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Aims of ANC
to prevent, detect and manage those factors
that adversely affect health of mother and baby
to provide advice, reassurance, education
and support for woman and her family
to deal with the minor ailments of
pregnancy
to provide general health screening
to help women limit harmful behaviors
during pregnancy

Booking visit
first visit is very important
should be done ASAP (preferably by 12 weeks
of POA)
frequency of visits
monthly until 28 weeks
biweekly until 36 weeks
weekly until delivery

Booking History

Past Medical History

Cardiac/HTN
previous pre-eclampsia
Thromboembolism
previous DVT
Respiratory
Renal
Alimentary
Liver
Endocrinological - DM
Neurological
Haematological anemia
Blood Transfusion

Contraception
Drugs in pregnancy
Allergies
Special Diet
Vegetarian
Drug Misuse
Bacterial Infections
Viral Infections
Chickenpox
Genetic
Previous Surgery
Previous Infertility
Mental Health
Alcohol (units per
week)
Smoking

Past Obstetrics History

Menstrual Cycle
Gravida
Parity
LMP
EDD
Bleeding since LMP?
Previous pregnancy
duration of pregnancy
method of delivery NVD, Caesarean,
Assisted with vacuum/forceps
sex
weight
condition at birth
screening tests

Previous Gynaecological History

STDs?
Prolapse of vagina/uterus?
PID?
any operational procedures?
previous PAP smear
date of last smear
any abnormal smear result
treatment received
Contraceptive history
when and why it was stopped
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 Family History
multiple birth
HTN
thromboembolism
DM
TB
congenital abnormalities
deafness (congenital)
Social History
smoking
alcohol
use of illegal substances cocaine, heroin,
amphetamines
social deprivation a/w poorer obstetric
outcomes
domestic violence

Physical Examination
General Examination
Height
Weight
Pallor, cyanosis, clubbing
Oral Hygiene
Oedema
Varicose Veins
Mothers gait any bony deformity of
pelvis
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o measurement of height and

weight for BMI
o low BMI fetal growth
restriction
o high BMI gestational DM,
pre-eclampsia, need for
emergency caesarean section,
anesthetic difficulties
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Blood Pressure
Throid
enlargement? Signs of hypo- or hyperthroidism?
Breast
CVS
Spine
kyphosis? Scoliosis?
Abdomen
scars? Palpate for uterine size and mass
Vaginal Examination
when indicated
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Booking Examination
o abdominal examination to record the size
of uterus
o recognition of any abdominal scars
indicative of previous surgery
o Urinalysis
o midstream urine dipstick for nitrates
presence or absence of bacteria if
+ve bacteriuria ascend and cause
pyelonephritis significant maternal
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PALPATION OF PREGNANT
ABDOMEN

Inspection

degree of distension
presence of umbilical eversion
suggests excessive distension = twins or
polyhramnios
fetal movements
presence confirms this distension is due to
pregnancy, not due to ovarian cyst
linea nigra
linea alba may become pigmented during pregnancy
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Fundus
determination of position of fundus
(uppermost part of uterus) w/ ulnar
border of left hand palpating
gradually from xiphisternum

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Symphysis fundal height

(SFH)
measured with measuring tape from
fundus through umbilicus to upper
border of pubic symphysis

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Uterus larger than Uterus smaller

dates
than dates
Wrong dates

Wrong dates

Polyhydramnios

Oligohydramnios

Multiple pregnancy

Intrauterine growth
restriction

Big baby
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Lateral palpation
to determine lie of fetus
both hands are placed flat, one on either side
of maternal abdomen
fetus is then gently ballotted between hands
lie maybe longitudinal, oblique or transverse
volume of amniotic fluid is described as
clinically normal when fetal parts can be felt

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Presenting part
both hands are used to palpate lower
pole of uterus and determine what fetal
part lies there
is the presenting part engaged?

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Fetal health
auscultation for fetal heart w/ Pinards
stethoscope or Doppler hand-held device

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Booking Investigations
Full blood count
for anemia (<9g/dL of Hb), thrombocytopenia
Blood group and red cell antibodies
women with rhesus ve prophylactic anti-D
administration at 28 and 34 weeks of gestation
to prevent rhesus iso-immunization and future
HDN
Rubella, Hepatitis B, HIV
Syphilis
vertical transmission can be prevented by
giving mother antibiotics

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 Hemoglobin studies
for Thalassaemia, sickle cell disease
(outside Northen Europe esp Indian, West
Indian, South-East Asian) if +ve, father
should be tested as chance for the
offspring to get the d/s
Gestational DM
random blood sugar, fasting blood
sugar, OGTT
Other routine investigations
cervical smear, vaginal swabs in

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Screening for fetal

Carried out between 11 and 22
abnormalities
weeks of gestation
nuchal translucency scanning at
11-13 weeks
serum screening at 15-19 weeks
free beta-HCG, PAPP-A
maternal serum alphafetoprotein at 15-19 weeks
detailed or anomaly
ultrasound scan at 19-22 weeks

Downs
syndrome
Neural tube
defects like
spina bifida,
anencephaly
Structural
Congenital
Abnormalit
ies

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Ultrasound Scan

o At booking
o for dating

o At 20/52
o for fetal anomaly
o At 28/52
o for placenta localization
o At 36/52
o for estimated birth weight, presentation, AFI
(amniotic fluid index)
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Follow-up visits
general questions regarding maternal well-being
enquiry regarding fetal movements from 24 weeks
measurement of BP
Urinalysis
for protein, blood and glucose infection, pre-eclampsia,
gestational DM
examination of oedema
warning feature of pre-eclampsia
abdominal palpation for fundal height
detection of fetal growth problems and abnormalities of liquor
volume is ed
auscultation of fetal heart (Pinards Fetoscope or Daptone) 37

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 full blood count and red cell antibody

screen
repeated at 28 and 36 weeks
from 36 weeks
lie of fetus longitudinal, transverse or
oblique
presentation cephalic or breech
degree of engagement of presenting
part
decision is made vaginal delivery or
caesarean section
at 41 weeks
discussion regarding merits of induction of
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labour for prolonged pregnancy

Management
folic acid supplementation
hematinics supplement > 12 weeks
nutritional advice
health education
alcohol cessation
smoking cessation
give information on antenatal screening
tests
benefits and limitations
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 Immunization
anti-tetanus vaccination (ATT)
Primigravida at quickening and
repeated 4 weeks later
Multigravida single dose is given in
3rd trimester before 37 weeks of
gestation

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Presentation of
fi ndings

For example,

Mrs X is a 30 y/o, para 2+0 at 36 weeks w/ raised BP

On examination, abdomen is distended compatible w/
pregnancy and old striae is noted
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3.
4.
5.
6.
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findings:
SFH is 35cm
w/ longitudinal lie
of a singleton infant
cephalic presentation
3/5 head palpable
fetal heart sounds heard
adequate liquor volume

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