Se ha denunciado esta presentación.
Utilizamos tu perfil de LinkedIn y tus datos de actividad para personalizar los anuncios y mostrarte publicidad más relevante. Puedes cambiar tus preferencias de publicidad en cualquier momento.
Detecting
High Risk Pregnancy
Dr. Varsha L. Deshmukh
Assoc. Prof & Unit Incharge
Govt. Medical College,
AURANGABAD
Introduction
• Pregnancy including labour & delivery is itself
a high risk event.
• The aim of risk assessment is to ident...
Receiving quality antenatal,
intranatal & postnatal services
is one of the reproductive
rights of women
Introduction
• It is impossible for the process of risk
assessment to predict every perinatal event.
• WHO recommends that...
Aim
• To identify women with maternal
complications & obst. risk factors.
Why to Identify or
Detect Women with
High Risk Factors
• It will reduce the number of cases
brought in a state of emergency when
t/t is most difficult & least effective.
• If t/...
Maternal Mortality
Major causes of maternal mortality are
• PIH
• Eclampsia
• APH
• PPH
• Puerperal sepsis
• Obstructed la...
Maternal mortality is a gender issue
& speaks about the status of women
in the society.
Maternal mortality is an equity is...
Except for hemorrhage other causes of
maternal mortality can be identified &
treated effectively, thus maternal
mortality ...
Obstetric Emergencies
The obst. emergencies are life threatening
• Fatality rate is more
• Difficult to treat
• Surgery ra...
Cost Effectiveness
• Early diagnosis leads to less
emergencies hence less drug
requirement & less morbidity
• Thus the ris...
What to Do ?
1. Early diagnosis
2. Community awareness about
antenatal care
3. Early initiation of appropriate therapy
4. ...
What to Tell ?
Every clinic must emphasize the following
1. ANC it is essential need
2. Eat more
3. Rest more
4. Get immun...
Ante-natal care
• Periodic check-ups
• Risk factors identified on time
• Treatment started early
• Hospital delivery
• Mat...
Early Registration
• Early – before 12 wks (preferably)
• Before 20 wks
• At 32 wks
• At 36 wks
• Encourage to visit more ...
ANC
• Careful history
• Physical examination
• Pregnancy progressing normally
• Complications if occurs diagnosed early
• ...
History
• LMP/EDD
• Age of the patient < 18 yrs. > 35
yrs.
• Order of pregnancy primigravida or
grand multi.
• Interval of...
Past Obst. History
• Parity
• H/o still birth
• IUFD
• BOH
• Preterm labour
• Macrosomic baby
• IUGR baby
• Sev. PIH
Life Threatening Situations
• H/o PPH
• H/o APH
• H/o MRP
• H/o Eclampsia/HELLP
• H/o Other complications
associated with
...
Complaints
• Breathlessness
• Excessive tiredness
• Palpitation
• Puffiness of face
• Headache
• Blurring of vision
• Blee...
Physical Examination
• Maternal weight
• Maternal height < 140 cm
• Look for pallor, puffiness
of face, oedema of feet.
• ...
Pallor
Abdominal Examination
• Abdominal examination is done to
monitor the progress of pregnancy, fetal
growth, fetal lie and fe...
Gravidogram
Fetal Lie
• Vertical
• Transverse
• Oblique
Fetal
Presentation
• Vertex
• Breech
• Shoulder
• Cord
• Hand
• Compound
FHS
• Normal 120-160 b.p.m.
• Fetal tachycardia > 160 b.p.m.
• Fetal bradycardia < 120 b.p.m.
• Loss of fetal movement
• P...
Advise to Mothers
• Food and rest
Advise to Mother
• Anaemia prophylaxis
• Tab. FS + FA 100 mg 1OD x 3 mths.
• S/o anemia present - Tab. FS + FA 100
mg one ...
Advise to Mother
• TT immunization
• Preparation for labour
Laboratory Test
• Anemia (Hb < 10 gm%)
• Rh –ve blood group
• Blood sugars
• HIV
• Hepatitis B
• Urine microscopy
Current Pregnancy Status
• Multiple gestation
• Vaginal bleeding
• Decreased fetal movements
• Preterm labour or cervical ...
High Risk Pregnancy
Low Risk Labour
• Spontaneous onset at 37 to 40 wks
• Single fetus with vertex presentation
• Estimated fetal weight avera...
Normal Low Risk Labour
• Acceptable rate of cervical dilatation
• FHS normal
• Head engaged at full dilatation
• Normal de...
High Risk Labour
• Abnormal FHS
• Meconium stained liquor
• Malpresentation
• Intrapartum hemorrhage
• PROM
• Instrumental...
High Risk Labour
• Multiple pregnancy
• Cord prolapse
• Fetal macrosomia
• Dysfunctional labour
• Previous LSCS
• Prolonge...
Labour
5 Cs
• Clean hands
• Clean surface
• Clean razor
• Clean cord tie
• Clean cord stump
Partogram
Partogram
• Cervical dilatation
• Descent of head
• Uterine contractions
• Drugs given
• Fetal heart rate record
Partogram
• Concept of alert line
• Concept of action line
• Assessment of maternal
condition
• Assessment of fetal
condit...
Each and every one working
in the health department is
committed to reduce the
maternal mortality and to
realize the repro...
Obst.
Emergencies
• ANC
• Anemia
• PIH
• Eclampsia
• Placenta previa
• Abruptio placenta
• PPH
• Retained placenta
• Malpr...
Referral Obst. Emergencies
• Position of the patient
• Left lateral position
• Mouth gag
• Start IV fluid – ringer lactate...
Referral Note
• Should mention salient
points about the
history
• Main clinical findings
• Medications (dose,
route, time ...
Advise to Family Members
• About high risk situation
• About blood donation
• About financial aspects
• Blood donors
• Sen...
Referral
• Should be transported by the quickest
mode of transport
• 3 delays
Through a team approach all of the skills
of the health care members involved can
be combined to provide the best possible...
A systematic & a well begun
programme with a positive thinking
will definitely show road to success
to accept this challen...
High risk pregnancy
High risk pregnancy
Próxima SlideShare
Cargando en…5
×
Próxima SlideShare
Screening of high risk pregnancy
Siguiente
Descargar para leer sin conexión y ver en pantalla completa.

48

Compartir

Descargar para leer sin conexión

High risk pregnancy

Descargar para leer sin conexión

Libros relacionados

Gratis con una prueba de 30 días de Scribd

Ver todo

Audiolibros relacionados

Gratis con una prueba de 30 días de Scribd

Ver todo

High risk pregnancy

  1. 1. Detecting High Risk Pregnancy Dr. Varsha L. Deshmukh Assoc. Prof & Unit Incharge Govt. Medical College, AURANGABAD
  2. 2. Introduction • Pregnancy including labour & delivery is itself a high risk event. • The aim of risk assessment is to identify the factors that may constitute greater than average risk to a pregnancy. • This permits the prediction of potential adverse pregnancy outcomes & enables the process of selecting women who may benefit from extra researches.
  3. 3. Receiving quality antenatal, intranatal & postnatal services is one of the reproductive rights of women
  4. 4. Introduction • It is impossible for the process of risk assessment to predict every perinatal event. • WHO recommends that a risk assessment approach be used in the mgt. of maternal, fetal health care. • It also suggest arrangement for delivery at tertiary care center for high risk obst. pts. .
  5. 5. Aim • To identify women with maternal complications & obst. risk factors.
  6. 6. Why to Identify or Detect Women with High Risk Factors
  7. 7. • It will reduce the number of cases brought in a state of emergency when t/t is most difficult & least effective. • If t/t is started in time, it is possible to save life of both mother & baby. • Timely referral after appropriate medication is important improving the prognosis.
  8. 8. Maternal Mortality Major causes of maternal mortality are • PIH • Eclampsia • APH • PPH • Puerperal sepsis • Obstructed labour • Unsafe abortions
  9. 9. Maternal mortality is a gender issue & speaks about the status of women in the society. Maternal mortality is an equity issue as maximum maternal death are reported from people living below poverty line from under privilege community
  10. 10. Except for hemorrhage other causes of maternal mortality can be identified & treated effectively, thus maternal mortality can be greatly reduced.
  11. 11. Obstetric Emergencies The obst. emergencies are life threatening • Fatality rate is more • Difficult to treat • Surgery rate is increased • BT rate is increased • Hospitalization prolonged • Morbidity more
  12. 12. Cost Effectiveness • Early diagnosis leads to less emergencies hence less drug requirement & less morbidity • Thus the risk assessment system along with timely referral is highly cost effective.
  13. 13. What to Do ? 1. Early diagnosis 2. Community awareness about antenatal care 3. Early initiation of appropriate therapy 4. T/t plan stream lining 5. Early identification 6. Timely referral
  14. 14. What to Tell ? Every clinic must emphasize the following 1. ANC it is essential need 2. Eat more 3. Rest more 4. Get immunized (Inj TT) 5. Take Tab. FS 6. Hospital delivery
  15. 15. Ante-natal care • Periodic check-ups • Risk factors identified on time • Treatment started early • Hospital delivery • Maternal complications diagnosed early • Maternal & fetal mortality less
  16. 16. Early Registration • Early – before 12 wks (preferably) • Before 20 wks • At 32 wks • At 36 wks • Encourage to visit more often in 3rd trimester
  17. 17. ANC • Careful history • Physical examination • Pregnancy progressing normally • Complications if occurs diagnosed early • Timely referral • Institutional delivery
  18. 18. History • LMP/EDD • Age of the patient < 18 yrs. > 35 yrs. • Order of pregnancy primigravida or grand multi. • Interval of < 2 yrs since last pregnancy • H/o cardiac disease, diabetes, chronic hypertension
  19. 19. Past Obst. History • Parity • H/o still birth • IUFD • BOH • Preterm labour • Macrosomic baby • IUGR baby • Sev. PIH
  20. 20. Life Threatening Situations • H/o PPH • H/o APH • H/o MRP • H/o Eclampsia/HELLP • H/o Other complications associated with pregnancy which were life threatening
  21. 21. Complaints • Breathlessness • Excessive tiredness • Palpitation • Puffiness of face • Headache • Blurring of vision • Bleeding p/v • Leaking p/v • Pain in abdomen
  22. 22. Physical Examination • Maternal weight • Maternal height < 140 cm • Look for pallor, puffiness of face, oedema of feet. • Blood pressure 120/80 mmHg > 140/90 mmHg after 20 wks. S/o PIH
  23. 23. Pallor
  24. 24. Abdominal Examination • Abdominal examination is done to monitor the progress of pregnancy, fetal growth, fetal lie and fetal presentation. • Height of uterus 12 wks just palpable 24 wks at umbilicus 36 wks at xiphisternum
  25. 25. Gravidogram
  26. 26. Fetal Lie • Vertical • Transverse • Oblique
  27. 27. Fetal Presentation • Vertex • Breech • Shoulder • Cord • Hand • Compound
  28. 28. FHS • Normal 120-160 b.p.m. • Fetal tachycardia > 160 b.p.m. • Fetal bradycardia < 120 b.p.m. • Loss of fetal movement • Passage of meconium • All suggestive of fetal distress
  29. 29. Advise to Mothers • Food and rest
  30. 30. Advise to Mother • Anaemia prophylaxis • Tab. FS + FA 100 mg 1OD x 3 mths. • S/o anemia present - Tab. FS + FA 100 mg one B.D. x 3 mths. • Tab. Mebendazol 1 B.D. x 3 days. • Dietary advise
  31. 31. Advise to Mother • TT immunization • Preparation for labour
  32. 32. Laboratory Test • Anemia (Hb < 10 gm%) • Rh –ve blood group • Blood sugars • HIV • Hepatitis B • Urine microscopy
  33. 33. Current Pregnancy Status • Multiple gestation • Vaginal bleeding • Decreased fetal movements • Preterm labour or cervical change • PIH • Abnormal uterine size (IUGR/V mole) • Abnormal amniotic fluid volume • Postdatism
  34. 34. High Risk Pregnancy
  35. 35. Low Risk Labour • Spontaneous onset at 37 to 40 wks • Single fetus with vertex presentation • Estimated fetal weight average • Normal vital signs • No pregnancy complications • No abnormal intrapartum bleeding
  36. 36. Normal Low Risk Labour • Acceptable rate of cervical dilatation • FHS normal • Head engaged at full dilatation • Normal delivery within 2 hrs of good expulsive force • Third stage < 30 min • Total blood loss < 500 ml
  37. 37. High Risk Labour • Abnormal FHS • Meconium stained liquor • Malpresentation • Intrapartum hemorrhage • PROM • Instrumental delivery • PIH
  38. 38. High Risk Labour • Multiple pregnancy • Cord prolapse • Fetal macrosomia • Dysfunctional labour • Previous LSCS • Prolonged labour • CPD • Rupture uterus • Chorioamniotis
  39. 39. Labour 5 Cs • Clean hands • Clean surface • Clean razor • Clean cord tie • Clean cord stump
  40. 40. Partogram
  41. 41. Partogram • Cervical dilatation • Descent of head • Uterine contractions • Drugs given • Fetal heart rate record
  42. 42. Partogram • Concept of alert line • Concept of action line • Assessment of maternal condition • Assessment of fetal condition • Timely referral
  43. 43. Each and every one working in the health department is committed to reduce the maternal mortality and to realize the reproductive rights of a women.
  44. 44. Obst. Emergencies • ANC • Anemia • PIH • Eclampsia • Placenta previa • Abruptio placenta • PPH • Retained placenta • Malpresentations • Obstructed & prolonged labour • Rupture uterus
  45. 45. Referral Obst. Emergencies • Position of the patient • Left lateral position • Mouth gag • Start IV fluid – ringer lactate • First dose of broad spectrum antibiotics • Other specific medication as indicated e.g. inj. MgSo4 in eclampsia • Breast feeding to be continued during transfer in cases of PPH
  46. 46. Referral Note • Should mention salient points about the history • Main clinical findings • Medications (dose, route, time of administration) • If telephonic facility is available should alert the referral hospital
  47. 47. Advise to Family Members • About high risk situation • About blood donation • About financial aspects • Blood donors • Senior members for consent
  48. 48. Referral • Should be transported by the quickest mode of transport • 3 delays
  49. 49. Through a team approach all of the skills of the health care members involved can be combined to provide the best possible approach to meet the pregnancy’s need. The role of patient education can not be over emphasized. Incorporating the mother as an active member in her health care is an investment in time and effort that is cost effective both during pregnancy and labour.
  50. 50. A systematic & a well begun programme with a positive thinking will definitely show road to success to accept this challenge
  • TanuBhatia8

    Sep. 25, 2021
  • SHUBHAMKUMARPATHAK2

    Aug. 19, 2021
  • MeerSeerat1

    Jun. 12, 2021
  • GopiGopi70

    May. 22, 2021
  • VictoryOgbonnnaya

    Apr. 29, 2021
  • Monikashankar

    Apr. 10, 2021
  • AsisMahto

    Feb. 23, 2021
  • usharathava

    Feb. 3, 2021
  • RaniKujur

    Dec. 20, 2020
  • PartgSarthi

    Dec. 19, 2020
  • RamaniVasamsetti

    Oct. 21, 2020
  • SoniKhatri3

    Aug. 23, 2020
  • PriyanshaKd

    Mar. 31, 2020
  • nehamathur54

    Feb. 24, 2020
  • AshwiniKollur1

    Feb. 3, 2020
  • ArunSharma10

    Jul. 10, 2019
  • gokulkatkade7

    Jun. 26, 2019
  • NishaChavan1

    May. 29, 2019
  • smriti35

    May. 24, 2019
  • CalvinMensah

    May. 22, 2019

Vistas

Total de vistas

21.526

En Slideshare

0

De embebidos

0

Número de embebidos

5

Acciones

Descargas

700

Compartidos

0

Comentarios

0

Me gusta

48

×