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Antenatal care & Counseling

Antenatal care & Counseling. DR. KHALED ALDOSSARI SBFM , ABFM , MBBS ASSISTANT PROFESSOR. objectives. To know definition of antenatal care. To be familial with common symptoms during pregnancy. to know what should be done every visit. To know ten elements of antenatal counseling. content.

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Antenatal care & Counseling

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  1. Antenatal care&Counseling DR. KHALED ALDOSSARI SBFM , ABFM , MBBS ASSISTANT PROFESSOR

  2. objectives • To know definition of antenatal care. • To be familial with common symptoms during pregnancy. • to know what should be done every visit. • To know ten elements of antenatal counseling.

  3. content • Definition • Antenatal visits • counseling & common problem during pregnancy

  4. Definition Continuous health care provided to pregnant women before labor.

  5. diagnosis • History: • Menstrual period. • Morning sickness. • Abdominal pain.

  6. antenatal visits • Every month until 28 weeks gestation . • Every 2weeks during till 36 week gestation. • Every week during the last month & any time when medical care needed.

  7. antenatal visits • 1st visit : • History: • Bio data. • Compliant.

  8. antenatal visits • Menstrual history: LNMP, EDD. • The Nãgele rule : • EDD is calculated by adding 7 days to the first day of the LMP and adding 9 months.

  9. antenatal visits • Past obstetric hx: • Hx of previous pregnancy. • Hx of abortion. • Mode of delivery. • Birth weight. • Mode of infant feeding.

  10. antenatal visits • Current obstetric hx : • Symptoms of pregnancy (nausea ,vomiting, sleep) • Symptoms of pre eclampsia (edema ,headache( • Quickening.

  11. antenatal visits • Past medical hx (DM,HTN,HEART DISEASE) • Past surgical hx. • Drugs history, blood transfusion ,x ray ,RH incompatibility. • immunization.

  12. Antenatal visits • Physical examination: • General examination (wt, hight, v/s, general appearance ,chest, abdomen ,breast ,thyroid) . • Local examination( inspection) • Size of abdomen ,scar, sign of pregnancy ,fetal movement ,varicose vein

  13. Antenatal visits • Palpation: (fundal level ,fundal grip) • Auscultation of fetal heart.

  14. Antenatal visits • 1st visit investigations ; • Hemoglobin & hematocrit • Urine analysis • Blood group

  15. Antenatal visits • Rh type • Rubella anti body titer • Syphilis screen • Culture for gonorrhea

  16. Antenatal visits • Hepatitis B virus • Cervical cytology • HIV test • ppd if there is risk of TB .

  17. At 26-28 weeks GA : • Routine screen for DM. • Repeat hemoglobin and hematocrit • At this time prophylactic administration of anti- D immunoglobin .

  18. At 32-36 weeks GA: • Testing for Sexually transmitted disease • Repeat hemoglobin and hematocrit if needed

  19. Vaccination During Pregnancy • The following vaccines are considered safe to give to women who may be at risk of infection: • Hepatitis B--Pregnant women who are at high risk for this disease and have tested negative for the virus can receive this vaccine. It is used to protect the mother and baby against infection both before and after delivery.

  20. Vaccination During Pregnancy • Influenza--This vaccine can prevent serious illness in the mother during pregnancy, but should be received after the mother has been pregnant for more than 14 weeks. If you have a serious medical condition that can lead to flu-related complications, you can receive the vaccine at any stage of pregnancy.

  21. Vaccination During Pregnancy • Tetanus/Diphtheria--This combination of vaccines are routinely recommended for pregnant women, both those who have never been immunized and those who have not received a booster in 10 years

  22. Consultancy ten I-Nutritional supplements II- Gestational age assessment III-Prescribed medicines VI-Lifestyle considerations V-Management of common symptoms of pregnancy VI-Clinical examination of pregnant women VII-Screening for hematological conditions VIII-Screening for fetal anomalies IX-Screening for infections X-Screening for clinical conditions (e.g GDM,Preclampsia,GHTN)

  23. The following guidance is evidence based. Developed by the National Collaborating Centre for Women’s and Children’s Health Developed at March 2008 The grading scheme used for the recommendations (A, B, C, D, good practice point [GPP] or NICE 2010)

  24. Counseling I Nutritional supplements

  25. Dietary supplementation with folic acid, before conception(about 3 month) and up to 12 weeks’ gestation, reduces the risk of having a baby with neural tube defects (anencephaly& spina bifida). The recommended dose is 400 micrograms per day.(Risky women 4mg) Folic acid A

  26. Iron supplementation should not be offered routinely to all pregnant women. It does not benefit the mother’s or fetus’s health and may have unpleasant maternal side effects Iron A

  27. Vitamin A supplementation (intake greater than 700 micrograms) might be teratogenic and therefore it should be avoided. Liver and liver products may also contain high levels of vitamin A, consumption of these products should also be avoided. Vitamin A C

  28. Advise women of the importance of vitamin D intake during pregnancy and breastfeeding (10mcg/day) Ensure women at risk of deficiency are following this advice. – South Asian, African, Caribbean or Middle Eastern family origin – women who have limited exposure to sunlight, such as women who are predominantly housebound, or usually remain covered when outdoors – women who eat a diet particularly low in vitamin D, e.g. no oily fish, eggs, meat, vitamin D-fortified margarine or breakfast cereal – women with a pre-pregnancy body mass index above 30 kg/m2. Vitamin D

  29. Counseling II Gestational age assessment

  30. Gestational age assessment: LMP and ultrasound Pregnant women should be offered an early ultrasound scan to determine gestational age and to detect multiple pregnancies. A

  31. Early ultrasound scan Ensure consistency of gestational age assessments, Improve the performance of mid-trimester serum screening for Down’s syndrome and Reduce the need for induction of labour after 41 weeks. A

  32. Ideally, scans should be performed between 10 and 13 weeks and crown–rump length measurement used to determine gestational age. Gestational age assessment: LMP and ultrasound GPP

  33. Pregnant women who present at or beyond 14 weeks’ gestation should be offered an ultrasound scan to estimate gestational age using head circumference or bi-parietal diameter. Gestational age assessment: LMP and ultrasound GPP

  34. Counseling III Prescribed medicines

  35. Prescribed medicines Few medicines have been established as safe to use in pregnancy. D

  36. Prescription medicines should be used as little as possible during pregnancy and should be limited to circumstances where the benefit outweighs the risk. Prescribed medicines D

  37. Prescribed medicines ؟؟؟؟؟؟antiepileptic medication No live vaccine (3month befor conception) No Expose to Radation

  38. Counseling IV Lifestyle considerations

  39. Exercise in pregnancy Beginning or continuing a moderate course of exercise during pregnancy is not associated with adverse outcomes. Pregnant women should be informed of the potential dangers of certain activities during pregnancy, e.g.: contact sports, scuba diving A

  40. The majority of women can be reassured that it is safe to continue working during pregnancy. A woman’s occupation during pregnancy should be ascertained to identify those at increased risk through occupational exposure. Working during pregnancy D GPP

  41. Sexual intercourse in pregnancy Sexual intercourse in pregnancy is not know to be associated with any adverse outcomes. B

  42. There are specific risks of smoking during pregnancy (such as the risk of having a baby with low birth weight and preterm). The benefits of quitting at any stage should be emphasized. Women who are unable to quit smoking during pregnancy should be encouraged to reduce smoking. Smoking in pregnancy A B

  43. Air travel during pregnancy Pregnant women should be informed that long air travel is associated with an increased risk of venous thrombosis. Wearing correctly fitted compression stockings is effective at reducing the risk. B

  44. Traveling abroad during pregnancy If pregnant women are planning to travel abroad, they should discuss considerations such as flying, vaccinations and travel insurance. GPP

  45. Counseling VManagement of common symptoms of pregnancy

  46. Red flag • Pain during urination • Vomiting and nausea symptoms that are extra persistent • Sudden body swelling • Rapid heartbeat

  47. Red flag • Decreased fetal activity (i.e. far less than normal to no baby movement) for more than a day • Vaginal bleeding

  48. Red flag • Early uterus cramping (such as weeks or months before your due date) • Leaking amniotic fluid early on - which will feel a little like a constant trickling peeing sensation

  49. Most cases of nausea and vomiting in pregnancy will resolve spontaneously within 16 to 20 weeks of gestation. Nausea and vomiting are not usually associated with a poor pregnancy outcome. Nausea and vomiting in early pregnancy A

  50. Nausea and vomiting in early pregnancy If a woman requests or would like to consider treatment, the following interventions appear to be effective in reducing symptoms: non-pharmacological – ginger pharmacological – Antiemetic A

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