PRENATAL

CONTROL
CPG
UPDATE 2017
 DEFINITION

Set of actions that involves a series of visits by the

pregnant woman to the health institution and the
respective medical consultation, in order to
monitor the evolution of the pregnancy, detect
risks early, prevent complications and prepare the
patient for childbirth, motherhood and the
upbringing of the newborn.
GOALS
Screening, treatment and surveillance
of
evolution of pathologies.

Risk factor assessment, detection

and management of obstetric
complications.

Systematic disease prevention

such as: neonatal and maternal tetanus,
anemia.

Preparation of an action plan prior to

Birth.
 TO WHOM
Personnel from the first, second and third levels of care with the intention of
standardizing national actions regarding:
6 Increase the opportunity for early initiation of prenatal care.
6 Increase the timely detection of urinary tract infection, gestational
diabetes, hypertensive disorders during pregnancy as well as sexually
transmitted diseases.
6 Promote the detection and timely treatment of complications associated
with pregnancy.
6 Increase reference timely treatment of the patient with diabetes
gestational, hypertensive disorders during pregnancy or maternal
pathologies that warrant it.
 CLINICAL
QUESTIONS
1. What are the health promotion interventions provided in prenatal care with
patient-centered care?
2. In disease prevention, what interventions are the most important in each
trimester in prenatal care with care focused on the pregnant person?
3. What pathology screening interventions are the most recommended in
every trimester during prenatal care?
4. What medical interventions are recommended to be performed at each
prenatal visit to improve maternal and fetal prognosis?
5. Medical interventions to control comorbidities in women with
Pregnancy during prenatal control improve maternal and fetal prognosis?
6. What are the most relevant health education interventions that should be
carried out in women with a pregnancy close to term?
WHAT ARE THE PROMOTION INTERVENTIONS
HEALTH PROVIDED IN CONTROL
PRENATAL WITH PATIENT-CENTERED CARE?
6 DEFINITION
They are those actions or procedures, systematic or periodic, intended
for the PREVENTION, DIAGNOSIS AND TREATMENT of those entities or
factors that may influence the increase in maternal-perinatal MORBI-
MORTALITY.
Prenatal care proposes an emphasis on the quality of the consultation
and not on its number. This person-centered approach recognizes that
prenatal consultations offer a unique opportunity for early diagnosis
and timely treatment of pathologies as well as reducing the risk of
complications of the binomial.
 & HEALTH PROMOTION ACTIVITIES

Individualized care routine carried out by a group of professionals (nursing,

social work, obstetrician-gynecologists, general practitioner, family doctor,
pediatrics)

Specific clinical review considering the needs of each woman, in order to

monitor the normal evolution of the pregnancy and facilitate the early
detection of complications.

AV '»
3?Education for the mother and her partner in the development of pregnancy,
preparation for childbirth, breastfeeding, family planning, safe sexual practices
and the use of contraceptive methods and the prevention of sexually
transmitted infections (STIs).
Maternal use of prenatal multivitamins.
The recommended folic acid supplementation is 400 mg/day.
Preventive supplementation with iron (30-60 mg) to avoid maternal anemia.
-Calcium supplementation in patients with low dietary intake, ≤600 mg/day, with doses of 1
g/day.

Guide the pregnant person to eat a balanced protein-energy diet and adequate intake of
water and dietary fiber. As well as informing her about the risks she runs when
consuming caffeine and alcohol.

Train pregnant women and their families to identify warning signs and symptoms
during pregnancy, childbirth and the postpartum period.
Inform about the type and amount of exercise you can do.
In disease prevention, what interventions are the most
important inInform
each trimester in prenatal
about the correct use of the seat belt
care with care
focused on the pregnant person?
Visit Visits Visits Visits Visits
(<14 SDG) 14-24 SDG 24-28 SDG 28-34 SDG 34-41 SDG
EVALUATION AND PROCEDURES
♦ Complete HC and ♦FHR • FCF • FCF • FCF
• Uterine height • Uterine Height • Uterine Height • Uterine Height
risk identification • Movements • Movements • Movements
Fetal Fetal Fetal ♦ Fetal Presentation
• Evaluate Gestational Age * Evaluate signs • Evaluate Signs • Evaluate Signs
• Evaluate vital signs vital vital vital • Fetal Movements

• Check vaccination •USG 18-22 SDG ♦Assess fetal health • Evaluate vital signs
schedule Apply • Evaluate Fetal
• USG11 to 13.6 SDG Anti-D immunoglobulin, 28 Health
SDG in non-sensitized Rh
negative

LAB TESTS
• BH Gpo and Rh. •Strip proteinuria • Strip proteinuria •Strip proteinuria •Strip proteinuria
Glucose reactive reactive reactive reactive
• VDRL ♦ Tolerance curve
♦HIV glucose
• B.H.
1st consultation
• Prepare a complete medical history with a breast examination and
request a complete blood count, fasting blood glucose, blood group
and RH.
• Look for symptoms and signs of risk, which are grounds for immediate
referral to the hospital.
• Check vaccination schedule. Administer 2 doses of tetanus toxoid (1st
trimester - 3rd trimester). Pregnant women should also get
vaccinated against influenza.

Vaccination in pregnancy
Administration of preparations intended to generate immunity in women during
pregnancy with the aim of protecting the mother and her child against infectious
diseases that can be prevented by vaccines.
TABLE I. VACCINE RECOMMENDATIONS DURING PREGNANCY
Vaccine Recommended Contraindicated Special Condition

Tetanus-diphtheria (Td) x
Teta no s-diftheria -Pert usis (Tdpa) x x
Influenza (TIV) x
Influenza (LAIV) x
Hepatitis B x
Hepatitis A x
Rubeola measles- x
Saram pión- Ru beola-Pa rot id i t is x
Rubella x
Chickenpox x
Polio (IVP) x
Pneumococcus x
Meningococcus x
Rage x
Source: CDC. Guidelines for Vaccinating Pregnant Woman, May-2007
 TABLE II. RECOMMENDED VACCINES IN PREGNANCY
Disease Risk of disease in pregnant women Disease risk in *1 redin born & Type of immunizing agent Agent risk Indications for immunization during pregnancy Comments
fetus Immunizer 11 fetus

Influenza Increase in disease and mortality during or You can increase it! number Inactivated virus None Confirmed Every woman who is in her second and third
periods of disease outbreak of spontaneous abortions. trimester of pregnancy during the dates of
No fetal malformations the disease outbreak. Women at high risk of
secondary to this disease pulmonary complications, regardless of the
have been confirmed. trimester of pregnancy

Hepatitis B Possible increase in the severity of the You can increase it! number Purified surface antigen N mgur u reporteddo Before and after exposure to the virus in Newborns exposed to the infection need to be
disease during the third trimester of of spontaneous abortions women at risk of infection vaccinated. Given the current component of this
pregnancy and premature births. May disease, it is prudent to be vaccinated prior to
cause neonatal hepatitis pregnancy [6 months prior]

Hepatitis A Pregnancy does not increase the risk of the Inactivated virus None reported Before and after exposure to the virus in Given the current component of this disease, it is
disease women at risk of infection. Women who prudent to get vaccinated prior to pregnancy [6
travel internationally frequently months prior]

Pneumonia Pregnancy does not increase the severity Unknown, but depends on Multipurpose polysaccharide N mgunü reported Women with asplenia; kidney, lung, heart or
or severity of the disease! maternal illness metabolic diseases; Smokers;
immunosuppressed - The indications are not
altered by pregnancy

Varieeln Possible increase in severe pneumonia It can cause congenital Live attenuated virus None Confirmed Contraindicated, but no adverse results The ability of this vaccine to cause malformations in the fetus

chickenpox in z% of have been reported if administered during has been confirmed to date. Immunization must be carried out
infected fetuses during the pregnancy in the postpartum period.
second trimester of
gestation.

Rubeoln Low mortality, pregnancy does not alter the The number of spontaneous Live attenuated virus None confirmed Contraindicated, but congenital rubella The ability of this vaccine to cause malformations in
normal course of the disease abortions and congenital syndrome has never been observed after the fetus has not been confirmed to date.
rubella syndrome increases vaccination . Immunization should be carried out in the
postpartum period.
 TABLE III. RECOMMENDED VACCINES IN SPECIAL SITUATIONS

Disease Risk of disease in pregnant Type of immunizing Risk of immunizing agent Indications for immunization Comments
women agent to the fetus during pregnancy
Risk of disease in
the newborn
Anthrax Significant mortality, pregnancy Unknown, but Preparation of Bacillus None confirmed It is not routinely recommended in The ability of this vaccine to cause
does not alter the normal course of depends on maternal anthracs cell-free filtrate pregnant women, except when malformations in the fetus has not been
the disease illness working directly with Bacillus confirmed.
anthracis, imported animals, and
potentially infected animals.

Yellow fever Significant mortality, pregnancy Unknown I saw rus alive dimmed A stranger Contraindicated, unless exposure to Very low frequency condition in Chile.
does not alter the normal course of the disease is unavoidable Postpone trip until the vaccine is
the disease administered.
Rage Near 100% mortality, pregnancy Determined by the I saw dead rus A stranger Each case must be considered
does not alter the normal course of disease individually —
the disease maternal
Rage
Close to 100% mortality. Pregnancy Immunoglobulin None reported After exposure to the virus.
does not alter the normal course of Determined by Rage It must be used in conjunction with the
the disease maternal illness vaccine containing killed rabies virus.
Tetanus 60% mortality 60% of Tetanus immunoglobulin None reported After the exhibition. Should be used in conjunction with
mortality in the tetanus toxoid
newborn
Fuenbe: http://www.germain.tl/vacunas-antes-y-durante-el-erbarazo
Note: Preconception immunization is most recommended for a woman, thus preventing diseases before starting a pregnancy. However, if necessary and urgent, the benefits of the vaccine for the pregnant woman and her developing baby outweigh the risks and adverse effects that the vaccine could

have.
Depression the pregnancy
RISK FACTORS FOR PRESENTATION
in
6 Maternal anxiety: high association
£ Stressful life events: high association
6 Personal history of depression: high association
6 Lack of social support, especially from the partner:
medium association 0 Domestic violence: medium
association
6 Unwanted pregnancy: low association.
6 Relationship: average association between not living
with your partner.
RISK FACTORS FOR THE DEVELOPMENT OF POST-PARTUM DEPRESSION
(PPD)

& Anxiety during pregnancy.

6 Depression during pregnancy
6 Stressful life events during pregnancy or
the beginning of the postpartum period.
6 Low levels of social support.
6 Personal history of depression
ORAL HEALTH (FIRST TRIMESTER OF
PREGNANCY)
6 Provide education to the pregnant person about
changes in the oral cavity
6 Emphasize the importance of hygiene in the oral
cavity during pregnancy and instructions for
controlling dental plaque. (Brushing teeth regularly 3
times a day, for three minutes each session, using a
soft or extra-soft bristle brush to avoid irritation and
receding gums and flossing to remove dental plaque
between the teeth)
S Offer odontoxesis when necessary and treat
emergencies only.