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1 ANTENATAL CARE AND ANTENATAL CARE AND HIGH RISK PREGNANCY HIGH RISK PREGNANCY
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ANTENATAL CARE AND ANTENATAL CARE AND HIGH RISK PREGNANCYHIGH RISK PREGNANCY

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Although pregnancy is considered a Although pregnancy is considered a normal physiologic event, yet it can be normal physiologic event, yet it can be complicated by pathologic processes complicated by pathologic processes dangerous to the mother and foetus in dangerous to the mother and foetus in about 5-20% of cases. Some of these about 5-20% of cases. Some of these complications are preventable; others are complications are preventable; others are predictable, allowing early diagnosis and predictable, allowing early diagnosis and management.management.

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Antenatal careAntenatal care (ANC)(ANC)

Antenatal careAntenatal care (ANC) (ANC) is a program is a program of preventive obstetrics, with a main of preventive obstetrics, with a main objective to ensure a safe objective to ensure a safe motherhood, culminating in a safe motherhood, culminating in a safe delivery of a healthy foetus.delivery of a healthy foetus.

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The objectives of ANC are The objectives of ANC are carried out via:carried out via:

1.1. Early detection and, possibly Early detection and, possibly prevention, of complications specific to prevention, of complications specific to pregnancy, as preeclampsia, eclampsia, pregnancy, as preeclampsia, eclampsia, and obstetric haemorrhage.and obstetric haemorrhage.

2.2. Detection and management, or at Detection and management, or at least amelioration, of any medical disorder least amelioration, of any medical disorder complicating pregnancy as anaemia, complicating pregnancy as anaemia, diabetes mellitus, cardiac, renal, or diabetes mellitus, cardiac, renal, or endocrine disorders.endocrine disorders.

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3.3. Detection of complications which may Detection of complications which may affect labour as disproportion and affect labour as disproportion and malpresentations.malpresentations.

4.4. Education of the patient and her family Education of the patient and her family about pregnancy, labour and delivery, the about pregnancy, labour and delivery, the hygiene and diet in pregnancy, and the warning hygiene and diet in pregnancy, and the warning or alarming symptoms that necessitate or alarming symptoms that necessitate consultation.consultation.

5.5. Laboratory investigations that may assure Laboratory investigations that may assure the general health and detect medical the general health and detect medical problems.problems.

6.6. Finally patients are classified into normal Finally patients are classified into normal or high risk throughout pregnancy and or high risk throughout pregnancy and managed accordingly.managed accordingly.

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The First ANC Visit:The First ANC Visit: Aim:Aim: Thorough history taking and clinical examination Thorough history taking and clinical examination

to to identify important risk factors:identify important risk factors:History:History: Menstrual H.: To identify LMP, calculate gestational Menstrual H.: To identify LMP, calculate gestational

age, and the EDD (Naegle’s formula).age, and the EDD (Naegle’s formula). Obstetric H.: Previous pregnancies provide important Obstetric H.: Previous pregnancies provide important

clues to potential problems in the current one.clues to potential problems in the current one. Medical H.: Medical disorders exacerbated by Medical H.: Medical disorders exacerbated by

pregnancy e.g. hypertension, diabetes, heart pregnancy e.g. hypertension, diabetes, heart disease…etc.disease…etc.

Surgical H.: e.g. uterine surgery as myomectomy, Surgical H.: e.g. uterine surgery as myomectomy, previous CS.previous CS.

Family H.: e.g. diabetes, twins, familial disorders.Family H.: e.g. diabetes, twins, familial disorders.

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General examination:General examination: Pulse, Pulse, temperature and B.P., pallor…etc.temperature and B.P., pallor…etc.

Abdominal ExaminationAbdominal Examination: abdominal : abdominal masses, enlarged liver or spleen, masses, enlarged liver or spleen, hernias,…etchernias,…etc

Vaginal examination:Vaginal examination: done only if done only if necessary, e.g.: for suspected pelvic necessary, e.g.: for suspected pelvic masses, ectopic pregnancy …etc.masses, ectopic pregnancy …etc.

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Routine laboratory tests:Routine laboratory tests: Blood group and Rh typing, to identify RH Blood group and Rh typing, to identify RH

negative patients.negative patients. Complete blood picture: for Hb%, WBCs, and Complete blood picture: for Hb%, WBCs, and

platelets.platelets. Blood sugar level: random blood glucose, or Blood sugar level: random blood glucose, or

fasting and 2 hrs postprandial levels.fasting and 2 hrs postprandial levels. Complete urine analysis: for pus cells, RBCs, Complete urine analysis: for pus cells, RBCs,

albumin and sugar…etc,albumin and sugar…etc, Other tests as: TORCH antibodies IgG and IgM, Other tests as: TORCH antibodies IgG and IgM,

VDRL, hepatitis B & C if necessary, especially VDRL, hepatitis B & C if necessary, especially in the first pregnancy.in the first pregnancy.

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RETURN VISITS:RETURN VISITS: Monthly visits are required in the first 6 months, Monthly visits are required in the first 6 months,

twice weekly visits in 7th and 8th months, then twice weekly visits in 7th and 8th months, then weekly visits in the 9th month until delivery. weekly visits in the 9th month until delivery.

In each visit important data include;In each visit important data include; Warning symptoms, e.g. Bleeding or regular Warning symptoms, e.g. Bleeding or regular

menstrual like colicky pains, persistant vomiting, menstrual like colicky pains, persistant vomiting, sudden escape of liquor amnii, severe persistant sudden escape of liquor amnii, severe persistant headache, blurring of vision, marked swelling of the headache, blurring of vision, marked swelling of the lower limbs.lower limbs.

Daily fetal movement count (DFMC).Daily fetal movement count (DFMC). Weight gain: the average weight gain during Weight gain: the average weight gain during

pregnancy is 11-16 Kg. pregnancy is 11-16 Kg. (normal = 0.5 kg/wk > 20 (normal = 0.5 kg/wk > 20 wks).wks).

Excessive weight gain many denote occult oedema Excessive weight gain many denote occult oedema (developing preeclampsia) while inadequate weight (developing preeclampsia) while inadequate weight gain may reflect nutritional deficit or fetal growth gain may reflect nutritional deficit or fetal growth retardation).retardation).

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Examination for L.L. Oedema: ankle oedema is Examination for L.L. Oedema: ankle oedema is acceptable in late 2nd and 3rd trimesters.acceptable in late 2nd and 3rd trimesters.

Blood pressure measurements: to detect early Blood pressure measurements: to detect early gestational hypertension or preeclampsia.gestational hypertension or preeclampsia.

Fundal level: Should be measured and recorded at Fundal level: Should be measured and recorded at each visit after 20 weeks.each visit after 20 weeks.

Fetal heart sounds, heard by the Sonicaid Duplex Fetal heart sounds, heard by the Sonicaid Duplex instrument, or by Pinnard stethoscope.instrument, or by Pinnard stethoscope.

Ultrasonography whenever needed to ensure Ultrasonography whenever needed to ensure gestational age, to assure normal fetal growth, to gestational age, to assure normal fetal growth, to assess fetal well being, to exclude major fetal assess fetal well being, to exclude major fetal anomalies, to evaluate placental location and anomalies, to evaluate placental location and amniotic fluid volume at various pregnancy amniotic fluid volume at various pregnancy trimesters.trimesters.

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INSTRUCTIONS TO THE INSTRUCTIONS TO THE

PATIENT:PATIENT: Exercise:Exercise: Mild to moderate exercise, as walking, Mild to moderate exercise, as walking,

and regular daily house work are allowed.and regular daily house work are allowed.

Sleep and rest:Sleep and rest: Proper night sleep (8 hrs), and Proper night sleep (8 hrs), and adequate periods of afternoon rest are advisable.adequate periods of afternoon rest are advisable.

Care of teeth: Care of teeth: To avoid dental caries caused by To avoid dental caries caused by increased acidity, and septic foci.increased acidity, and septic foci.

Bowel habit: Bowel habit: Avoiding constipation; fresh Avoiding constipation; fresh vegetables and mild laxatives if necessary.vegetables and mild laxatives if necessary.

Clothes: Clothes: Avoid tight and too heavy Avoid tight and too heavy uncomfortable clothing.uncomfortable clothing.

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Breasts: Breasts: Daily washes as a part of body Daily washes as a part of body hygiene. In the last few weeks, massage of hygiene. In the last few weeks, massage of the nipples using lubricant creams might the nipples using lubricant creams might reduce the incidence of cracking. Retracted reduce the incidence of cracking. Retracted nipple is withdrawn by the thumb and finger nipple is withdrawn by the thumb and finger using a lubricant.using a lubricant.

Sexual intercourse: Sexual intercourse: Is better minimized in Is better minimized in the first trimester to avoid bleeding then the first trimester to avoid bleeding then gradually allowed. It is completely restricted gradually allowed. It is completely restricted only if there is recurrent bleeding, tendency only if there is recurrent bleeding, tendency to abortion, preterm labour, or suspected to abortion, preterm labour, or suspected rupture of the membranes.rupture of the membranes.

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Smoking: Smoking: Should be strictly avoided as Should be strictly avoided as it may result in placental insufficiency, it may result in placental insufficiency, delivery of small babies, or may be a delivery of small babies, or may be a cause of premature labour.cause of premature labour.

Travelling: Travelling: Only comfortable travelling Only comfortable travelling may be allowed. However, travelling may be allowed. However, travelling should be avoided in the last month should be avoided in the last month and it is completely prevented in and it is completely prevented in patients with a history of bleeding, patients with a history of bleeding, threatened abortion, habitual abortion, threatened abortion, habitual abortion, or premature labour.or premature labour.

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Vaccination (immunization) in Vaccination (immunization) in pregnancy:pregnancy:

Live attenuated vaccines are contraindicated.Live attenuated vaccines are contraindicated.

The vaccines for the following diseases may The vaccines for the following diseases may be given if needed, preferably after the 1st be given if needed, preferably after the 1st trimester:trimester:

Tetanus, rabies, influenza, cholera and typhoid.Tetanus, rabies, influenza, cholera and typhoid.

Passive immunization against hepatitis A and B Passive immunization against hepatitis A and B may be given.may be given.

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Drug intake during Drug intake during pregnancy:pregnancy:

Drug categories during pregnancy Drug categories during pregnancy according to FDA classification:according to FDA classification:

Group: A SafeGroup: A Safe Group: B Risky in animal, no enough data Group: B Risky in animal, no enough data

on humans.on humans. Group: C Risk in human cannot be ruled Group: C Risk in human cannot be ruled

out.out. Group: D Risky in human pregnancy, but Group: D Risky in human pregnancy, but

the benefits may outweigh the risks.the benefits may outweigh the risks. Group: X Contraindicated in pregnancy, Group: X Contraindicated in pregnancy,

may cause adverse fetal effects.may cause adverse fetal effects.

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COMMON COMPLAINTS COMMON COMPLAINTS DURING PREGNANCYDURING PREGNANCY

Morning sickness:Morning sickness: A sensation of A sensation of nausea, with or without vomiting, nausea, with or without vomiting, which may be more evident in the which may be more evident in the morning, is common especially in morning, is common especially in primigravidas. primigravidas. Management byManagement by reassurance, frequent small light reassurance, frequent small light meals, vitamin B6, and if severe certain meals, vitamin B6, and if severe certain antiemetic drugs may be given for a antiemetic drugs may be given for a short period of time. short period of time.

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Heart Burn:Heart Burn:

Dilatation of the cardiac opening of Dilatation of the cardiac opening of the stomach and oesophageal the stomach and oesophageal regurgitation, commonly lead to a regurgitation, commonly lead to a sensation of heart burn. Less sensation of heart burn. Less commonly the cause is some degree commonly the cause is some degree of a hiatus hernia.of a hiatus hernia.

Management:Management: Frequent light diet, Frequent light diet, antacids, and allowing 2 hours antacids, and allowing 2 hours between meals and sleep. between meals and sleep.

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Constipation:Constipation:It is due to reduced intestinal motility due to It is due to reduced intestinal motility due to steroid hormones, with continued fluid steroid hormones, with continued fluid absorption and pressure by the gravid uterus. absorption and pressure by the gravid uterus. ManagementManagement includes increased fluid intake, includes increased fluid intake, regulation of bowel habits, diet should be rich regulation of bowel habits, diet should be rich in fresh vegetables. Mild laxatives may be in fresh vegetables. Mild laxatives may be required.required.

Haemorrhoids (Piles):Haemorrhoids (Piles):Haemorrhoids are predisposed to by Haemorrhoids are predisposed to by congenital weakness of the walls of the veins, congenital weakness of the walls of the veins, constipation, straining, and prolonged constipation, straining, and prolonged standing. standing. ManagementManagement is by avoiding is by avoiding constipation and local anaesthetic ointment constipation and local anaesthetic ointment as lignocaine when necessary.as lignocaine when necessary.

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Headache:Headache:

One of the commonest complaints, especially One of the commonest complaints, especially those with history of migraine headache those with history of migraine headache attacks. The condition is aggravated by attacks. The condition is aggravated by vasodilatation accompanying pregnancy. It vasodilatation accompanying pregnancy. It may also be due to nasal congestion or chronic may also be due to nasal congestion or chronic sinusitis, errors of refraction or emotional sinusitis, errors of refraction or emotional tension. In most cases tension. In most cases symptomatic treatmentsymptomatic treatment is achieved by use of Paracetamol derivatives.is achieved by use of Paracetamol derivatives.

Severe and persistent headache in the 3rd Severe and persistent headache in the 3rd trimester may be suggestive of preeclampsia. trimester may be suggestive of preeclampsia.

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Breast tenderness:Breast tenderness:

Caused by breast engorgement and Caused by breast engorgement and managed bymanaged by avoiding tight clothes. avoiding tight clothes.

Breathlessness:Breathlessness:

Common, can be noticed as early as Common, can be noticed as early as the first 12th week of pregnancy, due the first 12th week of pregnancy, due to hyperventilation caused by to hyperventilation caused by progesterone. In late weeks, the progesterone. In late weeks, the enlarging uterus can cause enlarging uterus can cause mechanical pressure.mechanical pressure.

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Abdominal pain:Abdominal pain:Pelvic heaviness or sensation of Pelvic heaviness or sensation of dragging caused by the weight of the dragging caused by the weight of the uterus on the pelvic support and the uterus on the pelvic support and the abdominal wall.abdominal wall. Management: Management: Rest Rest especially in the lateral position.especially in the lateral position.

Traction on the round ligament with Traction on the round ligament with slight rotation of the uterus can slight rotation of the uterus can cause abdominal discomfort along cause abdominal discomfort along the course of the ligament. the course of the ligament. Management: Management: Reassurance, change Reassurance, change of position.of position.

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Braxton-Hicks contractions:Braxton-Hicks contractions: infrequent, infrequent, irregular and not increasing in frequency irregular and not increasing in frequency or strength.or strength.

Management:Management: Reassurance, and if recurrent or Reassurance, and if recurrent or severe, mild sedatives or antispasmodics.severe, mild sedatives or antispasmodics. Flatulence and distension:Flatulence and distension: may be may be

caused by large, fatty meals or intestinal caused by large, fatty meals or intestinal hypotonia, constipation and pressure by the hypotonia, constipation and pressure by the enlarging gravid uterus.enlarging gravid uterus. Management: Management:

Avoiding large, fatty meals. Avoiding large, fatty meals. Regular evacuation of bowel.Regular evacuation of bowel. Treatment of constipation. Treatment of constipation. Antiflatulent drugs as charcoal tablets.Antiflatulent drugs as charcoal tablets.

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Urinary symptoms:Urinary symptoms:

Frequency, urgency and stress Frequency, urgency and stress incontinence are quite common in incontinence are quite common in late pregnancy which may be late pregnancy which may be explained by increased intra-explained by increased intra-abdominal pressure together with abdominal pressure together with pressure on the bladder by enlarging pressure on the bladder by enlarging uterus. The most important uterus. The most important management management is to exclude urinary is to exclude urinary tract infection.tract infection.

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Lower limb and Ankle oedema: Lower limb and Ankle oedema: Is Is common in late pregnancy.common in late pregnancy.Physiological:Physiological: due to salt and water due to salt and water retention caused by ovarian, adrenal and retention caused by ovarian, adrenal and placental steroid hormones, pressure of the placental steroid hormones, pressure of the uterus on the pelvic veins and prolonged uterus on the pelvic veins and prolonged sitting or standing.sitting or standing.Pathological: Pathological: (differential diagnosis of (differential diagnosis of

preeclampsia). preeclampsia).

Management:Management: (after exclusion of pathological (after exclusion of pathological causes) is by minimizing long sitting and causes) is by minimizing long sitting and standing, elevation of legs whenever standing, elevation of legs whenever possible, and mild exercise. Reduction of salt possible, and mild exercise. Reduction of salt intake, does not usually affect the condition.intake, does not usually affect the condition.

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Leg Cramps: Leg Cramps: Transient nocturnal painful Transient nocturnal painful cramps, mostly due to accumulation of lactic cramps, mostly due to accumulation of lactic acid with poor venous drainage due to acid with poor venous drainage due to pressure of gravid uterus and LL oedema. pressure of gravid uterus and LL oedema. Less commonly it may be attributed to Less commonly it may be attributed to reduced serum calcium or magnesium or reduced serum calcium or magnesium or elevated serum phosphorus.elevated serum phosphorus.

ManagementManagement includes massage to leg includes massage to leg muscles, calcium and magnesium muscles, calcium and magnesium supplementation. Aluminium hydroxide may supplementation. Aluminium hydroxide may be given to reduce phosphorus absorption.be given to reduce phosphorus absorption.

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Varicose veins (V.V.):Varicose veins (V.V.):

V.V. is predisposed to byV.V. is predisposed to by congenital congenital weakness of the wall of the veins (main weakness of the wall of the veins (main cause), poor muscle activity, increased cause), poor muscle activity, increased venous pressure, obesity and pregnancy venous pressure, obesity and pregnancy induced vasodilatation.induced vasodilatation.

Management includesManagement includes: avoiding long standing : avoiding long standing and sitting, active muscle exercise, elevation and sitting, active muscle exercise, elevation of the leg, control of weight gain, and elastic of the leg, control of weight gain, and elastic cotton stockings used while lying down and cotton stockings used while lying down and the veins are empty. Surgical or injection the veins are empty. Surgical or injection treatment is avoided during pregnancy.treatment is avoided during pregnancy.

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Backache:Backache: Backache is one of the commonest Backache is one of the commonest complaints during pregnancy. It may be complaints during pregnancy. It may be explained by increased lumbar lordosis, and explained by increased lumbar lordosis, and relaxation of the back muscles and pelvic relaxation of the back muscles and pelvic joints caused by steroids.joints caused by steroids.Management Management is by frequent bed rest to is by frequent bed rest to minimize lordosis, exercise, e.g., walking to minimize lordosis, exercise, e.g., walking to maintain muscle strength, light massage to maintain muscle strength, light massage to relax tense back muscle and avoiding high-relax tense back muscle and avoiding high-heels.heels.

Fatigue:Fatigue:Fatigue may be explained by anaemia, Fatigue may be explained by anaemia, extra-weight gain, breathlessness, or other extra-weight gain, breathlessness, or other systemic diseases. Early in pregnancy, systemic diseases. Early in pregnancy, there may be fatigue and desire for there may be fatigue and desire for excessive periods of sleep.excessive periods of sleep.

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Vaginal discharge (leucorrhoea):Vaginal discharge (leucorrhoea):Due to excess oestrogen production. No Due to excess oestrogen production. No treatment is required except if it is treatment is required except if it is associated with infection by trichomonas, associated with infection by trichomonas, or Candida albicans.or Candida albicans.

Sweating and "feeling of heat".Sweating and "feeling of heat".Hot flashes are common probably due to Hot flashes are common probably due to increased peripheral circulation and increased peripheral circulation and vasodilatation.vasodilatation.Management Management includes frequent rest includes frequent rest periods and cold showers and increased periods and cold showers and increased fluid intake.fluid intake.

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High Risk PregnancyHigh Risk Pregnancy

High Risk PregnancyHigh Risk Pregnancy is a pregnancy is a pregnancy complicated by a disease or a disorder that complicated by a disease or a disorder that may endanger the life or affect the health of may endanger the life or affect the health of the mother, the fetus or the newborn. the mother, the fetus or the newborn. Taking a thorough history and performing a Taking a thorough history and performing a physical examination are the best way to physical examination are the best way to identify the high-risk pregnant women. identify the high-risk pregnant women. Once identified, they should be referred to a Once identified, they should be referred to a center specialized in maternal and fetal center specialized in maternal and fetal medicine.medicine.

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High risk pregnancy may be High risk pregnancy may be associated with:associated with:

Severe medical conditions affecting the Severe medical conditions affecting the mother such as: mother such as: Diabetes Mellitus, cardiac disease grades III and Diabetes Mellitus, cardiac disease grades III and IV, artificial heart valves, systemic lupus IV, artificial heart valves, systemic lupus erythematosis, and sickle cell disease. erythematosis, and sickle cell disease.

Recurrent poor obstetrical outcomes such Recurrent poor obstetrical outcomes such asas::Habitual abortion, recurrent still birth (SB), Habitual abortion, recurrent still birth (SB), recurrent early rupture of membranes (ROM), recurrent early rupture of membranes (ROM), and recurrent pre term labor (PTL).and recurrent pre term labor (PTL).

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Obstetrical complications that require Obstetrical complications that require specialized care such asspecialized care such as::Severe pre-eclampsia (PE) or eclampsia, Severe pre-eclampsia (PE) or eclampsia, HELLP syndrome, severe intrauterine fetal HELLP syndrome, severe intrauterine fetal growth restriction (IUGR), and multiple high growth restriction (IUGR), and multiple high risk factors. risk factors.

Conditions that may require invasive Conditions that may require invasive procedures for fetal diagnosis or therapy procedures for fetal diagnosis or therapy as:as:

Immune and non immune hydrops fetalis, and Immune and non immune hydrops fetalis, and congenital anomalies or genetic disorders.congenital anomalies or genetic disorders.

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Preconception Preconception counseling:counseling:

The obstetrician discusses and The obstetrician discusses and explains the following items:explains the following items:

The high risk factor(s) and its possible effects The high risk factor(s) and its possible effects on the mother, fetus, and the newborn.on the mother, fetus, and the newborn.

The importance of proper monitoring during The importance of proper monitoring during pregnancy and labor. pregnancy and labor.

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The possibility of early intervention The possibility of early intervention and the sequelae of pre term labor.and the sequelae of pre term labor.

Antenatal care in a well equipped Antenatal care in a well equipped antenatal clinic.antenatal clinic.

The need to deliver in a well The need to deliver in a well equipped hospital, with warning equipped hospital, with warning against home delivery.against home delivery.

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Classification according to Classification according to a risk scoring system:a risk scoring system:

For each country or location, a For each country or location, a specific risk score is developed to specific risk score is developed to identify high risk cases and to identify high risk cases and to evaluate the magnitude of risk. The evaluate the magnitude of risk. The scoring system determines the scoring system determines the prevalence of risk factors together prevalence of risk factors together with the associated peri-natal with the associated peri-natal mortality. mortality.

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Identification of high risk Identification of high risk pregnancy during antenatal pregnancy during antenatal

carecare Conditions detected during history Conditions detected during history

taking:taking: Age; whether young (Age; whether young (>> 18) or elderly ( 18) or elderly (<<

35) Primigravida.35) Primigravida. Parity; whether nullipara (primigravida), or Parity; whether nullipara (primigravida), or

grand multipara (grand multipara (<< 4) 4) Previous obstetric difficulties, fetal loss or Previous obstetric difficulties, fetal loss or

abnormalitiesabnormalities Medical disorders as; Diabetes mellitus, Medical disorders as; Diabetes mellitus,

cardiac or renal diseasecardiac or renal disease

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Conditions observed during Conditions observed during general examination:general examination:

Extreme obesity (maternal weight > Extreme obesity (maternal weight > 120 kg).120 kg).

Short stature (less than 150 cm)        Short stature (less than 150 cm)         Hypertension (>140/90)Hypertension (>140/90) Severe anemia (Hb <8.0 gm %)Severe anemia (Hb <8.0 gm %) Cardiac or renal disease.Cardiac or renal disease. Poor weight gain during pregnancyPoor weight gain during pregnancy

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Conditions diagnosed during Conditions diagnosed during obstetric examinationobstetric examination

Pre- eclampsia (PE)Pre- eclampsia (PE)

Ante partum hemorrhage (APH)Ante partum hemorrhage (APH)

Multiple pregnancyMultiple pregnancy

Malpresentations, and Feto-pelvic Malpresentations, and Feto-pelvic disproportiondisproportion

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Conditions detected during Conditions detected during routine investigations routine investigations

Severe anemia, thrombocytopenia, Severe anemia, thrombocytopenia, and hyperglycemia, and hyperglycemia,

Glycosuria and Albuminuria.Glycosuria and Albuminuria.

Rh negative blood typingRh negative blood typing

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Screening for fetal Screening for fetal anomalies:anomalies:

Congenital anomalies: Ultrasonography for Congenital anomalies: Ultrasonography for fetal anatomy survey for detection of (e.g. fetal anatomy survey for detection of (e.g. anencephay, NTDs, Limb and skeletal anencephay, NTDs, Limb and skeletal deformities, cardiac and renal anomalies…deformities, cardiac and renal anomalies…etc).etc).

Chromosomal abnormalities, as Down's Chromosomal abnormalities, as Down's syndrome (by 1st trimester US, chorionic syndrome (by 1st trimester US, chorionic villus sampling, and 2nd trimester villus sampling, and 2nd trimester amniocentesis).amniocentesis).

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Screening for infections:Screening for infections:

TORCH, toxoplasmosis, rubella, TORCH, toxoplasmosis, rubella, cytomegalovirus, herpes simplex.cytomegalovirus, herpes simplex.

Hepatitis B & C and Human Immunity Hepatitis B & C and Human Immunity Virus (HIV).Virus (HIV).

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Fetal surveillance in high Fetal surveillance in high risk casesrisk cases

Correlation between fetal growth Correlation between fetal growth and gestational age. (Clinical & US). and gestational age. (Clinical & US).

Daily Fetal Movement Count Daily Fetal Movement Count (DFMC).(DFMC).

Non stress test (NST).Non stress test (NST). Contraction stress test (CST).Contraction stress test (CST). Biophysical profile score (BPPS).Biophysical profile score (BPPS).

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DeliveryDelivery ofof High Risk High Risk PatientsPatients

Attention to the risks that may develop during Attention to the risks that may develop during labor and may affect maternal or fetal conditions.labor and may affect maternal or fetal conditions.

The place of delivery should be fully equipped for The place of delivery should be fully equipped for maternal & fetal resuscitation (maternal & maternal & fetal resuscitation (maternal & neonatal intensive care units - ICU).neonatal intensive care units - ICU).

Efficient well-trained personnel, specialists & Efficient well-trained personnel, specialists & consultants should be available 24 hours a day.consultants should be available 24 hours a day.

Monitoring of fetal well being during labor, Monitoring of fetal well being during labor, maternal condition and progress of labor maternal condition and progress of labor (partogram) is essential.(partogram) is essential.

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THANK YOUTHANK YOU