THE BEGINNING FAMILY Part1

Maternal & Child Health Nursing

Antenatal Care
OBJECTIVES
At the end of the lecture session students will be able to:
1. Define key terms related to normal pregnancy, antenatal care, pregnancy,
gestation, lie, position, attitude, presentation, engagement.
2. Explain the purpose of ante natal care
3. State the aim and objectives of Ante-Natal Care
4. Outline the Nursing Goal in caring for the pregnant woman during ante natal
5.
6.
7.
8.
9.

period.
List the routine tests & investigations done in pregnancy
Outline the frequency of visits
Identify pre-natal danger signals and their management
Describe the nursing management of a pregnant woman
Discuss the nursing responsibility to the fetus (unborn child)

OBJECTIVE 1: INTRODUCTION/definitions
Antenatal care: is a planned programme of observation, education, medical
and obstetric management of the pregnant woman aimed at making
pregnancy and delivery a safe and satisfying experience.
ANC is Health care & supervision given to a woman during gestation to
onset of labour and delivery.

Pregnancy: The condition of having a developing embryo or fetus within

the body. The state from conception to delivery of the fetus and products of
conception
Gestation Period: 40 weeks from the 1st day of the last normal menstrual
period or 38 weeks from the date of conception.
Maternal/Antenatal & Postnatal Care: Consists of care of the pregnant
woman; a safe labour and delivery; care & examination of the woman during
the postnatal period; maintenance of lactation; care of the newborn baby.
Lie: this is the relationship of the long axis of the fetus to the long axis of
the mothers uterus. The normal lie is longitudinal.
Presentation: this refers to the part of the fetus that lies lowest in the birth
canal. The normal presentation is vertex.
Attitude: it is the relationship of the fetal limbs and head to its trunk. It is
normally flexion.
Position: it is the relationship of the presentation to the 4 quadrants of the
pelvic brim.
Engagement: head is said to be engaged when the greatest circumference of
the head has passed through the brim.

OBJECTIVE 2: PURPOSE OF ANC

Its broad purpose of ante natal care is to ensure that a live, healthy child is born to
the mother without harm to her in anyway, physically, psychologically and that
wherever possible she is enriched by the experience.

OBJECTIVE 3: AIM OF ANC

1. To promote and maintain good physical and mental health during pregnancy
(health promotion and education coupled with good nutrition)
2. To ensure a mature life and healthy infant (avoidance of unprescribed drugs,
systemic infections that could bring about congenital abnormalities).
3. To prepare the mother for labour, lactation, and subsequent care of her child
from physical, psychological, social and educational points of views.
4. To detect early and treat promptly conditions that is whether medical,
surgical and obstetrical that can endanger the life of the mother and or baby.

OBJECTIVES OF ANTE NATAL CARE

1. Assist the pregnant woman to promote and maintain good physical and
mental health during pregnancy.
2. Work effectively with other members of the health team in delivering care
to pregnant women and their families in meeting their basic needs.
3. Prepare the pregnant woman for labour, lactation and care of her child from
a physical, psychological, social and educational perspective

OBJECTIVE 4: NURSING GOALS

Nursing Goals: are two-fold: to provide physiological & psychological care

A) Physiological Care:
1. To alert women/clients to the symptoms that indicates deviations from
normal progress & the guidelines for reporting them.
2. To provide clients with relevant knowledge of the adaptation of the
maternal body to the developing foetus;
3. To facilitate their understanding of the rationale & methods of ANC
4. To provide clients with information & counseling, including those
relating to nutritional needs, sexual needs, activities of daily living, and
discomforts of pre
B) Psychological Care:
1. To encourage participation of clients & their families in their antenatal
care.
2. To provide support for clients & families during stress.
3. To establish an environment that promotes an emotionally satisfying
pregnancy.
OBJECTIVE 5: ROUTINE TESTS AND INVESTIGATIONS
Nos Prenatal tests
1.
History

Purpose of investigation
Family; medical; Obstetrical; Present Pregnancy

2.

Physical Examination

Systematic; Skeletal; Abdominal; Vaginal; Blood

Pressure; Weight gain

3.

Urine

Protein; Glucose; Oestriol

4.

Blood tests

Hb; Rh Factor & Antibodies; ABO; VDRL;

Rubella Antibodies; Sickle Cell; Alpha feto-

proteins; Placental lactogen; HIV

5.

Vaginal swabs

To rule out infection

6.

Weight

To monitor & identify deviations

7.

Auscultation

Intermittent; Doptone; Continuous Electronic

Monitoring of Foetal Heart

Ultrasonography

Assess Gestational Age; foetal growth; Bi-parietal

Cephalometry

9.

Amniocentesis

10.

Electrocardiography

Detect chromosomal anomalis, neural tube lecithin

sphyngomyelin ratio
Assess heart function

OBJECTIVE 6: FREQUENCY OF VISITS

It has been noted that the best results should obtain if the patient is seen
approximately the 12th week of pregnancy, and thereafter at four weekly intervals
until the 28thweek, two weekly interval until the 36th week and then weekly until
the woman delivers.
a. INITIAL VISIT

During this visit it is sometimes viewed as the longest visit. As during this visit
many details must be collected. This will better aid the midwife or nurse to
coordinate the care for the pregnant woman. This visit is arranged in such a way
that full record of the patients past and present social, medical surgical and
obstetrical histories are obtained. During this visit the nurse enquiries as to
where the woman wishes to be delivered. History taking include: ..

History taking includes:

Surname in block letters
Maiden name to trace her records and prevent confusion since two people
can bear the same name
Christian name must be obtained
Address and important landmarks, telephone numbers
Age of the pregnant woman
#of pregnancies
Marital status in order to know how she will cope with the pregnancy or
if she need the services of the social worker
Occupation-type of work, working hours, distance to work
Religion
NOK

Family Medical history( pt is asked whether medical conditions runs in

the family such as sickle cell, HTN, DM, heart dx, TB, Mental illness,
epilepsy, twin gestation, and congenital abnormalities
PMH find out if she has any of the above mentioned condition
Surgical HX
Obstetric hx- previous pregnancies, labor and puerperia.
Previous pregnancies- duration, history of abortion, or evacuation,
history of complications
Previous labours- spontaneous or induced, duration of labour mode of
delivery
Previous puerperium-amt of blood loss, hx surgical intervention, hx of
fever, hx of prolonged hospitalization
Previous babies alive or dead if dead cause of death, wt at birth, hx of
still birth, neonatal jaundice, or neaonatal death, sex of baby, age of baby.
Present pregnancy-duration of pregnancy, LNMP in order to calculate the EDD.
( Add nine months and seven days to the 1st day of the LNMP. E.g. inform
patient of the possibility of delivery two weeks before the calculated EDD or
two weeks after.
SUBSEQUENT VISITS
At each visits the midwife or nurse should;

a. Assess the patients general health: ask her for any complaint and exclude
anaemia by checking her hemoglobin or packed cell volume.
b. Test the urine for sugar, protein and ketone
c. Check the blood pressure and weight
d. Examine her for oedema and rule out signs of pre-eclampsia
e. Check antibodies in rhesus negative patients or patients with previous
history of blood transfusion. Usually in such cases antibody tests are done at
28, 32, 36 and 40 weeks of gestation or as often as antibodies dictate.
f. Examine breasts to ensure continuity of care especially in cases of flat or
retracted nipples.
g. Determine the growth of pregnancy and viability of the fetus by abdominal
examination including auscultation
h. Examine the vulva for vaginal discharge.

i.
ii.
iii.
iv.
v.
vi.
vii.

OBJECTIVE 7: Identify Pre-natal danger signals

Visual disturbance.
Swelling of the face and or fingers.
Severe, frequent or continuous headaches.
Muscular irritability or convulsions.
Epigastric pain.
Persistent vomiting beyond the first trimester or severe vomiting at any time.
Fluid discharge from vagina: bleeding or amniotic fluid (anything besides

viii.
ix.
x.

leukorrhoea.
Signs of infection: fever or chills, burning on micturition.
Severe/unusual abdominal pain
Absence of foetal movement after quickening.

OBJECTIVE 8: Describe the nursing management of a pregnant woman

Goal ) To obtain evidence of foetal wellbeing Interventions During
Normal Pregnancy: The Nurses Roles during this time includes:
Counsellor; Advocate; Teacher and clinician.
Nursing Assessment:
General & Specific History Taking involves:
1) Assessment of clients health & identifying defects which may adversely
affect childbearing.
2) Collecting & recording facts/data that should lead to remedial action where
possible.
3) Establish adequacy of home conditions e.g. Adequate space; Health hazards;
Source of income/Financial support; Marital status; Spouses position/status;
Nutritional status & availability of nutrients; Ability to budget & to care for
baby. To determine occupation & assess working conditions if applicable.
4) identify Genetic predisposition to diseases psychiatric
disorders; diabetes; essential hypertension; allergies, Tendency to produce
twins, Cause of death of near relatives e.g. parent (s), sibling if applicable.
5. Medical History to:
establish present & previous health
Previous illness may have damaged certain structure/s & organs resulting in
complications of pregnancy/labour Discuss examples.
6. (iv) Obstetric History:
Record of previous pregnancies, labours & puerperia will enable one to
anticipate possible progress and or outcome of present pregnancy.
Details of any previous complications
Particulars of abortions time & cause
Previous history of excessive sickness, Pyelonephritis or pre-eclampsia.

 Normal/Abnormal
Any Complications
Where Antenatal Care was obtained
Duration of pregnancy
Immunization (Tet Tox)
Antepartum haemorrhage
Premature/Postmature /post dates
Spontaneous/Induced
Length of Labour
Babys weight
Assisted Forceps etc.
(3.5 kg normal pelvic size)
Caesarean Section
Postpartum Haemorrhage
Date & Place of Delivery
Tear (3rd.degree) or Episiotomy
Adherent Placenta
SUMMARY
0-28 weeks
4 weekly appointment
28-36 weeks
2 weekly appointment
36- Delivery
weekly

REFERENCES
1. Clarke, Mary Jo, 1996 Nursing in the Community 2nd Ed. Appleton & Lange,
Stamford CA
2. Duval, E. M. Marriage & Family Development (5th Ed.) in Ludewig et al
Contemporary Maternal Newborn Nursing (7th ed.)
3. Ladewig , P.W. et al 2002. Contemporary Maternal Newborn Nursing
Care , New Jersey: Prentice Hall

4. Ricci , susan, 2007. Essentials of Maternity, Newborn and Womens Health

nursing , Lippincott Williams and Wilkins Philadelphia