- Pre-conceptional counseling
- Antenatal care
- High risk pregnancy management
- Recurrent miscarriage management
- Diagnosis of congenital anomalies
- Normal vaginal delivery
- Cesarean section
- Postpartum care, Advice on contraception and fitting of IUCD
A Pre-conceptional visit is crucial to impact outcome of pregnancy in many cases. It provides women and families information and opportunities to modify unhealthy behaviour, prevent & control factors contributing to poor mother and child health. Pre-conceptional care helps the couple as well as clinician in achieving the healthiest pregnancy possible by reducing unintended pregnancies,preventing low birth weight and prematurity, promoting healthy behaviour and preparing and reinforcing parents for parenting.
- Screening for anemia, diabetes, thyroid disorders, genetic disorders, STDs and substance abuse.
- Diagnosis and management of any high risk factor.
- Check for immunity against Rubella and varicella( chicken pox) infection.
- Folic acid supplementation.
- Vaccination ( Rubella, Varicella and hepatitis)
Best time to visit?
- Routine health maintenance visits
- Pre-marital or family planning visits
Over the next month, you should avoid rigorous exercise and heavy lifting. You may also need to take over-the-counter medications for any discomfort. Ask your doctors what pain relievers are safest for you.
High risk pregnancy:
A high risk pregnancy needs extra care and monitoring in order to have a healthy pregnancy and better outcome .
Factors that can make pregnancy high risk –
- Maternal age ( being very young/ teenage or older than 35 yrs)
- Maternal height 140 cm or less
- Being overweight or underweight
- A current or previous health conditions:
1.High blood pressure/ Hypertension
3.Autoimmune disorders ( eg. Lupus, thyroid disease)
5.Blood disorders ( eg. Sickle cell disease)
6.Chronic kidney disease
8.HIV or AIDS, STIs , Viral Hepatitis
9.Anxiety and depression
- Problems in a previous pregnancy ( eg. Premature delivery, recurrent miscarriage, Low birthweight or birthweight more than 4 kg, IUD.
- Rh isoimmunisation or ABO incompatibility
- Twin pregnancy or other multiples
- Conditions develop during pregnancy or delivery like Gestational diabetes or Pregnancy induced Hypertension/ Pre-eclampsia.
- Pre- natal testing suggesting risk of certain birth defects, genetic or chromosomal condition in baby.
- Previous operations : Myomectomy, repair of complete perineal tear, repair of vesico- vaginal fistula.
Screening and diagnosis of birth defects/congenital anomalies: :
Every female carries certain risk of having congenitally abnormal fetus and this risk increases with increasing maternal age and with exposure to certain medicines or environmental factors.
Some congenital defects can be diagnosed before birth through proper history, examination and pre-natal screening and diagnostic tests. Pre-natal diagnostic techniques intend to screen the risk and diagnose some congenital defects and chromosomal abnormalities( eg. Down syndrome) in developing fetus. Counseling has important role after genetic screening.
Screening should be offered to all pregnant women. It is recommended in some conditions like:
- Maternal age 35 years or more
- Congenital anomalies in previous children or pregnancies
- Family history of: Still birth, Recurrent first trimester abortions, Consangineous marriage.
- Drug intake ( eg. Antiepileptic, warfarin, alcohol, smoking)
- Radiation exposure
- Maternal chronic disease like Diabetes, Cardiac or Renal disease
- Uterine fundal height large or small for gestation
- Fetal malpresentation
- Viral infections in pregnancy
Non-invasive screening procedures:
– Maternal serum sreening:
1) Dual marker( 11-13 weeks)
2) Triple marker ( 15-18 weeks)
3) Quadruple marker ( 15-18 weeks)
4) Non invasive pre-natal testing ( NIPT) – After 10 weeks
1) NT + NB scan ( 11weeks 6 days to 13 weeks 6 days)
2) Level 2 Usg( 18-20 weeks)
3) Fetal echo ( 18- 20 weeks) – if indicated
4) Doppler sonography ( when indicated)
5) MRI ( when indicated)
Invasive diagnostic procedures:
1) Amniocentesis (after 15 weeks)
2) Chorionic villous sampling ( 10-13 weeks )