Prenatal Care

 Prenatal record
aids antepartum and intrapartum management
 Clinical evaluation : Pelvic examination
Initial Prenatal  Laboratory test
Evaluation Blood test: CBC, blood type with Rh status, and antibody screen.
Screening for hepatitis B virus, syphilis, and immunity to rubella
 Pregnancy risk assessment
 Previous and current health status
 Psychosocial screening
identify important issues and reduce adverse pregnancy
outcomes: preterm or low birthweight
Initial Prenatal  Cigarette smoking
Evaluation  Alcohol TERATOGENIC!
Adverse pregnancy outcomes
(History)  Illicit drugs
 Intimate partner violence
high risk of: preterm delivery, fetal-growth restriction, and
perinatal death
Prenatal Visits
 Subsequent laboratory test
 Prenatal surveillance If initial results were normal,
Interval
up to 28 weeks : every 4 weeks
most tests need not be
up to 36 weeks: every 2 weeks repeated
a) Fundal height
above 36 weeks : weekly
b) Fetal heart sound
a) Gestational diabetes
New Model
- first trimester visit & risk c) Sonography
b) Selected genetic
assessment screening
- another visits :26, 32, 38
weeks
  Weight gain recommendation
 Calories
caloric increase recommendation:
100 to 300 kcal/day

Nutritional Institute of medicine recommendation(2006):

1st trimester : 0 kcal/day
Counselling 2nd trimester : 340 kcal/day
3rd trimester : 452 kcal/day
 Protein
daily recommendation: 71 gr
Preferably, most protein should be supplied
from animal sources, such as meat, milk,
eggs, cheese, poultry, and fish
  Iron
iron supplementation 27 mg/day from 4 months of pregnancy
 Iodine
in pregnancy : ↑ fetal requirements and maternal renal losses
Nutritional recommendation: 220 𝜇g/day, from iodized salts and bread
Counselling : products
 Calcium
Mineral 1000-1300 mg/day
sufficient from maternal calcium storage
 Zinc
11-12 mg/day
  Folic Acid
recommendation: 600 𝜇g/day
nutritional source are insufficient, all women planning or capable of
pregnancy take a daily (single) supplement containing 0.4 to 0.8 mg of
folic acid
 Vitamin A
recommendation: 750-770 𝜇g/day
deficiency: risk of maternal anemia and spontaneous preterm birth
Nutritional  Vitamin B12
Counselling : recommendation: 2.6 𝜇g/day
source: food of animal origins, high risk of deficiency in vegetarian
Vitamin deficiency: risk of neural tube defects
 Vitamin B6 – Pyridoxine
when combined with the antihistamine doxylamine, is helpful to improve
nausea and vomiting of pregnancy
 Vitamin C
recommendation: 80-85 mg/day, sufficient from diet
 Vitamin D
recommendation: 15 μg per day (600 IU per day).
  Employment
 Exercise
In general, pregnant women do not need to limit exercise, provided they do not
become excessively fatigued or risk injury: activities with high risk of falling or
abdominal trauma and scuba diving. Regular, moderate-intensity physical
activities for 30 minutes or more day are encouraged.
Common In the setting of certain pregnancy complications, it is wise to abstain from
Concerns exercise and even limit physical activity

 Seafood consumption
pregnant and lactating women are advised to avoid specific types of fish with
potentially high methylmercury levels. These include shark, swordfish, king
mackerel, and tile fish.

 Travels
pregnant women can safely fly up to 36 weeks gestation
  Coitus
In healthy pregnant women, sexual intercourse usually is not harmful. Whenever
abortion, placenta previa, or preterm labor threatens, coitus should be avoided.
Oral-vaginal intercourse is occasionally hazardous.
 Dental care
periodontal disease has been linked to preterm labor
 Immunization
a) All women who will be pregnant during influenza season should be offered vaccination
Common b) Hepatitis B : Preexposure and postexposure for women at risk of infection

Concerns c) Hepatitis A : Preexposure and postexposure if at risk (international travel)

 Caffeine
heavy intake of coffee each day—about five cups or 500 mg of caffeine—slightly
increases the abortion risk. Caffeine intake during pregnancy be limited to less
than 300 mg daily, or approximately three 5-oz cups of percolatedcoffee
 Nausea and vomiting
can be minimized by:
Eating small meals at more frequent intervals, herbal remedy ginger, vitamin
B6 given along with doxylamine, phenothiazine or H1-receptor blocking
antiemetics
  Backache
can be reduced by squatting rather than bending when reaching down, by using a
pillow back support when sitting, and by avoiding high-heeled shoes.
usually responds well to analgesics, heat, and rest. Tylenol may be used chronically
as needed. Short course NSAID may also be beneficial
 Varicosities and Hemorrhoid
Varicosities: Treatment is generally limited to periodic rest with leg elevation, elastic
stockings, or both
Common Hemorrhoid : Pain and swelling usually are relieved by topical anesthetics, warm soaks, and
stool-softening agents.
Concerns  Heartburn
relieved by a regimen of more frequent but smaller meals and avoidance of
bending over or lying flat. Antacids may provide considerable relief
 Pica and Ptyalism
 Sleeping and fatigue
Most women experience some degree of sleep disturbance by the third trimester.
Daytime naps and mild sedatives at bedtime such as diphenhydramine (Benadryl)
can be helpful.