All pregnant women defect or genetic condition. Often identified through prenatal screening Diagnosis of a birth defect Risk for a birth defect or genetic condition (inconclusive) (mostly conclusive) Maternal serum screen (9 13.6 weeks) Chorionic villus
Result
Ultrasound examination sampling or CVS (11 to 14 First Trimester Tests (9 (10.5 14 weeks) measure weeks) detects specific to 14 weeks gestation) chromosomal the nuchal translucency, abnormalities or genetic detect nasal bone and conditions assess structural development (heart, brain)
Maternal serum screen or triple screen (14 to 18 weeks) Ultrasound or Fetal Anomaly scan (18 to 23 weeks) measure nuchal fold, assess development, detect major structural abnormalities and identify markers associated with genetic conditions.
Cordocentesis (18 weeks or later) detects specific chromosomal abnormalities or genetic conditions
NON-INVASIVE TESTS
Ultrasound scan(ultrasonography or sonar)
Maternal serum screening 2. INVASIVE PRENATAL TESTS Chorionic villus sampling (cvs) Amniocentesis
BIBLIOGRAPHY
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Betty.R.Sweet, Mayers midwifery : Text book of midwifery,2000, Tindal publishers, 12th Edition, Pp 208 239 Lowdermilk, Perry, Maternal and Womens Health Care, 1997, 6th Edition, Mosby Publishers, Missouri Fraser and Cooper, Myles Text Book of Midwifery, 2009, 15th Edition, Churchill- Livingstone Publishers, London, Pp 263 289 D.C.Dutta, Text Book of Obstetrics, 2004, 6th Edition, New Central Publishers, Kolkotha, Pp 95 113 Kamini Rao, Text Book of Midwifery and Obstetrics for Nurses, 2011, 1st edition, Elsevier Publishers, Kundli, Pp 95 120 www.everychildmatters.gov