Prenatal Care and Identification of

Risk

Submitted by:• Waleed Al-Qurashi• Husam Al-Sohaimi• Ahmed Abeed• Meshary Al-hazmi• Omar Al-Ghamdi• AbdulWaheed Al-Ghamdi

To Be Presented to:• Associate Professor: Ahmed

Malibary

• Associate Professor: Timoor Khattab

UMM AL-QURA UNIVERSITY

College of Medicine

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Seminar Title:Prenatal Care and Identification of Risk

Date & Time :Sunday 25/09/2011 - 11:00 AM to 12:00 PM

Place :UMM AL-QURA UNIVERSITY - College of Medicine

Submitted by :Waleed Al-Qurashi Meshary Al-hazmiHusam Al-Sohaimi Ahmed AbeedOmar Al-Ghamdi AbdulWaheed Al-Ghamdi

Index :Case HistoryPresentationResearches & Evidences

:: Antenatal Care ::1 - Case History

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Salma is a 20 years old pregnant

gravida2 para1 at 40 weeks gestational age

came to ER in Friday 25-10-1432

complaning of abdominal pain.

Case History

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Present obestatric history:

LMP: 14-1-1432 sure preceded by

regular periods with no contraception

used. The pregnancy test was confirmed at

the 6th week , she did not have any

antenatal care visit . she did not do any

ultrasound imaging .first kick movement

felt at 20th week after that she felt fetal

movement regularly. She reported no

complication during her pregnancy until

last night she started to have abdominal

pain which is on and off , progressive ,

sever , last for 2-3 minutes .Case History

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Physical exam:

- Vital sign: BP105/64 RR:26 PULS:103

TEMP:36C.

- In general she was in labor, conscious,

well oriented.

- The abdomen was soft, not tender,

normal liquor, the fundal height was

37cm, the uterus was REGULAR

NOT TENDER, with one longitudinal

fetus, breech , engaged , the back in

right side with normal fetal heart.

-Past obestatric history:

Gravida 2 para1Case History

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Case History

Gynecological history:

Menarch at age of 14 years old

with regular menses and that last 4 days

with out pain.

Medical and surgical history :

No DM, HTN, cardiac disease or

any chronic disease . no surgical history.

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Case History

Allergy and medication:

She is not taking any

corticosteroids or broad spectrum

antibiotics or any medication. she has no

allergy to any medication.

Social history:

A nonsmoker Saudi housewive

married once for two year living in azizai.

She delivered a normal healthy boy by through

SVD.

The baby's weight is height is head

circumference

:: Prenatal Care ::2- Presentation

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Prenatal Care Embraces:

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• Maternal health care

• Evolution of fetal health and development

• Disease screening

• Analysis the risk for development of complication

• Provision of advice and education

Prenatal Care Components:

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• 2.1 - Antenatal record

• 2.2 - First trimester

• 2.3 - Second trimester

• 2.4 - Third trimester

• 2.5 - Imaging

• 2.6 - Fetal assessments

• 2.7 - Complications and emergencies

2.1 - Antenatal record:

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• Medical history and physical examination

• Gestational age (GA)

• Symphysis-fundal height (SFH; in cm)

• Leopold maneuver

• Blood pressure

2.2 - First trimester:

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• Complete blood count (CBC)• Blood type

• Rapid plasma reagent (RPR)

• Rubella antibody screen

• Hepatitis B surface antigen• Gonorrhea and Chlamydia culture• PPD• Pap smear• Urinalysis and culture• HIV screen• Group B Streptococcus screen

2.3 - Second trimester:

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• Maternal serum alpha-fetoprotein screen (MSAFP/quad)

• Amniocentesis:triple test, nuchal screening, nasal bone, alpha-fetoprotein Chorionic villus sampling

2.4 - Third trimester:

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• Hematocrit

• Glucose loading test (GLT)

• Glucose tolerance test (GTT)

2.5 - Imaging:

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• Ultrasound 12th week (dating scan) and the 20th week

(detailed scan):1. Gestational age

2. Multiple gestation

3. Ectopic pregnancy

4. Evaluated of placentae and amniotic sacs

• X-rays and (CT) (MRI)

2.6 - Fetal assessments:

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• Fetal karyotype

• Biophysical profiles (BPP)

• Percutaneous umbilical blood sampling (PUBS)

• Nonstress test (NST)

• Oxytocin challenge test

2.7 - Complications and emergencies:

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• Ectopic pregnancy

• Pre-eclampsia

• Placental abruption

• Fetal distress

• Shoulder dystocia

• Uterine rupture

• Prolapsed cord • Obstetrical hemorrhage such as placenta previa, uterine

rupture of tears, uterine atony, retained placenta or placental fragments, or bleeding disorders

• Puerperal sepsis

:: Prenatal Care ::3- Researches &

Evidences

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:: Prenatal Care ::3- Researches &

Evidences

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Does lowering of antenatal care visit’s well increase the risk of pregnancy?!

3.1 –

3.2 -

Who systemic review of randomized controlled trials of routine antenatal care

Antenatal care in Saudi Arabia - Lifestyle

Background Methods

There is a lack of evidence of the

content, frequency, and timing of

visits in standard antenatal-care

programmes.• Standard Model (14 visits):

8-28 weeks every 4 weeks

28-36 weeks every 2 weeks

36 weeks every 1 weeks

• New Model:

Less than 14 visits (4-8

visit)

The main hypothesis was:

• New Model Vs Standard Model

The selected outcomes were:

• Preeclampsia

• Urinary-tract infection

• Postpartum anaemia

• Maternal mortality

• Low birthweight

• Women’s satisfaction & cost

effectiveness.

Findings Interpretation

• 7 eligible randomised controlled

trials• 57 418 women participated :

o 30 799 (new-model)

o 26 619 (standard-model)

• No clinically differential effect in

reduced number of visit

• Mortality were similar

• New-mode visits could be

introduced into clinical practice

• The cost of the new model was

equal to or less than that of the

standard model.

• NO risk to mother or baby

• Some degree of dissatisfaction by

the mother could be expected

• Lower costs can be achieved

• Dissatisfaction with care was

observed

Antenatal care in Saudi Arabia has been improved due

to:• Good planning and strategy

• Provide community education & health Facilities

• Participate in international research & trial

Ministry of Health

مولود ألف لكل الخامسة دون األطفال وفيات متوسطوالتعاون التنمية منظمة ودول المملكة في حي

واألوروبي ) (2009 – 1990األقتصاديالوفيات مؤشر

Ministry of Health

Best Time To Get Pregnant

Pregnancy Due Date Calculate

Saudi Society of Family and Community Medicine

Mobily Telecom Company

ThankYou

The

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