Prenatal Care
Q. Mojadidi, M.D. FACOG
Dr Zubaida Anwari Zhwak, M.D
Objective
The objective of prenatal care is to
assure that every wanted
pregnancy culminates in the
delivery of a healthy baby without
impairing the health of the mother
Objective
It is essential for the physician or midwife who
assumes responsibility for prenatal care to be
familiar with the normal physiological changes,
as well as the pathological changes, that may
develop during pregnancy
“Bad prenatal care may be worse then none”
Initial Comprehensive Care
Goal:
Establish care as early as possible(No later then two missed period)
Define the health status of the mother and fetus
To determine the gestational age of the fetus
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Last menstrual period (Nagle’s role)
Pelvic examination
Abdominal size of the uterus
Ultrasound
X-ray
To initiate a plan for continuing obstetrical care
To plan for subsequent visits and possible hospitalization
Management
Complete history and physical examination
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Obstetric history and previous complication
Family history
Habits (nicotine, alcohol, heroin, and craves)
Diet, 2500 calories
• Recommend high protein, low carbohydrate, 2000mg Na, and
persistent hydration
– Occupation and daily activity
– Is this pregnancy planed
– Counsel for breast feeding
Obstetrical Examination
Visualize the cervix
Obtain cytology specimen
Take culture swabs for Gonococcus and Chlomydia
Evaluate vagina for any infection
Bimanual examination to determine the size, position, and
consistency of the uterus
Clinical pelvimetry
Evaluate the adnexa
Further Instruction
She is tactfully instructed about the following dangerous signs,
which must report immediately, day or night
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Any vaginal bleeding
Swelling of the face and or fingers
Blurring of the vision
Sever or continuous headache
Abdominal pain
Persistent vomiting
Chills or fever
Dysuria
Escape of fluid from vagina
Marked change in frequency or intensity of fetal movement
Recommended Interval For Indicated
Test And Procedures
Time (weeks)
Initial as soon as possible
8-18
Assessment
H&H, U/A, including microscopic exam. Infection
screening (GC, CT, Syphilis, Hepatitis, HIV) blood
group and Rh type and antibody screening,
Rubella titer, cervical cytology,
Ultrasound, amniocentesis, CVS,
16-18
Maternal serum alphafetoprotein, HCG, SE3, Inhibit-A
(Quad Screen)
(26-28
Repeat antibody test for unsensitized Rh negative
patients
32-36
Ultrasound, testing for sexually transmitted diseases,
culture for Group B Streptococcus
Repeat H&H
High Risk Pregnancy
Determine on the base of following risk factors the degree of
the risk for pregnancy
– Previous pregnancy and delivery complication
• Operative vaginal delivery, C/Section, VBAC, IUGR, malformation, bleeding
– History of preterm birth
– Hypertension
• Preeclampsia, Eclampsia, Chronic Hypertension, HELLP
– Diabetes and or the history of diabetes
– Systemic diseases
– Socioeconomic status
– Abnormal reproductive history
• First and second trimester loses
• Infertility
– Habits, and daily activity
– Body Mass Index (BMI)
– Nutrition
Daily Management
Balance diet, 2500 calories
– High protein, low carbohydrate, 2000mg Na, and drinking 1012 glasses of water
Exercise (routine fitness exercise can continue, no jumping up
and down)
Daily activity and work may continue
Prenatal Vitamins
Calcium
Folic acid
Daily Management
Continue
Travel, no restriction
Bathing and clothing
Bowel habit
Coitus
Douches
Care of breast and abdomen
Care of the teeth
Immunization
Smoking
Caffeine
Medication
Subsequent Visits
Every four weeks to 28 weeks
Every two weeks to 36 weeks
Every week to delivery
Uterine fundal height measurement, FH, weight, BP, urine dip stick every
visit
26-29 weeks one hour GTT, if positive 3hGTT
Combs test 28 weeks for Rh negative patients and administer Rho-Gam
if negative
36 weeks culture for Group B Streptococcus if available, H&H, RPR
Treat high risk patient for GBS during labor
– Prolong PRM more then 18 h, P-PROM, maternal fever, preterm labor, history
of previous GBS newborn, UTI caused by GBS
Prenatal Surveillance
Fetal
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Fetal heart rate
Size of fetus(es), actual and rate of change
Amount of amniotic fluid
Presenting part and station (late in pregnancy)
Fetal activity (fetal kick count)
Prenatal Surveillance
Blood pressure, actual and rate of change
Weight, actual and amount of change
Symptoms, including headache, altered vision, abdominal pain,
nausea, vomiting, bleeding, fluid leak from vagina, and dysuria
Distance from symphysis to uterine fundus
Facial and upper body edema
A careful vaginal examination late in pregnancy
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Confirmation of the presenting part
Station of presenting part
Consistency, effacement, dilatation and position of the cervix
Evaluation of the pelvis
Common Complaints
Nausea and vomiting
Backache
Varicosities
Hemorrhoid
Heart burn (gastro-esophageal-reflex disease)
Pica, craving for unusual food
Ptylasim
Fatigue
Headache
Leucorrhoea
Thanks
for
Listening