PRECONCEPTIONAL COUNSELLING AND CARE

When a couple is seen and counseled about pregnancy, its course and outcome well before the time of actual conception is called preconception counseling. Objective is to ensure that a woman enters pregnancy with an optimal state of health which would be safe both for herself and the fetus.

Organogenesis is completed by the first trimester. By the time the woman is seen first in the antenatal clinic, it is often too late to advice because all the adverse factors have already begun to exert their effects.

Preconception phase is the time to identify any risk factor that could potentially affect the perinatal outcome adversely. The woman is informed about the risk factor and at the same time care is provided to reduce or to eliminate the risk factor in an attempt to improve the pregnancy outcome. -Virtually preconceptional counseling is a part of preventive medicine.

PRECONCEPTIONAL VISIT, RISK ASSESSMENT AND EDUCATION: -

• Identification of high risk factors by detailed evaluation of obstetric, medical, family and personal history. Risk factors are assessed by laboratory tests, if required.
• Base level health status including blood pressure is recorded.
• Rubella and hepatitis immunization in a nonimmune woman is offered.
• Folic acid supplementation (4 mg a day) starting 4 weeks prior to conception up to 12 weeks of pregnancy, is advised. This can reduce the incidence of neural tube defects.
• Maternal health is optimized preconceptionally. Problems of overweight, underweight, anemia, abnormal papanicolaou smears are evaluated and treated appropriately.
• Fear of the incoming pregnancy is removed by preconceptional education.
• Patient with medical complications should be educated about the effects of the disease on pregnancy and also the effects of pregnancy on the disease. In extreme situation, the pregnancy is discouraged. -Preexisting chronic diseases (hypertension, diabetes, epilepsy) are stabilized in an optimal state by intervention.
• Drugs used before pregnancy are verified and changed if required so as to avoid any adverse effect on the fetus during the period of organogenesis. For example, anticonvulsant drugs are checked warfarin is replaced with heparin and oral antidiabetic drugs are replaced with insulin.
• Woman should be urged to stop smoking, taking alcohol and abusing drugs. Addicted woman is given specialized care.
• Inheritable genetic diseases (sickle cell disease, cystic fibrosis) are screened before conception and risk of passing on the condition to the offspring is discussed.
• Importance of prenatal diagnosis for chromosomal or genetic diseases is discussed.
• Inheritable genetic diseases could be managed either by primary prevention (eliminating the causal factor) or by secondary prevention (terminating the affected fetus).
• Couples with history of recurrent fetal loss or with family history of congenital abnormalities (genetic, chromosomal or structural) are investigated and counseled appropriately.

There may be some untreatable factors.

Educational classes include discussion as regard delivery, timing, method and possible interventions (ventouse/forceps or cesarean delivery). Such prenatal classes are found helpful and valuable.The counseling should be done by primary health-care providers. The help of an obstetrician, physician and geneticist may be required and should be extended.

LIMITATIONS: Unfortunately, only a small percentage of women take the advantage of preconceptual care. The important reasons are: (i) lack of public awareness, (ii) many pregnancies are unplanned.

ROLE OF HOMOEOPATHIC MEDICINES IN MANAGEMENT OF PREGNANCY: -

1) Cal phos:- this remedy can help to strengthen a woman who tends toward easy tiredness,poor digestion, cold hands and feet, and poor absorption of nutrients. A person who needs cal phos is often irritable because of tiredness, and may long for a travel or a change of circumstances.

2) Caulophyllum:- this remedy may be helpful in women with weak muscle tone in the uterus. A history of irregular periods, slow and difficult labour with previous deliveries, or weakness of the cervix may bring this remedy to mind. She typically feels nervous, shaky, and trembling.

3) Carbo Veg:- this remedy can be helpful to a woman who feels weak and faints during pregnancy, with poor circulation, a general feeling of coldness, and a craving for fresh or moving air. She may also have frequent digestive upsets with burning pain and a tendency to belch.

4) Actaea racemosa:- this remedy can be helpful to women who are nervous and talkative,with a tendency to feel fearful and gloomy during pregnancy. They may become overagitated and a dear of miscarriage prevails.

5) Ferrum phos:- this remedy can be helpful for nervous sensitive women who feel weak or tired with easy flushing of face and a tendency towards anaemia. A woman who needs this remedy often has a slender build and may develop frequent neck and shoulder stiffness