Prenatal Care ppt
-
Upload
sharathv82 -
Category
Documents
-
view
227 -
download
1
Transcript of Prenatal Care ppt
![Page 1: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/1.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 1/49
ntenatal Care
DR. Yasir Katib
MBBS, FRCSC
Perinatologest
![Page 2: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/2.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 2/49
Antenatal care (ANC) goals and
strategy
Explain the components and objectives of
prenatal goals Describe the frequency and aim of each
prenatal visit
Genetic counseling and its available tools
Risks and benefits of the genetic tests
![Page 3: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/3.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 3/49
ANC ObjectivesTo ensure the birth of a healthy baby with minimal
risk for the mother by
1. Early, accurate estimation of GA
2. Identification of the patient at risk forcomplications
3. Ongoing evaluation of the health status of bothmother and fetus
4. Anticipation of problems and intervention, ifpossible, to prevent or minimize morbidity
5. Patient education and communication
![Page 4: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/4.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 4/49
ANC
Prenatal care is not a single intervention “Quantity" Vs. “Quality" of ANC A systematic review of observational studies and
randomized trials concluded that there was noconclusive evidence that prenatal care improvedbirth outcomes
Randomized trials have also shown that enhancedprenatal care did not result in improved outcomes
compared to routine prenatal care
![Page 5: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/5.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 5/49
ANC Components1. HISTORY
2. PHYSICAL EXAMINATION
3. LABORATORY TESTS
4. DIAGNOSTIC IMIGING
5. PATIENT EDUCATION
6. MEDICATIONS
![Page 6: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/6.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 6/49
![Page 7: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/7.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 7/49
Physical examination
A complete physical examination
Specially…
Uterine size and shape Evaluation of the adenexea
Baseline blood pressure, weight, and height
![Page 8: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/8.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 8/49
![Page 9: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/9.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 9/49
LABORATORY TESTS
1st visit
A standard panel of laboratory tests(Routine)
1. CBC
2. Blood gp & antibodies screen3. HbS Ag4. Rubella5. VDRL6.
Urine C&S7. Cervical PAP smear
![Page 10: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/10.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 10/49
LABORATORY TESTS
1st visit
In high risk population
1. Chlamydia swab
2. HIV3. TFT
![Page 11: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/11.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 11/49
![Page 12: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/12.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 12/49
Follow-up visits
Major goals (PET, malpresentation)
Components
1. Wt, B/P, SPH, FH auscultation, FM, lie,presentation
2. Patient’s concerns
3. Education4. Risk identifications
![Page 13: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/13.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 13/49
Presentation & lie
![Page 14: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/14.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 14/49
Follow-up visits
Uncomplicated pregnancies
Every 4 weeks until 28 wks
Every 2 to 3 weeks from 28 to 36 wks Weekly until delivery
![Page 15: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/15.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 15/49
Follow-up visits
Laboratory follow-up
GDM screening at 24-28 wks
CBC & antibodies screen GBS screening (recto-vaginal swab)
at 35-37 wks
![Page 16: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/16.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 16/49
DIAGNOSTIC IMIGING
Ultrasound
Minimum requirement
Usefulness
Limitations
Others
MRI
![Page 17: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/17.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 17/49
![Page 18: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/18.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 18/49
1st Trimester U/S
1. Confirm pregnancy
2. Viability
3. Assess GA (Dating)4. Multiple gestations (chorionicity /
amnionicity)
5. Maternal pelvic anomalies
AIUM Standards and Guidelines
![Page 19: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/19.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 19/49
2nd Trimester U/S
Fetal normality: • Head shape and size and internal structures (cavum
pellucidum, cerebellum, ventricular size at atrium < 10 mm) • Spine: longitudinal and transverse • Abdominal shape and content at level of stomach • Abdominal shape and content at level of kidneys andumbilicus • Renal pelvis < 5 mm anterior–posterior measurement • Longitudinal axis abdominal–thoracic appearance (diaphragm
and bladder)
• Thorax at level of a four-chamber cardiac view • Arms: three bones and hand (not counting fingers) • Legs: three bones and foot (not counting toes)
![Page 20: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/20.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 20/49
VALUE OF PRENATAL GENETIC
DIAGNOSIS:
Why do we do it?
Reassurance
Increases options
Antenatal fetal treatment
Preparation for outcome
Avoidance of obstetric complications
Selective termination
![Page 21: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/21.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 21/49
=
10
100
1000
15 20 25 30 35 40 45
Maternal age (yrs)
C h a n c e o f
D S
Maternal age-based screening
1/200 risk of
miscarriage
Rationale
=
1/200 chance of
abnormality 30%
70%
![Page 22: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/22.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 22/49
Assessment of Backg round Risk
Maternal Age
0.0001
0.001
0.01
0.1
1
10
20 25 30 35 40 44
Years
Trisomy 21
Trisomy 18 Trisomy 13
47xxx/xxy/xyy
45x
Triploidy
Risk %
Courtesy Dr J Johnson and the Fetal Medicine Foundation
![Page 23: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/23.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 23/49
%
0
20
40
60
80
100
10 14 18 25 30 35 40
Weeks
Trisomy 21
Trisomy 18Trisomy 13
Triploidy
47xxx/xxy/xyy
45x
Assessment of Backround Risk
Gestational Age
Snijders et al 1999Courtesy Dr J Johnson and the
Fetal Medicine Foundation
![Page 24: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/24.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 24/49
Prenatal ScreeningModalities
![Page 25: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/25.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 25/49
Screen ing at 11-20 wks
10 12 14 16 18 20 wks
• Allows adjustment of age-related risk
• Improved detection rate
Courtesy Dr J Johnson and the Fetal Medicine Foundation
![Page 26: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/26.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 26/49
A- Non-invasive prenatal
diagnostic tests1. Nuchal Screen
2. Nuchal plus biochemistry
3. Maternal Serum Screen
4. Ultrasound
![Page 27: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/27.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 27/49
“the skin is deficient in elasticity. . . . . . too large for the body” Langdon Down
Observations on an ethnic classification of idiots.
Clinical Lecture Reports, London Hospital 1866;3:259.
Nuchal Trans lucency
Courtesy Dr J Johnson and the Fetal Medicine Foundati
1-
![Page 28: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/28.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 28/49
Nuchal Translucency
• Gestation 11-14 wks• CRL 45-84 mm
• Mid-sagittal view
• Image size >75%
• Neutral position
•
Away from amnion• Maximum lucency
• Calipers on-to-on
Courtesy Dr J Johnson and the Fetal Medicine Foundation
FETAL CENTREFETAL CENTRE
![Page 29: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/29.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 29/49
FETAL CENTREFETAL CENTRE
Fetal Fetal Nuchal Nuchal Translucency Translucency
Chromosome abnormalities
Birth defects (cardiac, d.hernia)
Genetic syndromes
Increased mortality (> 3.5 mm)
Significance of increased nuchal fluid
Courtesy Dr J Johnson and the Fetal Medicine Foundatio
![Page 30: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/30.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 30/49
Pathophysiology of increased
nuchal translucency•Abnormal or delayed lymphatic development
• Venous congestion
• Cardiac failure• Altered composition of extracellular matrix
• Failure of lymphatic drainage due to fetalhypokinesia
• Fetal anemia or hypoproteinemia
• Congenital infection Courtesy Dr J Johnson and the Fetal Medicine Foundation
![Page 31: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/31.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 31/49
First Trimester Biochemical Markers
PAPP-A: Pregnancy associated plasma protein A•Produced by placental trophoblast
•Increases in 10-14 week period
•Lower in DS pregnancies (0.43 MOM)
•Associated with 42 % DR at 5% FPR.
Free - hCg: Free subunit of human
chorionic gonadotrophin.•Placental protein
•Decreases in T1 like total hGC•Higher in DS pregnancies (1.79 MOM)
•Associated with 23% DR at 5% FPR
Courtesy Dr J Johnson and the Fetal Medicine Foundation
2-
![Page 32: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/32.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 32/49
Fetal NT + Maternal age + ßhCG + PAPP-A at 11-14 wks
All0
20
40
60
80
100
%
Ag
e
ßhCG PAPP-A
Detection Rate
30%
89%
72%
60%
Age
ßhCGPAPP-A
Age
NT
Invasive
Testing
5%
Screening at 11-14 wks
Courtesy Dr J Johnson and the Fetal Medicine Foundation
![Page 33: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/33.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 33/49
3- Maternal Serum Screen
Three biochemical markers BHCG
AFP
Estriol
Gives age adjusted risk
Screens for Down’s and NTD 15-20 wks
![Page 34: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/34.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 34/49
MSS
1/1 01/378
Risk = age X OR BHCG X OR uE3 X OR AFP
![Page 35: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/35.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 35/49
MSS Limitations
Sensitivity 70 %
Specificity 95% ( False positive 5%)
Two reasons for a false positive:
Wrong dates
Twins
![Page 36: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/36.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 36/49
4- Ultrasound
Ultrasound screening (detailed scan)
18-20 weeks
![Page 37: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/37.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 37/49
B- INVASIVE TECHNIQUES FOR
EARLY PRENATAL TESTING
Chorionic Villus Sampling
Amniocentesis
![Page 38: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/38.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 38/49
Amniocentisis
http://wchs.health.wa.gov.au/health/a/amnio.htm
![Page 39: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/39.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 39/49
Amniocentisis
Performed at or more 15 weeks
Takes 2-3 weeks for Karyotype
Pregnancy loss risk 1/200 Can get result of trisomies 13,18,21 and
Turners Syndrome X0 in 48 hours withFISH (Florescent Insitu Hybridization)
![Page 40: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/40.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 40/49
![Page 41: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/41.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 41/49
Chorionic Villus Sampling
Performed at 10-14 weeks
Takes 2-3 weeks for the result
Pregnancy loss rate 1/100
Operator experience important
Link to limb abnormalities (stillcontroversial)
Placental mosaicism up to 3%, but littleeffect on outcome
![Page 42: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/42.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 42/49
Post Test
A standard panel of laboratory tests(Routine) dose not include
1. Rubella
2. TFT
3. VDRL
4. Urine C&S
5. Cervical PAP smear
![Page 43: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/43.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 43/49
Post Test
First trimister scan does not include
1. Fetal morphology
2. Viability3. Assess GA (Dating)
4. Multiple gestations (chorionicity /amnionicity)
5. Maternal pelvic anomalies
![Page 44: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/44.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 44/49
Post Test
Which of the following is not a cause for an
abnormal MSS
a) Down’s syndrome
b) IUFD
c) Twins
d) Wrong dates
e) Congenital heart disease
![Page 45: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/45.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 45/49
Post Test
A false positive on the MSS occurs in 1/20 tests
True False
![Page 46: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/46.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 46/49
Post Test
List Two advantages of Amniocentesis over
CVS
Decreased miscarriage rate
Lower risk of mosaicism
No association with limb reductions
![Page 47: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/47.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 47/49
Post test
Which of the following tests is the best at
detecting Down’s Syndrome
1. MSS
2. Nuchal
3. Nuchal plus PAPP A and Free BHCG
![Page 48: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/48.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 48/49
Post Test
What is the miscarriage rate with
amniocentesis?
0.5%
3%
5%
10%
![Page 49: Prenatal Care ppt](https://reader034.fdocuments.in/reader034/viewer/2022052407/577cd5521a28ab9e789a7958/html5/thumbnails/49.jpg)
8/13/2019 Prenatal Care ppt
http://slidepdf.com/reader/full/prenatal-care-ppt 49/49
Post Test
List one advantage of CVS over amniocentesis
Early results