Post on 27-Jun-2015
Prenatal Care and Identification of
Risk
Submitted by:• Waleed Al-Qurashi• Husam Al-Sohaimi• Ahmed Abeed• Meshary Al-hazmi• Omar Al-Ghamdi• AbdulWaheed Al-Ghamdi
To Be Presented to:• Associate Professor: Ahmed
Malibary
• Associate Professor: Timoor Khattab
UMM AL-QURA UNIVERSITY
College of Medicine
2
Seminar Title:Prenatal Care and Identification of Risk
Date & Time :Sunday 25/09/2011 - 11:00 AM to 12:00 PM
Place :UMM AL-QURA UNIVERSITY - College of Medicine
Submitted by :Waleed Al-Qurashi Meshary Al-hazmiHusam Al-Sohaimi Ahmed AbeedOmar Al-Ghamdi AbdulWaheed Al-Ghamdi
Index :Case HistoryPresentationResearches & Evidences
:: Antenatal Care ::1 - Case History
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4
Salma is a 20 years old pregnant
gravida2 para1 at 40 weeks gestational age
came to ER in Friday 25-10-1432
complaning of abdominal pain.
Case History
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Present obestatric history:
LMP: 14-1-1432 sure preceded by
regular periods with no contraception
used. The pregnancy test was confirmed at
the 6th week , she did not have any
antenatal care visit . she did not do any
ultrasound imaging .first kick movement
felt at 20th week after that she felt fetal
movement regularly. She reported no
complication during her pregnancy until
last night she started to have abdominal
pain which is on and off , progressive ,
sever , last for 2-3 minutes .Case History
66
Physical exam:
- Vital sign: BP105/64 RR:26 PULS:103
TEMP:36C.
- In general she was in labor, conscious,
well oriented.
- The abdomen was soft, not tender,
normal liquor, the fundal height was
37cm, the uterus was REGULAR
NOT TENDER, with one longitudinal
fetus, breech , engaged , the back in
right side with normal fetal heart.
-Past obestatric history:
Gravida 2 para1Case History
77
Case History
Gynecological history:
Menarch at age of 14 years old
with regular menses and that last 4 days
with out pain.
Medical and surgical history :
No DM, HTN, cardiac disease or
any chronic disease . no surgical history.
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Case History
Allergy and medication:
She is not taking any
corticosteroids or broad spectrum
antibiotics or any medication. she has no
allergy to any medication.
Social history:
A nonsmoker Saudi housewive
married once for two year living in azizai.
She delivered a normal healthy boy by through
SVD.
The baby's weight is height is head
circumference
:: Prenatal Care ::2- Presentation
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Prenatal Care Embraces:
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• Maternal health care
• Evolution of fetal health and development
• Disease screening
• Analysis the risk for development of complication
• Provision of advice and education
Prenatal Care Components:
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• 2.1 - Antenatal record
• 2.2 - First trimester
• 2.3 - Second trimester
• 2.4 - Third trimester
• 2.5 - Imaging
• 2.6 - Fetal assessments
• 2.7 - Complications and emergencies
2.1 - Antenatal record:
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• Medical history and physical examination
• Gestational age (GA)
• Symphysis-fundal height (SFH; in cm)
• Leopold maneuver
• Blood pressure
2.2 - First trimester:
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• Complete blood count (CBC)• Blood type
• Rapid plasma reagent (RPR)
• Rubella antibody screen
• Hepatitis B surface antigen• Gonorrhea and Chlamydia culture• PPD• Pap smear• Urinalysis and culture• HIV screen• Group B Streptococcus screen
2.3 - Second trimester:
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• Maternal serum alpha-fetoprotein screen (MSAFP/quad)
• Amniocentesis:triple test, nuchal screening, nasal bone, alpha-fetoprotein Chorionic villus sampling
2.4 - Third trimester:
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• Hematocrit
• Glucose loading test (GLT)
• Glucose tolerance test (GTT)
2.5 - Imaging:
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• Ultrasound 12th week (dating scan) and the 20th week
(detailed scan):1. Gestational age
2. Multiple gestation
3. Ectopic pregnancy
4. Evaluated of placentae and amniotic sacs
• X-rays and (CT) (MRI)
2.6 - Fetal assessments:
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• Fetal karyotype
• Biophysical profiles (BPP)
• Percutaneous umbilical blood sampling (PUBS)
• Nonstress test (NST)
• Oxytocin challenge test
2.7 - Complications and emergencies:
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• Ectopic pregnancy
• Pre-eclampsia
• Placental abruption
• Fetal distress
• Shoulder dystocia
• Uterine rupture
• Prolapsed cord • Obstetrical hemorrhage such as placenta previa, uterine
rupture of tears, uterine atony, retained placenta or placental fragments, or bleeding disorders
• Puerperal sepsis
:: Prenatal Care ::3- Researches &
Evidences
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:: Prenatal Care ::3- Researches &
Evidences
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Does lowering of antenatal care visit’s well increase the risk of pregnancy?!
3.1 –
3.2 -
Who systemic review of randomized controlled trials of routine antenatal care
Antenatal care in Saudi Arabia - Lifestyle
Background Methods
There is a lack of evidence of the
content, frequency, and timing of
visits in standard antenatal-care
programmes.• Standard Model (14 visits):
8-28 weeks every 4 weeks
28-36 weeks every 2 weeks
36 weeks every 1 weeks
• New Model:
Less than 14 visits (4-8
visit)
The main hypothesis was:
• New Model Vs Standard Model
The selected outcomes were:
• Preeclampsia
• Urinary-tract infection
• Postpartum anaemia
• Maternal mortality
• Low birthweight
• Women’s satisfaction & cost
effectiveness.
Findings Interpretation
• 7 eligible randomised controlled
trials• 57 418 women participated :
o 30 799 (new-model)
o 26 619 (standard-model)
• No clinically differential effect in
reduced number of visit
• Mortality were similar
• New-mode visits could be
introduced into clinical practice
• The cost of the new model was
equal to or less than that of the
standard model.
• NO risk to mother or baby
• Some degree of dissatisfaction by
the mother could be expected
• Lower costs can be achieved
• Dissatisfaction with care was
observed
Antenatal care in Saudi Arabia has been improved due
to:• Good planning and strategy
• Provide community education & health Facilities
• Participate in international research & trial
Ministry of Health
مولود ألف لكل الخامسة دون األطفال وفيات متوسطوالتعاون التنمية منظمة ودول المملكة في حي
واألوروبي ) (2009 – 1990األقتصاديالوفيات مؤشر
Ministry of Health
Best Time To Get Pregnant
Pregnancy Due Date Calculate
Saudi Society of Family and Community Medicine
Mobily Telecom Company
ThankYou
The
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