PRENATAL CARE

Why do we need prenatal care?

• To ensure the maintenance of the health and well being of the mother during pregnancy.

• To identify mothers who are at risk of developing complications.

• To establish the health status of the fetus to achieve a healthy outcome.

• To initiate a plan for continuing obstetric care.

Introduction

• Worldwide about 515,000 women die each year due to pregnancy and childbirth complications.

• 1 woman die per minute• 99% occur in developing countries• Adolescents are twice likely to die from

pregnancy and childbirth

Socio-economic factors

• Poor women’s health and nutrition• Poor hygiene and care during childbirth• Inadequate, inaccessible, and unaffordable

healthcare services• Poverty• Lack of information• Lack of decision making

Main causes of maternal morbidity

• Hypertension• Infection • Hemorrhage

When Should I have a prenatal care?• As soon as you have doubts that you are

pregnant.• As early as a few days after a missed

menstruation.

What do I expect during the first check up?

History1. Socio-demographic risks2. Obstetric 3. Menstrual4. Sexual5. Contraceptive6. Family and Genetic7. Medical

8. Nutritional 9. Infection 10. Psychological

What do I expect during the first check up ?

Physical Examination 1. Height 2. Weight 3. Pre-pregnancy and current weight 4. Blood pressure

Physical Examination 5. Abdominal Examination Fundic Height Leopold’s Maneuver Fetal Heart Tones 6. Pelvic Examination

What do I expect during the first check up ?

Laboratory Examinations 1. Hemoglobin/Hematocrit - performed at the initial visit and repeated once after 24 weeks. 2. Rh factor, Blood type 3. Urinalysis - sugar, protein, culture 4. Pap Smear 5. Hepatitis B screening

What do I expect during the first check up ?

Laboratory 6. Rubella titer 7. Tests for STI’s - syphilis, gonorrhea, chlamydia 8. Illicit drug screen 9. Genetic screen 10. HIV screening (optional, with consent)

What do I expect during the first check up ?

Schedule of Check ups

0 – 7 months - once a month7 – 8 months - every 2 weeks9 months - weekly

Screening for Diabetes mellitus

High Risk 1. (+) signs and symptoms 2. > 25 yrs old 3. strong family history 4. history of gestational diabetes 5. obeseDone between 24 – 28 weeks - GCT

What should I watch out for?• Vaginal bleeding• Severe or continuous headache• Dimness or blurring of vision• Abdominal pain• Persistent vomiting• Chills or fever• Painful urination• Watery vaginal discharge• Decrease fetal movement

How much weight should I gain?

Pre-Pregnancy BMI

Recommended Total Gain

Pounds Kg

Low (<19.8) 28 - 40 12.5 – 18Normal (19.8 – 26) 25 - 35 11.5 – 16High (>26 – 29) 15 - 25 7 – 11.5Obese (> 29) <15 <7

Diet Recommendations Pregnant women should increase their usual servings from the 4 basic food groups (2500 – 2700 kcal/day) as follows:

1 7 or more servings of fruits & vegetables combined (3 servings of fruits & 4 of vegetables) daily for vitamins and minerals

2 9 or more servings of whole-grains or enriched Breads/Cereals

3 4 or more servings of low-fat or non-fat milk, yogurt, or other dairy products like cheese for calcium

4 More proteins

Do I really need to take vitamins?

A healthy daily diet can still miss out on some important vitamins and minerals (i.e. folic acid)

“The average Filipino woman may not be able to meet the required dietary allowances for all nutrients, except Vitamin A” FNRI Survey, 1998

Helpful to take a daily multivitamin or prenatal vitamin and mineral supplementation

Key Recommendations

• to prevent neural tube defects Folic acid 0.4 mgs daily 3 months prior up to the first

3 months of pregnancy • to prevent iron deficiency anemia.

Elemental Iron 30 mgs from the 2nd trimester onwards

Do I need to have a vaccine?Influenza Vaccine - given in the 2nd or 3rd trimester

Td (Tetanus-diptheria) Vaccine - 0.5ml IM - Primary : 1st dose - now 2nd dose - 1 month after 3rd dose - 6 -12 months after the 2nd dose (at least 2weeks before delivery) - If received Td > 10 yrs administer during 2nd or 3rd trimester

What should I avoid during Pregnancy?

ALCOHOL• It crosses the placenta• Causes intrauterine growth retardation • Causes fetal alcohol syndrome

SMOKING

Fetal Effects : - Low birth weight - Premature labor - Premature rupture of membranes - Abruptio placenta - Hemorrhage

ARTIFICIAL SWEETENERS

Known to be - weakly carcinogenic in rats - US FDA restricts its use in pregnancy

CAFFEINE

• Found in colas, coffee, tea, cocoa• Known to be a diuretic and may cause

dehydration• Affects fetal heart rate and breathing• Limit to two 5 ounce cups per day.

STRENUOUS PHYSICAL ACTIVITY

Allowable Activity

• Walking• Climbing the stairs• Swimming• Cycling

Long Distance travels

• Traveling by land, sea or air has no harmful effects in pregnancy.

• Should be seen by her doctor prior to travel.• Encouraged to wear seat belts.• Should stand and walk every 2 hours to avoid

thromboembolism.

Can I take a bath?

• There is no objection to taking a bath during pregnancy.

Can I Have Sex?

• Sexual intercourse does no harm during pregnancy provided she is not in threatened abortion or in premature labor.

COMMON COMPLAINTS

Nausea and Vomiting

• Occurs during the first month but usually subsides on the fourth month.

• Due to increase in hormones• Managed by:• - avoid spicy food• - small frequent feeding• - ice chips.• Watch out for dehydration

Constipation

• Due to decreased motility of the intestines• Due to muscle relaxation• Managed by:• - increasing fluid intake• - high fiber diet• - bulk forming laxatives

Low Back Pain

Due exaggerated lordosis, and muscular spasmManaged by: - back support with pillows on sitting down - avoid bending but rather squat - avoid high heeled shoes - analgesics

Varicosities

• Congenital predisposition• Exaggerated by prolonged standing• Becomes prominent as pregnancy advances and

weight increases• Managed by:

- periodic rest, elevation of the legs - elastic stockings

Hemorrhoids

• Due to obstruction of venous return by the enlarged uterus.

• Increased pressure in the rectal veins• Managed by : - stool softeners - hot sitz bath

Heartburn• Reflux of gastric contents in the lower esophagus• Due to upward displacement and compression of

the stomach by the enlarged uterus• Managed by : - small frequent meals - avoid lying down on a full stomach - antacids

Ptyalism

• Profuse salivation due to stimulation of the salivary glands with the ingestion of starch.

• Managed by : - avoid diets high in starch - ice chips per orem

Fatigue

• It is normal for pregnant women to be easily tired.

• Should rest whenever she feels so.

Summary• Prenatal care is essential to achieve a healthy

mother and a healthy baby• Prenatal care should start as soon as you have

doubt that you are pregnant.• The recommended weight gain in a healthy

pregnant woman is 25 – 35 lbs.• The average Filipino woman may not be able to

meet the necessary dietary allowance and therefore a prenatal supplement maybe helpful.

• Folic acid 0.4 mgs daily 3 months prior up to the first 3 months of pregnancy to prevent neural tube defects.

• Elemental Iron 30 mgs from the 2nd trimester onwards to prevent iron deficiency anemia.

• Td vaccine is recommended during pregnancy• Lifestyle changes are necessary to achieve a

healthy pregnancy.

Summary