Antenatal Classes

7/28/2019 Antenatal Classes

1/22

Antenatal Classes

Dr. Alexander K. Doo

Specialist inObstetrics &Gynaecology

The Womens Clinic

Saturday 31/7/04

Antenatal Talk

City Hall


2/22

Warnings Signs in the

3rd Trimester

Starts from 28 weeks onwards.

Bright red vaginal bleeding.Leaking of water from the vagina (sudden

gush or slow leak).

Regular tightenings or cramping.

Dim or blurred vision or flashing bright

lights or spots.


3/22

Warnings Signs in the

3rd Trimester

Bad headache/dizziness, a lot of swelling offace and body

Chills and fever

Pain when passing urineDecreased fetal movement


4/22

Bleeding

Bleeding at any time during the pregnancy

should be immediately reported to your

health care provider. In the second and thirdtrimesters, it can be a sign of abnormal

placental (after-birth) implantation to the

uterine wall, or premature separation of theplacenta. Bleeding can also occur after

intercourse through pressure on or irritation

of the vagina and/or cervix.


5/22

Abruptio Placentae

Placenta becomes detached from the uterine

wall prematurely leading to bleeding and a

reduction of oxygen and nutrients to thefetus. The detachment may be complete or

partial.Occurs in less than 3.5 %

More common in women who smoke, havehigh blood pressure, and/or in women who

have had previous children or a history of

abruptio placentae.


6/22

Abruption

Symptoms and treatment of abruptio

placentae depend upon the degree of

detachment. Symptoms may includebleeding, cramping, and abdominal

tenderness. Diagnosis is usually confirmed

by performing a complete physicalexamination and an ultrasound. Women are

usually hospitalized for this condition and

may have to deliver the baby prematurely.


7/22

Placenta PreviaPlacenta previa is a condition in which the

placenta adheres itself to the uterus near orcovering the cervix. Often, the placenta

moves to the upper half of the uterus during

pregnancy requiring no treatment. When the

placenta does not move and remains in the

lower half of the uterus, the condition is

called placenta previa.


8/22

Placenta Previa

This type of placental complication occurs

in one in every 200 deliveries and occursmore often in women who have scarring of

the uterine wall from previous pregnancies,

in women who have fibroids or otherabnormalities in the uterus, or in women

who have had previous uterine surgeries.


9/22

Placenta Previa

Symptoms may include vaginal bleeding

that is bright red and not associated with

abdominal pain. Diagnosis is confirmed byperforming a physical examination and an

ultrasound. Depending upon the severity of

the condition and the stage of pregnancy,modification of activities or bedrest may be

ordered. The baby usually has to be

delivered by cesarean section.


10/22

Leakage of Watery Fluid From

Your Vagina

Urine leakage can be caused by the baby

pressing on your bladder. Fluid leakage canalso be the result of a spontaneous rupture

of membranes. The membranes are a

protective mechanism for the baby-they

cushion him or her and allow room for fetal

movement growth and provide a barrier

against infection.


11/22

Possible Signs of

Premature Labour

Increase in vaginal discharge

(watery, mucousy or bloody)Low, dull backache

(intermittent or constant)

Pressure like baby pushingdown (comes and goes)


12/22

What to Do?

Call if you have more than 8

contractions in 1 hour

Lie down drink some fluid and

count the contractions

Doesnt do away after 1 hour, or

> 5 X / hour in the next hour


13/22

Pre-eclampsia

Cause is unknown

More common in 1st pregnancy5% of all pregnancy

Raise BP, Proteinurea, swelling

due to fluid retentionEclampsia - siezure, coma,

HELLP syndrome,death


14/22

Signs and Symptoms

Headache, swelling of handsface and feet, epigastric pain,

irritability, nausea ,visual

disturbance, decreased urine

output, raised blood pressure,

proteinurea.


15/22

Treatment

Depends on gestation

ultimately requires delivery


16/22

Urinary Tract Infection

Burning or pain during urinationFrequency

can lead pre-mature labour

Treatment with antibiotics


17/22

Decreased fetal

Movement

First sign of fetal comprmiseIntensity decreases as

gestation advance

Rule of 10If in doubt, check it out


18/22

Indications for Elective

Caesarean Section

Patient choice

Multiple pregnancy

Placenta previa

Malpresentations

Previous section

Maternal medical condition


19/22

Some Arguments for

Caesarean Section

Maternal choice in 38% of cases

In a randomized trial comparing

elective section vs vaginal deliveryit showed perinatal mortality andserious morbidity of 1.6% vs 5%, andthat 90% delivered by section in theplanned group vs 56.7% in thevaginal gp

Vaginal delivery is associated withwith risk of urinary and feacalincontinence


20/22

Some Reasons for

Section

1/3 of women will have urinaryincontinence 3 months after delivery

11% life time risk of surgery forincontinence and prolapse

Feacal incontinence19% 6 weeks

Overall 1/3 of women will have

evidence of anal sphincter defect onUSS 6 weeks post-partum, and 65%of which will have symptoms of analincontinence.and 75% if its a

second vaginal birth


21/22

Indications for

Emergency Section

Failure to progress

Cord prolapseFetal distress

Placental abruption

Cephalo pelvic disproportionPremature labour (


22/22

The End

Antenatal Classes

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