Antenatal Assessment

Presented by Maj Ajitha K

Everything grows rounder and wider and weirder, and I sit here in the middle of it all and wonder who in the world you will turn out to be. - Carrie Fisher

History Taking
General information Name, age, gravidity, parity, edn qualification, occupation, income, religion, marital status Husband - age, edn, occupation, income, religion Current problem/ complaint History of current complaint

Menstrual History Age at menarche Cycle, duration Amount of Flow Dysmenorrhea Intermenstrual bleeding LMP and EDD Marital History - years of marriage, consanguineous marriage, late marriage Contraceptive History - use and type of devices

Past Obstetrics History

Pregnancy

Gestational age at time of delivery Outcome of pregnancy

Labour/delivery

Normal vaginal delivery, C-section Labor- Normal, prolonged Length of labor D&E D&C Place of delivery (at home or at the hospital) Any other complications

Past Obstetric History

Puerperium

Any complications Baby Gender of baby Age of baby Breast fed, length of breast feeding Birth weight

Present obstetric history

Date of booking No of antenatal visits

1st Trimester

Ask about nausea, vomiting Other associated symptoms such as fever Abdominal/pelvic/back pain, burning micturition Vaginal discharge Bleeding per vagina Use of folic acid tablets (small yellow colored pills) Was an ultrasound done at 6 or 7wks (Dating scan)

Present obstetric history

2nd Trimester

Ask about regular use of folic acid, iron and calcium supplements Ultrasound at 18-22wks (Anomaly scan) Quickening: fetal movements (normally felt around 20 weeks gestation) Fever, rash, abdominal pain

3rd Trimester

Tetanus toxoid vaccine at 28 wks & 32 wks Regular doctor checkups Ultrasound

Obstetric history
General - Any history of disease

Hyperemesis Bleeding ,dizziness,urinary complications Head ache,visual disturbances, constipation, edema, abdominal pain, indigestion History of drugs ,radiation Total weight gain

Past History

Past medical: HTN, Diabetes, TB, Seizures, Asthma , heart disease, malaria, kidney disease, syphilis Past Surgical - pelvic surgeries, abdominal surgeries, caesarian, lower genital tract infections Blood Transfusions Vaccination up-to-date

Family History :- heart disease, hypertension, DM, TB

History of breast cancer, ovarian cancer, uterine cancer History of obstetrical disorders, twin pregnancy, abortion

Personal History

Appetite Sleep Bowel Micturition Recent weight gain/weight loss History of any addictions (such as smoking, alcoholism, tobacco chewing etc..) History of any allergies to foods or medicines

Dietetic History

Veg/ non veg, meal pattern, food fads, habits, likes, dislikes for food, pica, cultural beliefs

Social History

Family members Earning members Approximate income Living condition

Psychosocial History

Aspects of Antenatal Assessment

Head

to toe examination Breast examination Abdominal palpation

Physical Examination
General Examination
Height Weight Temperature,

Pulse, Respiration Blood Pressure

Physical Examination
General Appearance
Build Pallor Jaundice

Gait

Physical Examination
Head and Scalp
Scalp,

infection, infestation Hair Quality Tongue Teeth Gums Tonsils Thyroid

Physical Examination
Breasts
Pregnancy Size Nipples

changes

Inverted Flat Retracted Cracked

Physical Examination
Skin
Colour

changes Texture Striae Gravida Linea Nigra

Physical Examination
Abdomen
Size:

Liver, Spleen Shape: Scaphoid, Pendulous Umbilicus: Protuberant, Dimpled

Extremities
Oedema

Varicosities
Deformities

Physical Examination
Perineum
Oedema

of vulva Discharge Soreness of vulva Vaginal bleeding Bartholins cyst Perineal hygiene

Abdominal Examination
Aim observe signs of pregnancy assess foetal size and growth assess foetal health diagnose the location of foetal parts detect any deviation from normal

Investigations
ABO

blood group, Rh typing Haemoglobin and haematocrit Blood sugar fasting, postprandial VDRL HIV Rubella immune status Urinalysis Ultrasonography

A baby is something you carry inside you for nine months, in your arms for three years and in your heart till the day you die. - Mary Mason

THANK YOU