In the name of God

Dr Solmaz PiriObstetrician & Gynecologist

Prenatalogist from KCL,England

Prenatal Care The major goal of

prenatal care is to ensure the

birth of a healthy baby with

minimal risk for the mother.

Main Components• Early, accurate estimation of gestational

age• Identification of the patient at risk for

complications• Ongoing evaluation of the health status

of both mother and fetus• Anticipation of problems and

intervention, if possible, to prevent or minimize morbidity

• Patient education and communication

•Woman-centred care

•Women, their partners and their families should always be treated with kindness,

respect dignity• The views, beliefs and values of the woman, and her family

in relation to hercare and that of her baby

should be sought and respected at all times

•booking (ideally by 10

weeks)

•Documentation of care

Gestational age• Crown–rump length

measurement should be used to determinegestational age. • If the crown–rump length is above 84mm, the gestational

age should be estimated using head circumference.

•Immunization

• Available vaccines • Tetanus and diphtheria

toxoid vaccine (Td)• Tetanus toxoid, reduced

diphtheria toxoid, and acellular pertussis vaccine (Tdap).

• In 2013, The ACIP recommendations supported by the American College of

Obstetricians and Gynecologists

• All pregnant women receive vaccination against pertussis

with Tdap during each pregnancy, optimally

between 27 and 36 weeks of gestation, regardless of prior vaccination status, to better

protect their infant

tetanus booster

• If Tdap is given earlier than 27 to 36 weeks

• and at any stage of pregnancy if the woman lives in an area with a pertussis epidemic

• or required as part of wound management

Varicella vaccination• Varicella vaccination is

recommended for women without evidence of immunity

preconceptionally or postpartum:

• Postpartum:The first dose is given while the patient is in the hospital and the second dose

is given four to eight weeks later, which typically coincides with the routine postpartum

visit. Breastfeeding is not a contraindication

History• The elements of the patient history

include:• Personal and demographic information• Past obstetrical history• Personal and family medical history• Past surgical history• Genetic history• Menstrual and gynecological history• Current pregnancy history• Psychosocial information

Physical examination• Classic and complete approach

• Everything is important • Every mild derangement should

be carefully adressed• Keep in mind : Pregnant women

is using her body reserve and may not be able to make further compensation

• Rhesus type and antibody screen — This

test will detect antibodies potentially

causing hemolytic disease of the newborn.

•Folic acid

• Dietary supplementation with folic acid, before conception and throughout the first 12 weeks, reduces the risk of having a

baby with a neural tube defect • The recommended dose is 400

micrograms per day

Vitamin A, be carefull !

• Pregnant women should be informed that vitamin A supplementation (intake above 700 micrograms) might be teratogenic and should

therefore be avoided.• Pregnant women should be informed

that liver and liver products may also contain high levels of vitamin A, and

therefore Consumption of these products should also be avoided.

•vitamin D

•haematological

conditions

•gestational diabetes

• fetal anomalies

and aneuploidies

•Air travel

Hepatitis B• Testing for HBsAg should be performed on all women at the first prenatal visit and repeated

late in pregnancy in those at high risk for HBV infection. The current

recommendation is to provide passive-active immunization to newborns of carrier mothers.

Antivirals• A meta-analysis of 10 studies concluded that the administration of lamivudine to the mother in late pregnancy in addition to hepatitis

B vaccination and hepatitis B immunoglobulin prophylaxis for the infant significantly reduced mother-to-child transmission

• More data are needed to clarify the HBV DNA cutoff for recommending antiviral

therapy to pregnant HBV carriers• At present, we tend to offer antiviral prophylaxis in women who have a high

viral load (more than 8 log(10) int. unit/mL). Treatment should be started preferably six to eight weeks before

delivery to allow enough time for HBV DNA levels to decline. Of the available

oral agents, telbivudine and tenofovir are pregnancy class B drugs

• With appropriate immunoprophylaxis, breastfeeding of infants of HBV carriers poses no additional risk for the transmission of HBV

• Infants who received HBIG and the first dose of vaccine at birth may be breastfed as long as they complete the course of vaccination

• but carrier mothers should not participate in donating breast milk.

• Mothers with chronic hepatitis B who are breastfeeding should also exercise care to prevent bleeding from cracked nipples

Further tests• VDRL

• Asymptomatic bactriuria•HIV

• Thyroid function tests

Not recommended

•CMV•Toxoplasmosis

•HSV•Bacterial Vaginosis

Thank youThank you very much for

your attention