antenatal care.pdf

ANTENATAL CARE

1. Mrs. Deepti Kukreti
PG Nursing Tutor
Obstetric & Gynaecology
SGRRCON

2. Systemicsupervision(examination
andadvice)ofawomenduring
pregnancyiscalledANC.

3. Aims
1.Toscreenthehighriskcases.
2.Topreventortodetectandtreatattheearliest
anycomplications.
3.Toensurecontinuedriskassessmentandto
provideongoingprimarypreventivehealthcare.
4.Toeducatethemotheraboutthephysiologyof
pregnancyandlabourbydemonstration,chartsand
diagramssothatfearisremovedandpsychologyis
improved.

4. 5.Todiscussthecoupleaboutthe
place,timeandmodeofdelivery,
provisionally and care of thenewborn.
6.Tomotivatethecoupleaboutthe
appropriate
needoffamilyplanningandalso
advicetocoupleseeking
medical termination ofpregnancy.

5. Objectives
To ensure a normal pregnancy with
delivery of a healthy baby from a
healthymother

6. Antenatal care comprises
of-
1.Registration ofpregnancy
2.Historytaking
3.Antenatalexaminations
[general andobstetrical]
4.Laboratoryinvestigations
5.Healtheducation

7. THE FIRSTVISIT
Historytaking
Examination
Investigation

8. Historytaking
1.Particulars of thepatient
2.Chief complaints withduration
3.Pasthistory
4.Obstetrichistory
5.Menstrualhistory
6.Familyhistory
7.DrugHistory
8.History ofimmunization
9.Socio-economichistory
10.Contraceptivehistory
11.History ofallergy

9. ➢Ideally –ANCvisits
First 28 weeks –once a month
Up to 36 weeks –twice a month
There after weekly tilldelivery.
➢Minimum –4 ANCvisits
1
st
visit –around 16weeks
2
nd
visit –between 24 and 28 weeks
3
rd
visit –at 32weeks
4
th
visit –at 36weeks.

11. Physical
examination
Pallor
Pulse Respiratoryrate
Weight
edema
Bloodpressure
Breastexamination

12. Pallor –Examine palpebral conjunctiva, nails,
tongue, oral mucosa,palms
Pulse –60-90 /min.
R.R. –18-20 breaths /min.
Edema

13. CONT.D
B.P. –Two consecutive readings –systolic >
140 mmHg and / or diastolic > 90mmHg
Check urine for the presence ofalbumin
Pre eclampsia –Hypertension + albuminuria
Imminent eclampsia –D.B.P. > 110mmHg.
Eclampsia –Hypertension+ albuminuria+
Convulsions

14. ➢Regular weight monitoring at eachvisit
11 kg. wt. gain entirepregnancy
After first trimester, wt. gain 2 Kg. /month
➢Breastexamination

15. Measurement of fundalheight
Fetal heartsounds
Fetal movements
Fetal parts
Multiplepregnancy
Fetallieandpresentation
Inspection of abdominal scar or anyother
relevantfindings

16. Lab.Investigations
Hbestimation
Blood grouping & Rhtyping UrineR/M/E
VDRL RBS
HBs Agtest
USG for Pregnancyprofile.

17. Elderly primi (30 yr. andabove)
Short statured primi (140 cm and
below)
Malpresentations
APH, threatened abortion
Pre –eclampsia, eclampsia

18. Anaemia
Twins,hydramnios
IUFD, Stillbirth
Elderly grandmultiparas
Prolongedpregnancy
H/o past caesarean orinstrumental
delivery
Treatment forinfertility
RiskApproach

19. In subsequentvisit
•Patientcomplains
•Generalexamination
•Gestational age to becalculated
•Identification ofproblem
•Foetalmovement
•SFH measurement
•Healtheducation
•Prophylaxis & treatment ofanemia
•Developing individualized birthplan

20. Second visit(24-28
weeks)
SFHmeasurement
To detect Multiplepregnancy

21. Third visit (32weeks)
Screenfor-
1.Preeclampsia
2.Multiplepregnancy
3.anemia
4.IUGR

22. Fourth visit (36weeks)
•Identification offoetal
1.Lie
2.Presentation
3.Position
4.Birth plan

23. Antenataladvice
Entire pregnancy –300
Kcal/day(extra)
Lactation –600Kcal/day

24. Diet:
Supplementaryirontherapyisneededforall
pregnantmothersfrom20weeks
onwards.(30mgofferrous/day)(60-100
mg/day)isgivenforlargewomen,twin,and
thosewomenwhobookforANClatein
pregnancyAnemicwomanshouldtake(200
mg/day

25. Hygiene:
Daily bath is recommended, as it stimulation
refreshing andrelaxing.
Avoid hot waterbath.
Bowelcare:
Asthereisincreasechanceofconstipation,regular
bowelmovementmaybefacilitatedbyregulation
ofdiettakingplentyoffluids,vegetablesandmilk.

26. BreastCare
Wash the breast with clean tap water.
Exercise
Walk in moderation.
Avoid lifting heavythings.
Avoid long timestanding.
Avoid sitting withcrossed
legs as this may impedecirculation.

27. Dressing:
Tight clothes and belts are avoided The
patient shouldwear
loose but comfortable dresses. High heel
shoes are betteravoided.
Alcohol, smoking and drugs should be
avoided as the may affect the fetal
wellbeing

28. Rest andsleep
8 hour sleep atnight
At least 2 hour sleep after mid-daymeal
Hard strenuous work should be avoided in first
trimester and last 4weeks
Coitus
Should be avoidedin
•1
sttrimester
•last 6weeks

29. Warningsign
1.Headache
2.Blurring ofvision
3.Convulsion
4.Vaginalbleeding
5.Fever

30. Thankyou