Antenatal Care

1. ANTENATAL CARE
The care of women during pregnancy is called antenatal care. This begins soon after
conception. The ultimate objective is to have a healthy mother and a healthy child at
the end of pregnancy.
ANC
includes visit to antenatal clinic, examination, investigations, immunization,
supplements (Iron, Folic acid, Calcium, Nutritional) and interventions as required.
Objectives
8. To promote , protect and maintain health of the mother
9. To detect ‘ at risk’ cases and provide necessary care
10. To provide advise on self care during pregnancy
11. To educate women on warning signals, child care, family planning
12. To prepare the woman for labour and lactation
13. To allay anxiety associated with pregnancy and childbirth
14. To provide early diagnosis and treatment of any medical condition/ complication of
pregnancy
15. To plan for “ Birth” and emergencies / complications
( where, how, by whom, transport, blood )
17. To provide care to any child accompanying the mother
VISITS
Under RCH, a minimum of 3 antenatal visits are recommended. Ideally - once a month during
first seven months, twice a month for 8th month and every week thereafter till delivery.
FIRST VISIT
Confirmation of pregnancy
Screening for high risk pregnancy
Baseline investigations
Initiation of Iron and Folic Acid supplementation
Immunization with Tetanus toxoid
Education of the mother on pregnancy and childbirth
SECOND VISIT
confirmation of EDD,
certain screening tests like maternal serum alpha fetoprotein
( 16-18 weeks) for Neural tube defects ( 4 per 10,000 live births).
Rule out gestational diabetes.
Rh negative women are given anti-D immunoglobulin at 28 weeks
Subsequent Visits
1.Monitor progress of pregnancy
2. Monitor Fetal well being
3. Identify and manage any condition
WARNING SIGNS
Swelling of feet
Convulsions/ unconsciousness
Severe headache
Blurring of vision
Bleeding or discharge per vaginum
Severe abdominal pain
any other unusual symptom
THIRDTRIMESTER VISIT
watch for complications.
Counsel the lady on warning signs, labour
and delivery
Work out birth plan.
Assess adequacy of pelvis
•Diet & Rest
•Personal Hygiene and Habits.
•Sexual intercourse-
•Drugs
•Exercise
•Travel
•Care of Breasts
•Warning signs
ANTENATAL ADVICE / HEALTH EDUCATION

2. Institutional delivery is a must if there is
2. Mild pre-eclampsia
3. PPH in the previous pregnancy
4. More than 5 previous births or a primi
5. Previous assisted delivery
6. Maternal age less than 16 years
7. H/o third-degree tear in the previous pregnancy
8. Severe anaemia
9. Severe pre-eclampsia/eclampsia
10. Antepartum Hemorrhage
11. Transverse fetal lie or any other Malpresentation
12. Caesarean section in the previous pregnancy
13. Multiple pregnancies
14. Premature or pre-labour rupture of membranes (PROM)
15. Medical illnesses such as diabetes mellitus, heart disease, asthma, etc.
16. Pregnancy in women who are HIV positive
INTRANATAL CARE
OBJECTIVES
• Thorough ASEPSIS (“The Five Cleans” - clean hands, surface, blade, cord, tie)
• MINIMUM INJURY to mother and child
• To deal with any COMPLICATIONS
• Care of the NEWBORN
DELIVERY AT PHC IF
■ First birth.
■ Last baby born dead or died in first day.
■ Age less than 16 years.
■ More than six previous births.
■ Prior delivery with heavy bleeding.
■ Prior delivery with convulsions.
■ Prior delivery by forceps or vacuum.
■ HIV-positive woman.
DELIVERY AT REFERRAL CENTRE
• Prior delivery by caesarean.
• Age less than 14 years.
• Transverse lie or other obvious malpresentation
within one month of expected delivery.
• Obvious multiple pregnancy.
• Tubal ligation or IUD desired immediately
after delivery.
• Documented third degree tear.
• History of or current vaginal bleeding or other
complication during this pregnancy.
Role of Birth Attendant/ Midwife
• Explain all the procedures
• Praise the woman, encourage her and reassure her that things are going well.
• Encourage the woman to bathe or wash herself and her genitals at the onset of labour.
• Always wash your hands with soap and water before examining the woman
• Ensure cleanliness of the birthing area.
• Enema should be given only when needed.
• Encourage the woman to empty her bladder frequently.
• Non-pharmacological methods of relieving pain during labour
RECORD OF-
Contractions, their intensity, frequency and duration are recorded.
Cervical dilatation and effacement are recorded.
FHS, amniotic fluid, vitals of the mother, fluid balance, drugs administered etc.
Readily available tool for decision making.
Advantages:
1. reduced prolonged labours and instrumental deliveries;
2. higher APGAR scores and
3. lower perinatal mortality.
WHO modified Partograph- No latent phase

3. POSTNATAL CARE
Puerperium begins after the placenta is expelled and lasts for 6-8 weeks
The Puerperium is characterized by –
1. Return of generative organs to pre-gravid state,
2. initiation of lactation and
3. Recovery from physical, hormonal and emotional experience of the parturition.
POSTNATAL CARE
The postpartum care is aimed at achieving a Puerperium which is free of any complications and to ensure a healthy newborn.
OBJECTIVES
1. Restoration of mother to optimum health
2. To prevent complications of puerperium
3. Provide basic postpartum care and services to mother and child
4. Motivate, educate and provide family planning services
5. To check adequacy of breast feeding
Monitor the following
- every 10 minutes for the first 30 minutes,
- then every 15 minutes for the next 30 minutes,
- and then every 30 minutes for the next three hours:
BP, pulse, temperature, vaginal bleeding, uterus
Ask the birth companion to stay with the mother.
Do not leave the mother and the newborn alone.
HELP IS NECESSARY IF-
•Bleeding increases.
• Feels dizzy.
• Severe headache.
• Visual disturbance.
• Epigastric distress.
• Breathlessness.
• Woman complains of increased abd/ perineal pain
POSTNATAL VISITS
Ask the mother to pay another visit on day 3rd and day 7th, or ask the ANM in charge of that area to pay a home visit during this period.
within 7-10 days after delivery. Either ask the ANM of that area to pay a visit to the woman and her baby, or ask the woman to return to the PHC for a postpartum check-up.
is mandatory to see that involution of uterus is complete.
once a month for 6 month and thereafter every 2-3 months till the end of one year.
COMPLICATIONS
•Puerperal sepsis
•Urinary tract infections
•Breast infections
•Venous thrombosis
•Pulmonary thromboembolism
•Puerperal haemorrhage
•Incontinence of urine
•Psychiatric disorders
Advise the woman to go to
an FRU WITHOUT WAITING.
(i)Excessive vaginal bleeding,
(ii)Convulsions
(iii)Fast or difficult breathing
(iv)Fever and weakness
(v)Severe abdominal pain
Advise the woman to visit the
PHC as soon as possible if-
(i) Fever
(ii) Abdominal pain
(iii) The woman feels ill
(iv) Swollen, red or tender breasts
or sore nipples
(v) Dribbling of urine or painful
micturition
(vi) Pain in the perineum, or pus
draining from the perineal area
(vii) Foul-smelling lochia.
All India Hospital Post partum Program
•Begun in 1969 with 54 participating hospitals,
•With a view to provide maternal, child health and family welfare services in semi-urban/ rural areas,
•The training of medical students and graduates in the techniques of birth control is an important aspect of the program.
•The major purpose of the program is to convince maternity and abortion patients to adopt birth control practices
•Rural areas are reached through the medical colleges and attached hospitals which have responsibility for the area.
•Educational programs
•Post Partum PAP Smear Test Facility Programme