1. ANTENATAL ASSESSMENT for bsc nursing students

All about antenatal ass

1. Presented By: Prof.Hemalatha College of Nursing, LLRM Medical College, Meerut.

2. Mrs.Ana primi of age 24 years with 36 weeks of gestation came for regular antenatal check-up, perceiving movement well, no complaints of bleeding per vagina, no complaints of leaking per vagina and no complaints of abdominal pain.

3. ANTENATAL ASSESSMENT

4. At the end of the session the group will be able to Define antenatal assessment Understand the importance of antenatal assessment. Describe pre-preparation for the antenatal assessment. Perform the procedure of antenatal assessment. LEARNING OBJECTIVES

5. Antenatal women refer to pregnant individuals receiving medical care and support from conception to birth, focusing on ensuring the health and well-being of both mother and fetus. Antenatal assessment is crucial for ensuring the health and well-being of both mother and fetus, preventing complications, and promoting positive pregnancy outcomes. INTRODUCTION

6. Systematic examination of a woman during pregnancy is called antenatal examination . Definition

7. Detect deviation from the normal. Detect high risk pregnancy and provide special attention. Assess the fetal size and growth Locate the fetal parts to indicate position and presentation. Auscultate the fetal heart sound. Reduce feto maternal morbidity and mortality. IMPORTANCE

8. 1. Enviornment preparation (PVLC) Maintain proper privacy Maintain adequate ventilation Maintain adequate lighting Keep the surrounding clean PRE-PREPARATION

9. 2 . Patient preparation (CBCP) Make her comfortable Ask her to empty the bladder Take her consent Position her properly

10. 3.Self Preparation (HA) Hand washing Article preparation -Weighing machine Clean tray (Vital signs tray) Thermometer-1 Stethoscope-1 Sphigmomanometer-1 Antenatal tray Drape sheet Inch tape Torch Fetoscope

11. STEP-I

12. History collection: Ask about the demographic information including Name, age, education, occupation, religion, socioeconomic status. Ask about obstetrical history including LMP, EDD and POG, previous birth history. Expected date of delivery (EDD) is calculated as followed: 1 st day of LMP −3 months +7 days, and change the year. Step 1

13. Traditionally been calculated by adding 9 calendar months and 7 days from the first day of the last menstrual period. Example: calculate EDD if LMP was August 30, 2024.

14. = June 6, 2025. Ask about chief complaints and present medical or surgical history. Ask about the present Obstetric history including duration of marriage, consanguinity, obstetrical score, and type of conception, antenatal checkups, H/O of hyperemesis, UTI, Bleeding or other minor ailments, immunization, USG scanning and other blood investigations. Ask about menstrual history . Ask about family and personal history. Past medical and surgical history Drug allergy

15. Step 2

16. General examination: Observe general condition: built and nourishment Check for height and weight Check vital signs Step 2

17. Step 3

18. Inspection Skin: color, texture, warmth, moisture, lesions etc. Head size and shape Hair color, texture, infection and infestation, scalp Face: Pigmentation of face (chloasma) Eyes: color of sclera, pupillary reaction and conjunctiva Mouth : oral cavity for any dental carries, gum bleeding, coated tongue, angular stomatitis . Step 3 Head to Toe Assessment.

19. Palpation Nose: Septal deviation- place a finger at nape of nose and moves downward to the tip of the nose. Ears : Setting of ears-draw a line from the outer canthus to the upper border of pinna. Check for any abnormal discharge. Neck : Inspect for any abnormal growth Palpate for lymph node enlargement and thyroid gland enlargement. Auscultation Auscultate for S1 and S2 and murmur sound, breath sound and bowel sound.

20. Breast : Inspection: - Expose the needed area that is one breast at a time Inspect for size , shape and symmetry, pigmentation (primary and secondary areola), Montgomery’s tubercle, prominent veins, any rashes or scar and dimpling. Inspect nipples for inversion and cracking SYSTEMIC EXAMINATION

21. Palpation Palpate clockwise and anticlockwise for tenderness, any mass and lymph node at Axillary tail. Squeeze nipple to check for any secretions .

22. Abdominal Examination

23. Abdomen Ask the woman, if her bladder is empty and instruct her to keep her legs and thighs in a semi-flexed position. Stand on the right-hand side of the woman. Ask the woman to loosen her clothing and expose only the area to be examined, i.e., abdomen. Inspection Inspect for shape, size, symmetry, contour, rashes, scar, pigmentation ( linea nigra , straie albicans and gravidarum ), lesions and visible fetal movements.

24. Palpation Rub hands together to warm them and place the ulnar border of hand at the fundus. Using ulnar border of left hand, start palpating from xiphisternum gently downwards until you meet the first resistance. That is the fundus of the uterus. Mark the level at the fundus, using a measuring tape measure the distance from the upper border of the symphysis pubis to the top of fundus in supine position.

25. Palpate gently by laying the both hands on the side of the fundus and determine the pole of fetus. Hard globular and movable mass denotes head of fetus Broad smooth mass denotes the buttocks of fetus Empty in transverse position. FUNDAL PALPATION-

26. Move the hand on the either side of the uterus at the level of umbilicus and apply the gentle pressure. A smooth continuous surface denotes the spine of fetus. Irregular knoblike structures denotes the extremities of the fetus. In case of transverse lie, the head or buttocks present at the lateral sides. LATERAL PALPATION-

27. LATERAL PALPATION

28. Gently spread right hand widely over the symphysis pubis , with the ulnar border of the hand touching the symphysis pubis and hold the presenting part and assess whether there is cephalic presentation or not and also confirm whether presenting part is mobile or not. If the head is not moving it denotes engagement of the head. PELVIC GRIP-FIRST ( Pawlik’s grip)

29. Pawlik’s grip

30. Face the foot end of the mother. Keep both palms of hand on the sides of the uterus, with the fingers held close together, pointing downwards and inwards. If the fingers are convergent of both hands, it denotes no engagement If divergent it denotes engagement. SECOND PELVIC GRIP

31. Pelvic grip

32. Auscultate the FHS by fetoscope or stethoscope by placing the fetoscope or bell of stethoscope at the spine/ back of the fetus at the midpoint of the spino -umbilical line (above the umbilicus in breech). Count the fetal heart rate (FHR) for 1 minute using a watch with a second hand. Inform the mother of the result and Record the findings in the woman’s record. Auscultation

33. Auscultation

34. Inspect: Mons pubis: hairs, sign of any infection. Labia majora and minora - Inspect for any edema, redness, rashes and lesions. Discharge: inspect for presence of any discharge. Per vaginal examination should be performed only when indicated. Perineum

35. Inspect for any rashes, lesions, scars and edema (pedal edema). Inspect for ROM Check for homan’s sign. Extremities

36. Laboratory data Test Purpose Blood group To determine blood type. Hgb To detect anemia. Rubella To determine immunity Urine analysis To detect infection or renal disease. protein, glucose, and ketones Papanicolaou (pap) test To screen for cervical cancer Chlamydia To detect sexual transmitted disease. Glucose To screen for gestational diabetes.

37. Test purpose Stool analysis for ova and parasites * Venereal disease tests should be performed (VDRL) To screen for syphilis Hepitits Bsurface antigen To detect carrier status or active disease

38. * Hemoglobin will be repeated: - At 36 weeks of gestation. - Every 4 weeks if Hb is<9g/dl. - If there is any other clinical reason.

39. Dutta D.C; Text book of obstetrics; sixth edition Kolkata, new central book agency (P) LTD , 2004; Jacob Annamma ;A comprehensive text book of midwifery ;First edition, new delhi . Jaypee brothers medical publishers (P) LTD, 2005 . Fraser . diane M; myles text book for midwives; fifteenth edition, elesevier publications limited,2009. Effendi R, Isaranurug S, Chompikul J.   Journal of Public Health and Development . 2008; 6(1): 113-122.  Symon A, Pringle J, Downe S, et al ; Antenatal care trial interventions: a systematic scoping review and taxonomy development of care models. BMC Pregnancy Childbirth. 2017 Jan 617(1):8. doi : 10.1186/s12884-016-1186-3. References

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