Jacob Trisusilo Salean, MD

FK UNAIR RSUD DR SOETOMO

Prenatal Care Jacob. T. Salean, MD
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1901 : Mrs. William Lowell Putnam began a program
of nurse visits to women enrolled in the home
delivery service of the Boston Lying-in Hospital.
1911 : this work was successful that an outpatient
prenatal clinic was established
1954 : Nicholas J. Eastman credited organized
prenatal care
1960s : Jack Pritchard established a network of
neighborhood prenatal clinics located in the most
underserved communities in Dallas County

Introduction
OVERVIEW OF PRENATAL CARE
Prenatal care has become one of the most
frequently used health services in the United States
Prenatal Care Jacob. T. Salean, MD
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OVERVIEW OF PRENATAL CARE
Prenatal Care Jacob. T. Salean, MD
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OVERVIEW OF PRENATAL CARE
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OVERVIEW OF PRENATAL CARE
Assessing Adequacy of Prenatal Care
A commonly employed system for measuring
prenatal care adequacy is the index of Kessner and
colleagues (1973).

Effectiveness of Prenatal Care
Prenatal care designed during the early 1900s was
focused on lowering the extremely high maternal
mortality rates.
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ORGANIZATION OF
PRENATAL CARE
1. Preconceptional care,
2. Prompt diagnosis of pregnancy,
3. initial prenatal evaluation, and
4. follow-up prenatal visits.
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Preconceptional Care
Preconceptional care program has the
potential to assist women by :
Reducing risks,
Promoting healthy lifestyles,
Improving readiness for pregnancy.
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Diagnosis of Pregnancy
Signs and Symptoms :
1. Cessation of Menses.
2. Changes in Cervical Mucus.
3. Breast Changes.
4. Vaginal Mucosa.
5. Skin Changes.
6. Changes in the Uterus.
7. Cervical Changes.
8. Perception of Fetal Movements.
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Diagnosis of Pregnancy
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Pregnancy Tests :
1. Measurement of
hCG.
2. Home Pregnancy
Tests
Diagnosis of Pregnancy
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Sonographic Recognition
of Pregnancy
A gestational sac may
be demonstrated by
abdominal sonography
after only 4 to 5 weeks
menstrual age

Initial Prenatal Evaluation

Prenatal care should be initiated as soon as there is a
reasonable likelihood of pregnancy. The major goals
are to:
1. Define the health status of the mother and fetus.
2. Estimate the gestational age.
3. Initiate a plan for continuing obstetrical care.
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Initial Prenatal Evaluation
Prenatal Record
Definitions (Nulligravida, Gravida, primigravida,
Nullipara, Primipara, Multipara)
Normal Pregnancy Duration
Trimesters
History
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Initial Prenatal Evaluation
Psychosocial Screening :
The American College of Obstetricians and
Gynecologists (2006) defines psychosocial risk
factors as nonbiomedical factors that affect mental
and physical well-being.
The College advocates psychosocial screening at
least once each trimester to increase the likelihood
of identifying important issues and reducing
adverse pregnancy outcomes.
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Initial Prenatal Evaluation
Cigarette Smoking :
Smoking results in unequivocal adverse sequelae for
pregnant women and their fetuses (United States
Department of Health and Human Services, 2000).
Babies born to women who smoke, 30 % more likely
to be born preterm, and are up to three times more
likely to die of sudden infant death syndrome (SIDS)
than infants born to nonsmokers (Centers for
Disease Control and Prevention, 2007)
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Initial Prenatal Evaluation
Cigarette Smoking :
In 2001, the incidence of lowbirthweight infants born
to American women who smoked during pregnancy
was 11.9 % compared with 7.3 % born to nonsmokers
(Martin and co-workers, 2002b).
risks for spontaneous abortion, fetal death, and fetal
digital anomalies are also increased (Man and
Chang, 2006).
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THANK YOU
Prenatal Care Jacob. T. Salean, MD
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