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OB&GYNE COURSE LECTUER FOR UNDERGRADUATE

Undergraduate course lectuers,Faculty of medicine ,Zagazig University

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OB&GYNE COURSE LECTUER FOR UNDERGRADUATE

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  1. ANTENATAL CARE DR: MANAL BEHERY Zagazig University , Egypt

  2. Definition • Antenatal care refers to the care that is given to an expected mother from time of conception is confirmed until the beginning of labor • It is a preventative cost effective service

  3. GOALS • 1-Ensure mother health. • 2- Ensure delivery of a healthy infant. • 3-Anticipate problem • 4- Diagnose problem early.

  4. Objectives • 1-Early detection and if possible, prevention of complications of pregnancy. • 2-Educate women on danger and emergency signs & symptoms. • 3-Prepare the woman and her family for childbirth • 4- Give education & counseling on family planning

  5. Schedual of antenatal care: Medical check up every four weeks up to 28 weeks gestation, Every 2 weeks until 36 weeks of gestation Every week until delivery An average 7-11 antenatal visits/pregnancy More frequent visits may be required if complications arise.

  6. On first antenatal visit • 1-First : Confirm pregnancy by pregnancy test or US. • 2-History • 3-Physical examination • 4-investigation

  7. History • Personal history • Menstrual history • Obstetrical history • Family history • Medical and surgical history • History of present pregnancy

  8. Menstrual history • Ask about • 1-Last menstrual period (LMP). • 2-Regularity and frequency of menstrual cycle. • 3-Contraception method used . • 4-Calculate expected date of delivery (EDD)as 1st day of LMP −3 months +7 days, and change the year.

  9. Obstetric History • Gravidity? Parity? abortion, and living children. • Weight of infant at birth & length of gestation. • Type of delivery, location of birth, and type of anesthesia. • Maternal or infant complications.

  10. Medical and surgical history: 1-Chronic conditions : as diabetes mellitus, hypertension, and renal disease ,cardiac disease. 2-Prior operation: as cesarean section, genital repair, and cervical cerclag. 3-Allergies, and medications. 4-Accidents involving injury of the bony pelvis

  11. History of present pregnancy • History suggesting e.g. Diabetes, hypertension and ante partum hemorrhage. • Ask about episodes of fever or chills • Ask about pain or burning sensation on urination. • Abnormal vaginal discharge, itching at the vulva or if partner has a urinary problem.

  12. IMMEDIATE ASSESSMENT for emergency signs. • Vaginal bleeding • Severe abdominal or pelvic pain • Severe headache with visual disturbance • Persistent vomiting • Unconscious/Convulsion • Severe difficulty in breathing • High grade Fever • Looks very ill

  13. Assessment and physical examination

  14. Weight measurement • Maternal height and weight measurements to determine body mass index(BMI). • Maternal weight should be • measured at each • antenatal visit

  15. Check for pallor or anemia. 1-Look for palmar pallor. 2-Look for conjunctival pallor 3-Count respiratory rate in one minute.

  16. Blood pressure measurement • Measure BP in sitting position. • If diastolic BP is 90 mm Hg or higher repeat measurement after 6 hour rest. • If diastolic BP is still 90 mm Hg or higher ask the woman if she has: • Severe headache • Blurred vision • Epigastricpain • Check urine for protein.

  17. Investigations Get baseline on the first or following the first visit. • Hemoglobin, blood type • Urine analysis • VDRL or RPR to screen for syphilis • Hepatitis B surface antigen To detect carrier status or active disease

  18. At each visit

  19. At each visit • 1-Questions about fetal movement • 2-Ask for danger signs during this pregnancy • 3-Ask patient if she has any other concerns

  20. Symphysis Fundalhieght • LMP plus 280 days • Add 7 days, subtract 3 months • MacDonald's Rule (cm = weeks)

  21. At third trimester Do Leopold’s exam

  22. Provide advice on • Diet and weight gain • Medication • Avoid Radiation exposure • Self-care during pregnancy • Minor complaints. • Family planning Breastfeeding • Birth place preparation and anticipation of complication& Emergency situations.

  23. Diet in pregnancy: • Total caloric intake increase to 300 kcal /day due to 15% increase in BMR . • Diet show contain 20%Protein(better from animal source), 30% fat ,and 50% carbohydrates . • Sufficient fluids should be available.

  24. Supplementation • 1-Folic acid 0.4 mg tab daily • 2- iron (ferrous sulphate or gluconate )300 mg/daily • 3- Ca 1200mg /daily • 4- • -Those with a normal balanced diet • probably don’t need extra vitamins

  25. Weight gain in pregnancy: • There is a slight loss of pounds during early pregnancy if the patient experiences much nausea and vomiting. • Weight gain of 2 to 4 lbs(0,5-1 kg) by the end of the first trimester. • Gain of 1 lb(0.5)/ per wk is expected during the second and third trimesters. • Monitoring of weight gain should be done in conjunction with close monitoring of BP.

  26. Medications During Pregnancy • Antibiotics - some OK, some not • Local anesthetics - OK • Local with epinephrine - not OK • Aspirin - not OK • Immunizations - some are OK, some are not • Antimalarial - some OK, some are not • Narcotics - OK except for addiction issue

  27. Case Study

  28. Case Study • A 35-year-old G2 P1+0 woman is seen for her first prenatal visit. • Based on her LMP, she is at 15 weeks’ gestation. • She has no complaints, and no significant medical history. • She denies dysuria or urinary urgency. • Her surgical history is remarkable • Her last delivery was a vaginal delivery and was uncomplicated

  29. On examination • Her blood pressure (BP) is 100/65 mm Hg • heart rate (HR)90 (bpm), • respiratory rate (RR) 12,temperature 98°F (36.6°C), • weight 70KG. • general physical examination is normal

  30. Abdominal examination • Her abdomen is non tender • Fundal height is at the level ofthe umbilicus. • Fetal heart tones are 140 bpm. • Her extremities are without edema.

  31. Prenatal laboratories • CBC: Hgb 10.0 g/dL ,Plt 150,000 WBC 8,000 • Rubella: nonimmune • Hepatitis B surface antigen: positive • Blood type: O, Rh negative • UC&S: 10,000 cfu/mL of group Bstreptococcus • Gonorrhea assay: negative Chlamydia assay: negative

  32. Questions • ➤ What items should be listed on the problems list? • ➤ What is your next step for the problems listed? • ➤ What other testing should be recommended to the patient?

  33. Problem List: • Advanced maternal age 35 Y or greater at EDD • fundal height at umbilicus corresponds to 20 weeks) • Mild microcytic anemia (Hgb < 10.5) • Hepatitis B surface antigen (HBsAg) positive • Rh-negative blood type • Urine culture with GBS 10,000 cfu/mL, • Rubella nonimmune

  34. Next Steps: • 1. AMA—genetic counseling • 2. Size/dates—fetal ultrasound to assess GA, multiple gestation • 3. Anemia—therapeutic trial of iron • 4. HBsAg positive—check liver function tests, and hepatitis B serology toassess for active hepatitis versus chronic carrier status

  35. Next step • 5. Rh negative Rhogam at 28 weeks and at delivery if the baby proves to be Rh positive • 6. Urine culture with GBS—treat with ampicillin and re-culture urine, peni-cillin IV prophylaxis in labor • 7. Rubella status—vaccinate postpartum

  36. Other tests recommended to patient • consider early diabetic screen

  37. Thank you

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