antenatal assessment
TRANSCRIPT
![Page 1: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/1.jpg)
Antenatal Assessment
![Page 2: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/2.jpg)
What do we mean by …….
Antenatal Assessment??
![Page 3: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/3.jpg)
Antenatal/prenatal care
Systematic supervision of a woman during pregnancy is called antenatal (prenatal care)
![Page 4: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/4.jpg)
Why is it important?
Determines the wellbeing of the newborn and chance for survival (mother history)
![Page 5: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/5.jpg)
AREA OF CONCERNS:
Pre-conception counselling Assessment of risk factors Ongoing assessment of fetal well-being Ongoing assessment of complications Education Discussion of birthing care options
![Page 6: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/6.jpg)
Timing of antenatal visits:
The first visit should not be deferred beyond the second missed period.
Once a month until 28 weeks.Twice a month until 36 weeks.Every week during the last 4 weeks of
pregnancy.
![Page 7: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/7.jpg)
PROCEDURE AT THE FIRST VISIT
> Detailed Health History
> Physical Examination
> Breast and Pelvic Examination
![Page 8: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/8.jpg)
Vital statistics:
NameAgeWard/unitIP noAddressReligionOccupationEducation
LMPEDCGAObstetric score Blood group
![Page 9: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/9.jpg)
Gravida:
nulligravida
primigravida
multigravida
Parity:
nullipara
primipara
multipara
grandmultipara
![Page 10: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/10.jpg)
Maternal history
Present ob. History:Diagnosis?Planned/unplannedMinor disordersImmunizationExposure to drugs/radiation
![Page 11: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/11.jpg)
Pregnancy tests
![Page 12: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/12.jpg)
![Page 13: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/13.jpg)
Maternal History and Risk Factors
Comprehensive maternal history and physical examination is important to point out the risk factors.
Risk factors can be related to mother, during pregnancy, during labor and delivery, or after delivery.
Antenatal assessment starts with determination of risk factors.
Better knowledge about risk factors better preparation to care for the patient.
![Page 14: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/14.jpg)
abortion
31% of pregnancies end in miscarriageOnly rarely would an abortion cause
problems in a subsequent pregnancyincreased risk of miscarriage only in
women who have had multiple induced abortions.
![Page 15: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/15.jpg)
Risk Factors
Preterm Birth:What is considered preterm??The second greatest cause of morbidity and
mortality in neonates.Previous preterm birth increases the subsequent
preterm birth:1 prior = 15% of subsequent preterm birth.2 prior = 32% of subsequent preterm birth.
![Page 16: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/16.jpg)
Risk Factors
Incompetent Cervix:Caused by cervical trauma, previous surgery, or
may be congenital. Usually leads to membrane rupture and
premature delivery.If severe, a suture around the cervical canal is
performed.
![Page 17: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/17.jpg)
Risk Factors
Maternal Smoking and Alcohol Intake:
In the US, about 10% of pregnant mothers smoke, drink alcohol or use drugs.
Maternal intake of alcohol leads to fetal growth problems.
Smoking HBCO decreases availability of oxygen to placenta and fetus.
![Page 18: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/18.jpg)
Risk Factors
Maternal HypertensionComplicates 6-8% of pregnancies.Hypertension during pregnancy (after W24) is
termed: Preeclampsia.Preeclampsia (High BP, proteinuria, edema)Can lead to placental abruption, and preterm
delivery.
![Page 19: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/19.jpg)
Risk Factors
Diabetes:Increase the risk for CV and CNS
malformations, and metabolic disturbances.When appears during pregnancy (Gestational
Diabetes Mellitus, GDM).Treatment: glycemic control.
![Page 20: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/20.jpg)
Risk Factors
Infections Diseases:Infections can be transmitted to fetus.Early screening and detection of the infection is
important.Complicated by the rupture of the membrane.
![Page 21: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/21.jpg)
Risk Factors
Problems in Placenta, UC, and Fetal Membrane:
premature rupture : causes 50% of preterm births.
UC : Prolapse, short, single artery (3%)Placental problems
![Page 22: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/22.jpg)
Antenatal assessment
HeightWeightPallorJaundiceVital signs
![Page 23: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/23.jpg)
BREAST EXAMINATION
flat (nipple does not protrude with stimulation)
retracted (nipple pulls back slightly)
inverted (nipple pulls inward when compressed)
![Page 24: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/24.jpg)
Breast examination
INVERTED NIPPLESGrade 1
![Page 25: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/25.jpg)
Grade 2:the nipple is inverted or retracted under the areola
![Page 26: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/26.jpg)
Grade 3There is no projection of the nipple, elements of nipple are usually buried under the breast and will not come out.
![Page 27: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/27.jpg)
Abdominal examination
InspectionSizeShapeContourFlankSkinBladderFetal movements
![Page 28: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/28.jpg)
palpation
![Page 29: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/29.jpg)
![Page 30: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/30.jpg)
Measuring SFH
After 14 weeks gestation the SFH in centimeters = Number of weeks of gestation + 3 cm.
![Page 31: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/31.jpg)
Antenatal schedule
![Page 32: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/32.jpg)
Investigations
First visit: Hb, Blood group, Rubella, Hep B and C and HIV screening.
10-12 weeks: Chorionic villous sampling15-18 weeks: USG, serum AFP/triple
test , amniocentesis28 weeks: Hb ,TC/DC, ferritin, GTT, and
low vaginal swab to exclude Group B strep.
36 weeks: Hb
![Page 33: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/33.jpg)
Antenatal chart should record the following:Weight gain (12-15 kg in total) BP (a diastolic pressure>90, or increase of >20
from first visit is significant) Urinalysis (watch for protein, glucose, and UTIs) Fetal movements Uterine size in accordance with dates and
ultrasound Fetal lie, presentation, and engagement,
especially after 36 weeks
![Page 34: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/34.jpg)
Antenatal Assessment
ULTRASOUND
Uses high frequency sound waves.Hand-held transducer is placed directly over the
mother’s abdomen, and reflected waves are recorded on screen image.
Can give valuable information about pregnancy and fetus
![Page 35: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/35.jpg)
Clinical Uses of Ultrasound
Identify pregnancy.Determine fetal age.Observe amniotic fluid
abnormalities.Detect fetal anomalies. Identify placental abnormalities.Determine fetal position.Examine fetal HR, and RR
![Page 36: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/36.jpg)
Embryo at 6 weeks
![Page 37: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/37.jpg)
Antenatal Assessment
AMNIOCENTESISIs the procedure of obtaining a sample of amniotic
fluid.Usually performed after W15 (w15-20).A needle is inserted through the skin and uterine
wall to the amniotic sac.Insertion is guided by Ultrasound.Sample from amniotic fluid is obtained for analysis. Very safe procedure (complication rate <1%).
![Page 38: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/38.jpg)
Antenatal Assessment
FETAL HEART RATE (FHR) MONITORING
Heart starts to beat between W16-W20, but beats can be detected as early as W8.
Normal 120-160 bpm.
Becomes very common test.
![Page 39: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/39.jpg)
Antenatal advicesDietexerciseRest and sleepBowelBathingClothingDental careCoitusCare of breast Immunisation
![Page 40: Antenatal Assessment](https://reader033.vdocuments.mx/reader033/viewer/2022061613/5524854b4a795907498b47fb/html5/thumbnails/40.jpg)
FHR Monitoring