antenatal care

antenatal care

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Antenatal care

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1. Prenatal (Antenatal) care.
•Antenatal care (ANC) means “care before
birth”
ANC includes:
•Education
•Counseling
•Screening
•Treatment

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2. Antenatal cares goal
•The major goal of prenatal care is to
ensure the birth of healthy baby with
minimal risk for mother.
..

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3. Type of prenatal care
•midwife/general practitioner-managed
care
•obstetrician/gynecologist-led shared care
•The clinical efficacy of the two groups in
low risk woman is similar (A).
Khan-Neelofur et.all”Who should provide routine antenatal care for low-risk women and how often”
WHO Antenatal care trial research group,1998

5. 4.Frequency of prenatal visits
•Antenatal care is not a single
intervention,instead it represents a series
of assasment and interventions over time
•The median number of visits is 8 and 5
•The minimum number is 4
•More frequent visits may be of benefit in
monitoring women with pregnancy
complications
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA

6. 5.New model of antenatal care
•First visit-less than12 weeks
•Second visit-26weeks
•Third visit-32weeks
•Fourth visit-38weeks
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA

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6.Organization of prenatal care
•preconceptional care
•prompt diagnosis of pregnancy
•initial presentation for pregnancy care
•subsequent prenatal visits

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7.Preconceptional care
Preconceptional care program has the
potential to assist women:
•By reducing risks
•Promoting healthy lifestyles
•Improving readiness for pregnancy
W. Obs.

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8. Prompt diagnosis of
pregnancy.
•Symptoms and signs
•Home urine pregnancy test
•Confirmatory testing for human chorionic
gonadotropin
•Ultrasonic recognition of pregnancy
Up To Date

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9. The presumptive signs of the
pregnancy
•Frequent urination.
•Nausea and Vomiting (Morning Sickness)
•Change of appetite and taste
•Pigmentation of the face, abdomen and the areola
•Enlargement of breast and increase of firmness
•Enlargement of abdomen

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10. The possible signs of the
pregnancy
•Amenorrhea
•Swollen and cyanotic cervix and vagina
•Changes in the form and consistency of
the uterus
•Enlargement of the uterus
•Hegar - Horvits sign
•Snegirov’s sign
• Immunological tests

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11. Home pregnancy tests
·A detection limit of 12,5 m IU/ml would be
required to diagnose 95 percent of
pregnancies of the time of missed
menses.

13. •Detection of hCG in maternal blood and
urine provides the basis for endocrine
tests of pregnancy
•With a sensitive test the hCG can be
detected by 8 to 9 days after ovulation.
•.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
12. Confirmatory testing for human chorionic
gonadotropin

14. •Fetal heart action

•fetal movements
•Ultrasonic scan

TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
13.The positive signs of the
pregnancy

15. •A gestational sac may be demonstrated:
• By abdominal sonograpy after only 4 to 5
weeks menstrual age.
•By transvaginal sonograpy-1-1,5weeks
earlier
•By 35 days all normal sacs should be
visible.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
14. Ultrasonic recognition of
pregnancy

16. •Prenatal care should be initiated as soon,
as there is a reasonable likelihood of
pregnancy.
•The major goals are:
–to define the health status of the mother and
fetus.
–to estimate the gestational age of the fetus.
- to initiate the plan for continuing
obstetrical care.
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
15. Initial prenatal evaluation

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16.Estimated date of Delivery
•Menstrual age (Naegel’s rule)
•Ovulatory or fertilization age

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17. Ultrasound examination
.First trimester ultrasound examination can
lead to:
- earlier detection of fetal malformations
-earlier delection of multiple pregnancy.
- predict more accurate the actual data of
delivery

19. 18.Normal pregnancy duration
•280 days
•40 weeks
•10 lunar months
•9 calendar months
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA

20. •I trimester- extended trough the
completion of 14 weeks
•II trimester – trough 28 weeks
•III trimester- included the 29th trough 42
weeks of pregnancy
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
19. Pregnancy trimesters

21. • Nulligravida
• Gravida
- primigravida
- multigravida
• Nullipara
• Primipara
• Multipara
TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA
20.Definitions

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21. The elements of the
patients history
•.Personal and demograpic information
•.past obstetrical history
•.Personal and family medical history
•.Past surgical history
•.Genetic History
•.Menstrual and gynecological history
•.Current pregnancy history
•.Psychosocial information

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22. Psychosocial screening
•.Cigarette smoking
•.Alcochol and illicit drugs
•.Domestic violence

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23. Physical examination
• Height
• Constitution
• Skin
• Abdomen
• Internal organs
•Baseline blood pressure
• Calculation of body mass index

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24. Pelvic examination
•Examination of cervix using mirrors
•.Digital pelvic examination:
-Palpation of the cervix
-Determination of the size and form of
the uterus
-Determination of conditionsof adnex

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25. Routine laboratory tests(1)
•.Rhesus type and antibody screen
•.Hematocrit or hemoglobin
•.Cervical cytology (a Pap smear)
•.Rubella immunity testing
•.Urinary infection testing

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26. Routine laboratory tests(2)
•.Syphilis testing
•.Hepatitis B-antigen testing
•.Human immunodeficiency virus
•.Down syndrome screening

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27. Additional laboratory
tests(1)
•Testing for infections:
•- N. gonorrea
•- Tuberculosis
•- Toxoplasmosis
•- Hepatitis C antibodies
•-Chlamydia testing

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28. Additional laboratory
tests(2)
•Testing for infections:
•- Varicella
•- Bacterial vaginosis
•-Herpes simplex virus
•Testing for heritable discorders
•- Thyroid function

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29. Patient education
•Potential areas for patient education:
•Number and frequency of prenatal visits
•Routine pregnancy monitoring
•How to reach the provider after the
business hours
•Confidentially issues.

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30. Common concerns (1)
•Exercise
•Employment
•Travel
•Seat belts

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31. Common concerns (2)
•Bathing
•Clothing
•Bowel habits
•Sexual activity

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32. Recommendations for
weight Gain
•A pregnant women with a normal BMI
should gain11,5- 16 kg during pregnancy
•Normal BMI is 18-35kg/m2
•The pregnant women can eat what she
wants in amounts she desires and salted
to taste

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33. Recommended dietary (1)
•Vitamins
•Minerals

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34. Recommended dietary
allowances (2)
•Calories
•Protein

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35. Subsequent prenatal sits
•At each prenatal visit, steps are taken to
determine the well being of:
• mother
• fetus
•To diagnosis :
•Preeclampsia
•Fetal malpresentation

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36. Prenatal surveillance (1)
•Fetal assesment
•- Heart rate
•- Size – current and rate of change
•- Amount of amniotic fdluid
•- Presenting part and station (late in
pregnancy)
•- Activity

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37. Prenatal surveillance (2)
•Maternal assesment
•- Blood pressure
•- weight
•- Symptoms
•- Height of uterine fundus from symphysis
•- Confirmation of the presenting part

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39. Subsequent laboratory
tests
•Maternal serum screening at 16 to18 weeks for
detecting open neural tube defects and
chromosomal anomalies.
•Hemoglobin and hematocrit should be repeated
at about 28 to 32 weeks.
•Antibody screening
•Retesting of HIV
•The urine screening for protein

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40. Sonography
•Ultrasound examination must be repeated
at 18-20weeks of gestation
•The routine use of ultrasound in the third
trimester (after 24weeks)) in low risk
women has not effective for, improving
outcome (evidens A)

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41. Common complaints (1)
•Nausea and Vomiting
• Heartburn
• Ptyalizm
•Backache
•Headache

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42.Common complaints (2)
• Varicosities
• Hemorrhoids
•Fatigue
•Leucorrhea

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43.Warning signs of the
pregnancy(1)
•Severe head ache
•Fatigue
•Blurred vision
•Pain in the epigastrium or right upper
quadrant of abdomen.
•Generalized oedema
•Smelly discharge form vagina

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44. Warning signs of the
pregnancy (2)
•Pain during urination
•Fever
•Vaginal bleeding
• Early discharge of the amniotic fluid
• Stopping of the movoment of fetus

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45. Effectiveness of prenatal
care
•The use of prenatal care significatly
lowered the rate:
•Of neonatal death associated with several
high – risk conditions
•Of preterm births
•Of pregnancy – related maternal death