7. Antenatal Care.pptx

Antenatal Care Dr Sathisha Nayak Antenatal Care • Goal • Objectives • Schedule of antenatal visits. • History taking • Clinical Examination • Investigations • High Risk pregnancy • Supplementation/immunization • Education, Counselling • Planning delivery Goal “Safe mother and safe baby” • To pr...

Antenatal Care Dr Sathisha Nayak Antenatal Care • Goal • Objectives • Schedule of antenatal visits. • History taking • Clinical Examination • Investigations • High Risk pregnancy • Supplementation/immunization • Education, Counselling • Planning delivery Goal “Safe mother and safe baby” • To prevent Maternal and perinatal mortality and morbidity Objectives 1. To confirm pregnancy, dating and to rule our early complications 2. Screen for high risk pregnancy 3. Monitoring foetal growth 4. Prevention, screening, early diagnosis and management of maternal and foetal complications. 5. Supplementation, immunization 6. Education/counselling 7. Planning delivery Schedule • First visit - 6 weeks • Second - 12 weeks • Third visit - 18 weeks • Fourth visit - 24 weeks • Next visit - 28 weeks • 2 weekly till 36 weeks • Weekly till 40 weeks History taking • Detailed profile • Parity Index, LMP/EDD/POG • Current pregnancy history Booking visit details First trimester history Second trimester history 3rd trimester history • Past obstetric history • Past/personal/family/social history. Clinical Examination • General Physical  Height, weight, pallor, edema, BP • Systemic  CVS,RS,SPINE • Abdominal  Fundal height > 12 weeks  Symphysio fundal measurement > 20 weeks  Presentation>32-34 week  Foetal heart> 24 weeks • Local: First visit to rule out local pathology Investigations-1st Visit(Booking) • Blood:  CBC, Blood Group& type HIV, Hepatitis, VDRL, TSH  MGTT for high risk cases • Urine analysis:  Albumin • Sugar • Microscopy • Ultrasound scan:  Dating scan Investigations-further visits • CBC repeat at 24 and 37 weeks • MGTT@ 24-28 weeks • Urine analysis: every visit • Ultrasound: NT scan at 11-13 weeks Anomaly screen scan: 18-20 weeks Growth scan at 30-32 weeks High Risk Pregnancy Education& Counselling • Education  Diet-Balanced, iron-calcium-fiber rich diet  Exercise-30 minutes/day(5 days/week),Moderate Degree aerobic exercise  Travel-Avoid long travel  Work  Common symptoms, warning signs :Pain, bleeding, headache, fetal movement, leaking • Counselling  Trisomy screen  Referral  Fetal anomalies  Preoperative  Plan of delivery Supplementation &Immunization • Tab Folic acid - 0.5mg to 5mg daily (Preconception-16 weeks) • Iron Tablets-60mg elemental iron(200 mg Ferrous Sulphate/Fumarate) daily from 16 weeks till 6 weeks following delivery) • Tab Calcium 1gm daily till 6 weeks following delivery. • Injection Tetanus Toxoid/Td 2 doses 4-6 weeks apart Planning for delivery &emergencies • Place of delivery • Obstetric Team • Mode and timing of delivery • Choice of analgesia/anesthesia • Emergency plan Planning Delivery • Place of Delivery • Obstetric team • Timing of delivery • Route of delivery • Choice of analgesia • Emergency References for further reading • Severe Maternal Morbidity: ACOG Clinical Guideline,2021 • Antenatal Care: www.myhelath. gov.my • Perinatal Care Manual:3rd Edition, Ministry of Health Malaysia,2013 • Antenatal Care: NICE Guidelines ,19 August 2021 • Australian Pregnancy Care Guidelines (DOH 20),2020 OSCE • Demonstrate mechanism of labor • Counselling VBAC, ECV Breaking bad news-IUFD, FoetalAnomalies • Pap smear • Pipelle sampling • 3rd stage management Note Interactive stations • OSCE is Objective and skill based. • Every step needs correct demonstration • Practice well • Each station will have 10 points with 4 marks each. • Focus on communication skills Static stations • Specific answers. Do not write multiple answers. • IUCD, OCP, Instruments, Partogram, CTG, USG, Lab data