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Preconceptional care (PCC) (The Critical role of Primary Care Physician)

Preconceptional care (PCC) (The Critical role of Primary Care Physician). Introduction to Primary Care a course of the Center of Post Graduate Studies i n FM. PO Box 27121 – Riyadh 11417 Tel: 4912326 – Fax: 4970847. Content of this session. Overview Rational of PCC. Objectives of PCC.

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Preconceptional care (PCC) (The Critical role of Primary Care Physician)

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  1. Preconceptional care (PCC)(The Critical role of Primary Care Physician) Introduction to Primary Care a course of the Center of Post Graduate Studies in FM PO Box 27121 – Riyadh 11417 Tel: 4912326 – Fax: 4970847

  2. Content of this session Overview Rational of PCC. Objectives of PCC. PCC implementation at PHC centers. Physicians' role - delivering PCC. Obstacles of PCC. Premarital check-up. Woman’s role.

  3. Birth Rate • United State 13.82 births/1000 population • Saudi Arabia 28.55 births/1000 population country comparison to the world 52 • Egypt 21.70 births/1000 population • United Arab Emirates 16.02 births/1000 population • Japan 7.64 births/1000 population

  4. Prematurity & Infant Mortality • United State 7 deaths/1000 live births. • Saudi Arabia 11.7 deaths / 1000 live births • United Arab Emirates 12.70 deaths / 1000 live births • Egypt 27.26 deaths / 1000 live births • Japan 2.4 deaths / 1000 live births Central Intelligence Agency, The WORLD FACTBOOK

  5. Factors Leading to Infant Mortality • Maternal health problems • Smoking • Age <20 or > 40 • Late entry into prenatal care • Education • Marital status • Inter-pregnancy interval

  6. Potentially all related to Maternal Health Prior to Pregnancy (Preconception)

  7. Key Factors • Health status overall • Nutrition • Exercise habits • Infection risk (immunization) • Specific health risks • Chronic medical conditions • Medication • Tobacco use

  8. Preconception Care: A window of opportunity • All women of child-bearing yrs : pre- screened for • health & risk potentials Before attempting to be pregnant. • Optimum: 3- 6 ms before conceiving attempt • This time frame allows: • 1- Successful conception & pregnancy • 2- any within control health risks.

  9. Rational of PCC • PCC has been advocated as a measure to improve pregnancy outcome. • Its components parallel those of prenatal care : risk assessment, health promotion and medical & physiological interventions. • Physician’ s role : providing PCC. • Woman’s role : ….

  10. Objectives of PCC Screening tool for physicians to assess women’s health In one sense, PCC can be compared to: Will Baby Clinic visit a baby is screened for Normal health, Normal Development to identify emerging unnoticed problems in an infant.

  11. Objectives of PCC For a Woman: PCC assess Normal health of a child-bearing woman, to identify: - Existing or emerging illness or disease which may have gone undetected before. Existing risks for the woman who may become pregnant. Existing risks which may affect a fetus if the woman does become pregnant.

  12. PCC at PHC centers PCC can be provided most effectively as part of ongoing primary care. • Physicians can deliver PCC during visits for • Routine health maintenance, • During examinations for school or work, • At premarital or family planning visits, • After a negative pregnancy test or • During well-child care for another family member.

  13. Components of PCC • Comprehensive check-lists. • Assessments – History & examination. • Screening: Investigations.

  14. What is involved in PCC? • Prescreening check-lists : • Reproductive & non- reproductive systems. Covers physical & psychological aspects. • Woman's lifestyle • Family history information. • Begins with basic information then in-depth, especially if there is previous disease/operation. • Pre-screening assessments: a Questionnaire filled by women generally before seeing the physician with a nurse.

  15. Assess & screen for: Medical conditions. Genetic counseling. Immunization. Lifestyle changes. STDs (STI) Medications. Occupational exposures. Domestic violence.

  16. Medical conditions: • DM: • Screen for DM and pre-diabetes. • If already diabetic --- shift to insulin Rx. • Congenital anomalies: 2- 6x > offspring of DM. • PCC care & good DM control  their rate • Recent meta analysis: lower rate among PCC recipients (2.1%) vs non-recipients (6.5%).

  17. Medical conditions: Hypertension. UTI & Renal problems. Obesity . Cardiac / pulmonary problems. Epilepsy . Psychological disorders.

  18. Premarital couselling • Genetic counseling in PCC is ideal time: • Before a couple attempts to conceive especially if the history reveals :- • Advanced maternal age, • Previously affected pregnancy, • Consanguinity or FH of genetic disease.

  19. Examples Genetic counseling • Blood conditions caries/ disease: • Sickle cell anemia, thalasemia, G6PD • Cystic fibrosis. • Mental retardation condition: • Screen women with a known FH of fragile X syndrome or FH of unexplained mental retardation or for women who have learning disabilities or mental retardation.

  20. Immunization • PCC is ideal time: • Screen • for rubella immunity. • Immunization: • Rubella • Hepatitis A • Hepatitis B • Tetanus • Chickenpox? Check : EIP complete? women <18 yrs. EIP = Expanded Immunization Program)

  21. Lifestyle changes • Caffeine: 1 cup coffee : ~ 120 mg caffeine. • 1 cup tea : ~ 40 mg caffeine. • 12- oz soft drinks (cola) : ~ 45 mg caffeine. • Caffeine metabolism  during pregnancy • especially with cigarette smoking. • Several studies: caffeine intake ± associated with •  fertility  abortion  birth wt. •  5-6 mg/kg/day spread on day + no smoke + no alcohol : NO  reproductive risk.

  22. Lifestyle changes • Tobacco : • Smoking women during pregnancy : subjects themselves & their infants to a no. of adverse health effects. • women contemplating pregnancy should quit smoking prior to conception. • Nicotine replacement could then be prescribed.

  23. Lifestyle changes • Tobacco :- • Smoking cessation before / early pregnancy : associated with improvement in maternal airway function & at infant birth wt vs among nonsmoking pregnant women. • Alcohol & illicit drugs • Both a major health problem in USA. • Both harm fetus. • 1981- USA : women abstain drinking alcohol during pregnancy & when plan pregnancy.

  24. Sexually Transmitted Infection (STI = STD) & medications STI : PCC is a good opportunity to screen for genital infections such as Chlamydia, gonorrhea, syphilis and HIV. Medications : therapeutic regimens for chronic illnesses are best modified, if possible, in PC period to include the drugs that have been used the longest & have been determined to pose the lowest risk.

  25. Medications Antihypertensives: Diuretics & angiotensin-converting enzyme should be avoided drug of choice: methyldopa- proven maternal & fetal safety. Anticoagulants: Warfarin ContraIndidated Switch to heparin Oral hypoglycemic: Switch to insulin before pregnancy.

  26. Occupational exposures Worldwide: women entry to workforce. Most women are in reproductive age • Three most common occupational hazards reported to affect • pregnancy are: • Radiation Exposure • Organic solvents • Lead

  27. Domestic violence Is increasingly recognized as a major public health issue. It crosses all racial, religious & educational boundaries. Physical abuse during pregnancy : significant Risk Factor low birth wt & maternal complications. Physicians should assess the victims & refer to local community resources.

  28. Obstacles of PPC • Pregnancies are still unplanned. • Women do not know, realize, or understand the benefits of visiting their physician before become pregnant. • The lack of health insurance.

  29. PCC in Saudi Arabia • Premarital check up : • Mandatory For limited inherited risks. • It could be provided to the married women at the center by:- • health education of the patient at Pre-Natal Care Well baby clinic , Chronic disease clinic ….etc • Let the patient be aware of its importance

  30. Woman’s role • A woman may need to adjust certain aspects of her health and well-being which are in her control. • These usually include aspects of lifestyle, drug and alcohol use, exercise, rest and stress reduction. • In addition, she may need to discontinue certain herbs or over-the-counter medications as recommended by the physician. • Many physicians will also recommend pre-natal vitamins before a woman actually conceives in order to boost her overall health.

  31. تم بحمد الله Thank you

  32. MCQ

  33. 1) Birth rate is • Annual number of births during one year/ 1000 population. • Crude birth rate. • Usually determine the rate of population growths. • All of the above.

  34. 2) Infant mortality rate • Number of infant deaths in one year/1000 live birth in same year. • Include total death rate. • It indicate the level of health in a community. • All of the above.

  35. 3) Factors leading to infant mortality include all EXCEPT a) Maternal health problems. b) Smoking. c) Age >20 or < 40 d) Late entry into prenatal care.

  36. 4) Drugs that need to be changed for safe motherhood are all EXCEPT • Diuretics • Warfarin • Insulin • Angiotensin-Converting Enzyme Inhibitors

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