Preventive And Social Obstetrics

Dr. Ghanshyam PatelM.D Gynec

Latest updates with reference to :1. Investigations2. Clinical examination3. Non therapeutic mx.4. Developmental anomaly

Social obstetrics

• It is a branch of preventive medicine

• Relation between social and environmental factors and human reproduction, even in preconception and premarital period

Social factors

Age at marriage Age at child bearing Birth spacing Family size Fertility pattern Level of education Economic status Role of woman in society

Investigations

• UPT• β-Hcg• CBC• BG• HIV• Serum creatinine ,• PT , APTT• LFT

• HBSAG• VDRL• RBS• URINE-routine and micro• TSH• OPTIONAL-Vit. D ,Vit. B12

Clinical examination

history

symptoms

signs

TVS

TAS

3D USG AND COLOR DOPPLER

STUDY

MRI

NON THERAPEUTIC MX.

1. Adolescent health screening

2. Premarital counselling

3. Preconception counselling

4. Good ANC

5. Birth spacing

Social factor

1. Age at marriage

2. Age at pregnancy

3. Women empowerment

4. Women education

5. Population Control

Anomalies Past historyExposure to drug , X’ ray etc.How to look for itChorion villus biopsy,AmniocentesisTriple testQuadruple testTargeted sonography3D USGCordocentesis

The recent development of high-resolution ultrasound equipment has markedly improved the diagnostic accuracy of ultrasound. In particular, the introduction of high-frequency vaginal probes has enabled early diagnosis of certain fetal abnormalities from the 12th to 14th week of pregnancy. Such early testing is of special importance for women with a history of pregnancies associated with birth defects

• 4D USG detects all structural anomalies while color Doppler detects

• outrightly vascular problems, and both can be done in one sitting

• . For down syndrome nuchal translucence, long bone length, major

• structural defect are to be looked for.

• anencephaly• open spina bifida• cleft lip  • diaphragmatic hernia • gastrochisis • exomphalos • serious cardiac abnormalities • bilateral renal agenesis• lethal skeletal dysplasia • Edwards' syndrome, or T18 • Patau's syndrome, or T13  

Frequent or Occasional Features

Syndromes Meckel-Gruber Encephalocele, cleft palate, polycystic kidney,

polydactyly, IUGR (A/R)

Dubowitz IUGR, hypertelorism, olinodactyly of fifth finger (A/R)

Robert IUGR, cleft lip, hypertelorism, hypomelia, CHD, polycystic kidneys, polyhydramnios, hydrocephalus (A/R)

Seckel IUGR, facial hypoplasia with prominent nose (A/R)

De Lange IUGR, micrognathia, micromelia, CHD, sporadic etiology

Coffin-Siris IUGR, CHD, Dandy-Walker anomaly, hypoplastic fifth finger (unknown etiology)

Bloom IUGR A/R

Chromosomal Deviations

Trisomy 13 Holoprosencephaly, hydronephrosis, polycystic kidneys, IUGR, single umbilical artery, CHD

Trisomy 18 Polyhydramnios, hydronephrosis, polycystic kidneys, IUGR, single umbilical artery, CHD, omphalocele, choroid plexus cysts

VATER associations Esophageal atresia, radial hypoplasia, renal dysplasia

Del (4p) and Del (5p) Hypertelorism, IUGR, CHD

Del (13 q) Hypertelorism, IUGR,CHD, hydrocephalus, small thumbs

Del (18p) IUGR, holoprosencephaly

Del (18q) Cleft lip, CHD, horseshoe kidney

Environmental Factors

Alcohol IUGR, hydrocephalus, CHD

Amniopterin IUGR, hydrocephalus, neural tube defect, hypoplasia/frontal bone, cleft palate, broad nasal bridge, hypertelorism, CHD

Hydantoin IUGR, hypertelorism, cleft lip, CHD, duodenal atresia, single umbilical artery

Maternal phenylketonuria IUGR, CHD

Rubella IUGR, CHD

Abnormal Ultrasound

FeatureSkeletal Dysplasias

Amniotic fluid volume and polyhydramnios Robert S, VATERS association

Acromelia Ellis-van Creveld dysplasia, Poland sequence acrodysostosis

Bowing of long bones Tibia Campomelic

dysplasia, metaphyseal chondradysplasia

Femur Split-hand S Cardiac abnormalities Thanatophori

c dysplasia, chondroectodermal dysplasia,

short rib polydactyly, campomelic dwarfism, Robert S

Cleft lip and cleft palate All facial skeletal dysplasias, diastrophic dwarfism,

chondroectodermal dysplasia, short-rib

polydactyly, campomelic dwarfism

Clubfoot Osteogenesis imperfecta, arthrogryposis, Robert S, other

Contractures Femoral hypoplasia/unusual facies S, popliteal web S,

sirenomelia sequence, arthrogryposis

Demineralization and poor calcification of bone

Mainly noted in spine Achondrogenesis

Mainly noted in skull Hypophophatasia

Mainly noted in long Osteogenesis imperfecta

bones with fractures Dolichocephaly Craniosynost

osis, trilobed or clover-leaf skull

Femur hypoplasia Femoral hypoplasia/unusual facies S, ectrodactyly-

ectodermal dysplasia-clefing S

Fetal motion absence Arthrogryposis

Finger abnormalities and Ectrodactyly ectodermal dysplasia-clefing S, Aase S

triphalangeal thumb Head shape abnormalities Brachycephaly Craniosynost

osis, acrodysostosis, achondroplasia,

(heterozygous form)

Hydrocephaly Thanatophoric dwarfism, osteogenesis imperfecta

Hydropic appearance Achondrogenesis, short rib polydactyly

(Saldino-Noonan type)

Hypertelorism Cleidocranial cleidostosis, acrodysostosis, VATERS

Intrauterine growth Robert S, VATERS

retardation Kyphoscoliosis Metatrophic

dysplasiaLimbs lower fusion Caudal

regression SLong bones (increased thickness) Diastrophic

dysplasiaMacrocephaly Achondroplas

ia, campomelic dysplasia

Mesomelia Neivergelt or Langer dysplasia

Micromelia (severe) Robert S, type II osteogenesis imperfecta, achondrogenesis

Microcephalus Robert S, thanatophoric dwarfism, De Lange S,

chondrodysplasia punctata

Protuberant abdomen Achondrogenesis, thanatophoric dwarfism, short rib

polydactyly (Majewski type)

Radial bone hypoplasia Miller S, TAR S, AASE S, VATERS, acromelia

Renal disease Short rib polydactyly, campomelic dwarfism, asphyxiating

thoracic dysplasia (Jeune type), short rib polylydactyly

Thorax (decreased size) Thanatophoric dwarfism, achondrogenesis, metatrophic

dwarfism, asphyxiating thoracic dysplasia (Jeune type),

short rib polydactyly, campomelic dysplasia

cleidocranial dysostosis

Umbilical cord (single umbilical artery) VATERS

Gestation (weeks) <10 10–12 12–14 >14Patients 19 34 65 26Four chamber - 13 (37) 44 (68) 21 (81)Head - 13 (37) 43 (66) 16 (62)Spine - 5 (15) 28 (43) 8 (31)Stomach 2 (10) 19 (56) 62 (95) 24 (92)Kidneys - 5 (15) 38 (58) 14 (54)Bladder 3 (6) 14 (42) 52 (80) 23 (88)

The recent development of high-resolution ultrasound equipment has markedly improved the diagnostic accuracy of ultrasound. In particular, the introduction of high-frequency vaginal probes has enabled early diagnosis of certain fetal abnormalities from the 12th to 14th week of pregnancy. Such early testing is of special importance for women with a history of pregnancies associated with birth defects. The frequency with which different organ systems can be imaged is shown in Table 1.1 The sequential appearance of fetal neural structures during the first trimester of pregnancy is shown in Table 2.2

TABLE 1. Frequency in Which Specific Fetal Anatomic Structures Are Visualized by Transvaginal Sonography from Approximately 10 to 14 Weeks' Gestation*

Take Home message• Adolesence health care• Premarital counselling• Marriage at approptiate age• Child bearing at appropriate age• Good anc• Good intrapatum care• Good pnc• Woman empowerment

• Anomaly scan at 18to22k• Nowdays 3d or 4d usg at 10wk to14• Cvs• Amniocentesis• Cordocentesis• If require opion of fetal medicine expert

THANK YOU