Prenatal Care

Ocampo, Joan
Oh, Howard
Panganiban, James
 GENERAL DATA

This is a case of S.M., 33 year

old,Female, Filipino, from
Valenzuela City consulted for
the first time in our institution
on January 12, 2018
 HISTORY OF PRESENT ILLNESS

1 day PTC, (+) vaginal bleeding, minimal

(no headache, blurring of vision, nausea and vomiting, RUQ
pain/epigastric pain,edema, fever, dysuria, watery vaginal
discharge)

consulted ER
 PAST MEDICAL HISTORY
• (-) DM
• (-) HPN
• (-)CARDIAC DISEASES
• (-)THYROID DISEASES
• (-)ASTHMA
• (-)ALLERGY
 FAMILY HISTORY
• (+) DM – PATERNAL
• (+) HPN – MATERNAL
• (-)CARDIAC DISEASES
• (-)THYROID DISEASES
• (-)ASTHMA
• (-)ALLERGY
 PERSONAL AND SOCIAL HISTORY
• NON-SMOKER
• NON ALCOHOLIC
• NO ILLICICT OF DRUG USE
 OBGYNE HISTORY
• OB SCORE M – 15 y/o Coitarche – 18 y/o
G3P0 (0020) I – regular # sexual partners – 3
G1 – 2005, Abortion D – 3-4 days Contraceptions – none
G2 – 2016 Abortion A – 2 pads per day
G3 – Present S – (+) dysmenorrhea
pregnancy
Diagnosis of Pregnancy
• Signs and Symptoms
1. Amenorrhea
2. Lower-Reproductive Tract Changes
3. Uterine Changes
4. Breast and Skin Changes
5. Fetal movement
• Pregnancy Tests
1. Measurement of hCG
2. Home pregnancy tests
• Sonographic Recognition of Pregnancy
• TV-UTZ: gestational sac by 4-5 weeks AOG, yolk sac by 5 weeks
• Early UTZ: done before 12 weeks AOG
• Isthmus – Hegar’s Sign – 6-8 weeks – softening
• Cervix – Goodell’s sign – 4 weeks – softening due to
edema
• Vagina – Chadwick’s sign – 6 weeks – Violaceous due to
increased blood
 10 Danger Signs of Pregnancy
SIGNS OF PREECLAMPSIA
Headache
Blurring of Vision
Prolonged Vomiting
Nondependent edema
Epigastric/RUQ pain

SIGNS OF INFECTION LIKE UTI, WHICH MAY CAUSE PROM

Fever
Dysuria
Watery vaginal discharge

SIGNS OF THREATENED PREGNANCY

Bloody vaginal discharge
Decreased fetal movement
HIGH RISK PREGNANCY
• EXTREMES OF AGE
 Young Primigravidas (≤17)
 Elderly Primigravidas (≥35)

• MEDICAL COMPLICATIONS (HPN, DM, heart diseases, asthma, infection,

malignancies etc.)

• POOR OBSTETRICAL HISTORY

 2 consecutive abortions
 3 or more repeated abortions
 History of preterm delivery
 History of term/preterm Fetal Death in Utero
 History of term/preterm neonatal death
 Previous baby with congenital anomaly
• PLACENTA PREVIA

• GYNECOLOGIC TUMORS

• WITH COEXISTING TROPHOBLASTOC DISEASE OF HAD

TROPHOBLASTIC DISEASE WITHIN THE LAST YEAR

• POLYHYDRAMNIOS OR OLIGOHYDRAMNIOS

• PATIENTS WITH PROBLEMS WITH FETAL AGING, STRUCTURE AND

SIZE
AOG ≥41 weeks
Fetal macrosmia or IUGR
Unsure fetal aging
Multiple gestation
Fetal congenital anomalies
ASSESMENT
• BASIS OF AGE OF GESTATION:
 Last normal menstrual period (LNMP) – if regular
 Early Ultrasound
 Late ultrasound
Quickening
Fundal height
PLAN FOR THE PATIENT
• FREQUENCY OF PRENATAL CHECK-UP
< 28 weeks – Monthly (during the first 2 semesters)
28-36 weeks – Every 2 weeks
> 36 weeks - Every week (when close to term)
Subsequent Prenatal Visits
• Prenatal Surveillance
• Subsequent Laboratory Tests
Initial Prenatal Workup
• CBC with DC/PC
• Blood typing
• Urinalysis
• FBS
• HBsAg
• Rubella IgG
• VDRL, RPR
• ICC ELISA
• Pap smear
• 75g OGTT at 24-28 wks AOG
• Biometry at 24-28 wks AOG
Nutritional Counseling
• Weight Gain Recommendations
• Calories
• Protein
• Minerals
• Vitamins
• Exercise
 Weight Gain
Recommendations
• Obesity is associated with significantly
increased risks for gestational
hypertension, preeclampsia,
gestational diabetes, macrosomia,
cesarean delivery, and other
complications
• Those who gained less than 25
pounds during pregnancy had a
lower risk for preeclampsia, failed
induction, cephalopelvic
disproportion, cesarean delivery, and
large-for-gestational age infants.
A woman with a prior child with a
neural-tube defect can reduce the 2-
to 5-percent recurrence risk by more
than 70 percent with daily 4-mg folic
acid supplements the month before
conception and during the first
trimester.
Pregnant woman retains
approximately 30 g of calcium from
her intake and this gets deposited into
the fetus in late pregnancy
With the exception of iron and iodine,
practically all diets that supply
sufficient calories for appropriate
weight gain will contain enough
minerals to prevent deficiency.
• COITUS – not hazardous unless placenta previa, preterm
labor, abortion

• CAFFEINE INTAKE – max 3 cups of 5 oz percolated coffee

• TRAVEL – safe up to 36 weeks AOG