Transcript Prenatal Care

In the name of God
Dr Solmaz Piri
Obstetrician & Gynecologist
Prenatalogist from
KCL,England
Prenatal Care
The major goal of
prenatal care is to
ensure the birth of
a healthy baby with
minimal risk for the
mother.
Main Components
• Early, accurate estimation of gestational
age
• Identification of the patient at risk for
complications
• Ongoing evaluation of the health status of
both mother and fetus
• Anticipation of problems and intervention,
if possible, to prevent or minimize
morbidity
• Patient education and communication
•Woman-centred
care
• Women, their partners and their
families should always be
treated with kindness, respect
dignity
• The views, beliefs and values of
the woman, and her family in
relation to her
care and that of her baby should
be sought and respected at all
times
•booking
(ideally by 10 weeks)
•Documentation
of care
Gestational age
• Crown–rump length
measurement should be used to
determinegestational age.
• If the crown–rump length is
above 84mm, the gestational
age should be estimated using
head circumference.
•Immunization
• Available vaccines
• Tetanus and diphtheria
toxoid vaccine (Td)
• Tetanus toxoid, reduced
diphtheria toxoid, and
acellular pertussis vaccine
(Tdap).
• In 2013, The ACIP recommendations
supported by the American College of
Obstetricians and Gynecologists
• All pregnant women receive
vaccination against pertussis
with Tdap during each
pregnancy, optimally between
27 and 36 weeks of gestation,
regardless of prior vaccination
status, to better protect
their infant
tetanus booster
• If Tdap is given earlier than 27 to
36 weeks
• and at any stage of pregnancy if
the woman lives in an area with a
pertussis epidemic
• or required as part of wound
management
Varicella vaccination
• Varicella vaccination is
recommended for women without
evidence of immunity
preconceptionally or postpartum:
• Postpartum:The first dose is given while the
patient is in the hospital and the second dose
is given four to eight weeks later, which
typically coincides with the routine
postpartum visit. Breastfeeding is not a
contraindication
History
• The elements of the patient history
include:
• Personal and demographic information
• Past obstetrical history
• Personal and family medical history
• Past surgical history
• Genetic history
• Menstrual and gynecological history
• Current pregnancy history
• Psychosocial information
Physical examination
• Classic and complete approach
• Everything is important
• Every mild derangement should
be carefully adressed
• Keep in mind : Pregnant women
is using her body reserve and
may not be able to make
further compensation
• Rhesus type and antibody
screen — This test will
detect antibodies
potentially causing
hemolytic disease of the
newborn.
•Folic
acid
• Dietary supplementation with
folic acid, before conception and
throughout the first 12 weeks,
reduces the risk of having a baby
with a neural tube defect
• The recommended dose is 400
micrograms per day
Vitamin A, be carefull !
• Pregnant women should be informed
that vitamin A supplementation (intake
above 700 micrograms) might be
teratogenic and should therefore be
avoided.
• Pregnant women should be informed
that liver and liver products may also
contain high levels of vitamin A, and
therefore Consumption of these
products should also be avoided.
•vitamin D
•haematological
conditions
•gestational
diabetes
•fetal anomalies
and
aneuploidies
•Air
travel
Hepatitis B
• Testing for HBsAg should be
performed on all women at the first
prenatal visit and repeated late in
pregnancy in those at high risk for
HBV infection. The current
recommendation is to provide
passive-active immunization to
newborns of carrier mothers.
Antivirals
• A meta-analysis of 10 studies
concluded that the administration
of lamivudine to the mother in late
pregnancy in addition to hepatitis B
vaccination and hepatitis B
immunoglobulin prophylaxis for the
infant significantly reduced
mother-to-child transmission
• More data are needed to clarify the HBV
DNA cutoff for recommending antiviral
therapy to pregnant HBV carriers
• At present, we tend to offer antiviral
prophylaxis in women who have a high viral
load (more than 8 log(10) int. unit/mL).
Treatment should be started preferably six
to eight weeks before delivery to allow
enough time for HBV DNA levels to decline.
Of the available oral agents, telbivudine and
tenofovir are pregnancy class B drugs
• With appropriate immunoprophylaxis,
breastfeeding of infants of HBV carriers
poses no additional risk for the transmission
of HBV
• Infants who received HBIG and the first
dose of vaccine at birth may be breastfed as
long as they complete the course of
vaccination
• but carrier mothers should not participate in
donating breast milk.
• Mothers with chronic hepatitis B who are
breastfeeding should also exercise care to
prevent bleeding from cracked nipples
Further tests
• VDRL
• Asymptomatic bactriuria
• HIV
• Thyroid function tests
Not recommended
•CMV
•Toxoplasmosis
•HSV
•Bacterial Vaginosis
Thank you very much for your
Thank you
attention