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7/28/2019 Antenatal Classes
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Antenatal Classes
Dr. Alexander K. Doo
Specialist inObstetrics &Gynaecology
The Womens Clinic
Saturday 31/7/04
Antenatal Talk
City Hall
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Warnings Signs in the
3rd Trimester
Starts from 28 weeks onwards.
Bright red vaginal bleeding.Leaking of water from the vagina (sudden
gush or slow leak).
Regular tightenings or cramping.
Dim or blurred vision or flashing bright
lights or spots.
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Warnings Signs in the
3rd Trimester
Bad headache/dizziness, a lot of swelling offace and body
Chills and fever
Pain when passing urineDecreased fetal movement
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Bleeding
Bleeding at any time during the pregnancy
should be immediately reported to your
health care provider. In the second and thirdtrimesters, it can be a sign of abnormal
placental (after-birth) implantation to the
uterine wall, or premature separation of theplacenta. Bleeding can also occur after
intercourse through pressure on or irritation
of the vagina and/or cervix.
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Abruptio Placentae
Placenta becomes detached from the uterine
wall prematurely leading to bleeding and a
reduction of oxygen and nutrients to thefetus. The detachment may be complete or
partial.Occurs in less than 3.5 %
More common in women who smoke, havehigh blood pressure, and/or in women who
have had previous children or a history of
abruptio placentae.
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Abruption
Symptoms and treatment of abruptio
placentae depend upon the degree of
detachment. Symptoms may includebleeding, cramping, and abdominal
tenderness. Diagnosis is usually confirmed
by performing a complete physicalexamination and an ultrasound. Women are
usually hospitalized for this condition and
may have to deliver the baby prematurely.
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Placenta PreviaPlacenta previa is a condition in which the
placenta adheres itself to the uterus near orcovering the cervix. Often, the placenta
moves to the upper half of the uterus during
pregnancy requiring no treatment. When the
placenta does not move and remains in the
lower half of the uterus, the condition is
called placenta previa.
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Placenta Previa
This type of placental complication occurs
in one in every 200 deliveries and occursmore often in women who have scarring of
the uterine wall from previous pregnancies,
in women who have fibroids or otherabnormalities in the uterus, or in women
who have had previous uterine surgeries.
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Placenta Previa
Symptoms may include vaginal bleeding
that is bright red and not associated with
abdominal pain. Diagnosis is confirmed byperforming a physical examination and an
ultrasound. Depending upon the severity of
the condition and the stage of pregnancy,modification of activities or bedrest may be
ordered. The baby usually has to be
delivered by cesarean section.
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Leakage of Watery Fluid From
Your Vagina
Urine leakage can be caused by the baby
pressing on your bladder. Fluid leakage canalso be the result of a spontaneous rupture
of membranes. The membranes are a
protective mechanism for the baby-they
cushion him or her and allow room for fetal
movement growth and provide a barrier
against infection.
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Possible Signs of
Premature Labour
Increase in vaginal discharge
(watery, mucousy or bloody)Low, dull backache
(intermittent or constant)
Pressure like baby pushingdown (comes and goes)
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What to Do?
Call if you have more than 8
contractions in 1 hour
Lie down drink some fluid and
count the contractions
Doesnt do away after 1 hour, or
> 5 X / hour in the next hour
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Pre-eclampsia
Cause is unknown
More common in 1st pregnancy5% of all pregnancy
Raise BP, Proteinurea, swelling
due to fluid retentionEclampsia - siezure, coma,
HELLP syndrome,death
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Signs and Symptoms
Headache, swelling of handsface and feet, epigastric pain,
irritability, nausea ,visual
disturbance, decreased urine
output, raised blood pressure,
proteinurea.
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Treatment
Depends on gestation
ultimately requires delivery
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Urinary Tract Infection
Burning or pain during urinationFrequency
can lead pre-mature labour
Treatment with antibiotics
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Decreased fetal
Movement
First sign of fetal comprmiseIntensity decreases as
gestation advance
Rule of 10If in doubt, check it out
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Indications for Elective
Caesarean Section
Patient choice
Multiple pregnancy
Placenta previa
Malpresentations
Previous section
Maternal medical condition
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Some Arguments for
Caesarean Section
Maternal choice in 38% of cases
In a randomized trial comparing
elective section vs vaginal deliveryit showed perinatal mortality andserious morbidity of 1.6% vs 5%, andthat 90% delivered by section in theplanned group vs 56.7% in thevaginal gp
Vaginal delivery is associated withwith risk of urinary and feacalincontinence
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Some Reasons for
Section
1/3 of women will have urinaryincontinence 3 months after delivery
11% life time risk of surgery forincontinence and prolapse
Feacal incontinence19% 6 weeks
Overall 1/3 of women will have
evidence of anal sphincter defect onUSS 6 weeks post-partum, and 65%of which will have symptoms of analincontinence.and 75% if its a
second vaginal birth
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Indications for
Emergency Section
Failure to progress
Cord prolapseFetal distress
Placental abruption
Cephalo pelvic disproportionPremature labour (
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The End