2. Principles of diagnosis
ďIn the majority of women, the diagnosis of
pregnancy is usually straightforward based on a
history of amenorrhea and a positive pregnancy test.
ďwomen with irregular periods or irregular vaginal
bleeding , the diagnosis of pregnancy is more
complex.
ď Other symptoms of pregnancy may alert the
clinician to the possibility of pregnancy.
3. Symptoms of pregnancy:
ďAmenorrhoea: HOWEVER
ďPregnancy may occur during period of lactation
amenorrhea.
ďSlight bleeding early in pregnancy (threatened
abortion) may be considered by the patient as menses .
ďHartman's symptoms: slight bleeding occurs at time of
menstruation
4. Symptoms of pregnancy:
ďMorning sickness: nausea, rarely vomiting
confined to morning
ďIncreased frequency of micturition.
ďEnlargement of the breast and sensation of
heaviness.
ďEasy fatiguability and tendency to sleep.
ďEmotional changes e.g. change of the
appetite:
5. In the second and third trimesters
ď1-Abdominal enlargement
ď2-Quickening
-1st perception (sensation) of fetal movements by
the lady
ď-PG (18-20 weeks), MP (16-18 weeks)
14. Auscultation:
ď Auscultation of FHS as early as 10-12 weeks by
sonicade
ďAuscultation of FHS as early as 20-24 weeks by
Pinard stethoscope
ďAuscultation of umbilical souffle as early as 20-24
weeks.
ďAuscultation of uterine souffl
15. Pregnancy tests:
Principle:
ďDetection of
ďHCG in the
ď urine or
ďserum .
16. 1- Urinary pregnancy test:
ďClassically it becomes +Ve 7- 10 day after 1st missed
period
ď
Commercial testing kits are available that are
sensitive to 25 iu/L in urine.
ďBy the time the mother has missed her first
menstrual period, her hCG levels are around 100
iu/L.
17. Serum pregnancy test:
ďClassically it becomes +Ve 5- 7 days before 1 st
missed period
ďA quantitative serum HCG assay level of > 5 iu/L
will usually denote a pregnancy.
ďWith a normal intrauterine pregnancy, the hCG
level doubles approximately every 36-48 hours.
22. Sure signs of pregnancy:
ďInspection of fetal parts as early as 20th week.
ď -Inspection of fetal movements as early as 20th
week.
ďPalpation of fetal movements as early as 20th week.
ď -Palpation of fetal parts as early as 20th week.
23. Sure signs of pregnancy
ď-Auscultation of FHS at 10-12 weeks by sonicade
ď Investigations: Visualization of fetal parts by
ultrasound
25. Definition
ďAntenatal care refers to the care that is
given to an expected mother from time
of conception is confirmed until the
beginning of labor
ďIt is a preventative cost effective
service
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
ď1-First : Confirm pregnancy by
pregnancy test or US.
ď2-History
ď3-Physical examination
ď4-investigation
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 â3 months +7 days, and change the
year.
32. Obstetric History
Gravidity? Parity? abortion, and living
children.
ď Weight of infant at birth & length of
gestation.
ď Type of delivery, location of birth, and
type of anesthesia.
ď 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
ď History suggesting e.g. Diabetes,
hypertension and ante partum hemorrhage.
ď Ask about episodes of fever or chills
ď Ask about pain or burning sensation on
urination.
ď Abnormal vaginal discharge, itching at the
vulva or if partner has a urinary problem.
35. Emergency symptoms
Vaginal bleeding
Severe abdominal ,epigastric, or pelvic pain
Severe headache with visual disturbance
Persistent vomiting
Unconscious/Convulsion
Severe difficulty in breathing
Fever, chills , dysurea
Absent fetal movement
37. Weight measurement
ďMaternal height and weight
measurements to determine body mass
index(BMI).
ďMaternal weight should be
ď measured at each
ďantenatal visit
ď
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
⢠Epigastric pain
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
45. Provide advice on
1.Diet and weight gain
2.Medication
3.Avoid Radiation exposure
4.Self-care during pregnancy
5.Minor complaints.
6. Family planning Breastfeeding
7.Birth place preparation and anticipation of
complication& Emergency situations.
to detect problems that might affect the woman's pregnancy and require additional care - routinely screen for anemia, hypertension, HIV, syphilis and diabetes mellitus. Recognize other problems that may complicate pregnancy: malnutrition and tuberculosis, vaginal bleeding, vaginal discharge, fetal distress and abnormal fetal position after 36 weeks Danger and emergency signs: Fever, vaginal bleeding, headache and blurring of vision, severe abdominal pain, convulsion, severe difficulty of breathing Birth and emergency plan
The World Health Organization (WHO) recommends giving ferrous sulfate 320 milligrams (60 mg of elemental iron) twice a day to all pregnant women. If the womanâs hemoglobin is 8 gm or less at any visit, increase her iron supplementation to three times a day for the entire pregnancy. If ferrous sulfate is not available, give an equal amount of elemental iron in another iron preparation.
Distinguish chronic hypertension, pre-eclampsia and severe pre-eclampsia. These patients should be referred to the doctor
Nutrition â what food to eat and what foods to avoid during pregnancy. Self-care during pregnancy â the importance of hygiene Discuss breastfeeding and benefits during the prenatal consultation. Explain the danger signs and the signs of labor.