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19. antenatal care
- 1. Antenatal Care Hale T., O & G Yr-2 Resident, Mekelle University, College of Health Sciences, Dep't of OB-GYN 1Hale T., M.D., Resident Physician18 Nov 2016
- 2. 18 Nov 2016 Hale T., M.D., Resident Physician 2
- 3. • ANC – Comprehensive medical and psychosoical services provided to a pregnant woman during the whole antepartum period and for women contemplating pregnancy – Goal of ANC is “helathy mother, healthy baby!” Hale T., M.D., Resident Physician 318 Nov 2016
- 4. • Preconceptional care – Assess health of mother and father •Revise medical history – DM, HTN, Seizure Consult MFM specialist •Stop or change medications that can affect pregnancy – Weight adjustment •BMI > 30 and BMI <20 related to bad outcomes in pregnancy – Loss or gain weight accordingly Hale T., M.D., Resident Physician 418 Nov 2016
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- 6. • Nutrition – Calories •25-35 kCal/kg, additional 300kCal/day – Protien •1.1 g/Kg/day – Iron •30 mg elemental iron per day – Calcium •100 mg daily from diet or suplemental 18 Nov 2016 Hale T., M.D., Resident Physician 6
- 7. – Folic acid •400 to 1,000 g/d to prevent neural tube defects •For women with history of infant with neural tube defect, recommended intake is 4 mg/d – Fish •Limit the fish intake to 12 oz/wk – Vitamin A •No more than 4,000 IU/d 18 Nov 2016 Hale T., M.D., Resident Physician 7
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- 10. Hale T., M.D., Resident Physician 1018 Nov 2016
- 11. – Folic acid supplementation – Infectious screen •HBsAg, VDRL, RVI, Gonnorrhea and Chlamydia, urinalysis and culture, PPD – Immunity and vaccination •Rubella and Varicella immune status – Screen for genetic diseases – Cystic fibrosis carrier screening Hale T., M.D., Resident Physician 1118 Nov 2016
- 12. – Aneuploidy screen •First TM screening tests 10-13 weeks – NTS, PAPP-A, free beta hCG •Quad screen 15-20 weeks – Inhibin-A, AFP, hCG, unconjugated estriol •Integrated Screening – the result of the first trimester test is withheld and incorporated into a final overall risk assessment •Sequential Screening – the result of the first trimester screen is released to the patient and provider. Hale T., M.D., Resident Physician 1218 Nov 2016
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- 17. • Afirm the gestational age and calculate the EDC – If menses comes every more than 28 days the GA and EDC is accordingly adjusted – If the EDC calculated by ultrasound from first trimester differes by more than 5-7 days take the one calculated from the ultrasound •2nd trimester 10 days, 3rd trimester 14 days Hale T., M.D., Resident Physician 1718 Nov 2016
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- 19. • 1st ANC visit – Take compelete obstetric history •G8P4306 – This mother » Has been 8 times pregnant » Has delivered 4 babies at term » Has delivered 3 preterm babies » Has a total of 6 babies alive – Previous obstetric history •GA at delivery, weight, route, alive or dead Hale T., M.D., Resident Physician 1918 Nov 2016
- 20. – Prior pregnancy complications •Medical complications •Obstetric complicaions – Cervical insufficiency – Preterm labor Hale T., M.D., Resident Physician 2018 Nov 2016
- 21. • Life Style Modification – Exercise •Not necessary to limit •Restrction in complications like preterm labor – Coitus •Does not pose harm to pregnancy – Travel •Air travel has no harmful effects on pregnancy •In long flights – hydrated and move arround every 2 hours 18 Nov 2016 Hale T., M.D., Resident Physician 21
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- 23. – Substance use •Smoking – Avoiding smoking would decrease perinatal mortality by 5% •Alcohol – No safe threshold during pregnancy – Fetal alcohol syndrome •Caffeine – Spontaneous abortion if taken > 5 cups per day 18 Nov 2016 Hale T., M.D., Resident Physician 23
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- 26. – Personal and social history •Bad habits •Violence Hale T., M.D., Resident Physician 2618 Nov 2016
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- 30. – Physical Exam •Look for any physiologic changes •Weight •Vitals •Uterine size – 20-34 weeks SFH well corelated with GA – Empty bladder before measurement – Important to determine fetal growth and amniotic fluid volume grossly – IUGR? Only 2/3rd of them can be picked up •Pelvic exam Hale T., M.D., Resident Physician 3018 Nov 2016
- 31. – Fetal heart sound 18 Nov 2016 Hale T., M.D., Resident Physician 31
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- 35. Thank you! Hale T., M.D., Resident Physician 3518 Nov 2016