1 / 80

Ante Natal Care

Ante Natal Care. Definition. Systematic supervision of a pregnant woman from time of pregnancy till delivery so as to have a healthy mother & baby. Aim. To deliver a healthy baby from a healthy mother. Objectives:. Promote, protect & maintain health of pregnant woman.

baruch
Download Presentation

Ante Natal Care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Ante Natal Care

  2. Definition Systematic supervision of a pregnant woman from time of pregnancy till delivery so as to have a healthy mother & baby.

  3. Aim To deliver a healthy baby from a healthy mother.

  4. Objectives: • Promote, protect & maintain health of pregnant woman. • Detect high risk cases & provide special attention. • To foresee complications & prevent them.

  5. Remove the fear of labor & delivery. • Motivate for family planning, incl. MTP. • Educate about personal hygiene, nutrition and child care. • ↓ MMR and infant mortality rate.

  6. High Risk Mothers: • Age > 35 yrs • Grand multi • Short primi (<150 cm) • Mal presentation (at term) • PIH, Anemia, Medical disorders • h/o recurrent pregnancy loss (RPL) • Multiple gestation, hydramnios • Previous surgery, MRP, difficult labor

  7. When should prenatal care start?

  8. IDEALLY, a woman planning to have a child should have a medical evaluation before she becomes pregnant.

  9. Frequency of ANC’s • First check up by 45 days • Monthly till 28 weeks • Fortnightly till 36 weeks • Weekly till EDD • Admission around EDD

  10. DAWN’s rule of 10 • 10 ANC’s • 10 kg weight gain • 10 hrs rest and sleep • 10g Hb • 2 doses Inj. TT by 10th month • 10 hrs in labor for primi and < 10 for multi • 10 APGAR score for baby • 10 months of breast feeding • Infant immunization by 10th month

  11. Methods: • History taking • Examination • Immunization & hematinic prophylaxis • Investigations • Advice: diet warning signals

  12. History • LMP/ EDD: previous menstrual history (3 cycles) • Conception: spontaneous/ assisted • Pregnancy Confirmation: time & method • Supervision of Pregnancy

  13. Age: Teenage pregnancy: CPD Anemia PIH Elderly primi:Down’s syndrome PIH GDM Anemia

  14. Husband’s Occupation: Socio-economic status Risk of STD/ AIDS • Previous Obstetric History: Recurrent Pregnancy Loss Preterm Labor APH PPH Labor complications

  15. Married Life: Previous pregnancies Low fecundity group • Past History: Allergy to drugs Previous operations Known medical disorders h/o blood transfusion

  16. Family History: Hypertension Diabetes Hemophilias Twins

  17. Examination • Height: < 145 cm  CPD • Weight: total weight gain: 10 – 12 kg 1st trimester : 1 – 2 kg 2nd trimester : 5 kg 3rd trimester : 5 kg

  18. Excessive Wt.:> 0.5 kg/ wk > 2 kg/ month seen in: Hydramnios Diabetes Twins PIH (earliest sign)

  19. If initial wt < 40 kg:↑ chances of IUGR • No ↑ in weight: IUD IUGR

  20. Gait: polio spinal abnormalities • Pallor • Pedal edema • Thyroid enlargement • Vital Signs: pulse, BP • CVS, RS

  21. Abdominal examination • Inspection: Striae Gravidarum, Linea albicans/ nigra Previous Scar Lie: longitudinal/ transverse • Palpation: Grips: fundal, lateral, 1st & 2nd pelvic • Auscultation: FHS

  22. Vaginal Examination Indications to do p/v in pregnancy: • Assess the pelvis at term • 1st trimester: • To confirm diagnosis of pregnancy • If uterus corresponds to POG • Intra/ extra-uterine pregnancy • Cervical length

  23. First Trimester • Ideally with in 45 days • Confirm pregnancy with tests: History taking (incl. LMP – EDD) Complete examination Urine test • Vital signs

  24. Routine investigations: Blood:ABO, Rh HIV, HBsAg, VDRL Hb. Urine:Protein Sugar Pus cells Culture & sensitivity

  25. USG: • Confirm pregnancy • Intra/ extra – uterine • Single/ multiple gestation • Viable/ non viable • Cervical length (after 12 weeks)

  26. Register the patient (booking of the patient): At least 5 visits with doctor: 1 investigation in 1st trimester, 1 in the second trimester and 3 in the 3rd trimester

  27. 2ND Trimester (13 – 28 weeks) • 1 ANC / month till 28 weeks • History: quickening complications: PIH IUGR Hydramnios Anemia UTI Fever, etc

  28. Examination(No p/v) • Weight • Fe & Ca supplements • Immunization: Inj TT (im) primi: 2 doses, 1 month apart between 16 – 36 weeks multi:1 dose (with in 3 years of previousdose) • USG: fetal anomaly scan

  29. 3rd Trimester (29 – 40 weeks) • Fortnightly till 36 wks, then wk’ly till EDD • History: PIH, Anemia, GDM, etc. • Examination: p/v at term • USG:Fetal Biometry(BPD, HC, AC, FL) Fetal Well Being - BPP(FM, FBM, FT, AFI, NST)

  30. Plan Delivery: Time Mode: Vaginal: spontaneous/ induced Abdominal

  31. Warning Signs of Pregnancy: • Bleeding p/v: Ectopic pregnancy Abortion Vesicular mole APH • White/ excessive watery discharge: Candidiasis Trichomoniasis Bacterial vaginosis Prom Circumvalate placenta

  32. Persistent ↑ / ↓ fetal movements: Fetal distress • Breathlessness:Heart disease Hydramnios Twins PIH • Headache: PIH

  33. Visual disturbances: PIH • Epigastric pain: PIH Heart Disease PTL • Burning micturition: UTI • Excessive vomiting: Hyperemesis g. Vesicular mole

  34. Thank You

  35. Nutrition and Micronutrients in Pregnancy

  36. Nutritional Interventions in Pregnancy • Nutrition • Micronutrients • Folic Acid • Iron • Iodine • Calcium • Zinc • Vitamin A • Vitamin D • Vitamin K • Copper • Selenium • Magnesium

  37. Nutritional Interventions in Pregnancy What is Their Effect on Pregnancy outcome?

  38. Maternal Malnutrition and Pregnancy Outcome • Periconception : fertility,  NTD. • 1st t trimester : SB, preterm births, early NND • 2nd & 3rd trimester : birth wt, SGA, preterm birth. • Birth wt significantly influenced by starvation • PNMR not affected. • No  in incidence of malformation.

  39. Dietary restriction trials in pregnant women: - • Inconclusive results to demonstrate / exclude effect on fetal growth / any significant effect on other outcomes • Nutritional supplementation trials: Mixed result • High protein: no evidence of benefit on fetal growth • Balanced protein and energy: minimal  in average birth wt (~30 g) & small  in incidence of SGA NB • Conclusion: - • Women manifesting nutritional deficits can benefit from a balanced energy/ protein supplementation

  40. Micronutrients & pregnancy outcome Micronutrient def. Assoc. with adverse pregnancy outcomes? • Folic Acid NTD • Iron anaemia, haemorrhage. • Iodine cretinism. • Calcium hypertension, pre-eclampsia. • Zinc anaemia, NTD, LBW, anencephaly.

  41. - Vitamin A Vertical transmission of HIV, Maternal anemia, Infection, Maternal mortality. • Vitamin D neonatal hypocalcaemia. • Vitamin K haemorrhage. • Copper anaemia, anencephaly, LBW • SeleniumNTD, dysfunction of brain & CVS, abortion. • Magnesium blood coagulability, toxaemia, preterm birth.

  42. Folic Acid • Strong evidence that folic acid periconceptionally prevents NTD • ng evidence that folic acid  risk of some other birth defects • Improves the hematologic indices in women receiving routine iron & folic acid • USPHS/ CDC recommends for US women • 400 g/day : all women in childbearing age • 1 mg/day : pregnant women • 4 mg/day : women with h/o NTD take folic acid 1 month prior to conception & during 1st trimester

  43. Nutritional Supplementation & Anemia • WHO definition of severe anemia: • hemoglobin < 7 g/dl • Level of risk • Moderate anemia (Hb 7–11 g/dl) : not  • Severe anemia : significant risk • Severe anemia is associated with: • LBW newborns • Premature newborns •  PNMR •  MMR

  44. Anemia and Obstetrical Hemorrhage • Anemia does not cause obstetrical hemorrhage. • Etiology of obstetric hemorrhage. • Early pregnancy: abortion complications. • Mid/late pregnancy to delivery: APH, atony, retained placenta, birth canal laceration. • Primary factors affecting outcome: • Rapid intervention to prevent exsanguination. • Availability of skilled provider, drugs, blood & fluids. • There is no evidence that  levels of hemoglobin are beneficial in withstanding a hemorrhagic event.

  45. Iron Supplementation • Iron requirements: • Average non-pregnant adult: • 800 g iron lost/day • + 500 g iron lost/day during menses • Pregnant woman: need due to • Expanded blood volume • Fetal and placental requirements • Blood loss during delivery

  46. Routine vs. Selective iron supplementation: • Routine iron & folate supplementationwhere nutritional anemia is prevalent • Recommended dose: 60 mg elemental iron+ 500 g folic acid

  47. Iodine Supplementation • Iodine deficiency is a preventable cause of mental impairment • Iodine supplementation & fortification programs have been largely successful in  iodine deficiency conditions • Population with high levels of mental retardation (e.g.:- Some parts of china): • Supplementation may be effective atpreconception up to mid-pregnancy period

  48. Calcium Assocn between PIH & calcium supplementation •  incidence of PIH. • Routine supplementation likely to be beneficial in women at high risk of developing PIH or have  dietary calcium intake •  calcium doses (2 g/day) not associated with adverse events.

  49. Calcium Supplementation Calcium  risk of: • hypertension, pre-eclampsia • low birth weight, chronic hypertension in children • Other health benefits not related to pregnancy: • Maintaining bone strength • Proper muscle contraction • Blood clotting • Cell membrane function • Healthy teeth

  50. Zinc and pregnancy outcome Zinc – involved in: • 300 enzymes, • nucleoprotein, • DNA and protein synthesis, • cell division. Serum zinc levelsin pregnant women: • Normal range: 7-10 mol/l •  • No change • 

More Related