ANTENATAL CARE Translate Googling
ANTENATAL CARE Translate Googling
Definition
The American Academy of Pediatrics and the American College of
Obstetricians and Gynecologists (1997) define antenatal care is a
comprehensive antepartum care program involving an integrated
approach to medical care and psychosocial support that is optimally begun
before the conception to the antepartum period.
Metabolism
1. BMR in pregnant women increases up to 15% -20%,
especially in the late trimester. 2. Acid bace balance
changes. 3. Protein is required for the development of fetus,
uterus, breast and mother's body, and for the preparation of
lactation. 4. Avoid charcoal, a pregnant woman often feel
thirsty, strong appetite, frequent urination and sometimes
found glucose suria reminiscent of diabetes mellitus. 5.
Cholesterol levels increase to 350mg / more per 100 cc. 6.
Mineral metabolism - Calcium: it takes an average of 1.5 g
daily - Phosphate: it takes an average of 2 g / day - bezi: it
takes iron approximately 800 mg / 30-50 per day - Water:
water retention 7 Weight gain of about 6.5-16.5 kg 8. Caloric
needs increase during pregnancy and lactation 9. Pregnant
women need nutritious foods and should contain lots of
protein
CLINICAL EXAMINATION
ANAMNESIS
PHYSICAL EXAMINATION
Inspection:
Advance → chloasma gravidarum, edema +/-
Eyes → conjunctiva anemis +/-, jaundice sclera +/-
Mouth → gums and teeth
Neck → JVP, enlarged thyroid gland and lymph node +/-,
Mammae → shape, symmetry, enlargement, widened nipples, hyperpigmented
areola, vascular mel
Abdomen → enlarged, pigmentation linea alba and striae, sikatriks +/-, visible
motion of child +/-
Vulva → perineum, varices +/-, flour albus +/-
Anus → hemoroid +/-
Limbs → varices +/-, edema +/- (pretibial, ankle, back leg), sikatriks +/-
Leopold II: the position is still the same, move the hand to the
side. Determine where the child's back is the one who gives the
biggest hurdle then look for small pieces that lie contradictory
Leopold IV: the position of the examiner facing the patient's feet,
with both hands determine what is at the bottom and whether this
part has entered into the LAP and how much it enters.
Genitalia Examination:
A clinical pelvic examination, assessed:
Conjugate diagonal → because the transverse diameter can not be measured
directly then look for diameter anteroposterior / conjugata diagonalis
How to: with the middle finger try to reach the promontory, then press the
network between the examiner's finger with the thumb and mark.
The distance between the fingertips that enter with the sign was the conjugata
diagonalis.
Vulva and surrounding structures are also carefully inspected. All lesions in the
cervix, vagina, and vulva are further evaluated by colposcopy, biopsy,
culture.The perianal region should be inspected and rectal touches are
examined to identify the hemorrhoids and other lesions.
Auscultation of Fetal Heart Sound
Fetal heart sounds can be heard first between week 16 and 19. The ability to
hear fetal heart sound without amplification will depend on several factors,
including patient size and auditory acuity. Fetal heart sounds can be heard at
week 20 in 80 percent of women. By the 21st week, the sound of the fetal heart
is heard at 95 percent, and at 22 weeks on all pregnant women.
GENITALIA EXAMINATION
A clinical pelvic examination, assessed:
Conjugate diagonal → because the transverse diameter can not be measured
directly then look for diameter anteroposterior / conjugata diagonalis
Linea innominata palpable entirely +/-
Sacrum concrete from the top down and from left to right
The side wall of the pelvis is straight / convergent
Spina ischiadica stands out +/-
Arcus pubis, judging the angle. Normal> 90º
Os. Coxigeus, assess the movement
Gb.1.Clinical clinvetry
(Source: Current Obstetric & Gynecologic Diagnosis &
Treatment, Ninth Edition)
SUPPORTING INVESTIGATION
General check up
Ultrasound
Ultrasonography is now an integral part of antenatal care in
the Western world and in many developing countries.
Ultrasonography is also an important tool in diagnosing fetal
abnormalities. Ultrasonography has also facilitated the
diagnosis of multiple pregnancies early in pregnancy. The
development of complications in early pregnancy can also be
recognized with the help of ultrasound.
Amniocentesis
Amniocentesis is the action of amniotic fluid sampling for
antenatal diagnosis of chromosomal abnormalities and
biochemical abnormalities through examination of detached
fetal cells and amniotic fluid itself. Amniocentesis is usually
performed after 16 weeks of pregnancy so that the loss of
aspirated fluid will not alter the volume of the uterine cavity
significantly, which may cause uterine contractions.
Fetoscopy
This technique has been used to diagnose small fetal malformations, such as
facial clefts or finger defects in families at risk of developing specific genetic
syndromes and as visual guidance on fetal blood sampling, liver biopsy, and
skin.
Cordoscopy
This technique has now outperformed fetoscopy in fetal blood sampling and
fetal blood transfusions. Besides being used for prenatal diagnosis of hereditary
blood disorders such as hemophilia, cordosynthesis is also used for the
diagnosis of fetal infection due to this procedure is less than 1%
This technique has now outperformed fetoscopy in fetal blood sampling and
fetal blood transfusions. Besides being used for prenatal diagnosis of hereditary
blood disorders such as hemophilia, cordosynthesis is also used for the
diagnosis of fetal infection due to this procedure is less than 1%
ADDITIONAL EXAMINATION OF
ACCORDING TO INDICATION
Chalmydia Trachomatis Examination
A universal examination to detect chlamydial infection
against all pregnant women is not recommended. In women
at high risk of weak socioeconomic status, infection at 24
weeks' gestation is associated with an increased incidence of
preterm labor by two to three times.
RECOMMENDATIONS AND
SUGGESTIONS
NUTRITION
15 30 15
12 15 19
RECOMMENDATIONS
Sports
Work
Traveling
Bath
Clothing
Habits of CHAPTER
Coitus
Sports
Pregnant women should not limit exercise, provided they do not experience
fatigue or are at risk of injury, such as jogging. Clapp (1989) reports that 18
pregnant women who are well-preserved have improved in their metabolic
efficiency during exercise. Oxygen consumption, pulse rate, stroke volume, and
cardiac output, all increase fairly during their exercise. Pivarnik et al. (1994)
showed that pregnant women who exercised regularly had a significantly
greater blood volume.
Work
Any work that causes pregnant women to experience great physical stress
should be avoided. The American Academy of Pediatrics and the American
College of Obstetricians and Gynecologists (1997) conclude that
uncomplicated pregnant women can continue their work until the onset of
labor. A rest period of 4-6 weeks is recommended before the woman returns to
work.
Traveling
Healthy and traveling pregnant women do not have a bad effect on their
pregnancy. Travel on aircraft with sufficient air pressure does not pose a
specific risk as long as it is not within 7 days of the expected date of labor. For
the use of seat belts, there is no evidence that the seat belt increases the
likelihood of injury to the fetus.
Bath
There is no prohibition of bathing during pregnancy or childbirth. Be careful
while bathing to avoid falling or slipping.
Clothing
We recommend using a comfortable and not tight clothes. Using a bra that can
support the breast properly and not using tight stockings.
Habits of CHAPTER
Constipation is common in pregnant women, possibly due to prolonged transit
time and depression of the lower intestine by the uterus. To prevent
constipation during pregnancy it is advisable to consume more water, enough
exercise, fibrous food consumption, and if necessary can be given mild
laxatives.
Coitus
If there is a threat of abortion or premature partus, coitus should be avoided. If
there is a previous abortion history, coitus should be delayed until a 16-week
pregnancy in which the placenta has been established and the possibility of
abortion
Dental Care
Pregnancy is rarely a contraindication to dental therapy. The concept that dental
caries is exacerbated by pregnancy is not proven.
Immunization
Measles, mumps, and varicella-zoster: contraindicated
Typhoid, Japanese Encephalitis, cholera: risk vs benefit
Polio: not recommended
Influenza: after TM 1
Rabies, Hepatitis A and B, Pneumococcus, Meningococcus, haemophilus,
tetanus, diphtheria: same as non-pregnant
Smoke
Smoking in pregnant women can cause fetal injury, premature labor, low birth
weight, fetal growth disorders, fetal death, and placental abruption.
Alcohol
Ethanol is a powerful teratogen. Alcohol use during
pregnancy can cause fetal alcohol syndrome, characterized
by growth disorders, facial abnormalities, and CNS
dysfunction.
Caffeine
Pregnant women should limit caffeine
consumption. Caffeine has a mutagenic-strengthening effect
of radiation and some chemicals when administered in
massive amounts and can decrease blood flow to the uterus
by 5% -10%.
Drugs
Chronic drug use during pregnancy can harm the
fetus. Fetal distress, LBW, and severe disruption due to
dropping of the drug soon after birth have been widely
reported.
Drug
Virtually all drugs that cause systemic effects on the mother
will penetrate the placenta and reach the fetus. When a drug
is administered during pregnancy, the benefits gained
should outweigh the risks involved in its use
Back Pain
Lower back pain is reported by half of pregnant women. Mild pain arises from
excessive stretching or fatigue and bending, lifting, or over-running. Risk
factors are history of previous back pain and obesity.
Varicose veins
Varicose veins generally occur due to congenital
predisposition and are aggravated by prolonged standing,
pregnancy, and old age. In pregnancy femoral venous
pressure increases significantly with the gestational age.
Liver pain
Liver pain is one of the most common complaints in pregnant women, and is
caused by reflux of lambugn contents into the esophagus, caused by upward
shifts and uterine stomach suppression accompanied by weakening of the lower
esophageal sphincter.
Pika
The desire to eat the odds is likely triggered by a fairly severe iron
deficiency. However, not all who suffer from this pica have iron deficiency.
Fatigue
In early pregnancy, most women complain of fatigue and
want to sleep continuously. This condition usually subside by
itself in the fourth month of pregnancy. This may be due to
the drowsiness effect of progesterone.
Headache
The pathological significance is to show signs of impending eclampsia,
especially in old gestational age
Leukorea
Pregnant women often experience increased vaginal discharge, which in many
cases is not pathological. This is caused by an increase in mucus by the cervical
glands in response to hyperestrogenemia clearly contributes.
Signs of Birth
The incidence of HIS
Bloddy Show
Rupture of membranes
Thank you
Teks asli Indonesia
1. Sistem sirkulasi darah • Volume darah bertambah kira-kira 25 %,dengan puncak
kehamilan 32 minggu.
Sarankan terjemahan yang lebih baik