Pre-conceptional Care

Pre-conceptional Care
“a set of interventions that aim to identify and modify
biomedical, behavioral, and social risks to a woman’s health or pregnancy
outcome through prevention and management.”

COUNSELING SESSION
• Diabetes Mellitus-
• prototype of a condition for which pre-conceptional counseling is beneficial.
• Many of these complications can be avoided if glucose control is optimized before
conception
• Epilepsy-
• those with a seizure disorder carry an undisputed augmented risk of having neonates
with structural anomalies elevated
• and risk for congenital malformations that was independent of anticonvulsant
treatment effects.
Immunizations
• includes assessment of immunity against common pathogens.
• Vaccines that contain toxoids such as tetanus are suitable before or
during gestation.
• those containing killed bacteria or viruses—such as influenza,
pneumococcus, hepatitis B, meningococcus, and rabies vaccines
• live-virus vaccines are not recommended during pregnancy.
Genetic disease

Family History
• The health and reproductive status of each “blood relative” should be
individually reviewed for medical illnesses, mental retardation, birth
defects, infertility, and pregnancy loss.
• Certain racial, ethnic, or religious backgrounds may indicate elevated
risk for specific recessive disorders.
nueral tube defect
• 2nd only to cardiac anomalies as the most frequent structual fetal
malformation.
• incidence :0.9 per1000 live births.
• preconceptional folic cid therapy significantly reduced the risk for
recurrent NTD by 72%.
• supplementation reduced the priori risk for NTD risk of first NTD
occurence.
phenylketonuria
• complications
• spontaneous abortion: 24%
• developmental delays: 92 %
• microcephaly :73 %
• congenital heart dse: 12%
• fetal growth restriction: 40%
• with appropriate preconceptional counceling and adherance to
phenylalanine restriceted diet before pregnancy, the incidence of fetal
malformation is reduces.
• target phenylalanine blood concentration: 120-360 umol/L
thalasemia
• most common single gene disorder worldwide.
• individuals who are high risk ancestry be offered carrier screening to
allow them informed desicion making regarding reproduction and
prenatal diagnosis
• one method of early prenatal dx is primplantation genetic diagnosis
REPRODUCTIVE HISTORY
• During preconceptional screening, information is sought regarding
infertility; abnormal pregnancy outcomes that may include
miscarriage, ectopic pregnancy, and recurrent pregnancy loss; and
obstetrical complications such as cesarean delivery, preeclampsia,
placental abruption, and preterm delivery
PARENTAL AGE
• adolescents-increased risk for anemia, preterm delivery, and
preeclampsia compared with women aged 20 to 35 years
-incidence of sexually transmitted diseases
• Conceptions after age 35 -the risks for obstetrical
complications and for perinatal morbidity and mortality rise
social history
recreational drugs and smoking
• smoking in pregnancy has been associated with numerous verse
perinatal outcomes.

environmental exposures
• contact with enviromental substance is inescapable.
• exposures to infectious dses have many deleterious effects and may
impart significant maternal and fetal risk.
DIET
pica
• craving for and consuming of ice,laundry starch, clay, dirt or other non
food items.
• some cases represents an unsual physiological response to iron
deficiency
anorexia and bulimia
• increase maternal risk of nutritional deficiency, electrolyte
disturbance, cardiac arrhytmias and gastrointestinal pathology.
Prenatal Care
Prenatal Care
• DIAGNOSIS OF PREGNANCY- Pregnancy is usually identified when a woman
presents with symptoms and possibly a positive home urine pregnancy test
result.
• Pregnancy Tests
• Detection of hCG in maternal blood and urine is the basis for endocrine assays of
pregnancy.
• main function of hCG is to prevent involution of the corpus luteum
• which is the principal site of progesterone formation during the first 6 weeks of pregnancy.
• this hormone can be detected in maternal serum or urine by 8 to 9 days after ovulation.
• Symptoms and Signs
• Amenorrhea
• uterine bleeding
• fetal movement (primigravida: 18-20wks)
(multigravida: 16-18wks)
Sonographic Recognition of Pregnancy
• Transvaginal sonography
• gestational sac: 4-5wks
• Yolk sac: 5-6 wks,confirms intrauterine location
• Embryonic pole: 6wks, with Cardiac motion noted at this point
• Crown rump length (CRL): up to 12wks AOG,predictive of AOG within 4 days
most accurate tool for gestational age
INITIAL PRENATAL EVALUATION-Prenatal care is ideally initiated early
• define the healthstatus of the mother and fetus
• estimate the gestational age
• initiate a plan for continued obstetrical care.
SUBSEQUENT PRENATAL VISITS
• <28wks –every 4wks
• 28-32 wks- every 2wks
• >32 wks- every 1wk
Fetal surveillance
• fundic height: Between 20 and 34 weeks’ gestation, the height of
the uterine fundus measured in centimeters correlates closely with
gestational age in weeks
:used to monitor fetal growth and amniotic fluid volume
• Fetal Heart Sounds:10wks : doppler ultrasound
• 16wks : sthethoscope
Subsequent Laboratory Tests
If initial results were normal, most tests need not be repeated
• Hematocrit -repeated at 28 to 32 weeks
• serology for syphilis - repeated at 28 to 32 weeks
For women at increased risk for HIV acquisition
• HIV test- repeat testing is recommended in the third trimester, preferably
before 36 weeks
For woman high risk for hepatitis B virus infection
• retested at the time of hospitalization for delivery
Women who are D (Rh) negative
• should have an antibody screening test repeated at 28 to 29 weeks
Group B Streptococcal Infection
• vaginal and rectal group B streptococcal (GBS) cultures be obtained in all
women between 35 and 37 weeks’ gestation
• Intrapartum antimicrobial prophylaxis is provided to those whose culture
results are positive
Gestational Diabetes
• All pregnant women are screened for gestational diabetes mellitus
• between 24 and 28 weeks’ gestation is the most sensitive approach
Neural-Tube Defect and Genetic Screening
• Serum screening for neural-tube defects is offered at 15 to 20 weeks
• aneuploidy screening may be performed at 11 to 14 weeks’ gestation
cervical infections
chlamydia trochomatis
• incidence of 2-13 % of pregnant woman
• recommend that all woman be screened for chlamydia druing first
prenatal visits
• risk factors: unmarried status, recent change of sexual partner,
multiple concurrent partners, <25 y/o. and history of STD.
neisseria gonorrhoeae
• typically causes lower genital tract infection in pregnancy
• risk factor are similar to chlamydia
Prenatal nutrition
Recommended daily allowance

Calories : 100-300 kcal/day

Protein: 5-6g/day

Iron : 27mg/day (low risk)

60-100 mg/day (large woman, twin pregnancy or anemia

Iodine :220 ug/day for patient with deficiency associated with

cretinism
Immunization in
pregnancy
Tetanus- • IM(3doses) 0, 1, 6 -12months
diptheria- • Booster: every 10 years or
acellular once per pregnancy
pertussis • Preferably between 27-36 wks
(Tdap)
(inactivated
vaccine)

Influenza • IM 1 dose: once a year

vaccine( inactivat
ed vaccine)

Hepatitis B • IM (3 doses): 0, 1 ,6 months

• Booster not routinely
recommended
COMMON CONCERNS
Employment- Some types of work, however, may increase pregnancy complication risks
-occupation that subjects the gravida to severe physical strain should
be avoided. Ideally, no work or play is continued to the extent that undue fatigue
develops. Adequate periods of rest should be provided.

Exercise- In general, pregnant women do not need to limit exercise, provided they do not
become excessively fatigued or risk injury
Coitus
• In healthy pregnant women, sexual intercourse usually is not
harmful.
• coitus is avoided- miscarriage, placenta previa, or preterm labor
threatens
• Oral-vaginal intercourse is occasionally hazardous, described a
fatal air embolism late in pregnancy as a result of air blown into
the vagina during cunnilingus
Dental care
• good dental hygiene is encouraged
• periodontal disease has been linked to preterm labor.
• pregnancy is not a contraindication to dental treatment including
dental radiographs
alcohoL- is apotent teratogen that causes fetal syndrome
• growth restriction
• facial abnormalities
• central nervous system dysfunction.

smoking
adverse effects
• miscariage
• stillbirth
• low brithweight
• preterm delivery
• placenta previa
• PROM
illicit drugs
-heroin, cocaine, amphetamines, barbiturates, marijuana.
-chronic use of most of these is harmful to fetus and may cause:
• fetal growth restriction
• low birthweight
• drug withdrawal soon after birth
automobile and air travel
• air travel in a properly pressurized aircraft has no harmful effect on
pregnancy
• without obstetrical or medical complication, pregnant woman can
safely fly upto 36wks gestation.

caffeine
• heavy intake of coffee each day, about five cups or 500mg of coffeine,
slightly raises the miscarriage risk
headache or backache
• common headaches are virtually universal to pregnancy
• lowback pain is reported by nearly 70% percent of gravidas
• backpain complaints increase with progessing gestation and are more
prevalent in obese.

sleeping and fatigue

• beginning early pregnancy, many woman experience fatigue and need
greater amount of sleep.
• due to soporific effect of progesteron
• sleep efficiency progressively diminish as pregnancy advances.
Thankyou 