The principles of antenatal care
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Transcript of The principles of antenatal care
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The Principles Of The Principles Of Antenatal CareAntenatal Care
J. RomainJ. Romain
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DefinitionDefinition
• ‘ 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)
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PrinciplesPrinciples
• To predict problems on the basis of the medical, social and obstetric history and physical examination.
• To prevent or reduce the severity of problems by prophylactic measures
• To detect and treat conditions which have harmful effects on the mother or foetus.
• To provide education, information and reassurance for mother and partner.
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Current ApproachCurrent Approach
• Prepregnancy counselling
• Booking visit
• Routine antenatal visits
• Antenatal education classes
• Inpatient care if required
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Prepregnancy CounsellingPrepregnancy Counselling
• General principles
Avoid smoking, ETOH and drugs. Exercise is okay
Folic acid supplements 6 wks prior to conception and until 14 wks.
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Prepregnancy Counselling 2Prepregnancy Counselling 2
• Conditions requiring referral to ObstetricianMaternal- Diabetes and other endocrine disorders
HTN Infections; herpes, HIVGenetic disease- age, FHDrug exposureabnormal nutrition-obese/skinnychronic medical problemsprevious adverse obstetric history
(preg loss, preterm del, IUGR, congenital defect
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General Pregnancy AdviceGeneral Pregnancy Advice
• Diet- sensible and may need iron
• Exercise- can continue but not vigorous!
• Coitus- no evidence its harmful
• Employment- tailored to individual
• Clothing- supportive and comfy
• Advice on benefits of breastfeeding
• Antenatal Classes
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Booking Visit- historyBooking Visit- history
• Ideally at 10-12 wks
IncludesIdentification details +/- shared GP careSH- occ, ?married, social situation, DHMenstrual/contraception- LMP, periods of
infertility, exclude ectopic Obs Hx- all prev pregnancies and any
complications
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Booking Visit- historyBooking Visit- history
Maternal Conditions
- Diabetes - Renal disease
- Epilepsy - Endocrine
- Thromboembolic - STD’s
- Anaemia - Rubella
- Cardiorespiratory - psychiatric hx
- HTN - smear results
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Genetic RiskGenetic Risk
• Maternal age > 35yrs
• Afro-Caribbean- sickle cell
• Mediterranean or Asian- thalassaemia
• Previous child with abnormality
• Inherited diseases- haemophilia
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Booking Scan- ExaminationBooking Scan- Examination
• Weight, height• BP• Urine dip- protein and glucose• Full CVS and resp exam• Breast check- inverted nipples• Abdomen-pelvic mass after 12 wks
-fundus at umbilicus 20-24 wks -xiphisternum at 36-38 wks
(although with an USS abdo exam not as useful)
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Booking- bloodsBooking- bloods
• FBC
• Blood group and antibody screen
• Hep B, syphilis, rubella, HIV serology
• Triple test at some centres
• For at risk; sickle test, Hb electrophoresis
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Place of DeliveryPlace of Delivery
• Only low risk women suit home delivery (1% of all deliveries)
- healthy aged 19-34yrs
- para 1 or 2
- no major contraindications such as; prev complicated obs/med hx, major gynae hx, <5ft, High BMI, abnormality in current preg or postmaturity, no telephone at home.
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Screening TestsScreening Tests
10-12 weeks booking scan
Confirm IU preg, foetal HR11-13 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)
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Screening TestsScreening Tests
18-20 wks, anomaly scan
Accurate assessment of gestation
Multiple pregnancy detection
Placental site
Detection of congenital abnormalities
Can see all 4 chambers of heart
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Subsequent VisitsSubsequent Visits
• Timing variable but traditionally - Every 4 wks until 28wks- 2 wks until 36wks- Weekly thereafter• BP and urine checked at each visit• Abdo- presentation assessed from 32wks
after 36wks breech needs managing
fetal head engages at 36-38wks in primip
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Subsequent VisitsSubsequent Visits
• Bloods
- Rhesus neg women have titres measured at 30 and 36wks. Anti-D given at 28 and 34 wks?
- If anaemic can have combined iron/folate preps
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Assessment of fetal GrowthAssessment of fetal Growth
50% IUGR remain undetectedMeans of monitoring; Clinical assessment Fetal movements Ultrasound Assessment, used in series Biophysical profileLimb and body movements, breathing, tone,
amniotic fluid vol, HR variability Fetoplacental Blood Flow Cordocentesis, for blood transfusions too
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End of Antenatal CareEnd of Antenatal Care
• If woman has EDD and passes it she is sometimes surprised.
• Need to explain that it is the probable expected date and not actual
• Still normal if within 2 weeks either side
• If longer, consider use of prostaglandins if cervix favourable.
• Ensure follow up if needed by obstetrician
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THE END!
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