Antenatal Care explanation Mechanism, method

It is best for care of pregnancy womwn

1. Antenatal Care

2. Session Objectives Define a ntenatal ca r e Discuss the aims of antenatal care Discuss the number of visits in each trimester Calculate EDD R e vi e w the comm o n t erminol o gies Discuss the signs of p r egn a ncy Lis t the dang er s i gns of p r egn a ncy Describe care during pregnancy

3. Antenatal Period Covers the time of pregnancy from the first day of LMP to the start of true labour Duration of pregnancy: approx. 280 days, 40 weeks Divided into 3 trimesters: 1 st trimester : 1 to 12 (12 weeks) 2 nd trimester: 13 to 27 (13 weeks) 3 rd trimester: 28 to 40 (15 weeks)

4. AIMS OF ANTENATAL CARE T o monitor p r og r e s s of p r egn a nc y T o mon i tor matern a l & f etal w ell be i ng To prepare mother for pregnancy, labour & postnatal period T o p r ep a r e mother f or l a ctation T o vacci n ate T o ru l e o u t risk factors To perform early referral to prevent morbidity & mortality

5. NUMBER OF ANTENATAL VISITS At leas t 4 Routine Visits First Visit -------- Within Four Months Or As Soon As Possible Second Visit ----- - At S i x th Month Th i r d Visit -------- - At Ei g hth Month F o u r th Visit ----- - In Ninth Month

6. Näg e le’s R ule C a lc u l a te E x pected Date of B i r th (E D B, E D D) F i rst d a y of l ast menstrual per i od (LM P) Add 7 days Subtr a ct 3 months OR First day of LMP+9M +7 DAYS

7. Gravida The term gravid comes from the Latin word gravidus. It is used to describe a female who is pregnant and is also a medical term for the total number of confirmed pregnancies a female has had, regardless of the outcome of the pregnancy Para Parity , or "Para",  indicates the number of births (including live births and stillbirths) where pregnancies reached viable gestational age. A multiple pregnancy (e.g., twins, triplets, etc.) carried to viable gestational age is still counted as 1 TPAL T erm, P r eterm , Abo r t i on, L i vi n g & Sti l l b i r th

8. Maternal Anatomical & Physiological Changes Physiological and Hormonal changes Indicative of Pregnancy: Presumptive Signs: of pregnancy are maternal physiological changes that the w omen ex pe rie n ce Probable Signs: maternal physiological and anatomical changes that are detected upon examination and documented by the examiner Positive signs: directly attributable to the fetus

9. Signs of P r e g nan cy Presumptive *Amenorrhea *Fatigue *Nau sea an d v o mit i n g *Urin a r y f r eq u ency *B r east chan ges – Dar k en ed a r eo l a, en l arged M o n t g o me r y ’ s t u b u l es *Qu i c k en i n g – sl i g h t fl u tteri n g mo v ements o f t h e f etu s f elt b y a w oman, u sua l l y b et w een 16 to 20 weeks o f gestati o n . *U teri n e en l arge m en t *Li n ea n i gra * Ch l o asma (mas k o f pregnancy) Probable * A bdo m in a l enla r ge ment r ela ted t o cha nges i n u t er in e s iz e , s h a p e , and po s ition *C e r vi cal cha ng es * H eg a r ’ s s i g n – s oftening a nd comp r e s s ibi lit y of l o w er u t erus * in c r ea s ed va s cul a r it y of the a r ea * P o s iti v e p r eg na ncy tes t * F etal out lin e f elt b y exa miner Positive * F etal h ea r t so un ds * V i su al i z a ti o n o f f etu s b y ultrasound * F etal mo v ement p al p ated b y an ex p e r i enced ex ami n er

10. M o n t g o me r y ’ s t u b u l es

11. Qu i c k en i n g – sl i g h t fl u tteri n g

12. Chloasma

13. H eg a r ’ s s i g n

14. Anatomical Changes/ Uterine Enlargement Changes Reason Uteri n e Growth (effect of Estrogen & P r o g e s te r one) Uterine growth by hyperplasia (increased number of cells) Ut e rine wall s inc r eased st r e n gth I n c r ease n um b er of e la s tic tis s u e s Chadwick’s Sign Goodell’s sign in size of uterine blood vessels and lymphatics V a s cularit y and edema Braxton Hicks contraction Caused due to stretching of uterine muscle cells

15. Care during Pregnancy History taking: Client Name Age Husband Name Cast Religion Address T el e p h o n e Num b er Client Occupation Husband Occupation Marital Hx Blood Group Reason Of Vi s it Ch i ef Com p lain (If A n y) & Its Detail

16. Assessment & Examination Gener a l Su r v e y Head to T oe E x ami n ati o n P er A b dom i n a l E x ami nation: Leopold Maneuver

17. Leopold Maneuver

18. Investigations In i tial visit Complete Blood Count ABO b l ood g r o u p Urine Detail Report Fasti n g Bloo d Sug a r He p . B & C U/S: F i rst trime s te r -- - f etal vi a b i l i ty scan F o l l o w - up visit Hemoglobin O r al G l u cose T o l er a n ce T es t --- Secon d trimester U/S: A n om a l y sca n --- 1 8 - 20wks G ro wt h sca n -- - 3 2 - 3 3 wks

19. Birth & Emergency Plan I n v ol v ement of h usband i s high ly important Birth Plan Hospital or ho m e Obstetrician , midwi f e Companion i n bi r th Arrangement for birth Feeding Emergency Plan Money Vehicle Place of bi r th Care provider Blood donor

20. 27 Feta l lie an d P resentati o n

21. Fetal Lie The relationship of long axis of fetus to long axis of uterus e.g longitudinal, transverse, oblique

22. Immunization administration of two doses of Td injection is an important step in the prevention of maternal and neonatal tetanus. The first dose of Td should be administered as soon as possible preferably when the woman register for ANC. The second dose is to be given one month after the first preferably at least one month before the EDD. If the woman receives the first dose after 38 weeks of pregnancy ,then the second dose may be given in the postnatal period, after a gap of four weeks. If the woman has been previously immunized with two dose during a previous pregnancy within the past three years, then give her only one dose as early as possible in this pregnancy.

23. Dose of Td o.5 ml by deep intramuscular injection. It should be given in the upper arm and not in the buttocks as this might injure the sciatic nerves. Inform the woman that there may be a slight swelling pain and or redness at the site of the injection for a day or two.

24. Nutritional supplements IFA Supplementation Help preventing the complication due to anemia. besides recommending IFA supplementation counsel the woman to increase her dietary food of iron rich foods such as green leafy vegetables, whole pulses , jiggery, meat , poultry and fish. Prophylactic dose :- 180 tab IFA OD starting after the first trimester at 12 weeks of gestation until delivery. Therapeutic dose :- (Hb less than 11 gm% /dl ) or has pallor 200 tab IFA , BD . If it does not rise in spite, refer the woman to the MO (medical officer ) at the PHC

25. Counselling for IFA IFA tab must be taken regularly, preferably early in the morning on an empty stomach . In case the woman has nausea and pain in the abdomen, she may take the tablet after meals or at night . This will help avoid nausea dispel.  The myths and misconceptions r/t to IFA and convince the woman about the importance of IFA supplementation. An example of a common myths is that the consumption of IFA may affect the baby’s complexion. t is normal to pass black stool while consuming IFA. Tell the woman not to worry about it. In case of constipation, the woman should drink more water and add roughage to her diet. IFA tab should not be consumed with tea, coffee, milk or calcium tab, as these reduce the absorption of iron .

26. Ask the woman to return to you if she has problems taking IFA tablets . Refer her to the MO for further management. Emphasis the important of a high protein diet, including items such as black gram, ground nuts, whole grains, milk, eggs, meats and nuts for anemic women . Encourage the woman to take plenty of fruits and vegetables containing vitamin ‘c’( e.g.:- mango, guava, orange and sweet lime) as these enhance the absorption.

27. Care during Pregnancy P r egnancy ca r e: Minor d i s com f o r ts of p r egn a ncy N ut r i t io n dur in g p r egn a ncy a nd aft e r d e l i v e r y P r eparat i on f or b r east f e e d i ng Antenatal e x e r cis e s Psych o lo g ic a l a d j ustm e nts du r in g p r egn a ncy The Fathe r ’ s Role: The f athe r ’ s r o l e th r o ugho u t t h e t r an s it i on to pa r enth o od F a the r ’ s c o nce r ns. Labo r and bi r th: P r o c ess of labo r and b i r th P ain r el i ef i n la b or Compan i o n sh i p i n la b or Common interventions used i n ma n y labors C a es a r ean section Ps ycho l ogic a l adjust me n ts to la b or and bi r th S ki n - t o - skin c o n t ac t with t h e n e wbor n and e a rl y breastfeeding.

28. Antenatal e x e r cis e s

29. Danger Signs of Pregnancy Bleeding /Gush of fluid from vagina Abdominal pain Temp > 38.3° (101°F) & chills Persistent vomiting Dysuria/ oliguria Dizziness, blurred vision, double vision, Severe headache Edema of face, hands including legs & feet Convulsions ( muscles contract and relax quickly and cause uncontrolled shaking of the body ) Decreased or absent fetal movement

30. References Fraser, D.M., & Cooper, M.A., (2014). Myles Text Book For Midwives. (16 th ed.). Churchill Living Stone Elsevier. WHO. (2002). Essential Antenatal, Perinatal and Post- Partum Care . World Health Organization, Regional Office for Europe, Family and Reproductive Health Unit. WHO. (2012). Guideline: Daily iron and folic acid supplementation in pregnant women. Geneva. Marchofdimes.com

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