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Antenatal care

What is Antenatal care

Periodic and regular supervision including examination and


advice of a woman during pregnancy is called Antenatal
care.

The supervision should be of a regular and periodic nature in


accordance with the need of the individual.

+Aims
The aims areTo

screen the high risk cases

To

prevent or detect or treat at the any earliest complication

To

ensure continued medical surveillance and prophylaxis

To

educate the mother about the physiology of pregnancy


and labour by demonstrations, charts and diagrams so that
fear is removed and psychology is improved

+
Aims (contd)

To discuss with the couple about the place, time and mode
of the delivery, provisionally and care of the newborn

To motivate the couple about the need of family planning

To advice the mother about breast-feeding, post-natal care


and immunization

Objectives
To ensure a normal pregnancy
with delivery of a healthy baby
from a healthy mother

Criteria of normal
pregnancy
Delivery of a single baby in
good condition at term with
no maternal complication

Services

As per WHO recommendation at least 4 visit1st

visit around 16 weeks

2nd

visit between 24-28 weeks

3rd

visit at 32 weeks

4th

visit at 36 weeks

+Services

(contd)

GenerallyAt

interval of 4 weeks up to 28 weeks

At

interval of 2 weeks up to 36 weeks

At

weekly interval up to EDD

+
Antenatal care comprises
of

Careful history taking and examination and investigation

Advice given to the pregnant woman

+
THE FIRST VISIT
History

taking

Examination
Investigation

+History taking
1.

Particulars of the patient

2.

Chief complaints with duration

3.

Past history

4.

Obstetric history

5.

Menstrual history

6.

Family history

7.

Drug History

8.

History of immunization

9.

Socio-economic history

10.

Contraceptive history

11.

History of allergy

+Particulars of the patient


1.Name
2.Age
3.Address
4.Marital

status

5.Date

of Admission

6.Date

of Examination

+ Chief complaints with

duration
Period of amenorrhea

1.
2.

Nausea & vomiting, vertigo

3.

Increased frequency of micturition

4.

Constipation

5.

Heaviness of breast

6.

Rise of temperature

7.

Edema

8.

Pain in the abdomen

9.

Backache

10.

Vaginal bleeding

Past history
1.HTN
2.DM
3.BA
4.Renal

Disease

5.Psychiatric

illness

6.IHD
7.Any

previous operation

+
Obstetrical History

Duration
Gravida
Para
ALC

of marriage

Menstrual History
Age

of menarche

Menstrual

period

Menstrual

cycle

LMP
EDD

Family history
a)HTN
b)DM
c)Multiple

pregnancy

Drug History
Antihypertensive
Hypoglycemic
Antidepressant
Corticosteroid
Anticoagulant

Physical
examination

General

examination

Abdominal

examination

+General examination

+
General examination
(contd)

Temperature

Pulse

BP

RR

Breast

Heart sound

Lungs

Abdominal
examination
Inspection
Palpation
percussion
Auscultation

Inspection
Shape

of the uterus

Striae
scar

mark

+
Palpation
Assessment

of fundal height

Lie
Abdominal

girth

Fundal

grip

Lateral

grip

First

pelvic grip

Second

pelvic grip

Auscultation
Normal

FHR is 120-160 b/m

Causes

of foetal tachycardia (>160

b/m)
Causes

b/m)

of foetal bradycardia (<120

Causes of foetal
tachycardia (>160
b/m)
1. Maternal
2. Foetal

high fever

distress

3. Maternal

tachycardia

Causes of foetal
bradycardia (<120
b/m)
1.

Foetal distress

2.

Foetal cardiac conduction defect

Investigation

CBC

Blood grouping & Rh typing

Urine R/E

RBS

VDRL

HBS Ag

Ultrasound

Ultrasound
early pregnancy (preferably at 10-13 weeks) to:
Determine
Detect
Help

gestational age

multiple pregnancies

with later screening for Down's syndrome

+Ultrasound (contd)
At 11-14 weeks:
offer nuchal translucency screening for Down's syndrome, with
other tests if available.

At 18-20 weeks:
offer screening with ultrasound for congenital anomalies.

At 36 weeks:
for foetal maturity, placenta praevia.

+In subsequent visit

Patient complains

General examination

Gestational age to be calculated

Identification of problem

Foetal movement

SFH measurement

Health education

Prophylaxis & treatment of anemia

Developing individualized birth plan

Second visit (24-28


weeks)
SFH
To

measurement

detect Multiple pregnancy

+
Third visit (32 weeks)

Screen for1.Preeclampsia
2.Multiple
3.anemia
4.IUGR

pregnancy

Fourth visit (36


weeks)
Identification

of foetal

1.Lie
2.Presentation
3.Position
Update

birth plan

+Antenatal advice
Principles:
1.To

impress the patient about the importance of regular


check up
2.To

maintain or improve the health status of the woman


to the optimum till delivery by judicious advice
regarding diet, drugs and hygiene
3.To

improve and tone up the psychology and ot remove


the fear of pregnancy by talking sympathetically to the
patient and explaining the principle changes and events
likely to occur during pregnancy

Antenatal advice (contd)

Following advices are to be given:

Diet

Rest & sleep

Bowel

Personal cleanliness

Clothing, shoes & belt

Dental care

Care of breast

Coitus

Travelling

Smoking &
alcohol
Immunization
Drug
Mental
preparation
Exercise
Child care
Birth plan

+Diet
Diet should be:
1.nutritious
2.balanced
3.light
4.easily
5.rich
6.with

digestible

in protein, mineral and vitamin


womans choice

DDA of a woman during


+
pregnancy (2nd half)
Food element

pregnancy

Kilocalories

2500

Protein

60 gm.

Iron

40 mg

Folic acid

400 g

Calcium

1000 mg

Vitamin A

6000 I.U.

Rest and sleep


8

hour sleep at night

At

least 2 hour sleep after


mid-day meal

Hard

strenuous work should


be avoided in first trimester
and last 4 weeks

+Bowel
Regular

bowel movement may be


facilitated by regulation of diet, taking
plenty fluid, vegetable and milk

Coitus
Should be avoided in
1st trimester
last 6 weeks

+Travelling
Should be avoided in
1st

trimester

last

6 weeks

Air travelling is contraindicated in


Placenta

praevia

Preeclampsia
Severe

anemia

+Immunization
IndicatedTT
HAV
HBV
Rabies

ContraindicatedLive

virus vaccine (rubella measles, mums, varicella)

Warning sign

1.

Headache

2.

Blurring of vision

3.

Convulsion

4.

Vaginal bleeding

5.

Fever

+Preconceptional

care

Preconceptional care is the one step ahead of


antenatal care.

When a couple is seen and counseled about


pregnancy, its course and outcome before the
time of actual conception, is called
Preconceptional care.

Objective: to ensure that, a woman enters


pregnancy with an optimal state of health which
would be safe both to herself and the fetus.

+ Preconceptional care includes:

Identification of high risk factor

Basal level health status including BP recording

Rubella & Hepatitis immunization

Folic acid supplementation

Maternal health is optimized preconceptionally such as


overweight anemia

Patient with medical disease like hypertension, diabetes are


stabilized in an optimal state by intervention

+Preconceptional care includes:

Drugs used before pregnancy are verified and


changed if required to prevent any adverse
effect of the fetus; e.g., warfarin is replaced
with heparin, oral anti-diabetic drug with insulin

Advise to stop smoking, alcohol and drug abuse

Proper counseling to those with history of


recurrent foetal loss or family history of
congenital abnormalities

Counseling regarding health care cost

Find out supporting or helping people to help


the mother and care of the new born