2 Obstetrician & Gynecologist Prenatalogist from KCL,England Dr Solmaz PiriObstetrician & GynecologistPrenatalogist from KCL,England
3 Prenatal Care The major goal of prenatal care is to ensure the birth of a healthy baby with minimal risk for the mother.
4 Main Components Patient education and communication Early, accurate estimation of gestational ageIdentification of the patient at risk for complicationsOngoing evaluation of the health status of both mother and fetusAnticipation of problems and intervention, if possible, to prevent or minimize morbidityPatient education and communication
6 care and that of her baby should be sought and respected at all times Women, their partners and their families should always be treated with kindness, respect dignityThe views, beliefs and values of the woman, and her family in relation to hercare and that of her baby should be sought and respected at all times
11 Tetanus and diphtheria toxoid vaccine (Td) Available vaccinesTetanus and diphtheria toxoid vaccine (Td)Tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap).
12 In 2013, The ACIP recommendations supported by the American College of Obstetricians and GynecologistsAll pregnant women receive vaccination against pertussis with Tdap during each pregnancy, optimally between 27 and 36 weeks of gestation, regardless of prior vaccination status, to better protect their infant
13 tetanus booster If Tdap is given earlier than 27 to 36 weeks and at any stage of pregnancy if the woman lives in an area with a pertussis epidemicor required as part of wound management
14 Varicella vaccination Varicella vaccination is recommended for women without evidence of immunity preconceptionally or postpartum:Postpartum:The first dose is given while the patient is in the hospital and the second dose is given four to eight weeks later, which typically coincides with the routine postpartum visit. Breastfeeding is not a contraindication
15 History The elements of the patient history include: Personal and demographic informationPast obstetrical historyPersonal and family medical historyPast surgical historyGenetic historyMenstrual and gynecological historyCurrent pregnancy historyPsychosocial information
16 Physical examination Classic and complete approach Everything is importantEvery mild derangement should be carefully adressedKeep in mind : Pregnant women is using her body reserve and may not be able to make further compensation
17 Rhesus type and antibody screen — This test will detect antibodies potentially causing hemolytic disease of the newborn.
19 The recommended dose is 400 micrograms per day Dietary supplementation with folic acid, before conception and throughout the first 12 weeks, reduces the risk of having a baby with a neural tube defectThe recommended dose is 400 micrograms per day
20 Vitamin A, be carefull !Pregnant women should be informed that vitamin A supplementation (intake above 700 micrograms) might be teratogenic and should therefore be avoided.Pregnant women should be informed that liver and liver products may also contain high levels of vitamin A, and therefore Consumption of these products should also be avoided.
27 Hepatitis BTesting for HBsAg should be performed on all women at the first prenatal visit and repeated late in pregnancy in those at high risk for HBV infection. The current recommendation is to provide passive-active immunization to newborns of carrier mothers.
28 AntiviralsA meta-analysis of 10 studies concluded that the administration of lamivudine to the mother in late pregnancy in addition to hepatitis B vaccination and hepatitis B immunoglobulin prophylaxis for the infant significantly reduced mother-to-child transmission
29 More data are needed to clarify the HBV DNA cutoff for recommending antiviral therapy to pregnant HBV carriersAt present, we tend to offer antiviral prophylaxis in women who have a high viral load (more than 8 log(10) int. unit/mL). Treatment should be started preferably six to eight weeks before delivery to allow enough time for HBV DNA levels to decline. Of the available oral agents, telbivudine and tenofovir are pregnancy class B drugs
30 With appropriate immunoprophylaxis, breastfeeding of infants of HBV carriers poses no additional risk for the transmission of HBVInfants who received HBIG and the first dose of vaccine at birth may be breastfed as long as they complete the course of vaccinationbut carrier mothers should not participate in donating breast milk.Mothers with chronic hepatitis B who are breastfeeding should also exercise care to prevent bleeding from cracked nipples
31 Further testsVDRLAsymptomatic bactriuriaHIVThyroid function tests
32 Not recommendedCMVToxoplasmosisHSVBacterial Vaginosis