Prenatal Care Jacob. T. Salean, MD 1 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 3 OVERVIEW OF PRENATAL CARE Prenatal Care Jacob. T. Salean, MD 4 OVERVIEW OF PRENATAL CARE Prenatal Care Jacob. T. Salean, MD 5 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. Prenatal Care Jacob. T. Salean, MD 6 Prenatal Care Jacob. T. Salean, MD 7 ORGANIZATION OF PRENATAL CARE 1. Preconceptional care, 2. Prompt diagnosis of pregnancy, 3. initial prenatal evaluation, and 4. follow-up prenatal visits. Prenatal Care Jacob. T. Salean, MD 8 Preconceptional Care Preconceptional care program has the potential to assist women by : Reducing risks, Promoting healthy lifestyles, Improving readiness for pregnancy. Prenatal Care Jacob. T. Salean, MD 9 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. Prenatal Care Jacob. T. Salean, MD 10 Diagnosis of Pregnancy Prenatal Care Jacob. T. Salean, MD 11 Pregnancy Tests : 1. Measurement of hCG. 2. Home Pregnancy Tests Diagnosis of Pregnancy Prenatal Care Jacob. T. Salean, MD 12 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. Prenatal Care Jacob. T. Salean, MD 13 Initial Prenatal Evaluation Prenatal Record Definitions (Nulligravida, Gravida, primigravida, Nullipara, Primipara, Multipara) Normal Pregnancy Duration Trimesters History Prenatal Care Jacob. T. Salean, MD 14 Prenatal Care Jacob. T. Salean, MD 15 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. Prenatal Care Jacob. T. Salean, MD 16 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) Prenatal Care Jacob. T. Salean, MD 17 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). Prenatal Care Jacob. T. Salean, MD 18 THANK YOU Prenatal Care Jacob. T. Salean, MD 19