Sigop Elliot Parsaulian Lumbantoruan A4-FAMMED

- PRECONCEPTIONAL COUNSELING
Definition
A set of intervention that aim to identify and modify biomedical, behavioural, dan social risk to
a womans health or pregnancy outcome through prevention and management.

Addresses all risk factor pertinent to morther and fetus how pregnancy will affect maternal
health, and how a high-risk condition might affect the fetus.

Function
1.
2.
3.
4.

Improve knowledege, attitude, and behaviour of men and women toward

preconceptional health.
Assure that all woman of childbearing age receive adequate service enter pregnancy
in optimal health.
Reduce risk indicated by a previuos adverse pregnancy outcome through
interconceptional interventions.
Reduce the disparities in adverse pregnancy outcome

# Social History
Maternal age

Benefit
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UNPLANNED PREGNANCY
Most women realize they are pregnant 1-2 weeks after the first missed period which
is the fetal spinal cord and the heart already beating many prevention are
ineffective if initiated in this time.

Half of pregnancies are unplanned at greatest risk more likely to be young or

single, lower educational status, use tobacco, alcohol or illicit drug and not supplement
with folate.
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PREVENTION OF CHRONIC DISORDER

OR GENETIC DISEASES

Methods
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Basic advice regarding diet, alcohol and illicit drug use, smoking, vitamin intake,
exercise, and other behaviors.
Review of pertinent medical records.
Counselors should be knowledgeable about relevant medical diseases, prior surgery,
reproductive disorders, or genetic conditions, and must be able to interpret data and
recommendations provided by other specialists.

# Personal and family history

Asking specific questions about each history and about each family member, open-ended
questions.
# Medical history

Genetic Diseases
Ethnic background, race, or personal or family history which places them at increased
risk to have a fetus with a genetic disease should receive appropriate counseling.
Reproductive history
Questions are asked regarding infertility; abnormal pregnancy outcomes, including
miscarriage, ectopic pregnancy, and recurrent pregnancy loss; and obstetrical
complications such as preeclampsia, placental abruption, and preterm delivery. History
of a prior stillborn infant is especially important.

Adolescent pregnancy
Adolescents are more likely to be anemic, to have growth-restricted infants, preterm
labor, and a higher infant mortality rate. The incidence of STDs is even higher during
pregnancy. Because most of their pregnancies are unplanned, adolescents rarely seek
preconceptional counseling. These young women usually are still growing and
developing and thus have greater caloric requirements than older women.
Pregnancy after age 35
Currently, about 10 percent of pregnancies occur in women within this age group.
likely to request preconceptional counseling, either because she has postponed
pregnancy and now wishes to optimize her outcome, or because she plans to undergo
infertility treatment. The maternal mortality rate is higher in women aged 35 and
older.
Maternal age-related fetal risks primarily stem from:
(1) indicated preterm delivery for maternal complications such as hypertension and
diabetes,
(2) spontaneous preterm delivery,
(3) fetal growth disorders related to chronic maternal disease or multifetal gestation,
(4) fetal aneuploidy, and
Assisted reproductive technique
Recall that older women have subfertility problems. And although the incidence of
dizygotic twinning increases related to maternal age, the more important cause of
multifetal gestation in older women follows the use of assisted reproductive technology
and ovulation induction.

Recretional Drugs and Smoking

The first step in preventing drug-related fetal risk is for the woman to honestly assess her
usage. Questioning should be nonjudgmental. Alcoholism can be identified by asking the
well-studied TACE questions, which correlate with DSM-IV criteria.

Sigop Elliot Parsaulian Lumbantoruan A4-FAMMED

Smoking affects fetal growth in a dose dependent manner. It increases the risk of premature
rupture of membranes, placenta previa, fetal-growth restriction, and low birthweight. Even
passive exposure to environmental tobacco smoke appears to negatively affect birthweight.
Smoking has also been associated with sudden infant death syndrome. Lastly, smoking
increases the risk of pregnancy complications related to vascular damage, such as
uteroplacental insufficiency and placental abruption. After counseling, the woman should be
provided with a prepregnancy program to reduce or eliminate smoking.
Environmental Exposures
Fortunately only a few agents have an impact on pregnancy outcome. Exposures to
infectious organisms and chemicals impart the greatest risk. i.e. Mercury.
# Lifestyle and work habits
Diet
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Pica.
Many vegetarian diets are protein deficient but can be corrected by increasing egg and
cheese consumption.
Obesity is associated with a number of maternal complications such as hypertension,
preeclampsia, gestational diabetes, labor abnormalities, postterm pregnancy, cesarean
delivery, and operative complications
Nutritional deficiencies, anorexia and bulimia increase the risk of associated maternal
problems such as risks of low birthweight, smaller head circumference, microcephaly,
and small for gestational age.

Excercise
Conditioned pregnant women usually can continue to exercise throughout gestation but
advised not to exercise to exhaustion, and she should augment heat dissipation and fluid
replacement. She should avoid supine positions, activities requiring good balance, and
extreme weather conditions.
Domestic Abuse
Pregnancy can exacerbate interpersonal problems and is a time of increased risk from an
abusive partner.
Abuse is more likely in women whose partners abuse alcohol or drugs, are recently
unemployed, have a poor education or low income, or have a history of arrest
hypertension, vaginal bleeding, hyperemesis, preterm delivery, and low-birthweight infants.
Family History
Construct a pedigree using the symbols understanding may be limited. For example,
several studies have shown that pregnant women often fail to report a birth defect in the
family or report it incorrectly.

Immunization
Vaccines consist of toxoidsfor example, tetanus; killed bacteria or virusessuch as
influenza, pneumococcus, hepatitis B, meningococcus, and rabies; or attenuated live
virusesincluding varicella-zoster, measles, mumps, polio, rubella, chickenpox, and yellow
fever.
Livevirus vaccines are not recommended during pregnancy and ideally should be given at
least 1 month before attempts to conceive.
Screening Tests
These include basic tests that are usually performed during prenatal care. Some examples
are that rubella, varicella, and hepatitis B immune status should be determined so that
vaccination can be carried out as part of preconceptional care.

Sigop Elliot Parsaulian Lumbantoruan A4-FAMMED