Antenatal care

Antenatal care

1. ANTENATAL CARE
MRS.JAGADEESWARI.J
M.SC (N) SCON

2. DEFINITION OF ANTENATAL
CARE
Systemic supervision (examination and
advice ) of a woman during pregnancy is called
Antenatal care / prenatal care.
D.C.DUTTA
Antenatal care refers to the care given to an
expectant mother from the time of conception
until the beginning of labour.

3. AIMS
•To 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.

4. AIMS (CONT’D)
•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

5. OBJECTIVES
To ensure a normal pregnancy with
delivery of a healthy baby from a
healthy mother

6. CRITERIA OF NORMAL
PREGNANCY
Delivery of a single baby in good
condition at term with no maternal
complication

7. THE FIRST VISIT
Objectives :
• To assess the health status of the
mother and fetus to screen out the
risk pregnancy and formulate the plan
subsequent management.
•To obtain baseline information.

8. PROCEDURES IN FIRST
VISIT
•History taking
•Examination
•Investigation

9. 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.Personal history
8.Socio-economic history

10. PARTICULARS OF THE PATIENT
1.Name
2.Age
3.Gravida and parity
4.Address
5.Date of first Examination

11. CHIEF COMPLAINTS WITH
DURATION
1.Period of amenorrhea
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

12. PAST HISTORY
1.HTN
2.DM
3.BA
4.Renal Disease
5.Psychiatric illness
6.IHD
7.Any previous operation

13. OBSTETRICAL HISTORY
•Duration of marriage
•Gravida
•Para
•No. of living children
•Health status of the babies
•Previous obstetrical history-antenatal and
intra-natal

14. MENSTRUAL
HISTORY
Age of menarche
Menstrual period
Menstrual cycle
LMP
EDD calculation by naegele’s
formula

15. FAMILY HISTORY
a)HTN
b)DM
c)Multiple pregnancy

16. PERSONAL
HISTORY
•Contraception use before
pregnancy.
•Smoking
•Alcohol

17. SOCIO ECONOMIC
HISTORY
•Occupation
•Family income

18. DRUG HISTORY
Antihypertensive
Hypoglycemic
Antidepressant
Corticosteroid
Anticoagulant

19. PHYSICAL
EXAMINATION
General examination
Abdominal examination

20. GENERAL EXAMINATION
•Appearance
•Vital signs
•Height of patient
•Weight of patient
•Anemia
•Jaundice
•Edema
•Neck
•Tongue ,teeth , gums
•Breast
•Abdomen

21. INVESTIGATION
•CBC
•Blood grouping & Rh typing
•Urine R/E
•RBS
•VDRL
•HBS Ag
•Maternal serum alpha protein
•Serological for rubella and hepatitis
•Ultrasound

22. SUBSEQUENT VISIT
SCHEDULE
Generally-
•At interval of 4 weeks up to 28 weeks
•At interval of 2 weeks up to 36 weeks
•At weekly interval up to EDD
As per WHO recommendation at least 4 visit-
•1
st
visit around 16 weeks
•2
nd
visit between 24-28 weeks
•3
rd
visit at 32 weeks
•4
th
visit at 36 weeks

23. OBJECTIVES OF
SUBSEQUENT VISIT
•To assess fetal well being
•To assess lie , presentation , position
•To assess anaemia , pre eclampsia ,amniotic fluid
volume ,fetal growth .
•To organise specialist antenatal clinics with
cardia disease and diabetes .
•To select time for ultra sound for
amniocentesis ,chronic villus sampling when
indicated.

24. IN SUBSEQUENT VISIT
•General examination-
•weight, BP ,Pallor ,edemas.
•Patient complaints
•Fetal movements and date of quickening
•Gestational age to be calculated
•Health education
•Prophylaxis & treatment of anemia
•Developing individualized birth plan
•Abdominal examination

25. ABDOMINAL
EXAMINATION
Inspection
Palpation
percussion
Auscultation

26. INSPECTION
Shape of the uterus
Striae gravidarum
Linea Niagara
scar mark
Fetal movements

27. PALPATION
•Assessment of fundal height
•Lie
•Abdominal girth
•Fundal grip
•Lateral grip
•Second pelvic grip/pawlick ‘s
maneuver
•First pelvic grip/pelvic palpation

28. AUSCULTATION
Checked by pinard
stethoscope or Doppler
Normal FHR is 120-160 b/m
 Foetal tachycardia (>160
b/m)
Foetal bradycardia (<120
b/m)

29. ANTENATAL ADVICE-
PRINCIPLES
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 to
remove the fear of pregnancy by talking
sympathetically to the patient and explaining the
principle changes and events likely to occur during
pregnancy

30. ANTENATAL ADVICE
•Diet
•Rest & sleep
•Bowel
•Personal cleanliness
•Clothing, shoes & belt
•Dental care
•Care of breast
•Coitus
•Travelling
•Smoking and alcohol
•Immunization
•Drug

31. DIET
Diet should be:
1.nutritious
2.balanced
3.light
4.easily digestible
5.rich in protein, mineral and
vitamin
6.with woman’s choice

32. DDA OF A WOMAN DURING
PREGNANCY (2
ND
HALF)
Food element pregnancy
Kilocalories 2500
Protein 60 gm.
Iron 40 mg
Folic acid 400 mg
Calcium 1000 mg
Vitamin A 6000 I.U.

33. 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

34. BOWEL
•Regular bowel movement may be facilitated by
regulation of diet, taking plenty fluid, vegetable and
milk
Coitus
Should be avoided in
•1
st
trimester
•last 6 weeks

35. BATHING
•The woman should take bath
daily but be careful against
slipping in bathroom due to
imbalance

36. CLOTHING ,SHOES, BELT
•Woman should wear loose
comfortable garments. High heel
shoes should better be avoided in
advanced pregnancy when the centre
of balance alters.

37. DENTAL CARE
•The dentist should be consulted at the
earliest if necessary this will facilitate
extraction or filling of the caries tooth ,if
required comfortably in 2 nd trimester the
best time for such procedure.

38. CARE OF BREAST
•If the nipples are anatomically normal
nothing is to be done beyond ordinary
cleanliness. If the nipples are retracted
,correction is to be done in the later
months by manipulation.

39. TRAVELLING
Should be avoided in
•1
st
trimester
•last 6 weeks
Air travelling is contraindicated in
•Placenta praevia
•Preeclampsia
•Severe anemia

40. SMOKING AND
ALCOHOLISM
•Smoking and alcohol are injuries to health
during pregnancy.
•Heavy smokers have low birth weight
babies and abortion
•Alcohol during pregnancy leads to fetal
growth retardation

41. IMMUNIZATION
Indicated-
•TT
•HAV
•HBV
•Rabies
Contraindicated-
•Live virus vaccine (rubella
measles, mums, varicella)

42. DRUGS
•Most of the drugs
cross the placenta to
reach the fetus while
prescribing the
physician should keep
in mind

43. 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.

44. 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

45. PRECONCEPTIONAL CARE INCLUDES:
(CONT’D)
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
fetal 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