Prenatal CarePrenatal Care..

Prenatal Care - Introduction

Prenatal care focuses on prevention

Majority of pregnant females will deliverwithout major complications

Goal of prenatal care is to select females atrisk for development of major complicationsand early prevention/intervention in order toaffect improved outcome

Prenatal CarePrenatal Care

Decide who will provide careDecide who will provide care– Obstetrician-Dr. who specializes in the care of the Obstetrician-Dr. who specializes in the care of the

female and her childfemale and her child– Certified nurse-midwife- advanced practical nurse Certified nurse-midwife- advanced practical nurse

who specializes in prenatal care and deliverieswho specializes in prenatal care and deliveries

Where will birth take place?Where will birth take place?– Hospital- most commonHospital- most common– Birthing Center- facility in which low-risk women can Birthing Center- facility in which low-risk women can

deliver their babies in a more home like settingdeliver their babies in a more home like setting– HomeHome

Gestational AgeGestational Age

Outcome in pregnancy is gestational age dependant

Calculation of gestational age is made using a varietyof methods:– Patient history– Initial pelvic exam/biochemical test of pregnancy– Fetal heart auscultation (10-11 or 18-19 weeks)– Serial fundal height measurement (at umbilicus - 20 weeks)– Ultrasound estimation of gestational age

Dating (U.S.) best based upon MENSTRUAL DATING (Last normal menstrual period to estimate

date of confinement 40 7-day weeks

UltrasoundUltrasound

Real time images produced on computer Real time images produced on computer screen using sound wavesscreen using sound waves

Used to monitor fetus in uterusUsed to monitor fetus in uterus

Determines how well the fetus is Determines how well the fetus is developing including organ developmentdeveloping including organ development

ULTRASOUND VIDEOULTRASOUND VIDEO

Laboratory TestsLaboratory Tests

Blood typically drawn each Dr. VisitBlood typically drawn each Dr. Visit– Hemoglobin/hematocritHemoglobin/hematocrit– UrinalysisUrinalysis– Glucose testing (gestational Diabetes)Glucose testing (gestational Diabetes)– Blood TypeBlood Type– Test for STD’sTest for STD’s– Numerous other testsNumerous other tests

Additional TestingAdditional Testing

High risk pregnancies at risk for fetal loss High risk pregnancies at risk for fetal loss receive antenatal testingat least once per receive antenatal testingat least once per week:week:– Non Stress testingNon Stress testing– Contraction stress testingContraction stress testing– Other tests as ordered by Dr.Other tests as ordered by Dr.– AMNIOCENTESIS VIDEOAMNIOCENTESIS VIDEO

Visit Interval - Pregnancy(Uncomplicated Patient)

• Conception until 26-28 weeks gestational age - Every 4 weeks (Pelvic exam on first visit)

28-36 weeks gestational age - Every 2 weeks

• 36-40 weeks gestation - Every week (Pelvic exam at least by term)

High risk pregnancy may alter visit intervals

Preterm labor risk may alter pelvic exam interval

Possible ConcernsPossible Concerns

BleedingBleeding

Decrease in fetal movementDecrease in fetal movement

SwellingSwelling

HeadacheHeadache

Visual DisturbanceVisual Disturbance

ContractionsContractions

Leakage of FluidLeakage of Fluid

Weight GainWeight Gain

It is normal for female to gain between 20-It is normal for female to gain between 20-40 lbs during pregnancy40 lbs during pregnancy

Too much = increased risk of gestational Too much = increased risk of gestational diabetesdiabetes

Gestational DiabetesGestational Diabetes

Too little = risks for fetusToo little = risks for fetus

Health of FetusHealth of Fetus

Females must be very careful about what Females must be very careful about what they take into their bodythey take into their body

– Everything she takes baby does too!Everything she takes baby does too!

Tobacco Tobacco

Smoking is estimated to count for up to:Smoking is estimated to count for up to:– 30% of low birth weight babies 30% of low birth weight babies – 14% of premature birth14% of premature birth– 10% of all infant deaths10% of all infant deaths

Studies also suggest that smoking during Studies also suggest that smoking during pregnancy can affect growth, mental pregnancy can affect growth, mental development, and behaviordevelopment, and behaviorFemales exposed to secondhand smoke Females exposed to secondhand smoke can also have increased riskscan also have increased risks

AlcoholAlcohol

ANY alcohol consumed during ANY alcohol consumed during pregnancy quickly passes pregnancy quickly passes through the umbilical cord to the through the umbilical cord to the fetus. Alcohol breaks down fetus. Alcohol breaks down much more slowly in a fetus then much more slowly in a fetus then in an adult, therefore fetus may in an adult, therefore fetus may have much higher BAC then have much higher BAC then mother and it will stay higher for mother and it will stay higher for longer.longer.

Alcohol and PregnancyAlcohol and Pregnancy

Fetal Alcohol Syndrome- group of alcohol Fetal Alcohol Syndrome- group of alcohol related birth defects that can cause both related birth defects that can cause both physical and mental problemsphysical and mental problems– Mental retardationMental retardation– Learning disabilitiesLearning disabilities– Serious behavior problemsSerious behavior problems– Slowed GrowthSlowed Growth– Physical deformitiesPhysical deformities– Heart defectsHeart defects

FAS is entirely preventable by avoiding alcohol FAS is entirely preventable by avoiding alcohol completely during pregnancy as well as for completely during pregnancy as well as for those considering pregnancythose considering pregnancy

Medicines and other drugs during Medicines and other drugs during PregnancyPregnancy

Using drugs while pregnant can have Using drugs while pregnant can have serious consequences even OTC serious consequences even OTC medicationsmedications

Babies can be born addicted to the drug Babies can be born addicted to the drug mother used while pregnantmother used while pregnant

ALL MEDICINESALL MEDICINES should be discussed should be discussed with Dr. before takenwith Dr. before taken

Environmental Hazards-Environmental Hazards- some some environmental substances can be harmful to fetus when environmental substances can be harmful to fetus when

exposed to motherexposed to mother

Lead- linked to miscarriages, mental disabilities, Lead- linked to miscarriages, mental disabilities, and behavior problemsand behavior problemsSmog- linked to birth defects, low birth weight, Smog- linked to birth defects, low birth weight, premature births, stillbirth, and infant deathpremature births, stillbirth, and infant deathRadiation- x-rays can affect fetal growth and Radiation- x-rays can affect fetal growth and cause mental retardationcause mental retardationCat litter- may contain parasite which can cause Cat litter- may contain parasite which can cause ToxoplasmosisToxoplasmosis which can result in miscarriage, which can result in miscarriage, premature labor, and health problems in a premature labor, and health problems in a newborn.newborn.

As a pregnant mother you are As a pregnant mother you are your unborn childs lifeline. You your unborn childs lifeline. You are solely responsible for the are solely responsible for the health of your baby for the next health of your baby for the next 9 months he or she is in you9 months he or she is in you