Preconceptional care pcc the critical role of primary care physician
This presentation is the property of its rightful owner.
Sponsored Links
1 / 37

Preconceptional care (PCC) (The Critical role of Primary Care Physician) PowerPoint PPT Presentation


  • 104 Views
  • Uploaded on
  • Presentation posted in: General

Preconceptional care (PCC) (The Critical role of Primary Care Physician). Introduction to Primary Care a course of the Center of Post Graduate Studies i n FM. PO Box 27121 – Riyadh 11417 Tel: 4912326 – Fax: 4970847. Content of this session. Overview Rational of PCC. Objectives of PCC.

Download Presentation

Preconceptional care (PCC) (The Critical role of Primary Care Physician)

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.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Preconceptional care pcc the critical role of primary care physician

Preconceptional care (PCC)(The Critical role of Primary Care Physician)

Introduction to Primary Care

a course of the Center of Post Graduate Studies in FM

PO Box 27121 – Riyadh 11417

Tel: 4912326 – Fax: 4970847


Content of this session

Content of this session

Overview

Rational of PCC.

Objectives of PCC.

PCC implementation at PHC centers.

Physicians' role - delivering PCC.

Obstacles of PCC.

Premarital check-up.

Woman’s role.


Birth rate

Birth Rate

  • United State

    13.82 births/1000 population

  • Saudi Arabia

    28.55 births/1000 population

    country comparison to the world 52

  • Egypt

    21.70 births/1000 population

  • United Arab Emirates

    16.02 births/1000 population

  • Japan

    7.64 births/1000 population


Prematurity infant mortality

Prematurity & Infant Mortality

  • United State

    7 deaths/1000 live births.

  • Saudi Arabia

    11.7 deaths / 1000 live births

  • United Arab Emirates

    12.70 deaths / 1000 live births

  • Egypt

    27.26 deaths / 1000 live births

  • Japan

    2.4 deaths / 1000 live births

Central Intelligence Agency, The WORLD FACTBOOK


Factors leading to infant mortality

Factors Leading to Infant Mortality

  • Maternal health problems

  • Smoking

  • Age <20 or > 40

  • Late entry into prenatal care

  • Education

  • Marital status

  • Inter-pregnancy interval


Preconceptional care pcc the critical role of primary care physician

Potentially all related to

Maternal Health Prior to Pregnancy

(Preconception)


Key factors

Key Factors

  • Health status overall

    • Nutrition

    • Exercise habits

    • Infection risk (immunization)

  • Specific health risks

    • Chronic medical conditions

    • Medication

    • Tobacco use


Preconception care a window of opportunity

Preconception Care: A window of opportunity

  • All women of child-bearing yrs : pre- screened for

  • health & risk potentials Before attempting to be pregnant.

  • Optimum: 3- 6 ms before conceiving attempt

  • This time frame allows:

  • 1- Successful conception & pregnancy

  • 2- any within control health risks.


Preconceptional care pcc the critical role of primary care physician

Rational of PCC

  • PCC has been advocated as a measure to improve pregnancy outcome.

  • Its components parallel those of prenatal care : risk assessment, health promotion and medical & physiological interventions.

  • Physician’ s role : providing PCC.

  • Woman’s role : ….


Preconceptional care pcc the critical role of primary care physician

Objectives of PCC

Screening tool for physicians to assess women’s health

In one sense, PCC can be compared to:

Will Baby Clinic visit

a baby is screened for Normal health, Normal Development to identify emerging unnoticed problems in an infant.


Preconceptional care pcc the critical role of primary care physician

Objectives of PCC

For a Woman: PCC assess Normal health of a child-bearing woman, to identify: -

Existing or emerging illness or disease which may have gone undetected before.

Existing risks for the woman who may become pregnant.

Existing risks which may affect a fetus if the woman does become pregnant.


Preconceptional care pcc the critical role of primary care physician

PCC at PHC centers

PCC can be provided most effectively as part of

ongoing primary care.

  • Physicians can deliver PCC during visits for

    • Routine health maintenance,

    • During examinations for school or work,

    • At premarital or family planning visits,

    • After a negative pregnancy test or

    • During well-child care for another family member.


Preconceptional care pcc the critical role of primary care physician

Components of PCC

  • Comprehensive check-lists.

  • Assessments – History & examination.

  • Screening: Investigations.


Preconceptional care pcc the critical role of primary care physician

What is involved in PCC?

  • Prescreening check-lists :

  • Reproductive & non- reproductive systems. Covers physical & psychological aspects.

  • Woman's lifestyle

  • Family history information.

    • Begins with basic information then in-depth, especially if there is previous disease/operation.

    • Pre-screening assessments: a Questionnaire filled by women generally before seeing the physician with a nurse.


Preconceptional care pcc the critical role of primary care physician

Assess & screen for:

Medical conditions.

Genetic counseling.

Immunization.

Lifestyle changes.

STDs (STI)

Medications.

Occupational exposures.

Domestic violence.


Preconceptional care pcc the critical role of primary care physician

Medical conditions:

  • DM:

    • Screen for DM and pre-diabetes.

    • If already diabetic --- shift to insulin Rx.

  • Congenital anomalies: 2- 6x > offspring of DM.

  • PCC care & good DM control  their rate

  • Recent meta analysis: lower rate among PCC recipients (2.1%) vs non-recipients (6.5%).


Preconceptional care pcc the critical role of primary care physician

Medical conditions:

Hypertension.

UTI & Renal problems.

Obesity .

Cardiac / pulmonary problems.

Epilepsy .

Psychological disorders.


Preconceptional care pcc the critical role of primary care physician

Premarital couselling

  • Genetic counseling in PCC is ideal time:

    • Before a couple attempts to conceive especially if the history reveals :-

      • Advanced maternal age,

      • Previously affected pregnancy,

      • Consanguinity or FH of genetic disease.


Preconceptional care pcc the critical role of primary care physician

Examples Genetic counseling

  • Blood conditions caries/ disease:

    • Sickle cell anemia, thalasemia, G6PD

  • Cystic fibrosis.

  • Mental retardation condition:

  • Screen women with a known FH of fragile X syndrome or FH of unexplained mental retardation or for women who have learning disabilities or mental retardation.


  • Preconceptional care pcc the critical role of primary care physician

    Immunization

    • PCC is ideal time:

      • Screen

      • for rubella immunity.

    • Immunization:

    • Rubella

    • Hepatitis A

    • Hepatitis B

    • Tetanus

    • Chickenpox?

    Check : EIP complete? women <18 yrs.

    EIP = Expanded Immunization Program)


    Preconceptional care pcc the critical role of primary care physician

    Lifestyle changes

    • Caffeine: 1 cup coffee : ~ 120 mg caffeine.

    • 1 cup tea : ~ 40 mg caffeine.

    • 12- oz soft drinks (cola) : ~ 45 mg caffeine.

    • Caffeine metabolism  during pregnancy

    • especially with cigarette smoking.

    • Several studies: caffeine intake ± associated with

    •  fertility  abortion  birth wt.

    •  5-6 mg/kg/day spread on day + no smoke + no alcohol : NO  reproductive risk.


    Preconceptional care pcc the critical role of primary care physician

    Lifestyle changes

    • Tobacco :

    • Smoking women during pregnancy : subjects themselves & their infants to a no. of adverse health effects.

    • women contemplating pregnancy should quit smoking prior to conception.

    • Nicotine replacement could then be prescribed.


    Preconceptional care pcc the critical role of primary care physician

    Lifestyle changes

    • Tobacco :-

    • Smoking cessation before / early pregnancy : associated with improvement in maternal airway function & at infant birth wt vs among nonsmoking pregnant women.

    • Alcohol & illicit drugs

    • Both a major health problem in USA.

    • Both harm fetus.

    • 1981- USA : women abstain drinking alcohol during pregnancy & when plan pregnancy.


    Preconceptional care pcc the critical role of primary care physician

    Sexually Transmitted Infection (STI = STD)

    & medications

    STI : PCC is a good opportunity to screen for genital infections such as Chlamydia, gonorrhea, syphilis and HIV.

    Medications : therapeutic regimens for chronic illnesses are best modified, if possible, in PC period to include the drugs that have been used the longest & have been determined to pose the lowest risk.


    Preconceptional care pcc the critical role of primary care physician

    Medications

    Antihypertensives: Diuretics & angiotensin-converting enzyme should be avoided

    drug of choice: methyldopa- proven maternal & fetal safety.

    Anticoagulants:

    Warfarin ContraIndidated Switch to heparin

    Oral hypoglycemic:

    Switch to insulin before pregnancy.


    Preconceptional care pcc the critical role of primary care physician

    Occupational exposures

    Worldwide: women entry to workforce.

    Most women are in reproductive age

    • Three most common occupational hazards reported to affect

    • pregnancy are:

      • Radiation Exposure

      • Organic solvents

      • Lead


    Preconceptional care pcc the critical role of primary care physician

    Domestic violence

    Is increasingly recognized as a major public health issue.

    It crosses all racial, religious & educational boundaries.

    Physical abuse during pregnancy :

    significant Risk Factor low birth wt & maternal complications.

    Physicians should assess the victims

    & refer to local community resources.


    Preconceptional care pcc the critical role of primary care physician

    Obstacles of PPC

    • Pregnancies are still unplanned.

    • Women do not know, realize, or understand the benefits of visiting their physician before become pregnant.

    • The lack of health insurance.


    Preconceptional care pcc the critical role of primary care physician

    PCC in Saudi Arabia

    • Premarital check up :

    • Mandatory For limited inherited risks.

    • It could be provided to the married women at the center by:-

      • health education of the patient at Pre-Natal Care Well baby clinic , Chronic disease clinic ….etc

      • Let the patient be aware of its importance


    Preconceptional care pcc the critical role of primary care physician

    Woman’s role

    • A woman may need to adjust certain aspects of her health and well-being which are in her control.

    • These usually include aspects of lifestyle, drug and alcohol use, exercise, rest and stress reduction.

    • In addition, she may need to discontinue certain herbs or over-the-counter medications as recommended by the physician.

    • Many physicians will also recommend pre-natal vitamins before a woman actually conceives in order to boost her overall health.


    Preconceptional care pcc the critical role of primary care physician

    تم بحمد الله

    Thank you


    Preconceptional care pcc the critical role of primary care physician

    MCQ


    1 birth rate is

    1) Birth rate is

    • Annual number of births during one year/ 1000 population.

    • Crude birth rate.

    • Usually determine the rate of population growths.

    • All of the above.


    2 infant mortality rate

    2) Infant mortality rate

    • Number of infant deaths in one year/1000 live birth in same year.

    • Include total death rate.

    • It indicate the level of health in a community.

    • All of the above.


    3 factors leading to infant mortality include all except

    3) Factors leading to infant mortality include all EXCEPT

    a) Maternal health problems.

    b) Smoking.

    c) Age >20 or < 40

    d) Late entry into prenatal care.


    4 drugs that need to be changed for safe motherhood are all except

    4) Drugs that need to be changed for safe motherhood are all EXCEPT

    • Diuretics

    • Warfarin

    • Insulin

    • Angiotensin-Converting Enzyme Inhibitors


  • Login