care in pregnancy

7/31/2019 Care in Pregnancy

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CARE IN PREGNANCY

BY

Ms. DEEPA DINESH

Iyr MSc (N)

KVMCON


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OBJECTIVES

To promote , protect and maintain thehealth of the mother during pregnancy

To detect high risk cases and give

them special attention To foresee complications and prevent

them

To remove anxiety and dreadassociated with delivery.

To reduce maternal and infant mortalityand morbidity rate.


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Contd.

To teach the mother elements of child care, nutrition , personal hygiene andenvironmental sanitation

To sensitize the mother to the need forfamily planning including advice to casesseeking medical termination of pregnancy

To attend to under fives accompanying themother


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Healthcare services

Antenatal visits Once in a month first 7 months

Twice in a month next month

Once in a week -- there afterIf it is difficult for them to attend the antenatal

clinic so often -- minimum of 3 visits

1 visit at 20 week or as soon as the pregnancy is

known

2 visit at 32 weeks

3 visit at 36 weeks


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Preventive services

Prenatal services (On 1 visit ) Health history

Physical examination

Laboratory examination

urine analysis

Stool examination

Complete blood count

Serological examination

Blood grouping & Rh determination

Chest x-ray if needed

PAP test

GC culture


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On subsequent visits

Physical examination

Laboratory tests

Iron & folic acid supplementation

TT immunization

Group or individual instruction on nutrition ,family planning , self care , delivery and parenthood

Home visit by a female health worker/ traineddai

Referral services


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Risk approach

Elderly primi(30 years and above)

Short statured primi(140cm or below)

Malpresentations

Antepartum haemorrhage Preeclampsia & eclampsia

Anaemia


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Twins , hydramnios

Previous still birth , IUD , manual removal ofplacenta

Elderly grand multiparas

Prolonged pregnancy(14 days after the EDD)

History of previous caesarean

Pregnancy assaociated with general disorders


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records

Antenatal cards containing

Registration no:

Identifying data

Previous health historyMain health events


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Home visits

Back born of MCH services.

At least one home visit by health

worker is recommended


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iron

Pregnant women should eat iron-rich foods to preventiron deficiency.

Iron-rich foods include leafy greens such as spinachand broccoli, strawberries, meats, whole grains, prune

juice, dried fruit, legumes, and blackstrap molasses. Routine prenatal care is a good way to determine if a

woman should take an iron supplement during

pregnancy. Some women require a 30 mg supplement per day or,

if diagnosed with iron-deficiency anemia, as much as60 to 120 mg of iron per day.


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Calcium & Pregnancy

Calcium is essential for maintaining the boneintegrity of a pregnant woman and providing theskeletal development of the fetus.

Women should increase their intake of calcium-rich foods, such as milk products.

Women who do not consume dairy productsshould take a calcium supplement of 600 mg perday.


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Folate & Pregnancy

Folate is essential for protein synthesis, the formation ofnew cells, and the production of new blood.

It is required for a pregnant woman's increasing bloodsupply and the growth of both maternal and fetal tissues.

Sufficient folate also decreases the risk of neural tubedefects.

The recommended intake for folate increases duringpregnancy from 200 mcg (micrograms) to 400 mcg perday.

It is possible to meet this requirement through a well-selected diet: folate-rich foods include eggs, leafyvegetables, oranges, legumes, and wheat germ.

Some women may require 300 mcg of folate supplementdaily.


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For women who have previously deliveredinfants with neural tube defects, Center for

Disease Control recommends 400 mcgsupplements daily, starting at least 4weeks before conception and for the first 3

months of pregnancy. Multivitamins containing folate should not

be used to achieve the desired level of

supplementation, as potentially harmfulquantities of other nutrients (such asvitamin A) could be ingested.


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Vitamin D & Pregnancy

Vitamin D is necessary for the absorption of calcium andis important for normal bone growth.

Women with a low intake of vitamin D-fortified milk andminimal exposure to sunlight should take a dailysupplement (10 mcg).


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Protein & Pregnancy

The estimated requirement for protein during

pregnancy is 60 gm, which is about 15 gm more thannormal.

Protein-containing foods can be excellent sources ofvitamins and minerals such as iron, vitamin B6, and

zinc. protein deficiency is uncommon because most people

consume and adequate amount of protein-rich foods.

Getting enough protein is important to help the woman

maintain, and the baby build, muscle and othertissues, enzymes, hormones, and antibodies. Goodsources of protein include lean meats, poultry, fish,beans, nuts, and low- or non-fat dairy products.


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A 3-ounce serving of lean beef, fish, or poultryprovides 2025 grams of protein. There are 68grams of protein in the following:

1/2 cup of beans 2 tablespoons of peanut butter

1/4 cup of nuts

1 cup of low- or non-fat milk or yogurt 1 ounce of cheese

1 egg


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Sodium & Pregnancy

Although sodium need not be restricted duringpregnancy, excessive use is not recommended.

A diet of primarily natural foods can be safely

salted "to taste." Pregnant women should avoid processed or

"junk" foods that are high in sodium.

Excessive intake of salt can cause high bloodpressure (hypertension) and may lead toexcessive weight gain.
http://www.cardiologychannel.com/hypertension/index.shtmlhttp://www.womenshealthchannel.com/nutrition/index.shtmlhttp://www.womenshealthchannel.com/nutrition/index.shtmlhttp://www.cardiologychannel.com/hypertension/index.shtml


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General guidelines to help ensure a healthy pregnancyand birth include the following:

Pregnant women should eat a variety of foods (e.g.,vegetables, fruits, grains) to ensure a sufficient supply ofbasic nutrients.

The diet should include low-fat dairy products and leanmeat.


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If a woman experiences nausea ormorning sickness, or if she feels too full

too soon in the later stages of pregnancy,it may be helpful to eat several smallmeals rather than a few large meals.

Pregnant women should limit theirconsumption of caffeine and excess saltand should avoid alcohol.


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Pregnant women are encouraged to engage inmoderate exercise after consulting with their

physician or midwife. Exercise should be geared to increasing the

woman's sense of well-being and maintaining

her general overall health. Pregnant women who exercise regularly tend to

enjoy their pregnancy more.

Exercise may also reduce the stress of thedelivery for both the mother and baby.


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Pregnant women should limit fish consumption to 2servings per week and

limit the intake of white or albacore tuna to no more than

6 ounces per week. Avoid shark, swordfish, king mackerel, and tilefish due

to potentially high levels of mercury.

National Academy of Science recommends a vitamin

and mineral supplement that contains the following: 30 mg iron

15 mg zinc

2 mg copper
http://www.womenshealthchannel.com/nutrition-guide/faqs-fat.shtmlhttp://www.womenshealthchannel.com/nutrition-guide/faqs-fat.shtml


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250 mg calcium (600 mg for women younger

than age 25 and for those whose daily intakeof calcium is less than 600 mg)

2 mg vitamin B6

3 mg folate

5 micrograms vitamin D (10 micrograms forwomen who do not drink vitamin D-fortifiedmilk, have minimal exposure to sunlight, or

are vegan) 2 micrograms of vitamin B12 for women who

are vegan

ow muc energy oes a woman nee


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ow muc energy oes a woman needuring pregnancy?

A woman who is not pregnant needs approximately 2100calories per day.

A pregnant woman needs approximately 2500 caloriesper day.

A breastfeeding woman needs approximately 3000calories per day.

Calories are sometimes called Kilocalories or KCals.

at sort o oo s ou pregnant


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at sort o oo s ou pregnantwomen eat?

A well-balanced diet should containsomething from all the food groups: dairyproducts, fruit, vegetables, fish, meat,

eggs, fat and carbohydrates. A pregnantwoman needs to eat something from allthese food groups every day in order to

get the proper amounts of energy.


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Approximately 10 per cent of caloriesshould come from protein. Protein is

mainly found in meat, fish, eggs, dairyproducts and beans.

Approximately 35 per cent of calories

should come from fat, which is mainlyfound in butter, oils, margarine, dairyproducts and nuts.

Approximately 55 per cent of caloriesshould come from carbohydrates, whichare found in bread, pasta, potatoes, rice,corn and other grain products.


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CONSTIPATION DURING PREGNANCY

can be caused by hormonal changes thatcause the intestines to move less. Ironsupplements can also cause constipation.

To avoid constipation, eat lots of fibre-richfoods such as fruit, vegetables, wholemealbread and cereal, prunes and prune juice.

Drinking 2 to 3 litres of water each day willalso help prevent constipation by keepingstools moist.
http://www.netdoctor.co.uk/pregnancyandfamily/constipationpreg.htmhttp://www.netdoctor.co.uk/pregnancyandfamily/constipationpreg.htm


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Regular exercise will also help get the intestines

moving. About 20 to 30 minutes' swimming orbrisk walking two to three times a week is agood level of exercise to aim for.

A pharmacist will be able to provide advice

about over-the-counter preparations that aresafe to use during pregnancy to relieveconstipation.

ow muc we g t s ou a woman ga n


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ow muc we g t s ou a woman ga nduring pregnancy?

It is considered normal to gain 10 to 12kg (22 to26lb).

For practical reasons the pregnancy is dividedinto three periods:

The first period runs from week 0 to 12 where itis normal to gain 1 to 2kg (2 to 4lb).

The second period runs from weeks 12 to 28 in

which it is normal to gain 300 to 400g (10 to14oz) a week.

The third period runs from weeks 28 to 40 and itis normal to gain 1 to 3kg (2 to 6lb) a month.

The key foods to stay away from


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The key foods to stay away from

are:

MackerelMackerel can contain high levels of mercury which canbe harmful to your unborn baby. Shark and swordfishshould be avoided for the same reason.

LiverLiver and liver products contain very high levels ofvitamin A which research has shown can cause birthdefects. Similarly, any supplements with high levels ofvitamin A should not be taken during pregnancy.


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Soft, mould-ripened and blue veined cheeseCheeses such as Brie, Stilton and Camembert

should be avoided because they can contain thepotentially poisonous listeria bug.

Anything unpasteurizedUnpasteurized eggs, milk, cheese and

vegetables can lead to toxoplasmosis - aninfection caused by a microscopic parasite thatcan live inside the cells of humans and animals,especially cats and farm animals.


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Underdone or lightly cooked eggs, meat or poultryRaw or uncooked eggs, meat and poultry can contain a

variety of bugs that could seriously harm your unbornbaby.

Alcohol and coffee

You can still enjoy your favourite drinks duringpregnancy but only in moderation. You should drink nomore than three cups of coffee a day and ideally onlyone of two glasses of wine a week. However, to be safeyou really shouldn't drink any alcohol at all until after

your little bundle of fun makes his or her firstappearance.


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PREGNANCY

PERSONAL HYGIENE DURING


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PERSONAL HYGIENE DURINGPREGNANCY

Skin care hair care

breast care

dental care

bowel elimination

vaginal douching

and clothing are all important to the pregnant patient.


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A. SKIN CARE. The glands of the skin may be more active during

pregnancy and the patient may tend to perspire more.Frequent baths or showers are recommended.

(1) Baths can be therapeutic--relaxes tensed and tiredmuscles, helps counter insomnia, and makes the patientfeel fresh and sweet smelling.

(2) Baths may pose a physical maneuverability problemwhich increases the chance of falling late in thepregnancy; showers are recommended, but with cautionwhen getting in and out and moving around in the

shower.

(3) The possibility of infecting the vaginal tract as a result oftub baths is considered highly unlikely.

(4) Tub baths are contraindicated after rupture of the

membranes.


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B. HAIR CARE.

The hair tends to become oily more frequently duringpregnancy due to overactivity of oil glands of the scalpand may require shampooing more frequently. The hairmay grow faster during pregnancy and may require

cutting more often.


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C. BREAST CARE.

It is important to begin preparing the breast for

breastfeeding during the prenatal period.

(1) A well-fitting support bra should be worn at all times.

This will provide good support for the enlarging breasts.As the breasts enlarge, an increase in bra and cup sizeshould be worn.


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(2) Pads may be worn inside the bra

cups to absorb possible colostrum

leakage from the nipples. The padsshould be changed if they becomewet from leakage. Prolonged moisture

against the nipples may lead totenderness and cracking once thenewborn infant begins nursing.


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The breasts should be washed daily (withoutsoap) to remove dried colostrum and to prevent

irritation to the nipples. Lanolin may be applied to the nipples to prevent

evaporation of perspiration, thereby softeningthe skin.

Wet tea bags may be placed on the nipples, asthe tea will release tannic acid, which willtoughen the skin.

The nipples should be air dried or blow driedafter washing to help toughen them, especially ifthe patient plans to breastfeed


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DENTAL CARE.

The patient must maintain normal, daily dental care.There is no documentation that supports increaseddental cavities during pregnancy.

(1) Minor dental work, such as fillings and simpleextractions, may be done during pregnancy; however,patients are advised to avoid anesthetics.

(2) Major dental work, to include all dental surgery, shouldbe postponed until after the pregnancy because of theneed to use anesthetics. Anesthetics may affect thedeveloping fetus and the need to use analgesics mayalso affect the fetus.


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E. BOWEL ELIMINATION.

(1) Patients who normally had no problems with bowelelimination habits will usually experience little or nochange in the daily routine.

(2) Patients who have a tendency toward constipationbecome noticeably more irregular during pregnancy

because of:

(a) Decreased physical exertion.

(b) Relaxation of bowel as a response to hormone.

(c) Pressure on the bowel from the gravid uterus.

(d) Constipating effect of iron supplements.

(3) To prevent or to relieve constipation, you shouldencourage the patient to eat a diet high in fiber, maintainan adequate fluid intake, and to exercise--especiallywalking.


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IMMUNIZATION

TT immunizatin at an interval of 16-20weeks

20-24 weeks .

there should be a gap of one monthbetween the doses


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FAMILY PLANING

Advice should be given on the methods of familyplanning

Temporary methods

Permanent methods


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Warning Signs

Advice to report immediately in case of thefollowing warning signs

Swelling of feet

FitsHead ache

Blurring of vision

Bleeding/ discharge per vaginaAny other unusual symptoms


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REST AND SLEEP

2 HOURS AFTER MEALS

8 HOURS DURING NIGHT


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OTHERS

Should not expose herself to x-rays of the abdomen

Especially during the first 4months of pregnancy

Avoid OTC drugs (corticosteroids , sex hormones,tetracyclines)

care in pregnancy

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