(3) prenatal care

8/9/2019 (3) Prenatal Care

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Components of prenatal visit

History taking

Physical examination

Treatment of disease

Tetanus toxoid immunization

Iron supplementation

Health education

Laboratory examination

Oral dental examination

Referral when necessary


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Schedule ofclinic visits

1st to 32 weeks every 4 weeks (once

a month)

32 to 36 weeks

every 2 weeks (twicea month)

36 weeks until delivery every week

(once a week)


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Terms Related to pregnancy

status Primigravida a woman who is pregnant

for the first time

Primipara a woman who has given birth

to one child past age of viability

Multigravida a woman who has been

pregnant previously

Multipara a woman who has carried twoor more pregnancies to viability

Nulligravida a woman who has never

been and is not currently pregnant


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Obstetrical history

Gravida a woman who is or has beenpregnant

Para the number of pregnancies thatreached viability, regardless of whether the

infants were born alive or not Term the number of full term infants born

Premature the number of preterm infantsborn

Abortion - The number of spontaneous orinduced abortions

Living the number of living children

Multiple multiple pregnancies


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Multiple pregnancy

Monozygotic or identical

Dizygotic or fraternal


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History of present pregnancy

Expected date of delivery/birth

Nageles rule

When she first felt the fetus move

primi add 22 weeks to the date ofquickening

multi add 24 weeks to the date ofquickening

Determination of AOGMcdonalds rule

Bartholomews rule


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Physical assessment

Head and scalp

Eyes

Nose

Ears

Mouth and teeth

Neck

Breast

Skin

Back

Rectum

Extremities


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It is a systematic method

by applying externalpalpation to evaluate the

presentation, position

and attitude of the fetus;the location to auscultate

the fetal heart sound;

and the engagementstatus of the presenting

part.


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Remember :

Patient should empty herbladder

Explain the procedure tothe patient

Provide privacy Position patient in dorsalrecumbent or supine.

Examiners hand should bewarm

Apply gentle but firmmotions Use palms not fingers


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FIRST MANEUVER


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Fundal grip

To determine what part of the

fetus lies in the upper part ofthe uterus.

Note:

Head - hard, round &

movable Buttocks - softer, more

angular & not movable


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SECOND MANEUVER


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Umbilical grip

To determine which side of

the uterus is fetal back is

located. Fetal Spine/Back smooth,

curved resistant plane.

Fetal extremities ( knees &

elbow ) angular

nodulations (smaller lumps &

irregular parts).


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THIRD MANEUVER


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Pawlicks grip

To determine what occupies in the lower

uterine segment and to determine

whether it is engaged or not.

Note:

Engagement

fetus is immovable

Ballotement

fetus movable/bounces


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FOURTH MANEUVER


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Pelvic grip

Fetal attitude


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Assessing fetal well being

Fetal movement

quickening begins 18-20 weeks, peaks

28-38 weeks

Fetal heart rate

rhythm strip testing

vibroacoustic stimulation

nonstress test

contraction stress testing


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Assessment Nonstress test Contraction

What is measured Response of fetal heartrate in relation to fetal

movements

Response of fetal heartrate in relation to

uterine contractions

produced by nipple

stimulation

Normal findings Two or more accelerations

of fetal heart rate of 15

beats/min lasting 15 sec or

more following fetal

movements in a 20 min

period

No late decelerations

with contractions

Safety

considerations

Woman should not lie

supine to prevent supine

hypotension syndrome

Observe woman for 30

min afterward to see

that contractions are

quiet and preterm labor

does not begin


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Internal or vaginal

examination

Purpose

To confirm pregnancy

To assess consistency of cervix, length& dilatation

To assess fetal presenting part, bony

architecture of the pelvis, anomalies of

the vagina and perineum


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Pregnancy test

Radioimmunoassay (RIA)

Enzyme linked immunosorbent assay(ELISA)

Radioreceptor assay (RRA) 24 to 48 hours after implantation (serum)

7 to 9 days after conception (50mIU/ml)

60 to 80 day of gestation (100mIU/ml)

Home (97%)

35mIU/ml of hCG


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Speculum examination (pap

smear)

Early detection of cervical cancer and

diagnosis of precancerous and

cancerous condition of the vulva and

vagina

Reveals inflammatory and infectious

diseases


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SP CULUM EX MI TI (PAP

SMEAR)

Class I Normal findings

Class II Normal with atypical cells present

Class III Suggestive of malignancy

Class IV Probably malignant

Class V Definitely malignant


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urinalysis

Performed to test protenuria, glycosuria

and pyuria

Test strips and microscopic examination


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Ultrasonography

Purposes:

To diagnose pregnancy as early as 6 weeks

gestation

To confirm the presence, size, location of placenta

and amniotic fluid

To establish that a fetus is growing and has no

gross anomalies To establish sex if a penis is revealed

To establish the presentation and position of the

fetus

To predict maturity by measurement of the


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Ultrasonography

Biparietal diameter

8.5 cm or greater 2,500 g (5.5lb) 40 weeks

Doppler umbilical velocimetry

measures the velocity of blood flow to the umbilical blood

vessels

Placental grading

0 12 to 24 weeks 2 36 weeks

1 30 to 32 weeks 3 38 weeks

Amniotic fluid volume assessment

Average index (12 to 15 cm) 28 to 40 weeks

20 to 24 cm (hydramnios), 5 to 6 cm (oligohydramnios)


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ECG

11 week of pregnancy

It is rarely used unless aspecific heart

anomaly is suspected


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MRI

Causes no harmful effects to the fetus or

mother

Potential to replace or complement

ultrasonography

Ectopic pregnancy or trophoblastic

disease


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Maternal Serum Alpha-

Fetoprotein

15 week of pregnancy

AFP produced by the fetal liver

(amniotic fluid and maternal serum

High neural tube defects

Low down syndrome


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Triple Screening

MSAFP, unconjugated estriol and hCG

More reliable result than AFP testing

Simple venipuncture of the mother


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ChorionicVilli Sampling

Biopsy and chromosomal analysis of

chorionic villi

10 to 12 weeks of pregnancy


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Amniocentesis

Amnion for sack and kentesis for puncture 14 to 16 weeks of pregnancy

Color transparent

Lecithin/sphingomyelin ration 2:1

Phosphatidyl glycerol and desaturated

phosphatidylcholine

Bilirubin determination

Chromosomal analysis

Fetal fibronection

Inborn errors of metabolism

Alpha-fetoprotein


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Percutaneous umbilical blood

sampling

Cordocentesis or funicentesis

Aspiration of blood from the umbilical

vein

Complete blood, direct Coombs test,

blood gases and karyotyping


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amnioscopy

Visual inspection of the amniotic fluid

through the cervix and membranes with

an amnioscope

Detect meconium staining


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fetoscopy

Fetus is visualized by inspection through

a fetoscope

Purposes

To confirm the intactness of the spinal

column

To obtain biopsy samples of fetal tissue

and fetal blood samples

To perform elemental surgery


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Biophysical profileAssessment Instrument Criteria for a score of 2

Fetal breathing Sonogram At least one episode of 30 sec of sustained

fetal breathing movements within 30 min of

observation

Fetal movement Sonogram At least three separate episodes of fetal limb

or trunk movement within a 30 minobservation

Fetal tone Sonogram The fetus must extend then flex the

extremities or spine at least once in 30 min

Amniotic fluid

volume

Sonogram A pocket of amniotic fluid measuring more

than 1 cm in vertical diameter must bepresent

Fetal heart reactivity Nonstress

test

Two or more accelerations of fetal heart rate

of 15 beats/min lasting 15 sec or more

following fetal movements in a 20 min period


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Biophysical profile

Fetal heart and breathing short termCNS function

Amniotic fluid volume long term

adequacy of placental function Fetal Apgar

Score

8 to 10

doing well6 suspicious

4 fetus in jeopardy


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Recommended Daily dietary

allowances for pregnant womenPregnant women

Calories 2,500 kcal

Protein 60 g

Vitamin A 800 g

Vitamin D 5 g

Vitamin E 15 mg

Ascorbic acid

(Vitamin C)

85 mg

Folic acid 600 g

Niacin 17 mg

Riboflavin 1.6 mg


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Recommended Daily dietary

allowances for pregnant womenPregnant women

Thiamine 1.4 mg

Vitamin B12 2.6 g

Vitamin B6 2.0 mg

Calcium 1,200 mg

Phosphorous 700 mg

Iodine 175 g

Iron 30 mg

Magnesium 350 mg

Zinc 15 mg

Fluoride 3 mg


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Exercise during pregnancy

To strengthen the muscles for labor anddelivery

Strengthen the muscle to promote theirquick return to normal condition after

childbirth Promote circulation, prevent and relieve

problems such as varicosities andhemorrhoids

Relieve tension and anxiety Improve posture and apetite

Improves metabolic efficiency


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Recommended exercises during

pregnancy

Exercise Benefit

Pelvic rocking Relieve backache and strengthen

the muscles of lower back

Squatting Stretch the perineal muscle and

improve circulation in the perineum

Rib cage lifting Relieve shortness of breath

Calf stretching Relieve leg cramps

Shoulder circling Relieve upper backache and

numbness of arms and fingers


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Recommended exercises during

pregnancy

Exercise Benefit

Abdominal

muscle

contraction

Strengthen abdominal muscle in

preparation for labor pushing

Modified knee

chest

Relieve hemorrhoids, vulvar

varicosities and low backache

Leg elevation Relieve swelling, fatigue,

varicosities of extremities

Leg raising Strengthen abdominal muscle

Kegels exercise Strengthen perineal muscle


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Methods for pain management

Bradley method (abdominal breathing)Psychosexual method (flow with)

Dick-Read method (fear-tension-pain)Lamaze method( gating control theory)Leboyer method (birthing room is

darkened)

(3) prenatal care

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