Академический Документы
Профессиональный Документы
Культура Документы
ANTENATAL CARE
ANTENATAL CARE
2. It is a form of health education. The doctor and midwife have
a duty to allay the pregnant womans fears, to instruct her in
the care of her body, to inform her about the process of birth,
the care of the newborn infant and eventually about methods
of family planning. This time can also be used to advise
women on a variety of other health matters such as diet,
smoching, alcohol or the timing of their next cervical smear.
Repeated visits offer a unique opportunity for building up a
personal relationship and feeling of confidence which are just
as valuable as any technical expertise.
ANTENATAL CARE
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
ANTENATAL CARE
ANTENATAL CARE
1.
2.
3.
4.
5.
6.
History
Previous serious illnesses. E. g. rheumatic fever, jaundice,
renal disease, tuberculosis.
Previous surgical operations- particularly abdominal
operations.
Family history of multiple pregnancy, fetal abnormality,
diabetes or hypertensions.
Obstetric history, with details of date and place of birth,
maturity of pregnancy, duration of labour, mode of delivery,
birth weight and an account of any complications.
Menstrual history should pay particular attention to the date of
the last period and the date of stopping the contraceptive pill.
Social circumstances, employment and dietary habits, with
special reference to smoching, alcohol, drugs and medicines.
ANTENATAL CARE
1.
2.
3.
4.
5.
6.
7.
General examination
Height, weight and general physical appearance.
Presence of oedema or varicose veins.
Condition of the brests.
State of the teeth.
Pulse and blood pressure.
Heart sounds and murmurs.
Any evidence of respiratory disease.
ANTENATAL CARE
Obstetric examination
ANTENATAL CARE
1.
2.
3.
4.
5.
6.
7.
8.
Blood tests
Haemoglobin;
ABO grouping;
Rhesus grouping and antibody screen;
Syphilitic serology;
Rubella antibody titre;
Serum alphafetoprotein (AFP) and human chorionic
gonadotrophin (hCG) estimation if the pregnancy is between
15 and 20 weeks;
In susceptible patients, tests are done for thalassaemia,
sicklecell trait and haemoglobin H;
Women at high risk from hepatitis B and HIV infection should
have tests for these and the results assessed before proceeding
to the other routine blood tests.
ANTENATAL CARE
Urine tests
ANTENATAL CARE
Advice
ANTENATAL CARE
ANTENATAL CARE
1.
2.
3.
4.
5.
6.
7.
ANTENATAL CARE
1.
2.
3.
Clinical
It is well to answer clinically two questions about every woman
who attends:
Is she pregnant?
Is the pregnancy intrauterine or extrauterine?
ANTENATAL CARE
1.
2.
3.
4.
5.
6.
7.
ANTENATAL CARE
2.
.
Urine tests
The presence of hCG in the urine of pregnant women has
been used since 1927 as a means of detecting pregnancy.
Modern tests are imunological. Numerous urine tesing kits
are available over the pharmacy counter. While these are
coneveint and quik, women should always see their family
doctors for further assesment and advice. Sensitive
radioimmunoassays are now available to detect and measure
the beat sub- unit of hCG in maternal serum. A positive result
may be obtained as soon as 10 days after fertilzation.
These urine tests are very sensitive. False positives may occur
due to technical errors, or in women over 40 years of age.
ANTENATAL CARE
3.
.
.
.
1.
2.
3.
4.
5.
6.
Ultrasound
Ultrasound was first employed in obstetrics and gynaecology by Ian Donald of
Glasgow.
It gives more detailed information about early pregnancy than other technique.
Now many units use both transabdominal and transvaginal scanning to give the
clearest possible early pregnancy views.
A gestation sac shows up as a white ring within the uterus as early as 52 weeks
after the first day of the last period.
The fetus can be seen from 6 weeks onwards and its crown- rump length measured.
The action of the fetal heart can be shown from as early as the 7th week using
transvaginal ultrasonography.
The placenta can be identified from 10 weeks onwards.
Absence of fetal ecoes and fetal heart pulsation leads to the diagnosis of blighted
ovum. This diagnosis must only be made when there is absolutely no doubt that
the pregnancy has failed. It is recommended that there should be two scans about 1
week apart before reaching this diagnosis.
Ultrasonic examination should be done in all cases where the uterine size differs
from the expected from the dates.
ANTENATAL CARE
1.
2.
3.
4.
ANTENATAL CARE
ANTENATAL CARE
Objecives of antenatal fetal monitoring
1.
If normal growth and development are present, to avoid
unnecessary intervention.
2.
To give warning of intrauterine risks to the fetus.
3.
To assess the ability of the fetus to survive after birth.
4.
To help in selecting the correct time and method of delivery,
when it is apparent that the risk of contiuing in utero exceeds
the risk of extrauterine life.
Methods of monitoring
. Some techniques were designed to detec fetal growth
retardation, others to assess featl well- being and still others
are said to do both.
. Methods of antenatal monitoring should be atraumatic and
acceptable to the woman.
ANTENATAL CARE
1.
2.
3.
4.
.
1.
2.
ANTENATAL CARE
1.
2.
ANTENATAL CARE
ANTENATAL CARE
3.
4.
1.
2.
3.
4.
5.
ANTENATAL CARE
FETAL ABNORMALITY AND ITS DETECTION
Although the great majority of severaly abnormal embryos are discarde by spontaneous
miscarriage during early pregnancy or mid- pregnancy, a substantial number survive.
2% of newborn babies have one or more malformation, 1% have a single gene disorder
and 1% will prove to be mentally handicapped.
Prenatal diagnosis of fetal abnormality can, depending on the individual disorder and
individual circumsatnces, be beneficial in a number of ways:
The pregnancy can be terminated if the abnormality is sufficiently severe, if the
diagnosis is made sufficiently early, and if the parents wish this.
Inappropriate caesarean section can be avoid when the fetus has a lethal abnormality
(renal agenesis).
The parents can be given forewarning of the abnormality and its possible saquelae. This
gives time to prepare for any specialist care which may be required or the possibility of
neinatal death.
Delivery can be planned to take place close to a pediatric surgical unit or some other
centre with special skills.
The existence of some abnormalities points to the likelihood of others are commonly
found in association with chromosomal abnormalities. Further investigations may be
indicated.
ANTENATAL CARE
1.
.
ANTENATAL CARE
2.
.
.
ANTENATAL CARE
Teratogenesis
ANTENATAL CARE
1. Infections
ANTENATAL CARE
ANTENATAL CARE
ANTENATAL CARE
ANTENATAL CARE
ANTENATAL CARE
2. Metabolic factors
ANTENATAL CARE
3. Radiation
ANTENATAL CARE
4. Drugs
ANTENATAL CARE
Estabilished teratogens
ANTENATAL CARE
ANTENATAL CARE
ANTENATAL CARE
ANTENATAL CARE
Probable teratogens
ANTENATAL CARE
ANTENATAL CARE
ANTENATAL CARE
ANTENATAL CARE
ANTENATAL CARE
ANTENATAL CARE