PRACTICE TEACHING

ON

ANTENATAL CARE

PREPARED BY:- PRAGATI BHOLE

 INTRODUCTION:-
Systematic supervision (examination and advise) of a women during pregnancy is called
antenatal care ( prenatal) care . The supervision should be of regular and periodic in nature.
The care should be started from the beginning of pregnancy and end at the delivery .

Aims:-

 To promote and maintained good physical, mental and emotional health of the
mother.
 To ensure a mature, healthy and alive baby.
 To prepare mother for labor, lactation and subsequent care of child.
 To detect early and treat promptly high risk condition (medical, surgical or
obstetrical) that may endanger life of the mother and baby.
 To prevent and detect and to treat at the earliest any untoward complication that may
arise.
 To reduce maternal morbidity and mortality.
 To give required healthy education to the mother.

ANTENATAL VISIT:-

 The antenatal mother should visit the antenatal clinic once a month during the
first 6 month/ 4 weeks up to 28 weeks.
 Twice a mother during the 8th month / 2 week up to 36 weeks.
 There after once a week till the end of the delivery.
 A large percentage of the mother in India belong to low socio- economic group
and many are working women , a minimum three visits covering the entire period
of pregnancy.
 1st visit – at 20th week as soon as the pregnancy known .
 2nd visit – 32nd week.
 3rd visit – 36th week.

Assessment of antenatal mother:-

(1) History taking and registration- During woman’s first visit to antenatal clinics
registration is done and antenatal card is made, it is also important to obtain base line
information to assess health status of the women, screen out high risk case and formulate the
plan subsequent management. History taking includes
i. General information of the mother.
ii. Period of gestation.
iii. History of present pregnancy.
iv. Past obstetrical history.
v. Menstruating history.
vi. Past medical and surgical history.
vii. Family history.
 viii. Personal history.
ix. Previous gynaecological problems.

(2) Head-to-toe examination: The initial physical examination provides a baseline for
assessing equipment changes. Each examiner develops a routine for proceeding with the
physical examination. Most choose head to toe progression.

 Physical examination:-Physical examination begins with assessment of vitals,

height, weight and urine analysis for albumin and sugar.
 Vital and BP:-These must be recorded at each visit. At first visit in first trimester a
baseline data regarding vitals should be obtained and compared with subsequent
reading to detect any changes at the earliest that might occur during pregnancy.
 Height-short stature in pregnant women is regarded as a high risk factor because of
its association with small pelvis.
 Weight-Weight is an important parameter to be recorded at every visit preferably on
the some machine. Stationary or decreasing weight is found in IUGR. Rapid gain in
weight of more that 0.5kg week is one of the manifestation of pre-eclampsia.

 Urine analysis- Presence of albumin in urine in inductive of pre-eclampsia/kidney

diseases. Presence of sugar in urine at more than two occasion calls for investigations
like blood sugar to exclude diabetes in pregnancy.

GENERAL PHYSICAL EXAMINATION OF THE ANTENATAL

WOMAN

Head to examination should be conducted in all patients to get information of any relevant
finding that may influence the approach to the management of pregnancy of patents.

Built: - May be obese/average/thin. Obesity is associated with multiple medical illness

like hypertension, cardiac illness and diabetes. Obese woman are likely to try out quickly
during labour. Thin built woman should be assessed for any evidence of malnutrition,
anaemia, vitamin deficiency, poor weight gain etc.
 Gait: - Normal/ any abnormality. Some changes in gait is normal features in late
pregnancy. However certain pelvic deformities arising due to orthopaedic illness (including
osteomalacia) cause unusual abnormal gait and may be suggestive of pelvic inadequacy.
‘
Appearance:- may be depressed, tired and lethargic. Pregnancy being a high stress phase
in the life of woman; noting the evidence of obvious psychological stress helps the nurse to
provide appropriate counselling and advising the near once for emotional support.

 Head :- examination for the scalp for cleanliness infection and infestation and hair for
their lustre and texture .
 Eye : - Palpebral conjunctiva for pallor, sclera for jaundice and eye for evidence of
infection.
 Nose :-Infection and blockage.
 Mouth : - Observe tongue for pallor, glossitis, (vitamin deficiency), teeth and gums
for dental carries, stomatitis, and tonsils for tonsillitis.
 Ear :- see for infection, blocking and wax.
 Neck :- Observe neck veins, thyroid glands, lymph glands for any abnormalities.
 Upper extremities :- For any bony abnormality
 Examination for breast :- Breast should be examined for size, symmetry, dimpling,
leision, masses, areas of thickening, tenderness, areas of inflammation, presence of
scars. Nipple should be examined for their development (whether inverted,
underdeveloped or cracked), discharge, crushing, and presence of scars, lymph node
are assessed for size condition and tenderness.

Normal changes in breast during pregnancy

a) 3-4 weeks- pickling, tingling sensation (stimulated by ovarian hormones i.e.

oestrogen and progesterone.
b) 6weeks -- enlarged and tense
c) 8weeks -- surface veins are visible
d) 8weeks -- Montgomery’s tubercles appear
e) 12 weeks -- darkening of the primary areola
f) 12 weeks -- fluid can be expressed
g) 16 weeks -- colostrums can be expressed
h) 16 weeks -- secondary areola appears

Lower extremities: -

Dorsiflexion of the foot) may be elicited to diagnose deep vein thrombosis. Oedema may
be associated with preeclampsia, anaemia, hypoprotenemia, cardiac failure and nephritic
syndrome.
Back:- back is to be examined for lordosis scoliosis and kyphosis.

ANTENATAL CHECK UP:-

 Complete blood count include Hb estimation helps in early detection and
treatment of anemia .

 Blood pressure(BP)
 Urine, weight and abdomen checked at every visit

 Ensure that mother receive IFA tablets and two doses of Inj. Tetanus Toxoid (TT).
 Get mother weight checked. (Average weight gain during pregnancy is 9 - 11 kg)
 TETANUS TOXOID INJECTION Tetanus Toxoid Injection protects both mother
and baby from Tetanus which is one of the life threatening conditions. Get two
doses of T.T. injection at one month interval.

 During pregnancy 100 tablets of iron and folic acid will be given.IRON FOLIC
ACID (IFA) TABLETS
Abdominal examination:-
There are following steps of abdominal examinations are:-

 Inspection
 Palpation
 Auscultation

1. Inspection :

 Fetal movements
 Scar mark
 Linea Niagara
 Striae gravidarum
 Shape of the uterus

2. Palpation

 Assessment of fundal height

 Lie
 Abdominal girth
 Fundal grip
 Lateral grip
 Second pelvic grip/pawlick ‘s maneuver
 First pelvic grip/pelvic palpation
 3. Auscultation

 Checked by pinard stethoscope or Doppler

 Normal FHR is 120-160 b/m
 Foetal tachycardia (>160 b/m) 
 Foetal bradycardia (<120 b/m)

DIET DURING PREGNANCY

1. Nutritious diet
2. Balanced diet
3. Light
4. Easily digestible
5. Rich in protein, mineral and vitamin
6. With woman’s choice.
DDA OF A WOMAN DURING PREGNANCY (2ND HALF)

Food element Pregnancy

Kilocalories 2500
Protein 60gm
Iron 40mg
Folic acid 100mg
Calcium 1000mg
Vitamin A 6000 I.U.

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.

BOWEL
• Regular bowel movement may be facilitated by regulation of diet, taking plenty
fluid, vegetable and milk
Coitus Should be avoided in 1st trimester and last 6 weeks

BATHING
• The woman should take bath daily but be careful against slipping in bathroom
due to imbalance.

CLOTHING ,SHOES, BELT

• Woman should wear loose comfortable garments. High heel shoes should better
be avoided in advanced pregnancy when the centre of balance alters.
 DENTAL CARE
• The dentist should be consulted at the earliest if necessary this will facilitate
extraction or filling of the caries tooth ,if required comfortably in 2 nd trimester
the best time for such procedure.

CARE OF BREAST
• If the nipples are anatomically normal nothing is to be done beyond ordinary
cleanliness. If the nipples are retracted ,correction is to be done in the later months
by manipulation.

TRAVELLING
Should be avoided in
•1st trimester
•last 6 weeks
Air travelling is contraindicated in
•Placenta praevia
•Preeclampsia
•Severe anemia
 SMOKING AND ALCOHOLISM

• Smoking and alcohol are injuries to health during pregnancy.

• Heavy smokers have low birth weight babies and abortion
• Alcohol during pregnancy leads to fetal growth retardation

IMMUNIZATION

Indicated- •TT •HAV •HBV •Rabies

Contraindicated- •Live virus vaccine (rubella measles, mums, varicella)

DRUGS

• Most of the drugs cross the placenta to reach the fetus while prescribing the
physician should keep in mind

General Instruction to women:-

1. Eat smellers and more frequent meals.

2. Avoid fatty or spicy food and food that increases heart burn.
3. Eat last meal at least 3 hours before bed time.
4. Avoid lying down immediately after a meal.
5. Maintain good posture to provide more room for the stomach to function better.
6. Light exercise can foster venous circulation in the large intestine and facilitate
intestinal motility.
7. Eat food that contains roughage, bulk and natural fibres.
 BIBLOGRAPHY

1) Datta D.C. (2004),’’Text book of obstetrics’’,6th ed .New central book agency (P) LTD
New Delhi (86-89).

2) Jacob Annamma,(2019) ‘’Acomprehensive textbook of midwifery & gynecological

nursing”5th ed. Jaypee brothers medical publishers New delhi(94-99 , 99-106).

3) J.B.Sharma (2015).” Midwifery & gynaecological nursing “ 1st ed. Avichal publishing
company New delhi (97-100).

4) Kumara neelam, shivani Sharma (2017)”A textbook of midwifery & gynecological

nursing”4th ed. S. Vikas and company (medical publisher) (105-133)

5) Bhaskar nima (2019) “Midwifery & gynaecological nursing” 3rd ed. Emmess publisher
(134-137).