1 / 37

OB&GYNE COURSE LECTUER FOR UNDERGRADUATE

Undergraduate course lectuers,Faculty of medicine ,Zagazig University

guest60819
Download Presentation

OB&GYNE COURSE LECTUER FOR UNDERGRADUATE

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. ANTENATAL CARE DR: MANAL BEHERY Zagazig University , Egypt

  2. Definition • Antenatal care refers to the care that is given to an expected mother from time of conception is confirmed until the beginning of labor • It is a preventative cost effective service

  3. GOALS • 1-Ensure mother health. • 2- Ensure delivery of a healthy infant. • 3-Anticipate problem • 4- Diagnose problem early.

  4. Objectives • 1-Early detection and if possible, prevention of complications of pregnancy. • 2-Educate women on danger and emergency signs & symptoms. • 3-Prepare the woman and her family for childbirth • 4- Give education & counseling on family planning

  5. Schedual of antenatal care: Medical check up every four weeks up to 28 weeks gestation, Every 2 weeks until 36 weeks of gestation Every week until delivery An average 7-11 antenatal visits/pregnancy More frequent visits may be required if complications arise.

  6. On first antenatal visit • 1-First : Confirm pregnancy by pregnancy test or US. • 2-History • 3-Physical examination • 4-investigation

  7. History • Personal history • Menstrual history • Obstetrical history • Family history • Medical and surgical history • History of present pregnancy

  8. Menstrual history • Ask about • 1-Last menstrual period (LMP). • 2-Regularity and frequency of menstrual cycle. • 3-Contraception method used . • 4-Calculate expected date of delivery (EDD)as 1st day of LMP −3 months +7 days, and change the year.

  9. Obstetric History • Gravidity? Parity? abortion, and living children. • Weight of infant at birth & length of gestation. • Type of delivery, location of birth, and type of anesthesia. • Maternal or infant complications.

  10. Medical and surgical history: 1-Chronic conditions : as diabetes mellitus, hypertension, and renal disease ,cardiac disease. 2-Prior operation: as cesarean section, genital repair, and cervical cerclag. 3-Allergies, and medications. 4-Accidents involving injury of the bony pelvis

  11. History of present pregnancy • History suggesting e.g. Diabetes, hypertension and ante partum hemorrhage. • Ask about episodes of fever or chills • Ask about pain or burning sensation on urination. • Abnormal vaginal discharge, itching at the vulva or if partner has a urinary problem.

  12. IMMEDIATE ASSESSMENT for emergency signs. • Vaginal bleeding • Severe abdominal or pelvic pain • Severe headache with visual disturbance • Persistent vomiting • Unconscious/Convulsion • Severe difficulty in breathing • High grade Fever • Looks very ill

  13. Assessment and physical examination

  14. Weight measurement • Maternal height and weight measurements to determine body mass index(BMI). • Maternal weight should be • measured at each • antenatal visit

  15. Check for pallor or anemia. 1-Look for palmar pallor. 2-Look for conjunctival pallor 3-Count respiratory rate in one minute.

  16. Blood pressure measurement • Measure BP in sitting position. • If diastolic BP is 90 mm Hg or higher repeat measurement after 6 hour rest. • If diastolic BP is still 90 mm Hg or higher ask the woman if she has: • Severe headache • Blurred vision • Epigastricpain • Check urine for protein.

  17. Investigations Get baseline on the first or following the first visit. • Hemoglobin, blood type • Urine analysis • VDRL or RPR to screen for syphilis • Hepatitis B surface antigen To detect carrier status or active disease

  18. At each visit

  19. At each visit • 1-Questions about fetal movement • 2-Ask for danger signs during this pregnancy • 3-Ask patient if she has any other concerns

  20. Symphysis Fundalhieght • LMP plus 280 days • Add 7 days, subtract 3 months • MacDonald's Rule (cm = weeks)

  21. At third trimester Do Leopold’s exam

  22. Provide advice on • Diet and weight gain • Medication • Avoid Radiation exposure • Self-care during pregnancy • Minor complaints. • Family planning Breastfeeding • Birth place preparation and anticipation of complication& Emergency situations.

  23. Diet in pregnancy: • Total caloric intake increase to 300 kcal /day due to 15% increase in BMR . • Diet show contain 20%Protein(better from animal source), 30% fat ,and 50% carbohydrates . • Sufficient fluids should be available.

  24. Supplementation • 1-Folic acid 0.4 mg tab daily • 2- iron (ferrous sulphate or gluconate )300 mg/daily • 3- Ca 1200mg /daily • 4- • -Those with a normal balanced diet • probably don’t need extra vitamins

  25. Weight gain in pregnancy: • There is a slight loss of pounds during early pregnancy if the patient experiences much nausea and vomiting. • Weight gain of 2 to 4 lbs(0,5-1 kg) by the end of the first trimester. • Gain of 1 lb(0.5)/ per wk is expected during the second and third trimesters. • Monitoring of weight gain should be done in conjunction with close monitoring of BP.

  26. Medications During Pregnancy • Antibiotics - some OK, some not • Local anesthetics - OK • Local with epinephrine - not OK • Aspirin - not OK • Immunizations - some are OK, some are not • Antimalarial - some OK, some are not • Narcotics - OK except for addiction issue

  27. Case Study

  28. Case Study • A 35-year-old G2 P1+0 woman is seen for her first prenatal visit. • Based on her LMP, she is at 15 weeks’ gestation. • She has no complaints, and no significant medical history. • She denies dysuria or urinary urgency. • Her surgical history is remarkable • Her last delivery was a vaginal delivery and was uncomplicated

  29. On examination • Her blood pressure (BP) is 100/65 mm Hg • heart rate (HR)90 (bpm), • respiratory rate (RR) 12,temperature 98°F (36.6°C), • weight 70KG. • general physical examination is normal

  30. Abdominal examination • Her abdomen is non tender • Fundal height is at the level ofthe umbilicus. • Fetal heart tones are 140 bpm. • Her extremities are without edema.

  31. Prenatal laboratories • CBC: Hgb 10.0 g/dL ,Plt 150,000 WBC 8,000 • Rubella: nonimmune • Hepatitis B surface antigen: positive • Blood type: O, Rh negative • UC&S: 10,000 cfu/mL of group Bstreptococcus • Gonorrhea assay: negative Chlamydia assay: negative

  32. Questions • ➤ What items should be listed on the problems list? • ➤ What is your next step for the problems listed? • ➤ What other testing should be recommended to the patient?

  33. Problem List: • Advanced maternal age 35 Y or greater at EDD • fundal height at umbilicus corresponds to 20 weeks) • Mild microcytic anemia (Hgb < 10.5) • Hepatitis B surface antigen (HBsAg) positive • Rh-negative blood type • Urine culture with GBS 10,000 cfu/mL, • Rubella nonimmune

  34. Next Steps: • 1. AMA—genetic counseling • 2. Size/dates—fetal ultrasound to assess GA, multiple gestation • 3. Anemia—therapeutic trial of iron • 4. HBsAg positive—check liver function tests, and hepatitis B serology toassess for active hepatitis versus chronic carrier status

  35. Next step • 5. Rh negative Rhogam at 28 weeks and at delivery if the baby proves to be Rh positive • 6. Urine culture with GBS—treat with ampicillin and re-culture urine, peni-cillin IV prophylaxis in labor • 7. Rubella status—vaccinate postpartum

  36. Other tests recommended to patient • consider early diabetic screen

  37. Thank you

More Related