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

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WHAT TO KNOW ABOUT PRENATAL CARE, LABOR AND
DELIVERY!!
Dr. Jessica Bardales Mitac, MD Hospital
Ginecobstétrico Camagüey, Cuba.
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THE PURPOSE OF PRENATAL CARE IS TO ENSURE AN
UNCOMPLICATED PG AND THE DELIVERY OF A LIVE
AND HEALTHY INFANT.
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WHEN SHOULD PRENATAL CARE START?
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1. WHEN TOM CRUISE RETURNS YOUR CALL?
2. 1ST DAY AFTER YOU HAVE MISSED YOUR PERIOD?
3. ALL OF THE ABOVE?
4. NONE OF THE ABOVE?

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History

• 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.

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

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AVOID DURING PREGNANCY

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

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• 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

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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

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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, mothers outcome.
• c) Length of labor, any complications?

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• 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, PAPS SMEAR FOR STD
• STOOL CULTURE FOR OVA AND PARASITES,
• TB TEST FOR HIGH RISK PATIENT
• ULTRASOUND EXAMINATION

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

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• 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

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COMMON COMPLAINTS DURING PG

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

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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.

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JUST BEFORE THE BEGINNING OF LABOR, A SMALL
AMOUNT OF RED-TINGED 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.
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• 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

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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.
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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.
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ALTERNATIVE MEDICINE?
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• 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.