Routine ANC ??????????

1
???????????????????????????? ??? ????????

• ???
• ??.????? ??????????
• ??.????????? ????-????????
• ??.??????????????????????? 17

2
????????????????????????????

• Routine ANC ??????????
• ???????????????????????
• ??????. ?????????? ???? UA , BP ???????? ???
• ???? UA ,BP ???????? ? ??
• ???????????????????????????????? 1 ???????? 16-20
  , 24-28 wks
• ??????????????????????????????????? 28 ???????
• ?????????????? 0, 1 , 6 ?????
• ????????? HBsAb, VDRL , Anti HIV, CBC, DCIP/OF
• ????????????????????
• ???????????? ???? B/V , ??????????? ?????
  ???????????? ????????
• ??????? High risk ????????

3

• ????????????????????????????????????
• ?????????????????
• ??????????????? ( Hb lt 11 gms ???? Hct lt 33 )
• ????????????????? ( ????? PIH UTI )
• ????????????????? GDM
• VDRL , HIV , HBsAg ????????
• DCIP / OF / MCV

4
???????????????????????????????????

• ????????? ???????????????????????????
• Down syndrome
• ????????????
• ???????????? ????? ?????? ??????? ?????
• ?????????????
• UTI , Abruption , Anomally , Fetal death
• ??????????????
• TORCH, Sy, HBV, thalassemia

5
???????????????????????????????????
????????? ( ??????? ?? ?? ?????? ,
??????????????? ) ??????? ????????????????? Rh
negative ??????? ??????????????? ( ????????
???????????????????? ) ????? ( ???????
????????????? ) ?????????? ( Chicken pox ,
Rubella , Measle ) Rubella (Anomally
-?1st-12.5, 2nd -25 , 3rd 50) Chicken Pox
? ???? 7 ???? 7 ??? All or None Law
6
Down Syndrome

1. ?????????????? ?
2. ??????? ?????????????
3. ??????????????????

7
???????? - Amniocentesis 14-18 wk ????????????????
???????????? ?????????????????????????????????
8
????????????????
??????????????????????? ????? ?????? ??????
?????????????? ?? ?? ?? ?????? ???????????????????
????? ?????????????? ?????????? ??? ?????????
???????????? ????? ????????????????
????????????????????????????????? ?????? HBsAg,
Anti HBs, Anti HBc , HBeAg , AntiHBe ????????????
????????? ??? HBIG, HB Vac ANC ?? HBsAg
?????????????????????? ???????????????? - ??Anti
HBc ??????????
9
Abnormal LFT in Pregnancy
?????????????? Severe preeclampsia (2-10 of
Pregnant, 4-6?HELLP) HELLP (50 no Hypertension)
0.2-0.6 of pregnant Fatty Liver in pregnancy
10
?????????????????????? Preeclampsia HELLP
2-10 Preeclampsia
0.2-0.6 HELLP
4-6 PH
11
?????????????????????? Hepatitis B virus
Acute hepatitis
Acute hepatitis virus B
12
Carrier hepatitis virus B
13
Carrier hepatitis virus B ???????? AntiHBe
14
HELLP syndrome
The most common symptoms of HELLP syndrome
include Headaches Nausea and vomiting that
continue to get worse ( ????? Influ.) Fatigue
or malaise Upper right abdominal pain or
tenderness
Hemolysis -Red blood bells Abnormal peripheral
smear Lacatate dehydrogenase gt600 U/L Bilirubin
gt 1.2 mg/dl Elevated liver Enzyme levels Serum
aspartate amniotransferase gt70 U/L Lacatate
dehydrogenase gt600 U/L Low Platelets Platelet
count lt 100,000 /mm3
15
HELLP syndrom
H- hemolysis ( breakdown of red blood cells) EL-
elevated liver enzymes (liver function) LP- low
platelets counts (platelets help the blood clot)
Incidence 0.2-0.6 3rd Trimester Associate with
Preeclampsia 4-6
16
???????
??????????????????????? ?????? - Spirchetes (
Treponema pallidum ) ??????????? ??????????????
?????????? 30-33 ??. ????????? ?????????????????
?? ????? ???????? ??????????????????????
??????????????????? USG -Hepatomegaly, asites,
hydrops, thikened placenta ???????????
????????????? 14 wks ??????????????? ????????????
?????? ??????? Congenital Sy VDRL gt 1 8 , ??
TPHA ???????? VDRL lt 1 8
17
????? VDRL titer ???????????
18
???????
VDRL (Veneral Disease Research Laboratory
test) Protein ???????????????????????????????
Sy ??? ???????? (titer gt 18) , CSF F/U
?????? titer ???? ???? Non Reactive False
Reactive Pregnancy , Viruses (mononucleosis,
Hepatitis), Drugs, Leprosy, Rheumatic fever, RA
, SLE TPHA , FTA-ABS (antibody titer) Life
long Confirmative Dx ???? VDRL Low titer
19
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20
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21
???????
??????? Anti HIV ???????? (14-36) Treatment Benza
thine PG 2.4 mU IM weekly x 2 weeks ?????????
penicillin ? desensitized Erythromycin 500 mg x
4 x 14 d Azithromycin 500 mg OD x 10
d ????????? gt congenital Sy Rx Husband
22
???????
1st trimester good prognosis for treatment 2nd
trimester Preterm , IUGR, congenital Sy ,
Failure Rx F/U VDRL titer - 28-32 wk at
delivery or every 1 mo Inadequate Rx
????????? 30 ????????????????? - Ab titer
????????? 4 ?????????????????? - ?????????? 12
mo
23
???????
Early congenital syphilis A child under two years
of age who was infected in utero. Clinical signs
are similar to secondary syphilis and may
include hepatosplenomegaly skin rash
condylomata lata rhinitis (snuffly babies)
bone involvement (osteochondritis)
pseudoparalysis (due to epiphysitis) meningitis
anaemia failure to thrive.
24
???????
Late congenital syphilis A child over two years
of age who was infected in utero. The child
presents with signs such as one or more of
Hutchinson's triad (interstitial keratitis,
defective incisors and nerve deafness) gummata
neurosyphilis frontal bossing and anterior
bowing of the shins. Cardiovascular lesions do
not occur in congenital syphilis.