ANTENATAL CARE

Systemic supervision (examination and advice) of a woman during pregnancy is called

Antenatal care.

The supervision should be regular and periodic in nature according to the need of
woman. This supervision or examination mainly done by the midwife or sometimes a
health care professional who is specialist in obstetrics.
Antenatal care comprises of:
1 Careful history and examinations (general and obstetrical).
2 Advice given to the pregnant women.

AIMS OF ANTENATAL CARE:

 To screen the “High Risk”

 To prevent or to detect and treat at the earliest any complication.
 To ensure continued risk assessment and to provide ongoing primary
preventive health care.
 To educate the mother about the physiology of pregnancy and labor by
demonstrations, charts and diagrammes so that fear is removed and
psycology is removed.
 To discuss with the couple about the place, time and mode of delivery and
care of newborn.
 To motivate the couple about the need of family planning and also advice
to couple seeking medical termination of pregnancy.

OBJECTIVES OF ANTENATAL CARE:

To ensure a normal pregnancy with a delivery of a healthy baby from a healthy mother.

The criteria of a normal pregnancy are delivery of a single baby in good condition at
term, with fetal weight of 2.5kgs. or more and with no complications.

History Taking

OBJECTIVES:

 To assess the health status of the mother and fetus.

 To assess the fetus geststional age and to obtain baseline investigations.
 To organize continued obstetric care and risk assessment.

Vital statistics:

Name-
 Date of first examination-

Address-

Age-

Gravida And Parity- gravida denotes a pregnant state of both present and past ,
irrespective of the period of gestation. Parity denotes a state of previous pregnancy
beyond the period of viability.

Duration Of Marriage- to note the fertility.

Religion-

Occupation of Mother And Husband- a fair idea about the socioeconomic condition of
the patient can be assessed.

Period of Gestation- the duration of pregnancy is to be expressed in terms of completed

weeks. Counting is to be done from the first day of last normal menstruation period
(LNMP) And in later months of pregnancy, counting is to be done from expected date of
pregnancy.

Complaints-

History of Present Illnes-

Obstetrical history-

Menstrual History-

Past Medical History-

Past Surgical History-

Family History-

Personal History-

ANTENATAL ADVICE

PRINCIPLES:

To improve the woman about the importance of regular checkup.

To maintain or improve the healthe status of the woman to the optimum till
delivery by juidicious advice regarding diet, drugs and hygiene.
 To improve the psychological status and to remove fear of the unknown by
counselling the woman.

DIET: The diet during pregnancy should be adequate to provide –

 A Good Maternal Health

 Optimum Fetal Growth
 The Strength And Vitality During Labor
 Successful Lactation

During pregnancy, there is increased caloric requirement due to increased growth of the
maternal tissue, fetus, placenta and increase basal metabolic rate.

The increased caloric requirement is to the extent of 300 over the non pregnancy state
during second haf of pregnancy.

Generally the diet during pregnancy should be of womans choice as regards the quantity
and the type of food.

Woman with normal BMI should eat adequately so as to gain the optimum weight
(11kg).

The pregnancy diet ideally should be light, nutritious, easily digestible and rich in
protiens, vitamins and minerals.

Dietetic advice should be given with due to consideration to the socioeconomic condition,
food habits and taste of the individual.

Woman with normal BMI should eat as to maintain the schedule weight gain in
pregnancy. The instruction about diet should be reasonable and realistic to individual
woman.

SUPPLEMENTAL NUTRITIONAL THERAPY:

There is negative iron balance during pregnancy and the dietetic iron is not enough to
meet the daily requirement,

Supplimental iron therapy- ferrous sulphate tablet(60mg) for 16 weeks onwards.

Dietary allowance of pregnant, non pregnant and lactations
 Dietary components Non pregnant Pregnancy second half Lactation

Energy (kcal) 2200kcal 2500kcal 2600kcal

Protein (g) 50g 60g 65g

Iron (mg) 18g 40mg 30mg

Calcium (mg) 500mg 1000mg 1500mg

Zinc (mg) 12mg 15mg 19mg

Iodine (ug) 150ug 175ug 200ug

Vitamin A (IU) 5000IU 6000IU 8000IU

Vitamin D (IU) 200IU 400IU 400IU

Thiamine (mg) 1.1mg 1.5mg 1.1mg

Riboflavin (mg) 1.1mg 1.6mg 1.1mg

Nicotinic acid (mg) 15mg 17mg 15mg

Ascorbic acid (mg) 60mg 70mg 60mg

Folic acid (ug) 200ug 400ug 200ug

Vitamin B12 (ug) 2ug 2.2ug 2ug

ANTENATAL HYGIENE

1.REST AND SLEEP- The patient may continue her usual activities throughout the
pregnancy. She should avoided excessive and strenuous work in the first trimester and the
last 4 weeks. Recreational exercises is permitted as long as she feels comfortable.

The patient should be in bed for 10 hours (8 hours at night and 2 hours at noon),lateral
posture is more comfortable.

2. BOWEL- Constipation is common. It may cause backache and abdominal discomfort.

Regular bowel movement can be facilitated by taking plenty of fluids, vegetables and
milk or prescribing stool softners at bed time.

3.BATHING- the patient should take daily bath but be careful against slipping in the
bathroom due to imbalance.
4.CLOTHING, SHOES AND BELT- The patient should wear loose but comfortable
garments. High heels should be avoided. Constructing belt should be avoided.

5.DENTAL CARE- Good dental and oral hygiene should be maintained.

6.CARE OF THE BREAST- A well-fitting brassier should be wear to avoid discomfort.

7.COITUS- Generally coitus is not restricted during pregnancy. Release of prostaglandins

and oxytocin with coitus may cause uterine contractions. Women with increased risk of
miscarriage or pre term labor should avoid coitus.

8.TRAVE- Travel by vehicles having jerks is better to be avoided. Rail routine is

preferable to bus routine. Air travel is contraindicated.

9.SMOKING AND ALCOHOL- In view of the fact that smoking is injurious to health, it
is better to stop smoking not only during pregnancy but even threatafter.

10.IMMUNISATION- In developing countries, immunization in pregnancy is routine for

tetanus. Live virus vaccines( rubella, measles, mumps, varicella, yellow fever) are
contraindicated. Rabies, hepatitis A and B vaccines, toxoids can be given as in non
pregnant state.

TETANUS- Immunization against tetanus not only protects the mother but also the
neonates. 0.5ml tetanus intramuscularly at 6 weeks interval for 2, the first one is given
between 16 and 24 weeks and booster dose in last trimester.

GENERAL ADVICE:

Women is instructed to report to the physician even at an early date if some unwanted
symptoms arise such as intense headache, disturbed sleep with restlessness, urinary
troubles, epigastric pain, vomiting and scanty urination.

She is adviced to come to hospital for consideration of admission in following

circumstances:

Painful uterine contraction at intervals about 10 min. and continued for 1 hour suggestive
of onset of labor.

Sudden gush of watery fluid per vaginam suggestive of premature rupture of the
membranes.

Active vaginal bleeding, however it may be sight.

MINOR AILMENTS IN PREGNANCY

NAUSEA AND VOMITTING: nausea and vomiting especially in the morning, soon after
getting out of the bed, are usually common in primigravidae.

Dietary changes- to take dry toast, biscuits, protein rich meals. And frequent small foods
are helpful fatty foods are avoided.

Behavior modification- to avoid personal triggering factors.

Medication- initial supplementation with vitamin B1 and B6 is started.

BACKACHE: it is a common problem in pregnancy. Physiological changes that

contribute to backaches are: Joint ligament laxity, weight gain, hyperlordosis and anterior
tilt of the pelvice. Excessive weight gain should be avoided. Rest with elevation of the
legs to flex the hips may be helpful.

Improvement of posture

Well fitted pelvic girdle belt which corrects lordosis

Rest in hard bed to relieve symptoms

Massaging the back muscles

Analgesics and rest to relieve the pain due to muscle spasm.

CONSTIPA TION: constipation is a quite common ailment during pregnancy. Atonicity

of the effect of progesterone, diminished physical activity and pressure of the gravid
uterus on the pelvic colon are the possible explanantion.

LEG CRAMPS: it may be due to deficiency of diffusibkle serum calcium or elevation of

serum phosphrous.

 Supplementary calcium therapy in syp or tablet after meal.

 Massaging the leg
 Application of local heat.
 Intake of vitamin B1 (30mg) daily

ACIDITY AND HEARTBURN: Heartburn is common in pregnancy, due to relaxation of

the esophageal sphincter to avoid over eating and not to go bed immediately after the
meal. Liquid antacid ,may be helpful.

VARICOSE VEINS: varicose veins in the legs and vulva or rectum may beb appear for
the first time or aggrevate during pregnancy usually in the later months. It is due to the
venious return by the pregnant uterus.

 Elastic crep bandage during movement

  Leg elevation during rest give a symotomatic reliefe.

HEMORRHOIDS: regular use of laxative to keep the bowel soft

Local application of hydrocortisone ointment.

CARPEL TUNNEL SYNDROME: women present with pain and numbness in the thumb,
index and middle finger. This is due to compression effect on the median nerve.

A splint is apply during sleep time to the slightly fixed wrist to give relief.

SYNCOPE: it is often see in a women following prolonging standing or standing upright

abruptly. This is due to pulling of blood in the veins of the lower extrimities. There is
the effect of compression of the pelvic veins by gravid uterus also.

Other causes may be dehydration hypoglycemia and over exertion.

Syncope in supine position managed by resting in lateral recumbent position.

ANCKEL EDEMA: execessive fluid retention as evidenced by weight gain or evidenced

of preeclampsia has to be excluded.

 It reduces with rest and leg elevation.

 Diuretics should not be prescribed.

VAGINAL DISCHARGE: assurance to the patient and advice for local cleanliness are
required. Presence of any infection should be treated with vaginal application of
metronidazole.

EXERCISES IN PREGNANCY

Physiologic changes of pregnancy may restrict certain type of exercise

Exercise should be regular (30 min. ) per day of low impact ad a part of daily activities.

Exercises should be avoid any symptoms of breathlessness and fatigue.

Exercises should be done in cool area without becoming uncomfortable and warm.

Prolonged supine position, any compression to the uterus or risk of injury should be
exercise.

BIBLIOGRAPHY
Text book of OBSTETRICS AND GYNECOLOGY D.C.DUTTA Jaypee publications
seventh edition page no.112

www.wikipedia.com

www.myoclinic.com

www.shutterstock.com

www.pubmed.com

www.healthlineplus.com
SEVA MANDAL
EDUCATION
SOCIETY’S
COLLEGE OF
NURSING
 SEMINAR
ON
ANTENATAL
CARE

Submitted To,

MS. NIKITHA BHONSALE.

(Clinical Instructor)

Submitted By,

Ms. Manasi Chaskar.

(Final Year Basic Bsc Nursing Student)