1 / 60

Diagnosis of pregnancy &antenatal care

UNDERGRADUATE COURSE LECTURES IN OBSTETRICS&GYNECOLOGY ,Faculty of medicine ,Zagazig University

guest60815
Download Presentation

Diagnosis of pregnancy &antenatal care

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Diagnosis of pregnancy DR: MANAL BEHERY Zagazig University , Egypt

  2. Principles of diagnosis • In the majority of women, the diagnosis of pregnancy is usually straightforward based on a history of amenorrhea and a positive pregnancy test. • women with irregular periods or irregular vaginal bleeding , the diagnosis of pregnancy is more complex. • Other symptoms of pregnancy may alert the clinician to the possibility of pregnancy.

  3. Symptoms of pregnancy: • Amenorrhoea: HOWEVER • Pregnancy may occur during period of lactation amenorrhea. • Slight bleeding early in pregnancy (threatened abortion) may be considered by the patient as menses . • Hartman's symptoms: slight bleeding occurs at time of menstruation

  4. Symptoms of pregnancy: • Morning sickness:nausea, rarely vomiting confined to morning • Increased frequency of micturition. • Enlargement of the breastand sensation of heaviness. • Easy fatiguability and tendency to sleep. • Emotional changes e.g. change of the appetite:

  5. In the second and third trimesters • 1-Abdominal enlargement • 2-Quickening -1st perception (sensation) of fetal movements by the lady • -PG (18-20 weeks), MP (16-18 weeks)

  6. Signs of pregnancy

  7. Chloasma gravidarum • Butterfly face • pigmentation

  8. Breast signs • Increased pigmentation of the nipple and lry areola.

  9. Appearance of Montgomery tubercle in the areola • dilated sebaceous glands

  10. Abdominal stria

  11. Linea nigra

  12. - Abdominal signs Inspection:-

  13. 2- Palpation:

  14. Auscultation: • Auscultation of FHS as early as 10-12 weeks by sonicade • Auscultation of FHS as early as 20-24 weeks by Pinard stethoscope • Auscultation of umbilical souffle as early as 20-24 weeks. • Auscultation of uterine souffl

  15. Pregnancy tests:Principle: • Detection of • HCG in the • urine or • serum .

  16. 1- Urinary pregnancy test: • Classically it becomes +Ve 7- 10 day after 1st missed period • Commercial testing kits are available that are sensitive to 25 iu/L in urine. • By the time the mother has missed her first menstrual period, her hCG levels are around 100 iu/L.

  17. Serum pregnancy test: • Classically it becomes +Ve 5- 7 days before 1 st missed period • A quantitative serum HCG assay level of > 5 iu/L will usually denote a pregnancy. • With a normal intrauterine pregnancy, the hCG level doubles approximately every 36-48 hours.

  18. Tran abdominal US

  19. Transvaginal ultrasound ( TVS):

  20. 12 WEEKS GESTATION • CROWN RUMP • LENGTH(CRL)

  21. 2ND TRIMESTER

  22. Sure signs of pregnancy: • Inspection of fetal parts as early as 20th week. • -Inspection of fetal movements as early as 20th week. • Palpation of fetal movements as early as 20th week. • -Palpation of fetal parts as early as 20th week.

  23. Sure signs of pregnancy • -Auscultation of FHS at 10-12 weeks by sonicade • Investigations: Visualization of fetal parts by ultrasound

  24. ANTENATAL CARE

  25. Definition • Antenatal care refers to the care that is given to an expected mother from time of conception is confirmed until the beginning of labor • It is a preventative cost effective service

  26. GOALS • 1-Ensure mother health. • 2- Ensure delivery of a healthy infant. • 3-Anticipate problem • 4- Diagnose problem early.

  27. Objectives • 1-Early detection and if possible, prevention of complications of pregnancy. • 2-Educate women on danger and emergency signs & symptoms. • 3-Prepare the woman and her family for childbirth • 4- Give education & counseling on family planning

  28. Schedual of antenatal care: Medical check up every four weeks up to 28 weeks gestation, Every 2 weeks until 36 weeks of gestation Every week until delivery An average 7-11 antenatal visits/pregnancy More frequent visits may be required if complications arise.

  29. On first antenatal visit • 1-First : Confirm pregnancy by pregnancy test or US. • 2-History • 3-Physical examination • 4-investigation

  30. History • Personal history • Menstrual history • Obstetrical history • Family history • Medical and surgical history • History of present pregnancy

  31. Menstrual history • Ask about • 1-Last menstrual period (LMP). • 2-Regularity and frequency of menstrual cycle. • 3-Contraception method used . • 4-Calculate expected date of delivery (EDD)as 1st day of LMP −3 months +7 days, and change the year.

  32. Obstetric History • Gravidity? Parity? abortion, and living children. • Weight of infant at birth & length of gestation. • Type of delivery, location of birth, and type of anesthesia. • Maternal or infant complications.

  33. Medical and surgical history: 1-Chronic conditions : as diabetes mellitus, hypertension, and renal disease ,cardiac disease. 2-Prior operation: as cesarean section, genital repair, and cervical cerclag. 3-Allergies, and medications. 4-Accidents involving injury of the bony pelvis

  34. History of present pregnancy • History suggesting e.g. Diabetes, hypertension and ante partum hemorrhage. • Ask about episodes of fever or chills • Ask about pain or burning sensation on urination. • Abnormal vaginal discharge, itching at the vulva or if partner has a urinary problem.

  35. IMMEDIATE ASSESSMENT for emergency signs. • Vaginal bleeding • Severe abdominal or pelvic pain • Severe headache with visual disturbance • Persistent vomiting • Unconscious/Convulsion • Severe difficulty in breathing • High grade Fever • Looks very ill

  36. Assessment and physical examination

  37. Weight measurement • Maternal height and weight measurements to determine body mass index(BMI). • Maternal weight should be • measured at each • antenatal visit

  38. Check for pallor or anemia. 1-Look for palmar pallor. 2-Look for conjunctival pallor 3-Count respiratory rate in one minute.

  39. Blood pressure measurement • Measure BP in sitting position. • If diastolic BP is 90 mm Hg or higher repeat measurement after 6 hour rest. • If diastolic BP is still 90 mm Hg or higher ask the woman if she has: • Severe headache • Blurred vision • Epigastricpain • Check urine for protein.

  40. Investigations Get baseline on the first or following the first visit. • Hemoglobin, blood type • Urine analysis • VDRL or RPR to screen for syphilis • Hepatitis B surface antigen To detect carrier status or active disease

  41. At each visit

  42. At each visit • 1-Questions about fetal movement • 2-Ask for danger signs during this pregnancy • 3-Ask patient if she has any other concerns

  43. Symphysis Fundalhieght • LMP plus 280 days • Add 7 days, subtract 3 months • MacDonald's Rule (cm = weeks)

  44. At third trimester Do Leopold’s exam

  45. Provide advice on • Diet and weight gain • Medication • Avoid Radiation exposure • Self-care during pregnancy • Minor complaints. • Family planning Breastfeeding • Birth place preparation and anticipation of complication& Emergency situations.

  46. Diet in pregnancy: • Total caloric intake increase to 300 kcal /day due to 15% increase in BMR . • Diet show contain 20%Protein(better from animal source), 30% fat ,and 50% carbohydrates . • Sufficient fluids should be available.

  47. Supplementation • 1-Folic acid 0.4 mg tab daily • 2- iron (ferrous sulphate or gluconate )300 mg/daily • 3- Ca 1200mg /daily • 4- • -Those with a normal balanced diet • probably don’t need extra vitamins

  48. Weight gain in pregnancy: • There is a slight loss of pounds during early pregnancy if the patient experiences much nausea and vomiting. • Weight gain of 2 to 4 lbs(0,5-1 kg) by the end of the first trimester. • Gain of 1 lb(0.5)/ per wk is expected during the second and third trimesters. • Monitoring of weight gain should be done in conjunction with close monitoring of BP.

  49. Medications During Pregnancy • Antibiotics - some OK, some not • Local anesthetics - OK • Local with epinephrine - not OK • Aspirin - not OK • Immunizations - some are OK, some are not • Antimalarial - some OK, some are not • Narcotics - OK except for addiction issue

  50. Case Study

More Related