Antenatal Classes

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Antenatal Classes

• Dr. Alexander K. Doo
• Specialist in Obstetrics Gynaecology
• The Womens Clinic
• Saturday 31/7/04
• Antenatal Talk
• City Hall

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Warnings Signs in the 3rd Trimester

• Starts from 28 weeks onwards.
• Bright red vaginal bleeding.
• Leaking of water from the vagina (sudden gush or
  slow leak).
• Regular tightenings or cramping.
• Dim or blurred vision or flashing bright lights
  or spots.

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Warnings Signs in the 3rd Trimester

• Bad headache/dizziness, a lot of swelling of face
  and body
• Chills and fever
• Pain when passing urine
• Decreased fetal movement

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Bleeding

• Bleeding at any time during the pregnancy should
  be immediately reported to your health care
  provider. In the second and third trimesters, it
  can be a sign of abnormal placental (after-birth)
  implantation to the uterine wall, or premature
  separation of the placenta. Bleeding can also
  occur after intercourse through pressure on or
  irritation of the vagina and/or cervix.

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Abruptio Placentae

• Placenta becomes detached from the uterine wall
  prematurely leading to bleeding and a reduction
  of oxygen and nutrients to the fetus. The
  detachment may be complete or partial.Occurs in
  less than 3.5
• More common in women who smoke, have high blood
  pressure, and/or in women who have had previous
  children or a history of abruptio placentae.

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Abruption

• Symptoms and treatment of abruptio placentae
  depend upon the degree of detachment. Symptoms
  may include bleeding, cramping, and abdominal
  tenderness. Diagnosis is usually confirmed by
  performing a complete physical examination and an
  ultrasound. Women are usually hospitalized for
  this condition and may have to deliver the baby
  prematurely.

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Placenta Previa

• Placenta previa is a condition in which the
  placenta adheres itself to the uterus near or
  covering the cervix. Often, the placenta moves to
  the upper half of the uterus during pregnancy
  requiring no treatment. When the placenta does
  not move and remains in the lower half of the
  uterus, the condition is called placenta previa.

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Placenta Previa

• This type of placental complication occurs in one
  in every 200 deliveries and occurs more often in
  women who have scarring of the uterine wall from
  previous pregnancies, in women who have fibroids
  or other abnormalities in the uterus, or in women
  who have had previous uterine surgeries.

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Placenta Previa

• Symptoms may include vaginal bleeding that is
  bright red and not associated with abdominal
  pain. Diagnosis is confirmed by performing a
  physical examination and an ultrasound. Depending
  upon the severity of the condition and the stage
  of pregnancy, modification of activities or
  bedrest may be ordered. The baby usually has to
  be delivered by cesarean section.

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Leakage of Watery Fluid From Your Vagina

• Urine leakage can be caused by the baby pressing
  on your bladder. Fluid leakage can also be the
  result of a spontaneous rupture of membranes. The
  membranes are a protective mechanism for the
  baby-they cushion him or her and allow room for
  fetal movement growth and provide a barrier
  against infection.

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Possible Signs of Premature Labour

• Increase in vaginal discharge (watery, mucousy or
  bloody)
• Low, dull backache (intermittent or constant)
• Pressure like baby pushing down (comes and goes)

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What to Do?

• Call if you have more than 8 contractions in 1
  hour
• Lie down drink some fluid and count the
  contractions
• Doesnt do away after 1 hour, or gt 5 X / hour in
  the next hour

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Pre-eclampsia

• Cause is unknown
• More common in 1st pregnancy
• 5 of all pregnancy
• Raise BP, Proteinurea, swelling due to fluid
  retention
• Eclampsia - siezure, coma, HELLP syndrome,death

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Signs and Symptoms

• Headache, swelling of hands face and feet,
  epigastric pain, irritability, nausea ,visual
  disturbance, decreased urine output, raised blood
  pressure, proteinurea.

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Treatment

• Depends on gestation
• ultimately requires delivery

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Urinary Tract Infection

• Burning or pain during urination
• Frequency
• can lead pre-mature labour
• Treatment with antibiotics

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Decreased fetal Movement

• First sign of fetal comprmise
• Intensity decreases as gestation advance
• Rule of 10
• If in doubt, check it out

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Indications for Elective Caesarean Section

• Patient choice
• Multiple pregnancy
• Placenta previa
• Malpresentations
• Previous section
• Maternal medical condition

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Some Arguments for Caesarean Section

• Maternal choice in 38 of cases
• In a randomized trial comparing elective section
  vs vaginal delivery it showed perinatal mortality
  and serious morbidity of 1.6 vs 5, and that 90
  delivered by section in the planned group vs
  56.7 in the vaginal gp
• Vaginal delivery is associated with with risk of
  urinary and feacal incontinence

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Some Reasons for Section

• 1/3 of women will have urinary incontinence 3
  months after delivery
• 11 life time risk of surgery for incontinence
  and prolapse
• Feacal incontinence 19 6 weeks
• Overall 1/3 of women will have evidence of anal
  sphincter defect on USS 6 weeks post-partum, and
  65 of which will have symptoms of anal
  incontinence.and 75 if its a second vaginal
  birth

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Indications for Emergency Section

• Failure to progress
• Cord prolapse
• Fetal distress
• Placental abruption
• Cephalo pelvic disproportion
• Premature labour ( lt1.5 Kg)
• Failed instrumental delivery

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The End