WHAT TO KNOW ABOUT: PRENATAL CARE, LABOR AND DELIVERY!!

Dr. Jessica Bardales Mitac, MD Hospital Ginecobstétrico Camagüey, Cuba.

THE PURPOSE OF PRENATAL CARE IS TO ENSURE AN UNCOMPLICATED PG AND THE DELIVERY OF A LIVE AND HEALTHY INFANT.

WHEN SHOULD PRENATAL CARE START?

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WHEN TOM CRUISE RETURNS YOUR CALL? 1ST DAY AFTER YOU HAVE MISSED YOUR PERIOD? ALL OF THE ABOVE? NONE OF THE ABOVE?

History
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Prenatal care as we know it today is a relatively new development in medicine. 1900 the nurses of the instructive nursing association in Boston began making house calls to pregnant mothers. These visits decrease the complications of delivery, the principle behind them was gradually accepted by physicians and our present system of prenatal care, which stresses PREVENTION, evolved.

IDEALLY, a woman planning to have a child should have a medical evaluation before she becomes pregnant.

Good Nutrition
Should include: Whole and organic foods; Proteins, fats; micronutrients such as, calcium, iron, magnesium, zinc and vitamins; moderate salt restriction, all in a balanced diet.

AVOID DURING PREGNANCY
• CIGARETTE SMOKING •ALCOHOL AND DRUG USE • EXPOSURE TO TERATOGENS. •EXCESSIVE PHYSICAL WORK

•Pregnancy is a normal physiologic event that may complicated by pathologic processes dangerous to the health of the mother and fetus in only 5-20% . • INITIAL OFFICE VISIT: Its’ purpose is to identify all risk factors to which the mother and fetus are exposed that may lead to the pathologic processes. This involves:

HISTORY TAKING
•PRESENT PREGNANCY: Medical history- many medical disorders affecting pregnancy: for example, genetic, cardiovascular, gastrointestinal, endocrine disorders as well as a familial history of Diabetes Mellitus and chronic hypertension among other pathologies require careful evaluation and counseling. • Immunization status of the expecting mother

HISTORY TAKING
Identify the last menstrual period FRO accurate gestational age of the pregnancy.  Previous pregnancy: a) Surgical history- C-section, forceps delivery, breech delivery or normal vaginal birth b) Length of gestation, birth weight, fetal outcome, mother’s outcome. c) Length of labor, any complications?

PHYSICAL EXAMINATION: COMPLETE GENERAL AND PELVIC EXAMINATION MUST BE PERFORMED ON EVERY NEW PREGNANT PATIENT. COMPLETE IMMUNIZATION SCHEME AGAINST TETANUS BASIC LAB TESTS: •BLOOD SCREENING FOR Rh FACTOR, VDRL FOR SEXUALLY TRANSMITED DISEASES •URINE TESTING, PAP’S SMEAR FOR STD •STOOL CULTURE FOR OVA AND PARASITES, • TB TEST FOR HIGH RISK PATIENT ULTRASOUND EXAMINATION

SUBSEQUENT VISITS TO THE OBSTETRICIAN CAN VARY:
STANDARD SCHEDULE FOR PRENATAL OFFICE VISITS: 1ST-32 WEEKS; ONCE Q4W 32-36 WEEKS; ONCE Q2W 36 TO DELIVERY; ONCE QW

MATERNAL WELL-BEING AS A SIGN OF FETAL WELL-BEING

•Maternal weight at beginning of pregnancy compared to maternal height and identification of weight group. Subsequent weight increases should be regulated and recorded. •Fundal height, fetal heart tones, fetal size and position

COMMON COMPLAINTS DURING PG
•EXCESSIVE SALIVATION • ABNORMAL CRAVING •FREQUENT URINATION • VARICOSE VEINS •EDEMA, BACKACHE, •LEG CRAMPS, •BREAST SORENESS, •DISCOMFORT IN THE HANDS.

PREPARATION FOR LABOR AND DELIVERY.
•NORMAL PREGNANCY USUALLY LASTS 266 +/- 6 DAYS •TRUE LABOR: INVOLVES REGULAR UTERINE CONTRACTION •FALSE LABOR: QUITE COMMON IN LATE PREGNANY CONTRACTION IS NOT REGULAR •FIRST BABY: 8-12 HOURS AVERAGE DURATION, •SUBSEQUENT PREGNANCY DURATION OF LABOR IS LESS.

JUST BEFORE THE BEGINNING OF LABOR, A SMALL AMOUNT OF REDTINGED MUCUS CALLED “SHOW” MAY BE PASSED. CERVICAL MUCUS MIXED WITH BLOOD AND POSSIBLE EVIDENCE OF CERVICAL DILATION AND EFFACEMENT. FETAL PRESENTATION AND POSITION CONTRIBUTE GREATLY WITH SMOOTH DELIVERY.

NORMAL LABOR DIVIDED INTO 3 STAGES;  1ST: BEGINS WITH ONSET OF LABOR AND ENDS WHEN DILATATION OF THE CERVIX IS COMPLETE (10CM).  2ND: FULL DILATATION OF THE CERVIX TO THE BIRTH OF THE BABY  3RD: BIRTH/DELIVERY OF THE INFANT AND THE PLACENTA

PREPARATION FOR DELIVERY:
NATURAL CHILDBIRTH PROGRAMS ARE POPULAR IN CURRENT ERA, FATHER-TO-BE ACTIVE PARTICIPANT AND HELPS DURING LABOR. THE LAMAZE TECHNIQUE FOR PREPARED CHILDBIRTH. ADEQUATE DELIVERY ROOM FACILITIES INCLUDE WELL TRAINED PERSONEL, ANESTHESIA AND RESUSCITATION EQUIPMENT AND MEDICATION, AS WELL AS THE STERILE SURGICAL INSTRUMENTS THAY MAY BE NEEDED.

CARE FOR MOTHER AND INFANT AFTER BIRTH INFANT: APGAR SCORE AT 1st MIN AND 5th MINS TO EVALUATE IMMEDIATE WELL-BEING AND PREDICT POSSIBLE FUTURE NEUROLOGICAL DEFICIT. MOTHER: PROMOTE BREAST FEEDING WITHIN 30 MINUTES OF DELIVERY. CERVIX AND REST OF BIRTH CANAL SHOULD BE EXAMINED FOR ANY ABNORMAL BLEEDING, REPAIRED FOR LACERATIONS ESPECIALLY IF BLEEDING. OFFER EMOTIONAL SUPPORT TO THE MOTHER.

ALTERNATIVE MEDICINE?

CHIROPRACTIC  ACUPUNCTURE  TRADITIONAL CHINESE MEDICINE  YOGA  NATUROPATHY  NUTRITIONAL THERAPY  AND MANY MORE!!! ARE ALL USEFUL IN HAVING A SUCCESSFUL PREGNANCY AS WELL AS LABOR, YOU MIGHT WANT TO CONSIDER THEM.