PEMERIKSAAN ANTENATAL CARE

&

USG
 Key- Point
 Anak yang sehat dan cerdas adalah anak yang
dikandung dari Ibu yang sehat dan Bapak
pemberi bibit yang sehat pula.

 Hasil akhir dari kehamilan sangat ditentukan

sejak awal sejak kehamilan mulai diawasi dengan
baik dan melakukan upaya-upaya untuk
mewujudkan hasil yang seoptimal mungkin.
 Latar belakang
 Mempunyai anak yang sehat dan cerdas
adalah dambaan dari setiap pasangan .
Adanya anak adalah merupakan kebanggan
dan harapan dari setiap pasangan dan
merupakan bukti bahwa masing-masing
pasangan baik calon Ibu dan calon Bapak
adalah manusia yang sempurna.
 antenatal
 Batasan dan Uraian Umum
Definisi
 Suatu program
berkesinambungan selama
kehamilan, persalinan, kelahiran
dan nifas yang terdiri atas
edukasi, penapisan, deteksi
dini, pencegahan, pengobatan,
rehabilitasi yang bertujuan
untuk memberikan rasa aman
dan nyaman kepada ibu dan
janinnya sehingga kehamilan
menjadi suatu pengalaman
yang menyenangkan.
 Prinsip Dasar
 Tabulasi faktor risiko
 Penapisan dan deteksi
dini
 Evaluasi dan penilaian
maternal dan pertumbuhan janin
 Evaluasi dan penilaian
rute persalinan dan kelahiran
serta persiapan maternal
menghadapi persalinan.
 Evaluasi dan penilaian
nifas.
 Konseling Nutrisi, Gerak
Badan (Exercise), Medis,
Genetik dan kontrasepsi
pascapersalinan.
 prosedur
Anamnesis
Pemeriksaan Fisik
USG
Laboratorium
 Antenatal (K4) sesuai standar adalah Ibu
hamil yang mendapatkan pelayanan
antenatal sebanyak 4 kali selama periode
kehamilan (K4) dengan ketentuan :
 • Satu kali pada trimester pertama
 • Satu kali pada trimester kedua
 • Dua kali pada trimester ketiga
 Pelayanan antenatal 4 kali dilakukan sesuai standar kualitas melalui 10 T antara
lain:
 1. Penimbangan berat badan badan
 2. Pengukuran tinggi badan
 3. Pengukuran tekanan darah
 4. Penilaian status gizi melalui pengukuran lingkar lengan atas (LiLA) 5.
Pengukuran tinggi fundus uteri, penentuan presentasi janin dan denyut jantung
janin
 6. Skrining status imunisasi TT dan pemberian imunisasi TT sesuai status
imunisasi ibu.
 7. Pemberian tablet besi (90 tablet selama kehamilan)
 8. Pemeriksaan test lab sederhana (Golongan Darah, Hb, Glukoprotein Urin) dan
atau berdasarkan indikasi (HBsAg, Sifilis, HIV, Malaria, TBC),
 9. Tata laksana kasus
 10. Temu wicara/konseling
 standart minimal perawatan Antenatal Care yang disebut “14 T”, yaitu :
 1. Tinggi badan
 2. Timbang berat badan
 3. Ukur tekanan darah
 4. Ukur tinggi fundus uteri
 5. Pemberian imunisasi TT lengkap
 6. Pemberian tablet zat besi minimum 90 tablet selama hamil
 7. Tes terhadap penyakit seksual menular
 8. Temu wicara dan konseling dalam rangka rujukan.
 9. Tes protein urine
 10. Tes urine glukosa
 11. Tes Hb
 12. Senam hamil
 13. Pemberian obat malaria
 14. Pemberian obat gondok
Perubahan jadwal ANC di negara
maju
 TAKSIRAN TANGGAL
PERSALINAN
 SIKLUS HAID
 TANGGAL + 7
 BULAN -3
 TAHUN -1
 29-januari-2007
 TRIMESTER I
 Trimester I
 a. Pemastian kehamilan
 b. Pemastian intrauterin - hidup
 c. Pemastian kehamilan tunggal/multipel
 d. Pemastian usia kehamilan
 e. Pemastian faktor risiko dan mereduksi kebiasaan
hidup yang merugikan kehamilan
 f. Persiapan dan pemeliharaan payudara
 g. Penapisan Thalasemia, Hepatitis B, Rhesus (bila
mungkin)
 h. Pemeriksaan TORCHS (bila mungkin)
 Trimester II

 a. Penapisan defek bumbung saraf (Neuro

Tube Defect)
 b. Penapisan defek jantung
 c. Evaluasi pertumbuhan janin
 d. Evaluasi toleransi maternal
 e. Penapisan servikovaginitis
 f. Penapisan infeksi jalan kencing (UTI)
 g. Penapisan diabetes melitus (DM) pada 24-
30 minggu
 Trimester III

 a. Evaluasi pertumbuhan janin

 b. Evaluasi toleransi maternal
 c. Evaluasi rute persalinan/kelahiran
 d. Evaluasi fasilitas kelahiran/perawatan
neonatal
 e. Membahas rencana kontrasepsi
pascapersalinan

 Antenatal terfokus
NUTRISI

HASIL AKHIR
LUARAN IBU
LUARAN ANAK
 Apakah ANC yang Efektif Itu ?
 Suatu asuhan yang berasal dari tenaga terlatih dan
asuhan terus-menerus
 Persiapan untuk kelahiran dan potensi terjadinya
komplikasi
 Mempromosikan kesehatan dan mencegah penyakit
– Tetanus toxoid, suplemen nutrisi, tembakau dan
penggunaan alkohol, dsb.
– Mendeteksi adanya penyakit dan cara pengobatannya
– HIV, syphilis, tuberculosis, dan penyakit lain yang
berhubungan dengannya (e.g., hipertensi, diabetes)
 Deteksi dini dan penatalaksanaan komplikasi
 Tujuan ANC
 Mempromosikan dan menjaga kesehatan fisik, mental dan
sosial ibu dan bayi dengan memberikan pendidikan
mengenai nutrisi, kebersihan pribadi and proses kelahiran
 Mendeteksi dan menatalaksana komplikasi-komplikasi
yang terjadi selama kehamilan, baik medis, pembedahan
atau obstetrik
 Mengembangkan rencana kesiapan persalinan dan
kesiapan menghadapi komplikasi
 Membantu mempersiapkan ibu untuk dapat menyusui
dengan sukses, menjalani masa nifas normal, dan
menjaga anaknya secara fisik, psikologi dan sosial
 Komponen-Komponen ANC Terarah ke-
Sasaran : Pendeteksian Penyakit

 Mencari permasalahan yang memerlukan asuhan tambahan

Parameter Kondisi
Kulit, kenampakan umum, rabun senja Malnutrisi
(night blindness), goiter
Suhu, disuria Tanda-tanda infeksi
Tekanan darah, edema, proteinuria, Tanda-tanda pre-eklamsia
Refleks
Hemoglobin, konjungtiva/telapak/lidah Tanda-tanda anemia
pucat
Pemeriksaan payudara Penyakit payudara
Gerakan bayi, tinggi fundus, detak Gawat janin/demise
jantung bayi
Pemeriksaan Pelvik dan speculum Penyakit Menular Seksual
 Komponen ANC Terarah ke-
Sasaran:
Kesiapan Menghadapi
Komplikasi
 Membuat suatu rencana/skema keuangan
 Membuat rencana untuk mengambil keputusan
 Mengatur suatu sistem transportasi
 Membuat suatu rencana mengenai donor darah

15% wanita hamil mengalami komplikasi yang membahayakan jiwanya

dan menghendaki adanya asuhan obstetrik
 Prenatal Care
 Initial visit
– Ideally before 10 weeks
 Subsequently
– every 4 weeks until 28 weeks
– every 2 weeks until 36 weeks
– every week until birth
 Reduced visit schedules are being promoted as
well
 Centering Pregnancy
SYMPHYSEAL FUNDAL HEIGHT

FUNDUS

BAG.ATAS
SYMPHISIS
 Kunjungan pertama
 Anamnese lengkap / status kesehatan/ data
dasar.
 Faktor resiko dan riwayat persalinan buruk.
 Hal yang berkaitan dengan kehamilan ini.
 Bimbingan menyeluruh mengenai kesehatan ibu
dan perkembangan janin.
 Membangun kepercayaan ibu dan keluarga.
 Physical exam
 Head to toe
 Breast changes – watch for tenderness
 Thyroid may be slightly enlarged
 May hear physiologic murmur…present in
most pregnant women
 Leopold’s maneuver
 To determine fetal position
 PEMERIKSAAN: USG
 Standar pemeriksaan USG trimester I:
1. Memastikan kehamilan dalam kandungan
2. Menentukan usia kehamilan
3. Mendeteksi tanda-tanda kehidupan
4. Deteksi kelainan mudigah
5. Deteksi kehamilan kembar
6. Dugaan kelainan kromosom
7. Evaluasi adnexa
8. Membantu tindakan intervensi.
Methods of ultrasound
assessment

 Abdominal ultrasound
 Transvaginal ultrasound
(TVS)
 Chronological assessment of
structures in early pregnancy

 4 weeks - gestational sac

 5 weeks - yolk sac
 6 weeks - fetal heart pulsations
 7 weeks - embryonic movements
 8 weeks - head and limb buds
 8 - 10 weeks - physiological omphalocoele
 9 weeks - cord insertion
Fetus/yolk sac
Week 9 - 12

At the 9th week the embryo is

now considered a fetus.
The fetus is able to grasp and
can suck his/her thumb.
Fingerprints are already visible
in the skin.
Able to sense touch, and feel
pain.
At week 12, the fetus sleeps
and awakens.
Week 8

Everything is now present that will be

found in a fully developed adult.
The stomach produces digestive juices
and the kidneys have begun to function.

Forty muscles sets begin to operate in

conjunction with the nervous system.

- Sensitivity to touch : cheeck, genital

area (10 weeks), palms (11 weeks), soles
(12 weeks), abdomen and buttock (12
weeks).

WPRC,2006
Week 15: WEEK 14-15

Fetus’s taste buds already look like

a Mature adult’s. Fetus can smell
strongly of curry, cumin, garlic,
onion. Fetus’s swallowing increases
when amniotic fluid is surrounded
by sweet tastes, and decreases with
bitter and sour tastes.
Week 18:

The ears are now functioning

and the baby can hear his
mother's voice.
By the end of the 4th month, the
fetus weighs a half pound or
more and is eight to ten inches
in length.
 Weeks 25 – 28

Rapid brain development

The fetus’ eyelids now open
and close. The tongue has
formed taste buds and the eyes
have fully developed. Vision is
the last sense to develop.The
baby's lungs are completely
functioning and he can even
cry.
 APAKAH
ANDA
MEMIKIRKA
N
KEPENTING
AN
SAYA?
 US Time Lines
4 Weeks - Thick echogenic endometrium 10-12 mm.

Gestational sac small, high up in

4 ½ - 5 Weeks - the uterus.

Chorionic ring seen (HCG 1000 –

1500 iu/lit)

Beware of the pseudogestational

sac ( ectopic ).

Yolk sac seen - HCG 7200 iu/lit.

Sequential
appearance of
embryonic structures
& functions during
the first trimester
pregnancy
[From Timor-Tritsch IE,
Farine D, Rosen MG: A
close look at early
embryonic development
with the high frequency
transvaginal transducer.
Am J Obstet Gynecol
1988;159:676-81]
 Uses: Estimation of
gestational age
 Gestational Sac Volume
(GSV)

 Crown Rump Length (CRL)

 Biparietal diameter BPD)

 Femur Length (FL)

Ultrasound pada kehamilan
Gambar: Citra anensefalus pada usia gestasi 13 minggu, yang
menunjukkan tak ada kalvarium, tampak sedikit jaringan otak
(serebrovaskulosa) diatas orbita
 Pemeriksaan
 Laboratorium: Pemeriksaan darah, meliputi:
Hematologi dasar (CBC, RH, Ferritin,
sediaan hapus) serta pemeriksaan urin.
 Wajib dilakukan di awal kehamilan dan jika
memungkinkan, diulang pada usia 32
minggu, kecuali Rh.
 Laboratorium, Hematologi Dasar

Mis: G1 hamil 8 minggu, Hb 12,1 gr%

 Laboratorium, Hematologi dasar

Hb 12,1
RBC 4,58 juta

MCV 71,8

MCH 25,2

MCHC 35

Ferritin 8,7
 Laboratorium, Urine.

 Identifikasi ISK
 Mudah dilakukan, lebih murah daripada tes
darah
 Meliputi pemeriksaan makroskopis dan
mikroskopis
 Laboratorium, Urine

 Urinalisa, dijumpai sedimen urine:

1. Sel leukosit: sering karena
kontaminan vaginal, ISK, jika ada indikasi
lain
2. Sel darah merah: trauma ginjal, penyakit
ginjal sistemik.
3. Bakteri
- Tidak hamil: 100.000 koloni/ ml=
infeksi
- Hamil: 10.000 koloni/ mL= infeksi.
 TRIMESTER KEDUA
Pemeriksaan USG:
 Pemeriksaan terhadap tanda kehidupan, jumlah
janin, presentasi janin, aktivitas janin.
 Pemeriksaan terhadap volume air ketuban
 Pemeriksaan terhadap plasenta dan tali pusat
 Penentuan usia kehamilan
 Menghitung berat janin.
 Pemeriksaan anatomi janin
 PEMERIKSAAN DUH VAGINA
 BV merupakan penyebab yang sering dari
keluarnya cairan vagina
 Menurut Goldman & Hatch (2000), dijumpai
3 juta kasus BV pada wanita, di mana
800.000 di antaranya terjadi pada
kehamilan.
 Prevalensi BV: 25%-50% di antara wanita
yang tidak hamil, dan 10%-35% di antara
wanita hamil.
 DIAGNOSA BV
Kriteria Amsel
 Peningkatan derajat keasaman vagina
(>4,5)
 Bau amis dengan KOH
 Dijumpai clue cells (20% di antara seluruh
sel)
 Discharge Vagina yang homogen
 Selain untuk diagnosis BV, perlu juga
dilakukan pemeriksaan Trichomoniasis,
Candidiasis, Sifilis, juka dicurigai.
 Diabetes mellitus GESTASI
Resiko tinggi DMG:
 Umur lebih dari 30 tahun
 Obesitas
 Memiliki riwayat keluarga DM
 Pernah menderita DMG sebelumnya
 Pernah melahirkan anak >4000 gram
 Adanya riwayat KJDK
 Adanya glukosuria.
 Pada resiko tinggi, pemeriksaan dimulai
pada saat ANC pertama
 Usia kehamilan 24-28 minggu.
 DMG berkaitan dengan abortus dan
kelahiran aterm, dengan KJDK,
makrosomia, kematian perinatal, dll.
 Dengan penatalaksanaan DMG yang
semakin baik, komplikasi perinatal akan
lebih ditentukan oleh keadaan normoglikemi
sebelum dan selama hamil.
PEMERIKSAAN KROMOSOM
Indikasi: Riwayat, usia ibu, keluarga,
thalasemia

Masalah: Prevalensi 1-2 % bayi baru lahir

akan menderita cacat mayor.

Klinis: Hidrmanion, oligohidramnion, PJT,

kelainan.
TEKNIK DIAGNOSA PRENATAL
 Amniosintesis
 Chorionic Villi Sampling
 Percutaneous Umbilical Blood Sampling
 Fetal Skin Sampling
 USG
 Laboratory Tests: Blood
 Initial:
– CBC or Hemoglobin & Hematocrit
– ABO and Rh type
– Serology (VDRL, RPR)
– Rubella titer
– HIV screen - offered to ALL pregnant women
– Drug screen (?)
– Sickle cell screen on all women
– Cystic Fibrosis screening
– HbsAg
– Early 1 hr GTT, if indicated
– Antibody screen
 Kell, Lewis, D
 Meds
 Prenatal vitamins
 FeSO4 if anemic (Hgb < 11 gm/dl)
 If on Synthroid, check TSH every
trimester…may need to increase dosage as
pregnancy progresses
 Depression Screening
 Beck Depression Inventory
 Primary Care Evaluation of Mental
Disorders Patient Health Questionnaire
 Center for Epidemiologic Studies
Depression Scale
 Edinburgh Postnatal Depression Scale
 Labs
 15-20 weeks
– MSAFP
 Neural tube defects
 Down’s syndrome
 Labs
 26-28 weeks
– CBC
– Antibody/Indirect Coomb’s on Rh negative
women - if negative, order Rhogam!
– 50 Gm, 1-hour GTT
 130 mg/dl needs 3 hour GTT
 Labs
 35-36 weeks
– GBS
– Offer HIV rescreen

 If history of HSV, offer suppressive therapy

(Valtrex, Zovirax, Famvir)
 Laboratory Tests: Other
 Urine dip at each visit for glucose, proteins,
ketones
 History: Subsequent Visits
 Fetal Movement
 Bleeding
 Uterine contractions
 Vaginal discharge
 Pelvic pressure
 Dysuria
 Edema
 Changes in psychosocial parameters
 Quickening
 Mother’s first perception of fetal movement:
– Primigravidas @ 18-19 weeks
– Multigravidas @ 16-17 weeks
 Fetal Heart Tones
 Doppler by 9-12 weeks
– Assume inaccurate dates if not audible by 12
weeks
– place Doptone just above pubic symphysis and
aim transducer towards feet/spine
 Fetoscope by 17-20 weeks
– Rarely used today
Diagnostic Tests
 Diagnostic Tests: Sonogram

 Confirmation
 Fetal number
 Dating
 Growth patterns
 Fetal health
 Fluid volume
 Diagnostic Tests: CVS
Chorionic Villus Sampling
 Chromosome analysis
 8-14 weeks
 Prior to procedure
– cultures
– sonogram for GA
– blood type
 If Rh negative - RhoGAM
 Amniocentesis

 Purpose
– Chromosome analysis
– NTD
– Fetal lung maturity
 PG presence
 L/S ratio
 Can’t be done prior to 15 weeks
 Amniocentesis

 Prior to procedure
– sonogram for GA
– blood type
 If Rh negative - give RhoGAM
 Doppler Blood Flow Analysis
 Specific ultrasound technique
 Looks at blood flow through the umbilical
and uterine arteries
 Specifically useful for looking at
uteroplacental insufficiency
– IUGR
– Postdates
 Results may be influenced by smoking
 Nausea and vomiting
70-90% of all pregnant women have nausea…until 12
weeks
– Relief
 Dry crackers/toast
 Avoid odors/causative factors
 Small, frequent, dry meals
 Wrist bands
 Pyridoxine
 Emetrol: 1-2 tbs q 15’
 Headache

 Evaluate
 Reduce stress
 Adequate sleep
 Eat regular meals
 Alternate heat/cold
 Tylenol prn
 Urinary Frequency

Void frequently
 fluids in the evening
 Fatigue
Plan naps and rest
Seek assistance
Avoid caffeine
Warm milk
 Breast tenderness
Wear well-fitting, supportive bra
 Leukorrhea
Hygiene
Avoid douching
Avoid pantyhose
Cotton underwear

www.cornellaging.com
 Epistaxis/nasal stuffiness

Cool air vaporizer may help

Avoid nasal sprays and decongestants
Sea spray
Apply ice packs to nose

www.justnaturalstuff.com
 Ptyalism

Astringent mouthwashes
Chew gum or suck hard candy
Good oral hygiene

Lowcarbluxury.com
 Pyrosis

Small, frequent meals

Low-sodium antacids/Tums
Avoid overeating, fatty and fried foods
Tagamet 200 mg
Zantac 75 mg
 Dependent Edema

Foot exercises
Maternity support hose
Elevate feet and legs
avoid prolonged standing
Drink 6-8 glasses of water daily
 Varicose Veins

Elevate legs frequently

Support hose
Avoid standing for prolonged periods
Avoid crossing legs
Avoid excessive weight gain
 Constipation

fluids, fiber and exercise

Regular bowel habits
Stool softeners

www.cowboycooking.com
 Hemorrhoids

Avoid constipation
Ice packs, topical ointments, tucks pads
Warm soaks or cool sitz baths
Kegels
High fiber diet
Stool softeners
Preparation H/anusol
 Flatulence
 Limit gas forming foods
– Carbonated beverages, beans, cheese,
bananas, peanuts
 Avoid mint
 Backache
Proper body mechanics
Pelvic tilt exercises/pelvic rock
Comfortable, low-heeled shoes
Back rubs

12.31.13.50
Abdominal discomfort/Round
ligament pain

Avoid stretching/twisting
Flex knee and hip on affected side
Heat
Avoid excessive exercise
 Leg cramps
Dorsiflex feet to stretch
Heat
Wear low heeled shoes

www.kabayim.com
 Faintness

Avoid sudden changes in position

Avoid prolonged standing
Wear compression stockings
 Dyspnea

Evaluate for severity

Avoid restrictive clothing
Posture
Avoid warm environments www.reliefmart.com

Pillows for sleeping

 Topics for Patient Teaching
 All Three Trimesters
– Discomforts of pregnancy
– Danger signs
– Nutrition and weight gain
– Fetal growth and development
– Sexual activity
– Sibling preparation
 Topics for Patient Teaching
 First Trimester
– Attitude toward pregnancy
– Weight gain
 25-35 lbs; 10 pounds by 20 weeks
 If obese, 15-20 lbs
– Exercise and rest
– Substance use/abuse
– Traveling
 Topics for Patient Teaching
 Second Trimester
– Concerns related to body changes
– Fetal movement
– Clothing
– Care of skin and breasts
– Decisions about infant feeding
 Topics for Patient Teaching
 Third Trimester
– Exercise and rest
– Traveling
– Preparation for labor and birth
– Decision-making about early postpartum
 Assistance
 Contraception
 Self-Care During Pregnancy
 Nutrition
– Increase daily caloric intake by 300 kcal in
second and third trimesters
 If twin gestation, double this
– Increase complex carbohydrates
 Primary source of energy
 Protein-sparing
 Self-Care During Pregnancy
 Nutrition (cont.)
– Increase proteins
 Fetal development
 Growth of maternal tissues
– Fat
 Unchanged needs
 Self-Care During Pregnancy
 Nutrition (cont.)
– Minerals
 Iron needs increase
 Supplements recommended
– Vitamins
 Folic acid needs increase
 Supplements recommended
 Foods to Avoid

 Swordfish, shark, king mackerel and tile fish. These fish can
contain potentially risky levels of mercury. Mercury can be
transferred to the growing fetus and cause serious health
problems. Also avoid game fish until you check its safety with
your local health department. (A game fish is any fish caught for
sport, such as trout, salmon or bass.)
 Raw fish, especially shellfish (oysters, clams)

 They can eat up to 12 ounces of these fish a week. The 12

ounces can include:
 Shrimp, salmon, pollock, catfish and canned light tuna
 Albacore (white tuna): Don't eat more than 6 ounces of this tuna
in one week
 Foods to Avoid
 Undercooked meat, poultry and seafood. Cook all of them thoroughly to kill bacteria.
 Do not eat hot dogs or luncheon meats. Examples are deli meats such as ham, turkey,
salami and bologna. If they do eat these foods, reheat them until steaming hot.
 Refrigerated pates or meat spreads. Canned versions are safe.
 Refrigerated smoked seafood unless it has been cooked (as in a casserole). Canned
versions are safe.
 Soft-scrambled eggs and all foods made with raw or lightly cooked eggs
 Soft cheeses made with unpasteurized milk. Examples are Brie, feta, Camembert,
Roquefort, blue-veined, queso blanco, queso fresco and Panela. Check the label to see
what kind of milk was used to make the cheese.
 Unpasteurized milk and any foods made from it
 Unpasteurized juices
 Raw vegetable sprouts, including alfalfa, clover, radish and mung bean
 Herbal supplements and teas

http://www.marchofdimes.com
 Self-Care During Pregnancy
 Fetal Monitoring
– Kick counts beginning at 28 weeks gestation
 Clothing
– Loose and non-constricting
– Supportive girdle is sometimes helpful for
women with large, pendulous abdomens
– Low-heeled, comfortable shoes
 Self-Care During Pregnancy
 Breast Care
– Well-fitting, supportive bra
– Cleanliness
 Avoid soap on nipples if planning to breastfeed
 Self-Care During Pregnancy
 Breast Care (cont.)
– Nipple preparation in third trimester
 Expose nipples to sunlight and air
 Nipple-rolling (unless at risk for PTL)
 If inverted nipples
– Hoffman’s exercises
– Nipple shield
 Self-Care During Pregnancy

 Bathing
– Avoid hot showers/baths
 Employment
– Be aware of fetotoxic environments
 Nursing, painting, day care, animal care
– Avoid prolonged, uninterrupted periods of
standing or sitting; lifting > 20 lbs
 Travel: No restrictions if no complications
– Rest frequently
 Self-Care During Pregnancy
 Activity and Rest
– Continue to do whatever she did before
pregnancy
– Encourage to do regular exercise
 Pregnancy is not the time, however, to take up
strenuous exercise for the first time
– High-risk activities that require balance and
coordination should be avoided
 Self-Care During Pregnancy
 Sexual Activity
– General rule
 As long as it is comfortable and desirable for both
partners, it is OK
– Exceptions: PTL, Bleeding, ROM
– Either or both may have a change in sexual
desire ( OR ) - communication is the key
– May need alternate positions
 Self-Care During Pregnancy

 Dental Care
– Important
– General dental repair and extractions can be
done, preferably under local anesthesia
– Dental x-rays and extensive dental work should
be avoided
 Immunizations: Use of attenuated live
viruses (measles, mumps) is
contraindicated
– Flu vaccine recommended after 1st trimester
 Self-Care During Pregnancy

 Exercises to Prepare for Childbirth

– Abdominal tightening
– Partial sit-ups
– Kegel exercises
– Tailor-sitting
 Self-Care During Pregnancy
 Teratogenic Substances
– Substances that adversely affect the normal
growth and development of the fetus
– May be apparent
 During pregnancy
 At birth
 Years later
 Self-Care During Pregnancy
– Effects are
 Gestation-dependent
 Dose-related
– Caused by
 Environmental toxins
 Radiation
 Medications
Self-Care During Pregnancy

 Tobacco
– Infants of mothers who smoke tend to have lower birth
weight and a higher incidence of perinatal deaths
– Any decrease in smoking during pregnancy improves fetal
outcome
 Alcohol
– FAS
– The effects of moderate alcohol consumption are not
known
Fetal alcohol syndrome

www.fetal alcohol.com
Fetal alcohol syndrome

www.thieme.de
Self-Care During Pregnancy

 Caffeine
– No evidence of teratogenic effects
– Does decrease maternal iron absorption
– Up to 12 ounces of caffeinated coffee a day may be okay
during pregnancy.
– There is also caffeine in chocolate, tea, cola, some
carbonated beverages other than cola, coffee ice cream
and some non-prescription medications.
 Cocaine
– Severe congenital anomalies, including genitourinary,
cardiac and CNS
– Higher incidence of abruptio placenta, preterm birth, fetal
distress, LBW
– Neonatal withdrawal
 Self-Care During Pregnancy
 Teratogenic Substances (cont.)
– Medications
 Greatest potential for gross abnormalities is in the
first trimester
– classic period is days 31-71 after LMP
– FDA Categories
 Category A
– Controlled human and animal studies show no risk
Self-Care During Pregnancy

– FDA classifications (cont.)

 Category B
– Animal studies show no risk, but no human studies OR
– Animals studies show risk, but controlled human
studies do not
 Category C
– No adequate animal or human studies available OR
– Animal studies show risk, but no human studies
Self-Care During Pregnancy

– FDA classifications (cont.)

 Category D
– Evidence of human fetal risk does exist, but benefits
outweigh risks
 Category X
– Demonstrated fetal risks clearly outweigh any possible
benefit
Danger Signs During Pregnancy
 ABC’s of Danger

 Abdominal pain
 Bleeding
 Chills and fever
 Dysuria
 Edema
 Fetal movements change
 Gush of fluid from vagina
 Danger Signs in Pregnancy

Visual Disturbances Blurred

Blurred
Blurred
Vision
Vision
Blurred Vision
Vision

Double Vision
Double Vision

Blind Spots
Halos
 Danger Signs in Pregnancy

Edema
generalized
face
fingers
pretibial
sacrum
 Danger Signs in Pregnancy

Headaches
severe
continuous
unrelieved
 Danger Signs in Pregnancy

Muscular irritability
Seizures
 Danger Signs in Pregnancy

Epigastric pain
 Danger Signs in Pregnancy
 Check BP
 Check reflexes
 Check clonus
 Order baseline PIH labs
– Proteinuria
– Platelets
– Serum creatnine, LDH, AST, ALT
 Danger Signs in Pregnancy

Fluid discharge
from vagina
bleeding
amniotic fluid
 Danger Signs in Pregnancy
 Bleeding
– Threatened, missed, spontaneous abortion
 βHcg
 U/S
 Bedrest/Pelvic rest/expectant management
– Placenta previa
– Abruptio placenta
– Determine last sexual intercourse
 Danger Signs in Pregnancy
 Amniotic fluid
– Nitrazine
– Ferning

http://www.mclno.org/webresources/Waived/fern/fern_image%201.jpg
 Danger Signs in Pregnancy

Persistent vomiting
 Danger Signs in Pregnancy
 Urinalysis for ketones
 Check skin turgor
 Check mucous membranes
 Check weight
 Danger Signs in Pregnancy

Signs of infection
fever
chills
dysuria
 Danger Signs in Pregnancy
 Viral?
 URI?
 UTI?
 Danger Signs in Pregnancy

Abdominal pain
severe
unusual
 Danger Signs in Pregnancy
 Round ligament pain
 Abruption
 Preeclampsia
 Danger Signs in Pregnancy

Change in fetal
movements
absence
pattern
count
 Danger Signs in Pregnancy
 Check for FHTs
 NST
THANK
YOU
YA!!!!!