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Antenatal care

Antenatal care. Pre conception counselling. Smoking Alcohol Drugs Diet Exercise Folic acid. Pre conception counseling. Family history Personal history Past obstetric history Folic acid Rubella status. First visit. LMP EDD POH MH PMH Drugs Allergies. First visit. Smoking

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Antenatal care

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  1. Antenatal care

  2. Pre conception counselling • Smoking • Alcohol • Drugs • Diet • Exercise • Folic acid

  3. Pre conception counseling • Family history • Personal history • Past obstetric history • Folic acid • Rubella status

  4. First visit • LMP EDD • POH • MH • PMH • Drugs • Allergies

  5. First visit • Smoking • Alcohol • FH • Advise • Exemption card • Referral

  6. Low risk pregnancies • 12-14/52 hosp visit • Routine blood tests • Blood group + rhesus factor • Fbc + haemoglobinopathies if indicated • Randon blood sugar • Treponemal antibody • Hep b • Hiv • pappa

  7. Low risk pregnancies • Hosp visit 12-14/52 • History • Nuchal transluceny scan

  8. Low risk pregnancy • 15 weeks • Serum AFP and downs screening • If booking scan not done before 14 weeks

  9. Low risk pregnancy • 23 weeks – anomally scan • 26 weeks – midwife/gp • 28 weeks – fbc + antibodies • 30 weeks – midwife/gp • 34/36/38/40 weeks – midwife/gp • 41 weeks - hosp

  10. Exercise • Non – contact sport only after 16/52 • Intensity decreased by 25% • HR under 140/min • Core temp < 38 • Strenuous exercise limited to 15-20 mins

  11. Antenatal visits • Weight gain 12-15kg in total • BP dias. >90 or increase > 20 from first visit is significant • Urinalysis watch for protein glucose uti • Fetal movements • Uterine size • Fetal lie presentation

  12. Common discomforts • Pelvic pains – ligamental stretch • Urinary frequency - ? Uti • Ankle swelling – ivc compression • Varicosities – support stockings • Heartburn – posture antacids • Constipation – fluids, fibre, fybogel

  13. Common discomforts • Low back pain – posture and relaxin • Dental decay – see dentist • Skin changes – chloasma • Itch – iron def, cholestasis antihistamines • Stretach marks - moisturisers

  14. First trimester • Ectopic preg • Sharp pain • Irregular vaginal bleeding • Abdo tenderness • Dizziness or fainting

  15. Ectopic pregnancy • Diagnosis • Pos preg test • Serial hcg levels they increase more slowly • Progesterone level lower than normal • Ultra sound scan vaginally/abdominally

  16. Ectopic pregnancy risk factors • PID • Previous tubal preg or tubal surgery • Endometriosis • IUD • Multiple induced abortions • Drugs that stimulate ovulation

  17. Ectopic pregnancy treatment • Tube not ruptured • Methotrexate • Salpinostomy flushng the tube out • Laparoscopic removal

  18. Ectopic pregnancy treatment • Tube ruptured • Laparoscopic removal of embryo and tube

  19. Miscarriage • Symptoms • Pv bleeding • Colicky pain • Refer to EPAU

  20. hyperemesis • 1 in 300 preg • Weeks 8-20 • Cause unknown – high oestrogen & hcg • More commom multiple preg obesity first babies

  21. Treatment • Exclude other causes • Drink small amounts frequently • Diet high in cho and proteins • Admit for iv fluids if severe, dehydrated or electrolyte imbalance • Drugs -

  22. Anaemia • Symptoms • Fatigue weakness • Pallor • Dizziness or fainting • SOB • palpitations

  23. Anaemia • Treatment • Diet • Pregaday • Does not alter outcome in most cases

  24. Infection in pregnancy • Chicken pox – only 2% of infections age > 20yrs • 3% risk of fetal damage in first 20/52 • If mum’s rash develops 1/52 before delivery or to 4/52 after baby can get sever infection needs protection • No risk between 20/52 and term • If no history of cp check varicella antibodies • If non immune needs VZ Ig no later than 10 days from exposure

  25. Infections in pregmnancy • Rubella – 2-10/52 90% chance of featal damage • Toxoplasma gondii 89% adults not immune • If fetus infected 10% chance of fetal damage • Avoid kittens particularly litter trays • Eat well cooked meat • Wash vegetables • Listeria – soft cheeses, pate. Cookchill foods

  26. Pre eclampsia • Raised BP • Proteinura • XS swelling

  27. Pre eclampsia • 3-4% pregnancies • !% very severe • 50,000 deaths world wide

  28. Pre eclampsia • Risk factors • Young mothers teenagers • Older mothers > 35 yrs • Family history • First pregnancy • New father • Diabetes • hypertension

  29. Pre eclampsia • Serious adverse effects • Fits • Stroke • Pulmonary oedema • Kidney failure • Liver damage • D I C

  30. Pre eclampsia • Warning signs • Raised bp • Proteinuria • Xs swelling • Headcahe • Flashing lights • Vomiting • Upper abdo pain

  31. Pre eclampsia • Treatment • Lower bp • Magnesium sulphate • Deliver baby • Aspirin • Metabolic syndrome

  32. Gestational diabetes • Plenty of insulin, but insulin malfunctioning • Macrosomia > 4500g • Problems with labour and delivery • Newborn has low blood sugar • Increased risk stillbirth • Proper management prevents increased risk ofcomplications

  33. Risk factors • Incidence 1%-3% pregnancies • Family history • Obesity • Maternal age > 30 yrs • Previous large baby • Prior icidence of gestational diabetes • Ethnic group – south asians, mexican american

  34. Treatment • Control blood sugar • Exercise • Diet • Blood glucose monitoring • A few will need insulin

  35. Intra uterine growth retardation • Birth weigth < 2500g • Causes • Smoking • Poor nutrition • Placental factors • Maternal ill health

  36. Risk factors • Smoking • Drug and alcohol use • Severe malnutrition • Maternal high bp, or pre eclampsia • Infections – cmv, rubella, toxoplasma • Chronic maternal disease – diabetes, rheumatological

  37. Diagnosis • Fundal height – 18-34/52 height = distance in cm • Ultra sound – ratio of head circumference to abdo

  38. Treatment • Stop smoking • Good nutrition • Bed rest on left side • Fetal movement chart • Serial ultrasound scans • Volume of amniotic fluid

  39. Hydatidiform mole • Incidence 1 in 2000 preg • Increased risk with age • Abnormalities in sperm chromosome • Abnormalities of egg

  40. Hydatidiform mole • Signs • Uterus larger than date • Vaginal bleeding • Diagnosis • Ultrasound • Hcg higher than normal

  41. Hydatidiform mole • Treatment • Suction curettage • Monitor hcg for several months due to risk of choriocarcinoma • Postpone preg for a year

  42. APH • Placenta abruptio • 1% of all deliveries • Vaginal bleeding in 3rd trimestre • Constant back or abdo pain • Contractions tenderness or rigidity of uterus

  43. Risk factors • Smoking • Pergnancy induced hypertension • Alcohol or drug use • Increased maternal age >40 yrs • Premature rupture of membranes • Injury to mother

  44. Diagnosis • No clear test • May or may not show on ultrasound • Exclusion of other causes of bleeding – placenta praevia

  45. Treatment • Evaluate maternal well being • Monitor • Evaluate fetal well being • If severe bleeding or fetal distress cesarean

  46. Placenta previa • 4-8% placentas low lying • Only 10% remain low • Marginal – placenta near edge of os • Partial – placenta covers cervical opening • Total – placent completely covers os • All need cesarean

  47. Placenta previa • Signs • Painless bright red vaginal bleeding • Risk factors • Smoking • First preg after lscs • Previous placenta previa • Advanced maternal age

  48. Placenta previa • Diagnosis • Ultrasound • Treatment • lscs

  49. Post term pregnancy • > 42/52 • Risks • Reduced amniotic fluid increased risk of cord compression • Meconium in liquor inhlaed by baby causing pneumonia • Too large baby > 4500g

  50. Management • Monitor baby • Too large baby • Decreased amniotic fluid • Deliver if cervix ripe try oxytocinon • If cervix not ripe try prostaglandin gel • Otherwise lscs

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