Antenatal Examination and Prophylactic Medication
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ANTENATAL EXAMINATION
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Antenatal Examination and Prophylactic Medication
- 1. ANTENATAL EXAMINATION INVESTIGATION AND PROPHYLACTIC MEDICATION Presented by:- KHUSHBOO SINGH
- 2. INTRODUCTION
- 3. ANTENATAL CARE /EXAMINATION IT’ S A SYSTEMIC (Examination and advice) of a women during pregnancy Assessment’ MEANS is ‘ to evaluate’i.e. here we gather the information of client status and it identifies the specific needs of a client by which better care can be given to the client and her developing fetus.That means,it is the systematic supervision(examination & advice)of a woman during pregnancy.So,it is the foundation stone for antenatal care.
- 4. Objective • To screen the ‘ high risk’cases • To prevent or to detect and treat at the earilest any complications. • To ensure continued medical surveillence and prophylaxis. • To educate mother about the physiology of pregnancy and labour by demonstration,charts and diagrams so that fear is removed and psychology is improved. • To discuss with the couple about the place,time and mode of delivery and care of newborn. • To motivate the couple about to the need of family planning. • To give appropiate advice to couple seeking MTP.
- 5. GENERAL PRINCIPLES • Always explain to the patient the need and the nature of the proposed examination. Obtain a verbal consent once she has been told what the examination would entail. • The examiner (male or female) should be accompanied by another female • Examination performed in a private side-room, respecting patient's privacy at all times. • Patient should be covered at all times and relevant parts of her anatomy only exposed. • Make sure the room is well lit and comfortably warm.
- 6. • Ensure the patient has emptied her bladder before examining her abdomen. • Patient should lie in the supine position with a pillow under the head and arms by her side. • She is slightly rolled to the left side to prevent compression of the inferior vena cava by the enlarged uterus (inferior venacaval syndrome or supine hypotensive syndrome). • Ask for any tender area before palpating the abdomen.
- 7. MEASURES • MATERNAL MEASURE • FETALMEASURE
- 8. Maternal measures • History Taking Examination • General • Physical • Obstetrical • Abdominal examination • Vaginal examination • Radiological Examination/investigation
- 9. History Taking Vital Statistics • Name: … … … … … … … … … … .. • Date of first examination: … … .. • Address:… … … … … … … … … … • Age:… … … … … … … … … … … … • Gravida:Parity… … … … … … … .. • Duration of marriage: … … … … . • Religion: • Occupation: … … … … … … … … … … … • Period of Gestation: … … … … … … … .. • Chief Complaints: … … … … … … … … .(sleep,appetite,bowel habit,urination) • History Of present illness:… … ........... • History of present pregnancy: … … … First trimester – Hyperemesis gravidarum second trimester-pyelitis, third trimester-anemia,pre- eclampsia and APH also note the no. of antenatal checkups,any exposure to medication or radiation
- 10. • Obstetrics History..No. of children,health status of the baby,immunization, if any miscarriage • Menstrual history: … … … … … … … … ..age of menarche, LMP,Duration,EDD,Amount of blood flow • Past medical history: … … … … … … … . • Past surgical history: • Family History Personal History
- 11. General and Physical Examination: • • Build:Obese/Average/Thin • Nutrition:Good/Average/Poor • Height:Short stature is likely to be associated with small pelvis. • Weight:The total weight gain during the course of singleton pregnancy for a healthy women averges 11 kg(24 Ib) • Pallor:The sites to be noted are lower conjunctiva,dorsum of tongue and nail beds.
- 12. • Jaundice:The sites to be noted are conjunctiva,tongue,skin. • Tongue,teeth,gums and tonsils: • Neck:Neck veins,thyroid gland or lymph nodes should be inspected. • Breast Examination:It should be inspected for pregnancy changes
- 14. Obstetrical Examination : ABDOMINAL EXAMINATION Inspection • Describe the abdominal distension (pyriform). • Previous operative(Caesarean)scars • Striae gravidarum or stretch marks • Linea nigra- a dark vertical line appearing on the abdomen from the pubis to above the umbilicus during pregnancy due to increase melanocyte- stimulating hormone made by the placenta. • Visible foetal movements.
- 15. Palpation • Fundal height (Symphysis-fundal height) • Foetal poles • Foetal lie • Presentation- cephalic(head),breech,etc • Attitude • Level of engagement of presenting part • State of uterine wall/ myometrium • Liquor volume • Estimate foetal weight • Foetal movements
- 16. Auscultation • Auscultation of the foetal heart: • Auscultated with a foetal stethoscope( Pinard's foetal stethoscope) or with a doptone machine. • Best place to listen is over the foetal back, closer to the cephalic pole. • The normal foetal heart rate is btw 110 to 160 beats per minute
- 19. Abdominal Examination: • Palpated using four Leopold's manoeuvres • The fundal grip(foetal poles): • Both hands placed over the fundus and the contents of the fundus determined. • A hard smooth, round pole indicates a fetal head. • A softer triangular pole continuous with the fetal body is the fetal buttocks(breech)
- 20. Lateral grip Symphysis-fundal height(Size and gestational age of the uterus) • More objective, distance from the symphysis pubis to the uterine fundus (top of the uterus) • size of the uterus directly related to the size of the fetus.
- 21. Technique • Palpate down from xiphi-sternum to determine the highest part of the uterus(fundus),may not always be in the midline. • -Mark this point with a pen after obtaining her permission. • -A tape measure turned upsidedown(blinded to avoid bias) is then placed from the mid-point on the uppermost border of the symphysis pubis over the curve of the uterus to the marked highest point of the uterus. • -The tape is then turned and actual measurement in cm is recorded, preferably in graphic form
- 23. Pawlik grip(3rd Leopold) – • The thumb and middle fingers of the right hand are placed wide apart over the suprapubic area to determine the presenting part. • -Presenting part of fetus is the lowest most part of the fetus at the inlet of the pelvis(the lower fetal pole as opposed to the fetal pole in the fundus). • -Cephalic or breech presentation distinguished from each other
- 24. Pelvic grip (Presenting part):
- 25. • -If cephalic prominence on the same side as fetal back, fetal head is extended (abnormal position). • -If examiners hands reach the fetal head equally on both sides, fetal head is deflexed ('Military position, indicating mal-position
- 26. Vaginal Examination: • It should be done by using the left fingers(thumb & index),the character of vaginal discharge,cervix consistency,cystocele,uterine prolapse,rectocele is to be elicited. • Can be done for taking vaginal swabs for investigations
- 28. Investigations
- 30. Investigations • Blood examination (for ABO,Rh,VDRL ) and screening for blood glucose in selected cases • Serological test for Rubella , hepatitis B virus, • Maternal alpha feto protein-at 16-18 weeks is done to detect neural tube defect down syndrome and other chromosomal abnormality • Urine examination • For examining protein, sugar,pus cells
- 32. FETAL MEASURE • Biochemical • MSAFP,Triple test,AChE,) • Cytogenetic • Amniocentesis • Chorion Villus Sampling(CVS) • Cordocentesis • Fluorescence In Situ Hybridisation(FISH) • Biophysical • • Fetal movement count(DFMC) • • Non Stress Test(NST) • • Fetal biophysical profile(BPP) • • Contraction stress test(CST) • • Doppler Ultrasound • •
- 37. Biophysical Profile Biophysical Profile: • It is the screening test for utero-placental insufficiency. • The fetal biophysical activities are initiated,modulated and regulated through fetal nervous system. • The fetal CNS is very much sensitive to diminished oxygenation.
- 39. Non Stress Test(NST) • It is the continuous electronic monitoring of the fetal heart rate along with recording of fetal movements (cardiotocography) is undertaken. • FHR acceleration with fetal movements,which when present,indicates a healthy fetus. • It is used as screening test. • The test is valuable to identify the fetal wellness rather than illness. • Test should be started after 30 weeks and frequency should be twice weekly • • Reactive(Reassuring): When two or more acceleration of more than 15 beats per minute above the base line and longer than 15 sec in duration are present in a 20 min observation. • • Non-Reactive(Non-Reassuring):Absence of any fetal reactivity.
- 40. Fetal movement count(DFMC) • • The patient counts the fetal movements every morning,noon and evening. • • Three counts each of one hour duration are recommended. • • If the no. of kicks are less than 10 in 12 hrs. or 3 in each hour it indicates fetal compromise. • • Increased fetal movements associated with maternal hypoglycemia. • • Decreased FM cause obesity,smoking,hypoxia, anterior placenta,hydramnios,narcotic drugs.
- 41. Ultrasound Indications • • Diagnosis of pregnancy. • • Assessment of gestational age. • • Diagnosis of multiple pregnancy. • • Assessment of IUGR or BPP. • • Uterine size either > dates or < dates. • • Asessment of liquor volume. • • Diagnosis of any abnormality e.g. placenta praevia etc.
- 43. PROPHYLACTIC MEDICATION • Calcium -1000mg • Zinc -15 mg • Protein -60gm • Vitamin A -5000 IU • Vitamin D -400 IU
- 46. Disease Prophylactic drug Anemia prophylaxic Nausea and vomiting Gestational diabetes Hyperthyroid Hypothyroid Thromboembolism HIV 30-60mg of elemental iron Folic 0.4 mg (800 ug) First-line management –Pyridoxine, Doxylamine •Alternatives – Phenothiazines, Metoclopramide (risk of sedation and extrapyramidal effects) – Ondansetron –Corticosteroids (for hyperemesis gravidarum) First-line treatment –Insulin • Alternatives –Glyburide and metformin • Intravenous drip insulin should be used during labor •Propylthiouracil –first trimester • Methimazole –second and third trimesters •Contraindication –Iodine131 – risk of thyroid damage in fetus •Thyroid replacement therapy – Levothyroxine (0.1 mg/day) Warfarin (between 6 and 12 wk) – Unfractionated heparin –Injectable direct thrombin inhibitors Lopinavir-ritonavir –Recommended in pregnant women •Prevention of mother-to-child transmission –Zidovudine with single dose of nevirapine
Notas del editor
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