PRE CONCEPTIONAL COUNSELLING Flashcards
A set of interventions that aim to identify and modify biomedical, behavioral and social risks to a womans health or pregnancy outcome through prevention and management.
Pre conceptional care
Gynecologists, internists, family practitioners, and pediatricians have the best opportunity to provide preventive counseling during periodic health maintenance examinations.
Counselling session
Preconceptional Counselling
❖Family History ❖Medical History ❖Personal and Social History ❖Lifestyle and work habits ❖Immunizations ❖Screening tests: Rubella, varicella, hepatitis B
vaccines NOT associated with adverse fetal outcomes
Pneumococcus
Hepatitis B
Meningococcus
Rabies
vaccines NOT recommended during pregnancy
Live virus vaccines: varicellazoster, MMR, Chicken pox, polio and yellow fever
how many month/s should pass between vaccination and conception attempts
1 month
It is currently recommended, therefore, that all women who may become pregnant take _____ of folic acid orally daily before conception and through the first trimester
400 μg
significantly reduces the risk of a recurrent NTD by 72 %
Preconceptional folic acid therapy
Gene mutation in 677C
T substitution in the gene that encodes methylene tetrahydrofolate reductase
❖Incidence: 0.9 per 1000 live births
❖Most frequent structural fetal malformation
NEURAL TUBE DEFECTS
❖Phenylalanine metabolism defect
❖phenylalanine readily crosses the placenta and can damage developing fetal organs especially neural and cardiac tissues.
❖must be normalized 3 months before conception
PHENYLKETONURIA
❖Most common single gene disorder worldwide
❖Endemic in mediterraneanand south east asiancountires.
❖Individuals of high risk ancestry be offered carrier screening to allow informed decision making regarding reproduction and prenatal diagnosis
THALLASEMIAS
has been associated with an increased risk for several pregnancy related complications, including hypertension, vaginal bleeding, hyperemesis, preterm delivery, and low-birth weight infants
INTIMATE PARTNER VIOLENCE
Pregnancy can exacerbate interpersonal problems and is a time of increased risk from an abusive partner
INTIMATE PARTNER VIOLENCE
Because domestic violence can escalate during pregnancy, even to the point of homicide, the preconceptional period provides an ideal time for screening, and if indicated, intervention
INTIMATE PARTNER VIOLENCE
craving for and consumption of ice, laundry, starch, clay or dirt and other non food items
PICA
increase risk of maternal risks of nutritional a deficiencies, electrolyte disturbances, cardiac arrhythmias, and gastrointestinal pathology
Anorexia and bulimia
increased risk of hypertension, preeclampsia, gestational diabetes, labor abnormalities, cesarean delivery, and operative complications
Obesity
excess exposure to these 2 agents is associated with neurodevelopmental disorders
methyl mercury and lead
- 40 %of multifetal gestations are conceived with the use of this technology
Assisted Reproductive Technology
Assisted Reproductive Technology increases incidence of
placenta previa and abruption
- comprise 15% of pregnancies
- more likely to request counseling
- Increased risk of complications and pregnancy related mortality
Advanced maternal age
- increased risk for anemia, preterm delivery, pre eclampsia
- incidence of STI is also higher in pregnancy
Adolescents
❖At least 3% of neonates in US will have at least 1 birth defect
❖neural-tube defects, phenylketonuria, thalassemias, and other diseases more common in individuals of Eastern European Jewish descent
GENETIC DISEASES
2-3 fold risk of having infants with structural anomalies
epilepsy
Epilepsy etiology - exposure to what anticonvulsant therapy
valproicacid and polytherapy
supplemental folic acid medications
carbmazepine, phenobarbital, phenytoin, primidone
Incidence of fetal anomalies in women with elevated FBS is higher than normal women
GDM
