Antenatal care and examination

brief description of antenatal care and examination. Discussion of antenatal examination

1. Antenatal care Presented by: Captain Donna W.M. Khyriem 166 MH

2. What is Antenatal care? Periodic and regular supervision including examination and advice of a woman during pregnancy is called Antenatal care.

3. AIMS The aims are- To screen the high risk cases To prevent or detect or treat at the earliest any complications 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 (38 -42), with fetal weight of 2.5kg or more and with no maternal complication

7. SERVICES 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

8. Services (cont’d) 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 15 visits

9. Antenatal care comprises of- Careful history taking and examination and investigation Advice given to the pregnant woman

10. THE FIRST VISIT History taking Examination Investigation

11. History taking Particulars of the patient Chief complaints with duration Past medical surgical history Obstetric history Menstrual history Family history Drug History History of immunization Socio-economic history Contraceptive history History of allergy

12. Particulars of the patient Name Date of first Examination Address Age Duration of marriage Religion Occupation

13. Chief complaints with duration Period of amenorrhea Nausea & vomiting, vertigo Increased frequency of micturition Constipation Heaviness of breast Rise of temperature Edema Pain in the abdomen Backache Vaginal bleeding

14. Past history HTN DM Renal Disease Psychiatric illness IHD Any previous operation

15. Obstetrical History Duration of marriage Gravida Para Abortions

16. Menstrual History Age of menarche Menstrual period Menstrual cycle LMP EDD

17. Family history HTN DM Multiple pregnancy Tuberculosis Known hereditary diseases

18. Drug History Antihypertensive Hypoglycemic Antidepressant Corticosteroid Anticoagulant

19. Physical examination General examination Abdominal examination

20. General examination Appearance Height of patient Weight of patient Anemia Jaundice Edema Cyanosis

21. General examination (cont’d) Temperature Pulse BP RR Breast Heart sound Lungs

22. Abdominal examination A thorough and systemic abdominal examination beyond 28weeks of pregnancy

23. Patient Preparation Patient is asked to evacuate the bladder Lie in dorsal position with thighs slightly flexed Abdomen is fully exposed Examiner stands on the right side of the patient

24. Abdominal Examination Inspection Palpation Percussion Auscultation

25. Shape of the uterus- Longitunidal /transverse/ oblique Inspection

26. Inspection Striae scar mark

27. Inspection Contour of the uterus- fundal notching, convex or flattened anterior wall, cylindrical or spherical shape Undue enlargement of the uterus

28. PALPATION Assessment of fundal height Abdominal girth Fundal grip Lateral grip First pelvic grip Second pelvic grip

29. SYMPHYSIS FUNDAL HEIGHT (SFH)

30. Leopold maneuvers

31. FETAL POSITIONS

32. Auscultation Normal FHR is 120-160 b/m Causes of foetal tachycardia (>160 b/m) Causes of foetal bradycardia (<120 b/m)

33. Fetal heart monitoring

34. Causes of foetal tachycardia (>160 b/m) Maternal high fever Foetal distress Maternal tachycardia

35. Causes of foetal bradycardia (<120 b/m) Foetal distress Foetal cardiac conduction defect

36. FETAL HEART SOUND

37. Per Vaginal Examination

38. Normal Labour

39. Station of the head

40. Investigation CBC Blood grouping & Rh typing Urine R/E RBS VDRL HBS Ag Ultrasound

41. In Subsequent Visit Patient complains General examination Gestational age to be calculated Identification of problem Fetal movement SFH measurement Health education Prophylaxis & treatment of anemia Developing individualized birth plan

42. Second visit (24-28 weeks) SFH measurement To detect Multiple pregnancy

43. Third visit (32 weeks) Screen for- Preeclampsia Multiple pregnancy Anemia IUGR

44. Fourth visit (36 weeks) Identification of fetal Lie Presentation Position Update birth plan

45. Antenatal advice Principles: To impress the patient about the importance of regular check up To maintain or improve the health status of the woman to the optimum till delivery by judicious advice regarding diet, drugs and hygiene 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

46. Antenatal advice (cont’d ) Diet Rest & sleep Bowel Personal cleanliness Clothing, shoes & belt Dental care Care of breast Coitus Travelling Smoking & alcohol Immunization Drug Mental preparation Exercise Child care Birth plan Family planning Following advices are to be given:

47. DIET Diet should be: nutritious balanced light easily digestible rich in protein, mineral and vitamin

48. 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

49. 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

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

51. Immunization Indicated- TT HAV HBV Rabies Contraindicated- Live virus vaccine (rubella measles, mumps, varicella)

52. Warning sign Headache Blurring of vision Convulsion Vaginal bleeding Fever

53. Thank you