FM_K36_PRENATAL CARE.ppt

8/16/2019 FM_K36_PRENATAL CARE.ppt

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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

FM_K36_PRENATAL CARE.ppt

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