• Gestational Age - Dating by LMP (Regular Periods)
• USG Dating - ( Irregular Periods )

1. Previous Abortion / Premature or Still born babies
2. Previous difficult delivery or caesarian section, haemorrhage after delivery

1. pallor or Anameia (Haemoglobin below 10 gm).
2. Poor Weight Gain.
3. Swelling of Hands , Legs and Face.
4. High Blood Pressure.
5. Diabetes.
6. Jaundice.
7. Twins, Breech, Transverse lie
8. Prolonged Pregnancy

1. Diagnosis and Confirmation
2. Urine Pregnancy Test
3. Early Scan - Viability, Dates, number
4. Identify Risk Factor
5. Investigation
   1. CBC
   2. Rubella , IgG, IgM
      • TSH
      • Blood Group and RH Factor
      • Blood Sugar Fasting
      • Hb Electrophoresis
        

Treatment Less than 12 weeks

1. Folic Acid
2. Symptomatic Rx in High Risk Cases
3. Fortnightly Visits

Subsequent Visit

Every Visit

• Weight
• Pulse, BP
• Urine R/E, M/E
• Utrine Size

Utrine Investigation Completed

• VDRL
• Hbs Ag
• HIV
• Urine C & S
• S. Creat / SGOT/ SGPT

• USG – Level-II (11-14 weeks)
  • Nuchal Translucency – 11-12 wks
  • Level II – 20 wks Congenital Malformation
• Triple Test/ PAPPA Test/ Quadra Test
• Wet Smear / Pap Smear
• GCT/ GTT
• Advise –  Iron / Calcium
  • 2 doses of TT
  • Monthly Visit

1. Glucose Challenge Test (GCT) / GTT (100 gm Glucose)
2. Weekly visit after 35th week.
3. Obstetrics Ultrasound at 30-31 weeks, 34-36  weeks.
4. Vaginal swab at 35-37 weeks.
5. Pelvic Assessment at 37th week
6. Non-Stress Test (NST) after 35th week or earlier of high risk case.

1. Excessive Vomiting
   • Multiple Pregnancy
   • Molar Pregnancy
   • Thyroid Functioning
   • Psychosocial
2. Bleeding, Pain or both

Late Pregnancy

1. Maternal problems
2. Fetel Problems

1. Multiple Pregnancy
2. Rh Iso immunizaton- ICT
3. Congenital Malformation

Different forms of Anaemia

• Anaemia due to Nutritional deficiency – 80%
• Anaemia due to bleeding - 10%
• Inherited disease (like thalassemia, sickle cell defects)  – 10%

Anaemia is associated

1. increase preterm birth,
2. Low birth weight babies,
3. A higher perinatal loss of babies
4. Significant in maternal deaths

Anaemia

1. Importance
2. Detection – Hb, CBC, PBS
3. Treatment- Treat Cause
   • High Protein diet
   • Iron supplements (oral, injections)
   • Blood Transfusion

Complication of Hypertensive pregnancy are:-

Gestational Diabeties

1. Undiagnosed and untreated diabetes, can be harmful for your baby and can create trouble for you too.
2. Most of the patients are diagnosed by Glucose Tolerance
3. Detection – 20-28 Wks GCT / GTT -  Rapid weight gain
4. Control: Diet - 1800 calorie
5. Insulin
6. Careful monitoring of blood sugar

Premature Pains

1. Risk Factors
   • Multiple Pregnancy
   • Previous Pre term
   • Infections
2. Treatment
   • Report early to avoid preterm delivery / Rest

Heart Diseases

1. Detection
2. Additional Care
   • During Pregnancy
   • After delivery

Symptoms which should alert the patients are:

1. Shortness of breath.
2. Patient feels easily tired after doing little work.
3. Fainting spells
4. Chest pain, heaviness in chest
5. Blood in sputum
6. Swelling in legs not relived by rest as seen in normal pregnancy.
7. Patient might feel better in sitting posture than in lying posture.
8. At times patients has to get up from sleep as patient feels bresthless.