Short Notes and Short Cases in Obstetrics UN Panda
INDEX
×
Chapter Notes

Save Clear

Short Notes

Preconception Counseling1

  1. Role of preconception counseling
    Preconception counseling plays two roles:
    1. Interventions to decrease birth defects
    2. Assessment and possible alteration of risk factors that may influence pregnancy outcome
  2. Routine tests in preconception counseling
    1. Hematocrit
    2. Rubella titre
    3. Hepatitis B antigen
    4. HIV screen
    5. VDRL
    6. Pap smear, mammogram in appropriate cases
  3. Role of folate supplement
    Folate supplement prior to conception decreases neural tube defects. In women with increased risk of NTD, folate 4 mg daily decreases NTD risk by 60 percent.
  4. Role of Vit A intake
    Excess intake of vitamin A (> 25.000 IU/day) increase the risk cranial neural crest malformations.
  5. Drug use and pregnancy
    Alcohol consumption during pregnancy can cause fetal alcohol syndrome and attention deficit disorders. Cocaine consumption leads to placental ischemia and increased congenital anomalies, particularly of genitourinary tract. 4Incidence of fetal IVH is increased. Pregnancy outcome includes higher spontaneous abortions, placental abruption; maternal risks include myocardial infarction, cerbovascular hemorrhage, seizure, hypertension and sudden death.
  6. Medical conditions to be addressed during preconception counseling
    • Diabetes mellitus—poor control is associated with increased birth defects
    • Seizure—various anti seizure medications are teratogenic
    • Hypertension—ACE inhibitors and diuretics are not safe; aspirin and calcium supplement to reduce risk of preeclampsia be considered.
    • Connective tissue disorders—anti cardiolipin—anti phospholipid antibody screen be made in SLE that increase chance of miscarriage and congenital heart block.
  7. Role of family history
    Occurrence of autosomal recessive/dominant/X-linked disorders; multifactorial disorders (cardiac anomaly, cleft lip/palate, neural tube defects) and chromosomal disorders be enquired. Idiopathic mental retardation in family members may indicate fragile X. Hemoglobinopathies, cystic fibrosis, storage diseases be given due consideration.
  8. Risks associated with increase in maternal age
    • ↑ chromosomal anomalies and first trimester abortions
    • Fetal growth retardation
    • ↑ perinatal death
    • ↑ preeclampsia
    • ↑ chance of cesarean delivery
    • Chance of maternal death is doubled at 35 years and 4 times more at 45 years.
    5
  9. Absolute contraindications to pregnancy for fear of increased maternal mortality
    • Pulmonary hypertension
    • Marfan's syndrome with aortic root dilatation
    • Dilated cardiomyopathy
    • Complicated aortic coarctation
    • Decompensated heart failure/renal failure.