Preconceptional care (PCC) (The Critical role of Primary Care Physician) (The Critical role of Primary Care Physician) PO Box 27121 – Riyadh 11417 Tel: 4912326 – Fax: 4970847 Introduction to Primary Care a course of the Center of Post Graduate Studies in FM
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(The Critical role of Primary Care Physician) Preconceptional care (PCC) (The Critical role of Primary Care Physician) PO Box 27121 – Riyadh 11417 Tel:
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Preconceptional care (PCC)(The Critical role of Primary Care Physician)(The Critical role of Primary Care Physician)
PO Box 27121 – Riyadh 11417Tel: 4912326 – Fax: 4970847
Introduction to Primary Care
a course of the Center of Post Graduate Studies in FM
Content of this session
1. Overview
2. Rational of PCC.
3. Objectives of PCC.
4. PCC implementation at PHC centers.
5. Physicians' role - delivering PCC.
6. Obstacles of PCC.
7. Premarital check-up.
8. Woman’s role.
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Birth Rate United State 13.82 births/1000 population
Saudi Arabia 28.55 births/1000 population country comparison to the world 52
Egypt 21.70 births/1000 population
United Arab Emirates 16.02 births/1000 population Japan 7.64 births/1000 population
Prematurity & Infant Mortality United State 7 deaths/1000 live births.
Saudi Arabia 11.7 deaths / 1000 live births
United Arab Emirates 12.70 deaths / 1000 live births Egypt 27.26 deaths / 1000 live births
Japan 2.4 deaths / 1000 live births
Central Intelligence Agency, The WORLD FACTBOOK
Factors Leading to Infant Mortality
Maternal health problems Smoking Age <20 or > 40 Late entry into prenatal care Education Marital status Inter-pregnancy interval
Potentially all related to
Maternal Health Prior to Maternal Health Prior to PregnancyPregnancy
(Preconception)(Preconception)
Key Factors
Health status overall
1. Nutrition
2. Exercise habits
3. Infection risk (immunization)
Specific health risks
1. Chronic medical conditions
2. Medication
3. Tobacco use
Preconception Care: A window of opportunity
• All women of child-bearing yrs : pre- screened for health & risk potentials Before attempting to be pregnant. • Optimum: 3- 6 ms before conceiving attempt This time frame allows: 1- Successful conception & pregnancy 2- any within control health risks.
PCC has been advocated as a measure to improve pregnancy outcome.
Its components parallel those of prenatal care : risk assessment, health promotion and medical & physiological interventions.
Physician’ s role : providing PCC.
Woman’s role : ….
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Rational of PCC
Screening tool for physicians to assess women’s health
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Objectives of PCC
In one sense, PCC can be compared to: Will Baby Clinic visitWill Baby Clinic visit
a baby is screened for Normal health, Normal Development to identify emerging unnoticed problems in an infant.
1. Existing or emerging illness or disease which may have gone undetected before.
2. Existing risks for the woman who may become pregnant.
3. Existing risks which may affect a fetus if the woman does become pregnant.
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Objectives of PCC
For a WomanFor a Woman: : PCC assess Normal health of a child-bearing woman, to identify: -
PCC can be provided most effectively as part of ongoing primary care.
Physicians can deliver PCC during visits for • Routine health maintenance, • During examinations for school or work, • At premarital or family planning visits, • After a negative pregnancy test or • During well-child care for another family member.
STI : PCC is a good opportunity to screen for genital infections such as Chlamydia, gonorrhea, syphilis and HIV.
Medications : therapeutic regimens for chronic illnesses are best modified, if possible, in PC period to include the drugs that have been used the longest & have been determined to pose the lowest risk.
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Medications
Antihypertensives: Diuretics & angiotensin-converting enzyme should be avoided
drug of choice: methyldopa- proven maternal & fetal safety.
Anticoagulants: Warfarin ContraIndidated Switch to heparin
Oral hypoglycemic: Switch to insulin before pregnancy.
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Occupational exposures
Worldwide: women entry to workforce. Most women are in reproductive age
Three most common occupational hazards reported to affect pregnancy are:
Radiation Exposure
Organic solvents
Lead
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Domestic violence
Is increasingly Is increasingly recognized as a major public health issue.It crosses all racial, religious & educational boundaries.