Obstetrics

1: Antenatal Care (ANC)

ANC provides necessary services to the mother and fetus. Its purpose is manifold: to maintain the mother in the best possible state of health, so that she may in turn give birth to a healthy child; to recognize abnormalities and complications at an early stage; and to educate the mother in the birthing process and the duties of motherhood, dispelling unwarranted anxieties and fears concerning pregnancy and labor.

In the absence of ANC the incidence of perinatal baby loss is five times greater. This is accomplished by simply recognizing high risk patients, conducting routine screening to detect diseases (Rhesus disease, anemia, hypertension, diabetes, etc.) and over- or under-sized babies, and preventing premature labor.

The first visit usually entails diagnosing the pregnancy, taking the patient’s history, obtaining laboratory samples (for blood group – Rh., CBC, blood sugar, urine analysis, and VDRL), and examinations – both clinical and ultrasound. Further visits are monthly until 28 weeks, then every two weeks till 36 weeks, then weekly till full term at 40 weeks.

In the last trimester (between 28-40 weeks) attention is focused on the exact age of the baby (in case induction of labor is necessary); the well-being of the baby (to identify intrauterine growth retardation); and, finally, the mechanics, methods, and timing of delivery are thoroughly assessed and discussed.

2: Antenatal Screening

The screening process can make use of blood tests (to test for antibodies and hemoglobin levels), an ultrasound (to test for structural abnormalities in the fetus), and a urine test (to test for possible infections).

-At 9-12 weeks chorionic villus sampling may be necessary to diagnose chromosomal anomalies.

-At 11-13 weeks a blood test is taken to examine biochemical markers (PAPP-A and free B-HCG) that can detect fetal chromosomal anomalies (such as Down's Syndrome).

-At 11-13 weeks pelvic ultrasound is done to measure fetal nuchal translucency and the presence of the fetal nasal bone, for early detection of chromosomal anomalies (such as Down's Syndrome).

-At 14-16 weeks if necessary, amniocentesis is performed if either of the above tests are inconclusive or doubtful.

-At 20-22 weeks a 3D or 4D ultrasound is advised to detect structural and anatomical fetal anomalies (for example, Down's Syndrome, neural tube defects, facial and limb anomalies).


Prenatal Screening	Ultrsound Screening for Fetal Nuchal Translucency

3: Amniocentesis

This is a diagnostic test that helps shed light on the possibility of abnormalities of the fetus. Amniotic fluid is removed from the amniotic sac during pregnancy. Usually about 16 ml are aspirated under the guidance of an ultrasound. The fluid is then sent to the lab, and is tested for certain disorders using polymerase chain reaction (PCR), a biochemical and molecular biology technique for exponentially amplifying DNA. A full chromosome analysis can be obtained within approximately three and half weeks.

PCR tubes

4: Management of High Risk Pregnancy

There are certain factors that contribute to a woman facing complications during pregnancy. Women that are very young or old, that are overweight or underweight, that have had problems with previous pregnancies, that have pre-existing health problems (HIV, Gestational Diabetes Mellitus, Diabetes, Preeclampsia, and Eclampsia, etc), or that are carrying twins or higher order pregnancies are all susceptible to problems during the gestation period. Hayat can carefully monitor such patients and can administer medication when necessary in order to increase the probability that the pregnancy reaches its full-term.