100% found this document useful (2 votes)
787 views26 pages

ANTENATAL CARE Translate Googling

Antenatal care involves comprehensive medical care and psychosocial support for pregnant women, ideally beginning before conception. It monitors the health of the mother and fetus during pregnancy. Regular antenatal visits include physical exams, lab tests, health screenings and education. The schedule of visits is usually every 4 weeks until 28 weeks, every 2 weeks until 36 weeks and weekly thereafter. Antenatal care aims to promote normal pregnancies and deliveries while early detecting any risks or complications.

Uploaded by

Lutfi ari206
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
100% found this document useful (2 votes)
787 views26 pages

ANTENATAL CARE Translate Googling

Antenatal care involves comprehensive medical care and psychosocial support for pregnant women, ideally beginning before conception. It monitors the health of the mother and fetus during pregnancy. Regular antenatal visits include physical exams, lab tests, health screenings and education. The schedule of visits is usually every 4 weeks until 28 weeks, every 2 weeks until 36 weeks and weekly thereafter. Antenatal care aims to promote normal pregnancies and deliveries while early detecting any risks or complications.

Uploaded by

Lutfi ari206
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
You are on page 1/ 26

ANTENATAL CARE

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.

B. Effectiveness of Antenatal Care


 In general, the pregnancy develops normally and results in the birth of a
healthy enough baby through the birth canal but sometimes not as
expected. It's hard to know beforehand that pregnancy will be a
problem. The risk assessment system can not predict whether pregnant
women will have problems during pregnancy. Therefore, antenatal care is
an important way to monitor and support the health of normal pregnant
women and detect mothers with normal pregnancies.

C. Objectives of Antenatal Care


 Antenatal care has the following objectives:
 Monitor progress of pregnancy
 Improve and maintain the physical, mental and social health of mothers and
infants
 Early recognition of abnormalities
 Preparing for normal labor pregnancy
 Preparing mom
 Preparing the role of mother and family

D. Antenatal Care Procedure


 1. Preconception Treatment
 Because health during pregnancy depends on health before pregnancy,
Antenatal care becomes part of Antenatal care.
 Antenatal care potentially reduces risk, promotes a healthy lifestyle, and
improves pregnancy preparedness.
2. Early Antenatal Examination
Should start as soon as pregnancy is predicted.
The main objectives of this action are:
1. Determining maternal and fetal health status
2. Determine the gestational age of the fetus
3. Start a plan to continue obstetric care
 The components are (American Academy of Pediatrics and American
Colleges and Gynecologists):

1. Risk assessment includes genetic, medical, obsessive


and psychosocial factors
2. Estimated partus
3. General physical examination
4. Laboratories test: Hb, Ht, urinalysis, blood type
determination, Rhesus, rubella status, syphilis
screening, Pap smear, HBsAg test, offering HIV testing.
5. Patient education: about activities, nutrition and
nutrition, avoid smoking and alcohol

E. Antenatal medical records


There are several important definitions to produce accurate
antenatal medical records:
 Primipara: a woman who gives a fetus who reaches gestational age more than
20 weeks or more
 Multipara: a woman who has been twice or more pregnant until the age of 20
weeks or more
 Nuligravida: a woman who is not currently or never pregnant
 Gravida: a woman who is or has been pregnant, whatever the outcome of her
pregnancy. With the occurrence of the first pregnancy, then he becomes a
primigravida, and with subsequent pregnancies a multigravida.
 Nulipara: never finished pregnancy beyond 20 weeks' gestation

F. High Risk Pregnancy


 In the management of pregnancy, there are several major topics that have
high risk and can be attention and given appropriate attention. These
categories are:
 Have a medical illness
 Pre-pregnancy history is poor: perinatal death, premature labor, fetal growth
disorder, malformation, placental impairment, or maternal bleeding.
 Signs of malnutrition in the mother

G. Antenatal Visit Schedule:


 An ANC schedule according to WHO
 According to WHO for pregnant women who do not have risk factors in
pregnancy, at least can do ANC 4 times at 1 TM TM time, 1 time at TM II, and
2 times at TM III.
 First Visit; preferably before 12 weeks of pregnancy
 General patient information
 Information about patient's medical history

 Previous patient's obstetric history


 Physical examination includes signs of anemia, blood pressure, weight and
height, and vaginal examination with speculum including Pap smear
 Blood tests (preferably Hb examination only done at 32 weeks of gestation or
3rd visit, unless there are signs of anemia), urine, and blood type
 Provision of iron supplements Provide education and health information during
pregnancy
 TT injection

 2nd visit; performed in a pregnancy approaching 26 weeks.


 Repeating questions about the patient's medical history and illness
 Record the condition of the patient not found during the first visit (accident,
illness, vaginal bleeding / vaginal discharge, etc.)
 Note any changes to the patient's body
 Ask baby movement
 Check BJA
 Ask about mother's habits: smoking, alcohol, etc.

 Check the blood pressure


 Leopold examination
 Vaginal examination when the first visit is not done.bila bleeding vaginal
examination is prohibited.
 Hb examination again if on examination of the first Hb <7 g%
 Provision of iron supplements
 Providing advice and education about pregnancy
 The member knows the schedule of the next visit is the pregnancy approaching
the age of 32 weeks

3rd Visit; performed at approx. 32 weeks of gestation.


 If the patient does not come on the 2nd visit, the examination is completed at
the 3rd visit
 Ask patient complaints: back pain, bleeding, vaginal discharge, etc.
 TD measurement, Leopold examination, urinalysis, BB weight and hemoglobin
examination
 Ask the child's movement and check BJA

4th Visit; preferably at gestational age between 36-38 weeks.


 Examination of baby presentation and decrease of baby's bottom
 Judge a narrow pelvis or not
 Provide all information about the signs of labor, and if there is immediately go
to the hospital or maternity clinic.
 If there are no signs of labor at 41 weeks' gestation, go to the hospital
immediately.
 Physical and laboratory checks such as previous visits

Schedule of follow-up visits by parkland


hospital
 Traditionally, the timing of the next Antenatal examination is scheduled every
4 weeks interval through the age of 28 weeks, and then every 2 weeks to 36
weeks and thereafter every week. In pregnancy without complications the
number of visits can be less.

Antenatal visit schedule used at Parkland


Hospital for nulliparous women without
medical risk factors and multiparous women
with a history of normal pregnancy
Woman Woman
Number of
Purpose of Visit
Visits
Nulipara Multipara
1 Week 16 Week 16 AFP screening, ultrasound if necessary
2 Week 19 Week 22 Assessing gestational age, Auscultation of BJA
Assess gestational age, gestational diabetes
3 Week 26 Week 26
screening, Ig anti-Rh testing if necessary
Assess the size of the fetus, Hb, Ht, VDRL and
4 Week 30 Week 30
syphilis serology if necessary
5 Week 34 Week 36 Assess the size of the fetus, check TD
6 Week 36 Week 38 Surveillance TD
7 Week 37 Week 40 Surveillance TD
TD Surveillance, postmature induction schedule
8 Week 38 Week 41
for multiparas
9 Week 39 TD surveillance, postmature induction schedule
10 Week 40 TD surveillance, postmature induction schedule
11 Week 41 TD surveillance, postmature induction schedule

Physiological changes in pregnant women


 Changes in the reproductive system

Uterus Size: The size of a 30x25x20 cm long pregnancy


with a capacity of more than 400cc.Weight: up from 30
g to 1000g at the end of pregnancy (40 weeks) Position
of the uterus in pregnancy: - At the beginning of
pregnancy in the location of anteflexion or retro flexion
- At 4 months of pregnancy, the uterus remains in the
pelvic cavity after it begins to enter the deep abdominal
cavity enlargement can reach the limit of the heart. -
Vascularization: veins (venous) expands and increases -
Cervical uterine: the cervix becomes soft (soft) is called
the Godell sign.
 Ismus becomes hypertrophy, long and soft occurs in young pregnant ( mark
hegar)

Ovary • Ovulation stops • There is still a


corpus luteum gravidity until the formation
of cirri that takes over the expenditure of
estrogen and progesterone.
 Ovary • Ovulation stops • There is still a corpus luteum gravidity until the
formation of cirri that takes over the expenditure of estrogen and progesterone.
 Vagina and Vulva Due to hyper vaginal and vaginal vaginalization of the
more red / bluish livid color on the vagina and portio cervix is called the
Chadwick sign.
 Breast (mammae) Bigger, tense and heavy. May be palpable nodules due to
hypertrophy of shadow alveolar glands of veins more blue in hyper
pigmentation of the nipple and breast areola.
 Abdominal wall Arise striae gravidarum and linia nigra.

 Changes in organs and other systems

1. The blood circulation system • The blood volume


increases approximately 25%, with a peak of 32 weeks
of pregnancy. • Blood protein will decline in the first
quarter and only increase slowly at the end of
pregnancy
• Calculate the type and the hemoglobin will become
lower

2. Respiratory Tract Sometimes complaining


of shortness of breath.
 2. Respiratory Tract Sometimes complaining of shortness of breath.
 3. Saliva's digestive tract increases in the first trimester, nausea and
vomiting. The tone of the gastrointestinal muscles weakens so that motility and
food will last longer in the food channel, food resorbtion is good, but leads to
obstipation.
 4. Bones and teeth Pelvic joints will feel more loose, because the ligaments
soften (softening). If feeding can not meet the needs of fetal calcium, then
maternal calcium in long bones will meet this need. When calcium intake is
enough, the tooth will not lack calcium.
 5. Skin Advance: cloasma gravidarum Breast: nipple & breast areoal
Abdominal: linia nigra and striae

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 +/-

 Abdominal Palpation (Leopold)


 Leopold I: the examiner stands facing the patient, then with both
hands fingers with the fingers to determine the height of the
uterine fundus and what part of the child is found in the fundus

 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

 High Measurement of Fundus Uterus


 Measurement of fundal height of uteri above the symphysis. Before making a
measurement, the bladder should be emptied.
 Leopold III: wearing only one hand, touch the bottom and decide
whether it can still be shaken to determine what is on the bottom
and whether / has not entered the top door of the pelvis.

 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.

 Inspeculo Inspection and inspection in:


 The cervix is seen using speculum. The typical feature is a passive red-bluish
hyperemia in the cervix, but this picture is not diagnostic for pregnancy. It may
be obvious that cervical glands are dilated, blocked, and protruding (also
called nabothian cysts ) under the exocervical mucosa. If the cervix undergoes
significant dilatation, the fetal membrane can be seen through the cervical
canal, which at least suggests that there may be expulsion of the
conception. Then, to identify cytologic abnormalities, Pap smears and
specimens were taken to identify Neisseria gonorrhoeae and
possibly Chlamydia trachomatis.

 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.

Abdominal Palpation (Leopold)


 Leopold I:

The examiner stands facing the patient, then with both


hands touching with the fingers to determine the height
of the fundus uteri and what part of the child is found
in the fundus
 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
 High Measurement of Fundus Uterus

Measuring the height of the uterine fundus above the


symphysis can provide useful information. Jimenez and
colleagues (1983) prove that between weeks 20 to 31
fundal height in centimeters is equivalent to gestational
age in weeks. Quaranta and colleagues (1981) and
Calvert and colleagues (1982) reported basically similar
observations up to 34 weeks' gestation. Before making a
measurement, the bladder should be emptied.
 Leopold III:

Wearing only one hand, touch the bottom and decide


whether it can still be shaken to determine what is on
the bottom and whether / has not entered the top door
of the pelvis.
 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 been entered into the LAP and
how the entry

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)

Inspeculo inspection and deep inspection


 The cervix is seen using a speculum that is lubricated by warm water
 Speculum is expelled and examined in the pelvis (vaginal touché) by palpation,
with particular attention to the consistency, length, and opening of the cervix,
the lower part of the fetus, especially towards the end of pregnancy, in the
architecture of the pelvic bones, and in all vaginal and perineal abnormalities,
including cystocele, rectocele, and perineum that have been relaxed or torn.

Auscultation of Fetal Heart Sound


 Fetal heart sounds can be heard first between week 16 and 19 when done
carefully using a DeLee fetal stethoscope.
 Herbert et al. (1987) reported that 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.

SUPPORTING INVESTIGATION
 General check up

Hematologic examination can be for all practical


purposes, limited to the determination of hemoglobin or
hematocrit concentration. White blood cell count and
differential can recognize rare cases of leukemia that
occur during pregnancy if there is clinical suspicion.
 Urinalysis

Midstream urine examination and following


examination:
1. Analysis of glucose, ketone, protein
2. microscopic examination of sediment
3. Quantitative cultures or biochemical screening for
the presence of basiluria
 Blood Type, Rhesus Factor and Antibodies Filtration

Every pregnant woman should undergo blood type,


rhesus and antibody screening at the first prenatal
visit. When found in a positive screening, antibodies are
recognizable and the patient is treated appropriately.
 Glucose Filtration

The best glucose screening for gestational diabetes is


performed between 24 and 28 weeks of pregnancy,
when the need for insulin is maximized. Each pasaien
with one or more risk factors (table 1) should undergo
screening at the first visit if the visit is before 24 weeks.

Risk factors for Diabetes Mellitus


 Age 25 years or older
 Obesity
 Family history of DM
 Infants who previously weighed> 4000 mg
 The previous baby was born dead
 Previously crippled birth defects
 Polihidramnion
 Recurring abortion history

Serum alpha-fetoprotein test


In each pregnant woman should be checked for the
availability of serum alpha-fetoprotein test if indicated. This
examination, which can predict open neural tube defects, is
best performed between 16 and 20 weeks.

Examination of HIV-AIDS and surface


antigen Hepatitis B (HbsAg)
HIV is deadly to mothers and fetuses, even harmful to the
examiner. Mother with antigen (HbsAg +), then her baby
has 70-90% risk of hepatitis B and 85-90% risk to be a
chronic HBV carrier.

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.

Chorionic villus sampling (CVS)


 Sampling of chorionic villi (CVS, chorionic villus sampling). enables active
cell division culturing, distinct from cell release to amniocentesis, and if
abnormalities are obtained, termination of pregnancy may be performed at a
relatively early stage. Nevertheless, CVS carries a 2-3% risk of fetal death in
connection with the procedure, a figure higher than the risk of amniocentesis.

In the past, CVS was done via a transervical route. However,


the high rates of complications and the relative difficulty of
this technique pave the way for transabdominal techniques:
the 19-20 G needle is not directed to the amniotic fluid pool,
but rather the placenta with real-time ultrasound
guidance. Thus, basically this operation is similar to
amniocentesis.
 Another risk of CVS if performed in pregnancy less than 10 weeks is a greater
incidence of limb defects, but the exact mechanism for this is
unknown.Another problem in interpreting the coronary villi culture results is
the high incidence of moassic forms, which can be misinterpreted as fetal
karyotype abnormalities. In this case, confirmation is required with
amniocentesis

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.

Bacterial Vaginosis Examination


 Screening for bacterial vaginosis may be considered in women at high risk of
preterm labor.

Fetal Fibronectin Inspection


Measurement of this protein in vaginal fluids was once used
to estimate preterm labor in women with contractions. The
Committee on Obstetric Practice of the American College of
Obstetricians and Gynecologists (1997a) does not
recommend routine thinning in general obstetric
populations.

Group Streptococcal Examination


 The eradication of these organisms during labor substantially reduces early-
onset neonotor sepsis. However, there is currently no clear consensus regarding
culture screening for streptococcal colonization

Examination of rubella antibodies


 Filtering of rubella antibodies should be performed on each prenatal patient
who is vulnerable or whose status is unknown

RECOMMENDATIONS AND
SUGGESTIONS
 NUTRITION

Maternal weight gain during pregnancy does affect the


baby's birth weight. Abrams and Laros (1986) studied
the effect of maternal weight gain on birth weight in
2946 pregnancies with aterm labor. Women who weigh
less to give birth to smaller babies while the opposite
applies to women who weigh more. The average
maternal weight gain during pregnancy is 15
kg. patients who are at the greatest risk of having LBW
babies (<2500 g) are those whose weight is less than 7
kg.

Weight Added Recommendation


BMI is preterm The recommended total increase
Pound Kilogram
Low (BMI <19.8) 28-40 12.5-18
Normal (BMI 19,8-26) 25-35 11.5-16
High (BMI> 26-29) 15-25 7-11.5
Obesity (BMI> 29) <15 <7

Recommended Food Intake


Nutrition Not pregnant Pregnant Breastfeeding
Kilocalories 2200 2500 2600
Protein (g) 55 60 65
Fat soluble vitamins 800 800 1300
 A (μg RE) 10 10 12
 D (μg)
 E (TE) 8 10 12
 K (μg)
55 65 65
Water-soluble vitamins
60 70 95
 C (mg)
 Folate (μg) 180 400 280
 Niacin (mg)
 Riboflavin (mg) 15 17 20
 Tiamin (mg)
 Pyridoxine (mg) 1.3 1.6 1.8
 Kobalamin (μg)
1.1 1.5 1.6
Mineral
1.6 2.2 2.1
 Calcium (mg)
 Phosphorus (mg) 2.0 2.2 2.6
 Iodine (μg)
 Iron (mg iron fero) 1200 1200 1200
 Magnesium (mg)
 Zinc (mg) 1200 1200 1200
150 175 200

15 30 15

280 320 355

12 15 19

Pragmatic Nutrition Surveillance


 In general, advise a pregnant woman to eat what she wants in quantity to suit
her needs; food is salted, to be delicious.
 Make sure that enough food is available for consumption, especially in the case
of women with less socioeconomic conditions.
 Make sure that she is experiencing weight gain, targeting around 25 to 35
pounds (11.5-16 kg) in women with normal body mass index.
 Periodically, the value of food intake with anamnesis. In this way, sometimes
we can express the nutritional content diet is not appropriate.
 Give iron salt tablets containing at least 30 mg of iron every day. Provide folate
supplementation before and during the early weeks of pregnancy.
 Re-check the hematocrit or hemoglobin concentration at weeks 28 to 32 to
detect a significant reduction.
 If there is udem in the legs should not eat foods containing salt.

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

Nausea and Vomiting


 Usually nausea and vomiting begin between the first and second menstrual late
and continue until about 14 weeks. Usually worse in the morning but may
continue throughout the day.

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

You might also like

pFad - Phonifier reborn

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.

Note: This service is not intended for secure transactions such as banking, social media, email, or purchasing. Use at your own risk. We assume no liability whatsoever for broken pages.


Alternative Proxies:

Alternative Proxy

pFad Proxy

pFad v3 Proxy

pFad v4 Proxy