INTRODUCTION

Antenatal care is the care for women during pregnancy. It is essential even for a
normal and healthy pregnant woman for her own well being and the baby, and there is no
pregnancy and child birth is free from risk for both mother and baby. Ideally the care should
start immediately after conception but practically as early as possible during the first
trimester and should continue through the second and third trimester.

When couple is seen and counseled about pregnancy, its course and outcome well
before the time of actual conception is called preconception counseling. It is a very new
concept. Its objective is to ensure that a woman enters pregnancy with an optimal state of
health which would be safe to herself and also fetus. Organogenesis is completed by the first
trimester. By the time woman is seen first in the antenatal clinic it is often too late to advice
because all the adverse factors have already begun to exert their effect.

In the ideal world antenatal care would commence at the preconception stage where
health education (general advice about nutrition, lifestyle, avoidance of teratogens, folic acid
supplementation, etc) and risk assessment has been focused toward a planned pregnancy.
Preconception counseling is of much greater importance among married women.
DEMOGRAPHIC DATA

Name of the mother :Mrs. Sobana

Age : 22years

Educational level : 7th std

Name of Husband : Mr.Ramesh

Age : 27 Years

Educational level : X Std

Religion :Hindu

Address sekkanur

Madurai (Dt)

Occupation : Autodriver

Income : Rs. 10000- / per month

Admitted on : 27/11/2019@ 08.45AM

I.P.No. :77845

Ward : Antenatal Ward

Unit : I OG

Diagnosis : 8 MONTHS AMENORRHOEA WITH POLYHYDRAMNIOS

Obstetrical score :G2P1L1A0

REASON FOR HOSPITALIZATION/NEED FOR SEEKING HEALTH CARE:

Mother got admitted for difficulty in breathing since yesterday night

PERSONAL HISTORY:

A. Nutrition : Non vegetarian

Frequency of meals : 3-4 times a day
Food allergy : She has no allergies to any food
B. Habits : There are no habits such as Alcohol, Smoking, Chewing pan,
Using snuff.
C. Drugs : There is no history of drug intake except iron supplements and
antihypertensive and no allergic reactions to any drug.
D. Sleep : She sleeps 6-8 hours at night time and 2 hours at day time.
E. Rest : She takes adequate rest in between household activities.
F. Hygiene : Maintains optimal personal hygiene.
G. Exercises :She is doing mild exercises like walking.
H. Urinary pattern :She voids about 8-10 times a day and no urinary incontinence
or retention.
I. Bowel pattern : She defecates one time a day. No constipation
J. Menstrual history : She attained menarche at the age of 13 years
Irregular cycle with normal blood flow
No history of dysmenorrhea.
K. Marital history :Married since 6 years back , married at the age of 16 yrs
There is no consanguineous marriage.

IV.SOCIO ECONOMIC STATUS:

She belongs to a moderate socio economic status and lives in her own concrete house
with adequate facilities such as electricity, ventilation, water supply through street pipes,
closed drainage facilities and used RCA type of latrine . Her husband is the bread winner of
the family. He works as a autodriver and earns about Rs.10000/- per month. She is a
housewife. There is no kitchen garden and pet animals.
FAMILY MEDICAL HISTORY

Multiple pregnancies : There is no history of multiple pregnancies.

Communicable diseases : There is no history of communicable diseases like pulmonary

tuberculosis, chicken pox, measles and non communicable diseases like bronchial asthma,
anemia, heart diseases, hypertension and diabetes mellitus.

Mental illness : No history of mental illness such as mental retardation,

psychosis, depression, etc.

Genetic disorder : No history of any genetic disorders in her family

Any other : No history of food and drug allergies.

MEDICAL HISTORY:

Childhood illness : There is no history of childhood illnesses

Previous illness : There is no history of medical illness or surgical illness

GENOGRAM

56YRS 52YRS 60YRS 50YS

28YRS

35YRS 27YRS 21YRS 22YRS

P
KEY FACTORS P

MALE 5YRS

-MALE

- -FEMALE

P -PREGNANCY
OBSTETRICAL HISTORY:

a. Past obstetrical history:

Year Antenatal Intranatal Postnatal Newborn Birth Breast Remarks

of period period period sex weight feeding
delive
ry
There is no
2013 During Normal postnatal Female 2.250 Upto Nil-
antenatal vagninal complication baby kg 1year
period delivery line PPH and
there is no .baby cried anyother illness
complicatio soon after
n birth

Present obstetrical history:

Date of booking :18-06-2019 LMP:NOTKNOWN

Gestation at 1st visit :9 weeks EDD:NOTKNOWN

Height :156Cms Weight: 78kg

First trimester

 Registered, routine investigations done.

 Inj. TT 2 doses received.
 No history of excessive vomiting, drug intake, pica, constipation, exposure to drugs.
 History of folic acid tablet intake since third month of pregnancy

Second trimester

 Quickening felt at 4 months of amenorrhea

 Undergone routine medical check up
 No history of head ache, blurring vision, abdominal pain, decreased urine output and
muscle cramps.

Third trimester
  Able to perceive fetal movements
 No history of abdominal pain, constipation
 History of frequency of micturition
 Overdistension of abdomen in gestational age

b. Attendances :

Date Weight Urine B.P FHR Finding Treatment Rema

(Mm Hg) rks
18/06/19 65 kg hCG +ve 110/60 - Normal
Albumin-Nil
Sugar –Nil T.FST
21/07/19 67.5 kg - 140/70 + (USG) Hypertensi 335 mg - BD Chron
on T.BCT ic
18/8/19 70 kg Albumin-Nil 130/70 152/min Normal 5 mg – BD hypert
Sugar –Nil T. Calcium ensive
20/10/19 72.4 kg - 120/70 146/min Normal lactate mothe
Normal 300 mg – OD r
Normal T.Labetalol
100mg BD
27/11/19
74 kg Albumin-Nil 120/70 USG Polyhydra
Sugar –Nil AFI-25.2 mnios
-

VIII.PHYSICAL EXAMINATION:
General appearance

 Conscious, oriented to time, place and person.

 Moderate built, well groomed
 Afebrile

Skin

 Fair in skin complexion

 Dry skin, skin turgor is good
 No inflammation, redness or itching.
 NO any skin changes

Hair and Scalp

 Hair is black in colour and equally distributed

 Scalp is clean, no dandruff and pediculosis.
 There is no excessive growth of the hair

Eyes

 Normal vision in both eyes

 Conjunctiva is slightly pale, Sclera is white.
 Eyes are clean and no sign of inflammation.

Nose

 Nostrils are patent and clean

 Septum in midline, no discharges

Ears

 Symmetrical ears, hearing aquity is normal in both ears

 Auditory canal is clean
 No accumulation of wax and no discharges.

Mouth and throat:

Lips

 Lips are dried and pink in colour

 No cyanosis and no angular stomatitis

Tongue

 Pink in colour
 Coated tongue is present
 No halitosis
 Adequate oral hygiene is maintained.

Teeth

 Dental alignment is normal

 Dental carries present in 2 teeth

Gum and oral mucosa

 No sign of inflammation and Euplis syndrome

Neck

 Carotid pulse is felt on both sides

 Range of motion is good
 No swelling in neck and no lymphadenopathy
 Trachea in midline
 No thyroid gland enlargement

Chest

 Symmetrical in shape
 Breathing movements are symmetrical
 Normal vesicular breath sounds heard

OBSTETRIC EXAMINATION
Breast

 Symmetrical, moderate in size

 Nipples are normal and not contracted or retracted
 Primary and secondary areola is present
 Montgomery tubercle is present
 No sign of inflammation and discharges
 No palpable masses and auxiliary lymph nodes
 Colostrums is present

Abdomen

Inspection:

Size : It is not Appropriate to gestational week (32 weeks)

Shape : Ovoid shape

Contour : Firm

Skin changes : Striae gravidarum and linea nigra is present

Scar : No scar

Umbilicus : Located in midline and protruded

Flanks : Fullness

Visible fetal movements: Present

Visible veins : No visible abdominal veins

Abdominal girth: 95 cms

Fundal height :36cms, . It is not appropriate to the gestational age

Palpation:

Fundal palpation : A broad soft mass presents in the upper pole of uterus, it indicates
fetal buttocks.
Lateral palpation :

Left side – continuous curvature like resistance felt that indicates foetal spine

Right side – Irregular buds like projections that indicate fetus extremities.

Pelvic palpation :

Grip I – Not engaged

Grip II –Convergent

Auscultation :Fetal heart rate is 152 beats/minutes

SUMMARY OF FINDINGS:

Lie : Longitudinal

Position : Left occipito anterior

Presentation : Cephalic presentation

Attitude : Universal Flexion

Height of the fundus : 36cms

Engaged/Not engaged: Not engaged

Foetal heart rate :152 beats/minutes

Extremities

 Range of motion is good

 No pedal edema
 No scar or injuries
 No clubbing of fingers

Back and spine

 Spine curvature is in Lordosis shape

 No pressure ulcer and scar.
Perineum

 No vaginal edema
 No ulcer or discharge
 Urethral meatus is clean and patent
 History of Normal micturition

Vital signs :

Temperature :98.20 F

Pulse : 84 beats/minute

Respiration : 22 beats/minute

Blood pressure: 120/80 mm Hg

SPO2 : 100 % on room air

Pain score :0

LAB INVESTIGATION/DIAGNOSTIC PROCEDURE:

S.No Name Client Value Normal Value Remarks

1 Blood Mild
Hemoglobin 11.0gms% 12-16 gms% anemia
Hematocrit 45 % 37-47 % Normal
Total count 6000 cells/cumm3 4000-11000 cells/cumm3 Normal
Blood glucose 120 mg% 80 – 120 mg% Normal
Serum Urea 13 mg/dl 8-23 mg/dl Normal
Serum Creatinine 0.9 mg/dl 0.6 – 1.2 mg/dl Normal
HIV 1 & 2 Ab Non reactive Non reactive Normal
2 Urine
Urine albumin Nil Nil Normal
Urine sugar Nil Nil Normal

SPECIFIC INVESTIGATIONS

Blood group : O Positive

Abdomen and pelvis scan report : Single live intra uterine pregnancy

27/11/2019 Gestational age 32 weeks

Placenta posterior

AFI- 25.2 cm severe polyhydramnios

Cardio topography : Normal

GCT 1HOUR : 115mg/dl normal value 160mg/dl

2 HOUR 108mg/dl normal value 135 mg /dl

3 HOUR 105mg/dl normal value 120 mg /dl

HEALTH EDUCATION

Antenatal check up
  Regular compliance with treatment measures like iron, folic acid supplementation,
anti hypertensive medications.
 Fetal monitoring by antenatal examination, Ultrasonography and other measures

Antenatal diet

 It includes high calories, high protein, iron rich diet and folic acid supplementation.
 Easily available iron rich foods such as green leafy vegetables, jaggery, red gram
dhal, dates.
 Adequate fluid intake to maintain adequate hydration.
 Avoid pica and goitrogens during pregnancy.
 Practice small and frequent diets.
 Includes all diet includes pulses, cereals, vegetables, fruits, oils and seeds, milk and
milk products.
 Encourage to take vitamin c rich foods like oranges, lemon, papaya, amla, gooseberry
in order to enhance the absorption from the body.
 Includes more vegetables for balanced diet
 Adviced the mother to restrict salt

Measures to treat minor and major disorders or discomforts

 It includes heartburn, dyspepsia, fatigue, dyspnea, peripheral edema and back pain.
 Encourage to take food 2-3 hours prior to sleep
 Eat small and frequent diets
 Avoid lying down immediately after taking food
 Avoid beverages includes alcohol, soft drinks and other artificial energy drinkers.
 Encourage to sleep in left lateral position.
 Maintain correct posture, gait as much as possible while sitting, standing and carrying
articles.
 Demonstrate deep breathing and abdominal breathing exercises.
 Avoid more sodium in diet to prevent pedal edema by intracellular fluid depletion
 Avoid taking medicines without prescription to avoid over counter reactions and
teratogenic effects.

Preparing for safe delivery process

  Regular antenatal check up will reduce the chance of acute, existing diseases or
changes.
 Appropriate nutritional pattern will reduce the chance of energy depletion during
birth process.
 Iron and folic acid supplementation will prevent anemia during antenatal period.
 Oral hygiene measures like brushing 2 times a day, rinsing mouth after feeding to
prevent infection.

CONCLUSION

In this clinical presentation I gained more knowledge about the history collection
physical examination,& obstetrical examination of the client and polyhydramnios causes ,
types ,diagnostic methods ,and also management of polyhydramnios ,nursing care to the
client with polyhydramnios .

I would like to thank our respected faculties for giving this wonderful opportunity

REFERENCES

Book reference:
 1. Diane. M.Fraser. Margaret. A. Copper,. (2007). Textbook for Midwives. 14 thedition.
Philadelphia: Elsevier publishers.
2. Deifer. (2011). Introduction to Maternity and Pediatric Nursing. 6th edition. Bangalore:
Elsevier publisher.
3. LowdermilkDeitra. (2007). Maternity and Womens Health Care. 9th edition.
NewYork: Mosby Publishers.
4. D.C.Dutta. (2015). Textbook of obstetrics. 5th edition. Kolkata. Saunders publishers.
5. Annamma Jacob. (2012). A Comprehensive Textbook of midwiferyand gynaecological
Nursing. 3rd edition. New Delhi: Jaypee brothers and Medical Publishers.
6. Nima Bhasker. (2015). Midwifery and Obsterical Nursing. (2015). 2nd edition.
Bangalore:EMMESS Medical publishers.

Net reference:

1. https://en.wikipedia.org/wiki/Maternal physiological changes in pregnancy

Journal
1. https://www.ncbi.nlm.nih.gov/pmc/articles/Physiological Maternal Changes

POLYHYDRAMNIOS
DEFINITION

Polyhydramnios is defined as amniotic fluid volume more than 2000 ml at any

period of gestation

- D.C. DUTTA

TEXT BOOK OF OBSTETRICS AND GYNAECOLOGY

DEFINITION 11

Polyhydramnios is the excessive accumulation of amniotic fluid the fluid that

surrounds the baby in the uterus during pregnancy

-NETSOURCE

INCIDENCE

0.5-1.6%

1 in 200 pregnancies

BIBLIOGRAPHY:
1. D.C.Dutta,2015,”Text book of obstetrics”.8th edition,published by New central book
agencies private limited.

2. Myles,2011,”Text book for Midwives”,15th edition,published by Churchill Livingston

pvt ltd.

3. Annamma Jacob,2012 “A comprehensive textbook of midwifery and Gynaecological

Nursing”,3rd edition,published by Jaypee brothers pvt ltd.
New delhi, Jaypee brothers.
4. B.T.Basavanthappa, “Textbook of midwifery and reproduction health nursing”
New delhi, Jaypee brothers .
5. Sanju sira,2010,”Text book of Obstetrics and Midwifery”,2 nd edition,published by
lotus publishers.
6. Sadar. A. Orshan, “Maternity Newborn women’s health nursing”, Bangallur,
Lippincott pvt ltd.

7. P.V./2014,”A text book of Midwifery and Gynaecology Nursing”,4 th edition,published

by S.Vikas company pvt ltd.

8. Marie Elizabeth,2012,”Midwifery for Nurses”,2nd edition,published by CBS publishers

and distributer.

9. . Sharen M.Zakas et al, 1990, “Mosby’s fundamentals of medical assisting”, 2

Edition.

10.NET REFERENCE:
www.google.com
www.wikipedia.com
www.pubmed.com..