PREGNANCY AND

CHILDBIRTH
DR.SWARNAPRIYA.K
MS DGO DNB(OG)
CHRI

OBJECTIVES

PRENATAL CARE
ANTENATAL CARE
MANAGEMENT OF LABOUR
MANAGEMENT OF COMPLICATIONS
POSTPARTUM CARE
CONTRACEPTION

PRENATAL CARE
Age
Personal habits
Medical disorders, infectious diseases
ruled out
History of medications
Family history
Periconceptional intake of folic acid

ANTENATAL CARE
ANTENATAL VISITS

upto 28 wks- monthly

28-36 wks-fortnightly

after 36 wks-weekly
should be individualised for high risk
cases

FIRST VISIT
Complete history
Confirmation of pregnancy- urine
pregnancy test
Calculationof EDD from LMP
Examination of the patient .
Start on folic acid
Dietary advice

INVESTIGATIONS

HB,PCV
Blood grouping and rh typing
Urine complete
HIV,HBSAg,VDRL
75gm GTT
TFT

TRIMESTERS OF
PREGNANCY

FIRST TRIMESTER- upto 14 wks

SECOND TRIMESTER-upto 28 wks
THIRD TRIMESTER- UPTO 40 WKS
Rule out PIH, GDM
REGULAR BP check up
Inj.TT 2 Doses
Iron 100 mg , calcium 500mg

ULTRASOUND
DATING SCAN (9-11 wks)

DATE

LOCATION

NUMBER
ANOMALY SCAN
GROWTH SCAN

ANTEPARTUM FETAL SURVIELLANCE

NON STRESS TEST
AMNIOTIC FLUID INDEX

Usually done after 32 wks but

can be done as early as 28 wks
especially in high risk pregnancy

MANAGEMENT OF LABOUR

Selection of cases
primary/ tertiary health centre
Establishing iv line
INDUCTION OF LABOUR
PGE2
Oxytocin
AUGMENTATION

PARTOGRAM
CARDIOTOCOGRAPH
Avoiding frequent PV Examination
Prophylactic antibiotics

STAGES OF LABOUR
FIRST STAGE

Around 12 hrs

From onset of true labour pains

to full cervical dilatation(10 cm)

rupture of membranes
SECOND STAGE

From full dilatation to expulsion

of foetus

STAGES OF LABOUR
Application of instrument
THIRD STAGE OF LABOUR

ACTIVE MANAGEMENT

Uterine massage

oxytocin-10 units IM

Controlled cord traction

FOURTH STAGE OF LABOUR

Monitor vitals every 15 minutes

CONDUCT OF LABOUR

MONITOR VITALS
FIRST STAGE
LOW RISK- FHR Once in 30 mts
HIGH RISK-FHR Once in 15 mts
SECOND STAGE
LOW RISK- FHR Once in 15 mts
HIGH RISK-FHR Once in 5 mts
CROWNING
EPISIOTOMY

OBSTETRIC EMERGENCIES
Ectopic pregnancy
Eclampsia

Mgso4 regimen loading dose can be

given in PHC

4 gm slow iv, 10 gm im 5 gm each buttock

Maintenance- 5 gm 4 th hrly
Abruptio placenta
Placenta previa
Cord prolapse
Incomplete abortion

OBSTETRIC EMERGENCIES
Postpartum haemorrhage

oxytocin- 80- 100 units

methergine-0.2 mg im/iv max 5 doses

carboprost- 250 micro gm max 8 doses

misoprostol- upto 1000micro gram

HEART DISEASE

INFECTIVE ENDOCARDITIS
PROPHYLAXIS

POSTPARTUM CARE

UPTO 6 WKS
EXCLUSIVE BREAST FEEDING
EARLY MOBILISATION
AVOID DEHYDRATION
DIETARY ADVICE
CONTRACEPTION
IRON AND CALCIUM SUPPLEMENTS