Antenatal class

Prof Dr Jamil Mohd Sharif

Consultant Obstetrician & Gynecologiet MBBCh (Cairo) , Masters O & G (UKM) , MRCOG (London)

Task for obstetricians/ midwives

Safe deliveries for mother and babies It is not the quantity but the quality

PREGNANCY
LMP EDD 1st day of menses of last cycle 40 weeks +\- 2 weeks

Preg --> 3 trimesters : 1st trimester 2nd trimester 3rd trimester 12 weeks 28 weeks 28 weeks - term

SCREENING (antenatal care)

1st trimester : normal
nausea & vomiting flush

loss of weight
uterus not yet palpable breast / skin changes mood postural hypotension

SCREENING (antenatal care)

1st trimester : abnormal
excessive vomiting any pain frequency of micturition bleeding faintness

SCREENING (antenatal care)

2nd trimester : normal
from 14/52 : uterus palpable at 20weeks : palpable to umbilicus 18 - 20wks. : quickening normal BP urine sugar / protein : negative sex : 16weeks onwards detailed scan : 18-24 weeks

SCREENING (antenatal care)

2nd trimester : abnormal
any bleeding any pain frequency epigastric pain tightenings uterus < date : liqour reduced uterus > date : liqour increased glycosuria increased BP excessive wt gain

SCREENING (antenatal care)

3rd trimester : normal
uterus to xiphisternum : 36/52 Braxton-Hicks fetal movements wt gain 10 - 12kg scan for growth liqour volume CTG VE

SCREENING (antenatal care)

3rd trimester
increase in BP diabetes mellitus big baby - macrosomia small baby - IUGR normal birth wt: 2.5 - 3.5kg long lie / transverse breech placental localisation scan for growth

LABOUR
prelabour - contractions

labour

- show
- leaking

- abdominal pain
Confirmed with VE

In labour - proceed
Not in labour - home with monitoring

LABOUR
NORMAL LABOUR

onset symptoms sign

Phases of labour : latent phase - variable active phase - 6 hours Total - 12 hours

LABOUR
1st stage :
rupture of membranes
monitoring

augmentation
pain relief support food & drinks

LABOUR
2nd stage : onset os station position size of baby Pushing & SVD - episiotomy Vacuum Forceps LSCS slow progress/ no progress

LABOUR
3rd stage :
Placental removal - CCT MRP PPH Suturing of episiotomy

LABOUR
ABNORMAL LABOUR
prolonged labour no progress fetal distress meconium stain breech / transverse lie shoulder dystocia ruptured uterus birth asphyxia - A/S injuries

CAESAREAN SECTION indications

ELECTIVE

placenta praevia
breech/ transverse lie / unstable lie macrosomia IUGR pre eclampsia bad obstetric history twins - 1st twin not cephalic

CAESAREAN SECTION indications

EMERGENCY LSCS :
no progress/slow progress of labour big baby fetal distress maternal distress failed forceps/vacuum neglected labour cord prolapse