Antenatal care

Topics: Pregnancy, Obstetrics, Childbirth Pages: 10 (1224 words) Published: March 24, 2014
Antepartum care

Purposesphysical and psychic preparation
genetic risk identification
associated diseases treatment

Basic principlesPregnancy is not a disease
Mental preparation is necessary
Good nutrition
Early detection and treatment of illnesses
Adjustment to physical limitations of pregnancy
Education of the couple about normal and abnormal events
Avoidance of substances harmful to the fetus

Pre-conception careHistorydrug, alcohol, tobacco abuse
genetic history (thalassemia, sickle cell)
medical diseases (diabetes)
surgical interventions
Laboratory screeninggenetic diseases
infectious diseases (hiv)

Aims of antepartum consultation1.Diagnosis of ongoing intrauterine pregnancy 2 Gestational age and estimated date of delivery
3 Prognosis of pregnancy evolution and pregnancy outcome improvement 4 Prognosis of delivery outcome and way of delivery
5 Prognosis of puerperium and newborn outcome

The initial visitas early as possible (first 12 weeks)
includescomplete history
physical examination
laboratory screening

The prognosis depends on:
I. Father’s health ( history)
II. Mother’s healthformer diseases
pregnancy-specific diseases
III. External factors: nutrition
social factors (housing, education)
working place and legislation

Historycharacter of menstrual cycle, frequency
date and character of last menstrual period
previous obstetrical historyweight
medical historydiabetes
cardiovascular diseases
surgical historyabdominal, uterine cardiac surgery
medications used during pregnancy (alcohol, drugs)
any problems during this or previous pregnancies
familial relationships

Physical examinationweight, height, blood pressure
heart murmurs, breasts
lower extremity oedema or varices
pelvic examination

laboratory screening
Complete blood count (CBC)
Blood type and Rh identification with antibody screening
VDRL (repeat after 28th week)
Rubella titer
Serum glucose
Clean-catch urinalysis for sugar, acetone, albumin and microscopic examination Papanicolaou smear
Cervical culture or antibody smear for Chlamydia trachomatis Bacteriologic and parazitologic examination of vaginal secretion PPD for tuberculosic followed by x-ray if necessary
TORCH antibody screening (Toxoplasma gondii, cytomegalovirus, herpes, B hepatitis, HIV) Stomatologic examination and treatment

Ultrasound examinationfirst consultationdiagnosis of pregnancy
20 weeksfetal screening
termpresentation, position, nuchal cord, placental insertion

Pregnancy evolution prognosis categories
A) Goodhealthy woman
healthy husband
good social conditions and education
Follow-up visits
Monthly 12-28 weeks
Every two weeks 29-40 weeks
Informations at every visit
blood pressure
fundus height and uterine tonus
fetal heart rate
fetal lie
any recent pathology
stări patologice apărute de la consultul anterior;
conclusions and prescriptions
schedule of next visit
B) Reserved prognosis which can be improved (high-risk pregnancies) Risk factors
A) Social and psychic
1. Unwanted pregnancy
2. Children and wife abuse, low income, subnutrition
3. Isolated home, difficult to reach by ambulance
4. Working place not respecting protection law
5. Iatrogenic: poor history
B) General factors
1. Age below 20 and over 35, primiparas
2. High pregnancy rank >4
3. Height under 1,55 m.
4. Weight under 45 kg.
5. Genital hipotrophy
6. Reduced hearth volume
7. Rh or blood type immunisation
8. Autoimmune diseases
C) Gynecological and obstetrical antecedents
1. Uterine scar (corporeal c-section, hysteroplasty, myomectomy) 2. Uterine malformations or tumors (myoma)
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