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Prenatal CareRINA AMELIA
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Objective
At the end of the session the students
will be able to describe:
-Prenatal care in the office
- History and risk assessment
- Second trimester prenatal care
-Third trimester prenatal care
- Family physicians and Obstetric
consultants
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Introduction
• Prenatal care is one of the most rewarding
aspects of family practice
•Prenatal care is a time during which strongdoctor-patients bonds often deelop
• The continuity of care proided by family
physician allow these bonds to continue
• !ontinuing to care for the women" other
family members" and the new baby
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Prenatal Care in The Office
• High quality of prenatal care" reduce
maternal mortality and infant mortality
•The goal of prenatal care arecomprehensie and aim for 3 outcomes :
1. Healthy baby and mother
#$ A labor and deliery that go assmoothly as possible
%$ A smooth adjustment of the mother
and family to this lie eent
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• Prenatal care must emphasize clinical
surveillance of both the mother and her
fetus" such attention should set the stage
for a successful labor and deliery
• &deally" a precondition for all delieries
would be a healthy woman with a
reasonable idea of what support during
pregnancy should be an integral part of
care during pregnancy and childbirth
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• Such support reduce anxiety and physicalmorbidity and increased confidence thatthe ad'ustment to motherhood will be
successful
• The family physicians who incorporate this
type of care into this their practice willen'oy satisfied patients$
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Preconception Planning
• &deally a pregnant is planned or at least
wanted" and the prospectie mother isit
her physician before conception has occur
• The physician can e(plore and clarify the
motives for the pregnancy
• Help the patient maximize her health in
anticipation of pregnancy
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The point should be covered during
pregnanc counseling are !
) Assessing risk for genetic birth defects
) Attaining physical fitness prior to
pregnancy
) *ubella testing and immunization
) +aternal Health behavior
) +aternal health problems
) ,nironmental health risk
) Prenatal vitamins
)sychosocial risk
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"iagnosing Pregnanc
• The pregnancy test
• -reast tenderness and enlargement"
fatigue and nausea• Physical e(amination : .terus
enlargement" bluish coloring to
aginal mucosa and ceri(/!hadwick0s sign1
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#irst Tri$ester Prenatal Care
• 2eeks : 345%
• The most crucial for the deeloping child
• The period of greatest susceptibility toembryoto(ic and teratogenic substances
• For the physicians : initial contact during
the first trimester should help set the stagefor a healthy pregnancy
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%istor and Ris& Assess$ent
• Patient0s leel education" work status"ethnic background and lifestyle
• &dentified the risk of complications during
pregnancy hypertension" 6iabetic• The number of previous pregnancies"
route of deliery" weight and gestation of
the newborn" and any complication"especially resulted in morbidity or fetalmortality
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%istor and Ris& Assess$ent'
• &dentified high risk patient /from historical
information1
• ,(amples:
) history of premature delivery
) History of second trimester looses due to
early cerical dilatation /cervicalincompetent 1
) *isk placenta previa /women high parity1
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Ris& behavior !
• Alcohol consumption• !igarette smoking• 6rug use /risk for A&6S1•
,nironmental ha7ard• *rubella and to(oplasma• ,ctopic pregnancy• History of herpes /neonatal infection1
• A family history congenitalabnormalities" mental retardation" multiplebirth
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Phsical E(a$ination
The First Prenatal visit :
• -lood Pressure
• The si7e and shape of the uterus and adne(al
area" and the configuration of the bony pelisThe subsequent visit :
• -lood Pressure check
• The si7e and shape of the uterus• Fetal cardiac actiity
• 2atching for edema
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Laborator Test
• Hematocrit
• Syphilis serology
• *ubella immunity status
• Hepatitis surface antigen
• .rine culture
•Pap smear • &n addition : gonorrhhea /819!hlamydiaassay /81recommended Test H&
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Patient Education
and Pschosocial )upport
• First trimester : visit once a month
• ,arly pregnancy should center on the
rapid physical and emotionaladjustment demanded of the mother
• ,ducation about fatigue" nausea and
ambialent
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Patient Education
and Pschosocial )upport'*• Sign of miscarriage : discuss the earliest
isit
• Total pregnancy weight : 5345;
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)ECON" TRIME)TER
PRENATAL CARE
• -etween 1! and "# $eeks a woman really
begins to feel pregnant
awareness of foetal movements
• The risk of miscarriage is largely passed"
nausea has faded and the uterus
beginning to =show>
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• &deal time to get to kno$ the couple better
longer isit: to obtain a genogram" to
hae each complete a family circle" to
discuss family and indiidual e(pectations
about parenting
• isits to the doctor occur at ? weeks
interal parameters of pregnancy
• .terine si7e from symphysis to fundus
• #3 weeks uterus at the umbilicus
• Ask first detected fetal moements
=@uickening>
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• The second trimester can be a high point
psychologically and physically for the
e(pectant mother
• +ost accurate for dating baby0s se(
and anatomy
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+enetic Counseling
• !ongenital malformations occur in about
% of newborns
neural tube defects /anencephaly1"
chromosomal abnormality /6own0s
Syndrome1
• %ssessment of genetic risks will hae
begun during the preconception isit or
the first prenatal isit
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• Screening for 6own0s Syndrome is currently
focused largely on older mothers a
chromosomal abnormality increases $ith age
age of %; for routine testing
• Benetic screening remains controersial
• +any parents to be" for personal or religious
reasons" would not choose to terminate a
pregnancy een if a fetal abnormality were
detected
• ,(plain the benefits and limitations of these
screening tests
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T%IR" TRIME)TER
PRENATAL CARE
• 2eeks #C4?3
• &ncreasing discomfort " sleep problems"
shortness of breath" urinary fre@uency"
and fatigue
more intensie medical monitoring
• Fre@uency of isit: #4% weeks between #D ) %E weeks gestation
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• 'isk assessment is an important
component of eery isit : measuring the
distance from the top of the pubic
symphysis to the top of the urine fundus
fetal position: a erte( /head first1
presentation" a breech" etc
blood pressure: %3 mmHg Systolic"
5;mmHg 6iastolic Hypertensie
disorder 8 edema and proteinuria preeclampsia
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• *isk factors for 6iabetes include: a family
history of 6iabetes" preious deliery of a
macrosomic" malformed" or stillborn infant"obesity and Hypertension
• Past history of genital herpes
• *epeat gonorrhea culture" syphilis
serology" Hepatitis - screen" and H& test
• (hildbirth education is an important part of
trimester office isit
• )reastfeeding discussion and
recommended readings
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Post ter$ Pregnanc
• ,(tends more than ?# weeks beyond the
last menstrual period
incorrect dating of the gestation
oligohydramnions with umbilical cord
compression and uteroplacental
insufficiency
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#a$il Phsician,s Approach
to The $anage$ent of Labor• *ducation during prenatal care
• +echniques learned in prenatal education
class
• Proide ongoing surveillance of the
mother and fetus and proide support to
the mother and attending friends and
family members
• Any practitioners deliering babies must
learn patience..patience..patience,
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#a$il phsicians
and Obstetric Consultants• Family doctors are trained to proide
independent prenatal and delivery care to
lo$ risk $omen" identifying and managing
emergencies and risk factors as theyoccur
• Aware of personal limitations
• *espect the long4standing doctor4patient
relationship
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Major ris& factors!obstetric consultation $andator
• &ncompetent cerical or #nd trimester
spontaneous abortion by history
• Premature labor
• Preeclampsia
• Placenta preia
• Post maturity• ,tc$
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Other ris& factors!Consultation should be considered
• Seere anemia
• Gon erte( presentation at term
• Preious stillbirth or prenatal death• Preious premature deliery
• Obesity
• *ecurrent urinary tract infections• Bestational hypertension
• ,tc$
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CONCL-)ION)
• Prenatal care seres important functions of
medical screening and sureillance
• Opportunity for educating mothers and for
planning the birth itself
• 2e should support efforts to remoe the
barriers to prenatal care in our
communities
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CONCL-)ION) '
• The care of fa$ilies throughout the
pregnanc. deliver. and post partu$.
and the longitudinal care of fa$ilies
throughout the lifeccle. enables fa$ilphsicians and their patients to vie/
prenatal care as part of an ongoing
relationship.
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%%
Thank
You