The
concept
of
premarital
counseling is well recognized in
developed countries. However, in
developing countries, PMCC are
not yet popular.
Is there a need for premarital
counseling clinics(PMCC)?
CONTENTS
I. TARGET POPULATION.
II. MAIN FUNCTIONS.
III. THE PROCEDURE
I. TARGET POPULATIONS
1. Couples about to marry.
2. The newly weds.
3. Any individual seeking
advise.
II. MAIN FUNCTIONS
1. Medical counseling.
2. Genetic counseling.
3. Family planning counseling.
4. Nutritional counseling.
5. Sex education.
1.MEDICAL COUNSELLING
The aim is diagnosis of diseases:
A. Transmitted to the other partner:
STD, TB ,Viral diseases such as
hepatitis A,B &C and HIV.
B. Represent a risk factor during
pregnancy:
1) cardiac disease.
2) chronic renal disease.
3) renal transplantation.
C. Affect reproductive function:
Female:
fibroid, genital hypoplasia,
anovulation, menstrual disorders,
hirsutism.
Male:
undesnded testes, varicocele,
azospermia, physical disability.
2. GENETIC COUNSELLING
Aim:
identify individuals at risk
of having a child with genetic
disorder
Indications
1.Age > 35:
Down syndrome:
1/2000 at 20 y.
1/500 at 40y.
1/32 at 45 y.
2. First cousins:
share large groups of identical genes
(1/16): increasing the risk of recessive
diseases particularly if there is family
history.
3. Chromosomal abnormality in either
partner.
4. Family history of genetic disorders.
5. Ethnic groups:
Blacks: Sickle cell anemia.
Mediterranean's:
B thalassemia, Glucose 6 phosphate
dehydrogenase def.
6. Pregnancy loss in those previously
married.
Steps
1. Establishment of a diagnosis.
2. Estimation of a recurrent risk.
3. Communication of relevant
information.
4. Provision of long term support.
Teratogenic medications:
e.g. Anticonvulsant, antineoplastic, Oral
anticoagulant, isotretinoin lithium, alcohol,
smoking Effects should be explained
.
3. FAMILY PLANNING COUNSELLING
A. Encourage pregnancy
1) > 30 y.
2) A cause of possible impairment of
fertility: fibroid, PCOS, oligomenorrhea
and genital hypoplasia.
3) Chronic medical disease which
progress with advancement of age .
B. Contraception
Aim
reduction the hazards of:
a. adolescence pregnancy.
b. unnecessary resort to
induction of abortion.
c. birth of unwanted child.
Explain the hazards of:
a. uncontrolled fertility.
b. high risk pregnancy (too early,
too many & too close together)
Methods:
a. Natural barrier & chemical:
not good choices.
b. IUCD, injectable &
implants: not suitable.
c. Pills best choice.
d. Emergency contraception
(levonorgestrel) may be
required
.
4. Nutritional counseling
BMI:
preferred indicator of
nutritional status.
Eating habits:
fasting, pica,
eating disorders, megavitamin
Preconceptional intake of
folic acid.
5. SEX EDUCATION
Important
{level of sexual knowledge
amongst youth is moderate}.
Includes
1. Sensitive sexual sites.
2. Healthy marital relations.
3. Communication skills to
reduce the chance of marital
difficulties increase marital
satisfaction.
4. Safe sex & protection against
STD.
5. Answers of questions on
sexually related issues.
Requirements
1. The partners may be
counseled separately or together.
2. The doctor:
Good knowledge of different
aspects of human reproduction
& sexuality.
Good listening.
Encourage them to ask
questions.
III. PROCEDURE
A. History.
B. Examination.
C. Investigations.
D. Health education.
A. History :
1. Menstrual.
2. Family.
3. Drug intake.
4. Past: STD.
B. Examination:
1.Female:
Body mass Index(BMI), secondary
sextual charecters (SSC), hair
distribution, galactorrhea.
2. Male:
External genitalia:
undesended testes, varicocele,
hydrocele, hypospadias.
C. Investigations
:
I. Routine investigations :
Female:
RH typing, Rubella Ab, Toxoplasmosis Ab,
Pelvic ultrasonography.
Male:
semen analysis .
Both:
urine analysis, CBC, Bl group, blood
sugar, liver function.
II. Special investigations
1.Hormonal profile: amenorrhea,
oligomenorrhea, galactorhea, PCOS,
hypogonadism.
2. Karyotyping: at risk cases.
3. Screening for STD: some cases.
4. Investigations for specific
medical diseases: cardiac ECHO,
GTT, kidney function, IVP, CT of skull
in galactorrhea, thyroid function test.
D. Health education
1.Family planning
2.Nutritional
3.Sex