in the name of god. dr solmaz piri obstetrician & gynecologist prenatalogist from kcl,england
TRANSCRIPT
In the name of God
Dr Solmaz PiriObstetrician & 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 hercare 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 youThank you very much for
your attention