Antenatal Classes

1. Antenatal Classes • Dr. Alexander K. Doo • Specialist in Obstetrics & Gynaecology • The Women’s Clinic • Saturday 31/7/04 • Antenatal Talk • City Hall

2. Warnings Signs in the 3rd Trimester • Starts from 28 weeks onwards. • Bright red vaginal bleeding. • Leaking of water from the vagina (sudden gush or slow leak). • Regular tightenings or cramping. • Dim or blurred vision or flashing bright lights or spots.

3. Warnings Signs in the 3rd Trimester • Bad headache/dizziness, a lot of swelling of face and body • Chills and fever • Pain when passing urine • Decreased fetal movement

4. Bleeding • Bleeding at any time during the pregnancy should be immediately reported to your health care provider. In the second and third trimesters, it can be a sign of abnormal placental (after-birth) implantation to the uterine wall, or premature separation of the placenta. Bleeding can also occur after intercourse through pressure on or irritation of the vagina and/or cervix.

5. Abruptio Placentae • Placenta becomes detached from the uterine wall prematurely leading to bleeding and a reduction of oxygen and nutrients to the fetus. The detachment may be complete or partial.Occurs in less than 3.5 % • More common in women who smoke, have high blood pressure, and/or in women who have had previous children or a history of abruptio placentae.

6. Abruption • Symptoms and treatment of abruptio placentae depend upon the degree of detachment. Symptoms may include bleeding, cramping, and abdominal tenderness. Diagnosis is usually confirmed by performing a complete physical examination and an ultrasound. Women are usually hospitalized for this condition and may have to deliver the baby prematurely.

7. Placenta Previa • Placenta previa is a condition in which the placenta adheres itself to the uterus near or covering the cervix. Often, the placenta moves to the upper half of the uterus during pregnancy requiring no treatment. When the placenta does not move and remains in the lower half of the uterus, the condition is called placenta previa.

8. Placenta Previa • This type of placental complication occurs in one in every 200 deliveries and occurs more often in women who have scarring of the uterine wall from previous pregnancies, in women who have fibroids or other abnormalities in the uterus, or in women who have had previous uterine surgeries.

9. Placenta Previa • Symptoms may include vaginal bleeding that is bright red and not associated with abdominal pain. Diagnosis is confirmed by performing a physical examination and an ultrasound. Depending upon the severity of the condition and the stage of pregnancy, modification of activities or bedrest may be ordered. The baby usually has to be delivered by cesarean section.

10. Leakage of Watery Fluid From Your Vagina • Urine leakage can be caused by the baby pressing on your bladder. Fluid leakage can also be the result of a spontaneous rupture of membranes. The membranes are a protective mechanism for the baby-they cushion him or her and allow room for fetal movement growth and provide a barrier against infection.

11. Possible Signs of Premature Labour • Increase in vaginal discharge (watery, mucousy or bloody) • Low, dull backache (intermittent or constant) • Pressure like baby pushing down (comes and goes)

12. What to Do? • Call if you have more than 8 contractions in 1 hour • Lie down drink some fluid and count the contractions • Doesn’t do away after 1 hour, or > 5 X / hour in the next hour

13. Pre-eclampsia • Cause is unknown • More common in 1st pregnancy • 5% of all pregnancy • Raise BP, Proteinurea, swelling due to fluid retention • Eclampsia - siezure, coma, HELLP syndrome,death

14. Signs and Symptoms • Headache, swelling of hands face and feet, epigastric pain, irritability, nausea ,visual disturbance, decreased urine output, raised blood pressure, proteinurea.

15. Treatment • Depends on gestation • ultimately requires delivery

16. Urinary Tract Infection • Burning or pain during urination • Frequency • can lead pre-mature labour • Treatment with antibiotics

17. Decreased fetal Movement • First sign of fetal comprmise • Intensity decreases as gestation advance • Rule of 10 • If in doubt, check it out

18. Indications for Elective Caesarean Section • Patient choice • Multiple pregnancy • Placenta previa • Malpresentations • Previous section • Maternal medical condition

19. Some Arguments for Caesarean Section • Maternal choice in 38% of cases • In a randomized trial comparing elective section vs vaginal delivery it showed perinatal mortality and serious morbidity of 1.6% vs 5%, and that 90% delivered by section in the planned group vs 56.7% in the vaginal gp • Vaginal delivery is associated with with risk of urinary and feacal incontinence

20. Some Reasons for Section • 1/3 of women will have urinary incontinence 3 months after delivery • 11% life time risk of surgery for incontinence and prolapse • Feacal incontinence – 19% 6 weeks • Overall 1/3 of women will have evidence of anal sphincter defect on USS 6 weeks post-partum, and 65% of which will have symptoms of anal incontinence.and 75% if it’s a second vaginal birth

21. Indications for Emergency Section • Failure to progress • Cord prolapse • Fetal distress • Placental abruption • Cephalo pelvic disproportion • Premature labour ( <1.5 Kg) • Failed instrumental delivery

22. The End