Академический Документы
Профессиональный Документы
Культура Документы
Prenatal Care
Definition
A comprehensive antepartum care program involves
a coordinated approach to medical care and
psychosocial support that optimally begins before
conception and extends throughout the antepartum
period
This program includes :
1. preconceptional care
2. prompt diagnosis of pregnancy
3. initial prenatal evaluation
4. follow-up prenatal visits
American Academy of Pediatrics and The American
College of Obstretricians and Gynecologists 2007
History of prenatal care
Definition
High risk pregnancy is one in which some
condition puts the mother, the developing fetus
at both or higher-than-normal risk for
complications during or after the pregnancy
and birth
Beers, Mark H., et al., editors. "High-Risk Pregnancies." In The Merck Manual of
Diagnosis and Therapy. Rahway, NJ: Merck Research Laboratories, 2004.
Recommended Consultation for Risk Factors
Identified in Early Pregnancy
Medical History and Conditions Initial laboratory Tests
Cardiac and pulmonary dissease HIV
Asthma Bronchiale CDE (Rh) of other blood isoimunization
Diabetes melitus Initial examination condilomata
Drug and alcohol use
Family history of genetic problem
Hypertension
Renal dissease
Epilepsi on medication
Haemoglobinophathy
Obstetrical History and Conditions
Age > 35 years at delivery
Cesarean delivery
Incompeten cervic
Prior neonatal and fetal death
Prior low birth weight
Second trimester pregnancy loss
Prior fetal structure and chromosomal abnormality
Williiams Obstretrics 23rd Edition p 198
Recommended Consultation for Ongoing Risk
Factors Identified During Pregnancy
Medical History and Conditions Examination and laboratory Findings
Drug and alcohol use HIV
Proteinuria CDE (Rh) of other blood isoimunization
Pyelonephritis Condilomata
Severe Systemic dissease that adversely Anemia
effect pregnancy Abnormal papsmear result
Abnormal MSAFP ( high or low )
Obstetrical History and Conditions
Blood pressure elevation, no proteinuria
Fetal growth restriction suspected
Fetal abnormality suspected by sonography
Fetal demise
Hydramnions or oligohydramnions by sonography
Multifetal gestation
Preterm labor threatened
Premature rupture of the membrane
Vaginal bleeding > 14 weeks
Herpes active lesion at 36 weeks Williiams Obstretrics 23rd Edition p 199
16 September 2014 8
How to keep small baby
Great Challenge
16 September 2014 9
Preterm infants
Temperature-controlled beds.
Monitoring of temperature, blood pressure,
heart and breathing rates and oxygen levels.
Giving extra oxygen by a mask or with a
breathing machine.
Mechanical ventilators (breathing machines)
to do the work of breathing for the baby.
Management Respiratory
Distress Syndrom
Prenatal Care
Delivery Room Stabilisation
Surfactant Therapy
Oxygen Supplementation Beyond Stabilisation
Role of CPAP
Mechanical Ventilation (MV) Strategies
Avoiding or Reducing Duration of MV
Prophylactic Treatment for Sepsis
Supportive Care: thermal, fluid and nutrition, tissue
perfusion, ductus arteriosus
Miscellaneous Considerations
Sonographer skill and experience play a great role in the accuracy of ultrasound
There have been exciting advances in the field of prenatal imaging within the past few
years including three-dimensional ultrasound and fetalMRI, and the future holds the
It is expected that imaging modalities will continue to improve, and it is hoped that
advance
patient counseling and allowing for informed patient and physician decision making
First Trimester Screening for Aneuploidy
Nuchal translucency measurement in the first trimester is the most powerful
indications for chorionic villus sampling (CVS) without need to await serum
marker results
First trimester absence of the nasal bones, reversal of flow in the ductus
These second-line screening test are unlikely to have any value for routine
can be utilized with likelihood ratios to adjust the risk of Down syndrome
Risk of Chromosomal
Age Risk Of Down syndrome
Abnormality
20 1/1667 1/526
25 1/1250 1/476
30 1/952 1/385
35 1/385 1/202
36 1/295 1/162
37 1/227 1/129
38 1/175 1/102
39 1/137 1/82
40 1/106 1/65