Antenatal care:

12.3.23
The risk approach:
About 15% of pregnant women need skilled obstetrical care, we
can specify these group of pregnancies among all pregnant
through risk indicators.

The risk approach provides care for the pregnant women as well
as for other individuals, through flexible & rational distribution of
existing resources to the level of risk, so that some care will be
provided for all, but more skilled care to be given to those at high
risk.
High risk pregnancy:
Defined as pregnancy in which the fetus &/ or the mother has a
significant increased chance of morbidity & mortality.

Pregnant women at such risk must be identified during ANC,

according to the presence of certain risk factors.
There are two types of risk indicators:
1-factors already present in the female:
-age: < 18years or > 35 years, -weight: < 40 kg, or >90 kg
-height: < 150 cm, ->5 previous births,
-first pregnancy, -previous infertility,
-short spacing (< 2years),
 -previous Rh-isoimmunization or hydrops fetalis.

-bad obstetrical history (low birth weight, premature babies,

difficulty in delivery, cesarean section, still birth, miscarriage,
congenital abnormalities),

-medical conditions: DM, HPT, Thyrotoxicosis, heart diseases,

TB or Anti-TB drugs, epilepsy or anti-epileptic drugs, chronic
illness.
2-factors arise during pregnancy:
-failure to get weight (< 6kg),
-anemia,
-excessive oedema of the leg( knee, hands, face)
-infection,
-bleeding
-drugs or hormonal therapy.
-smaller or larger uterine size than gestational age.
-blood pressure >140/90.
-Malpresentation.
-excess or diminished amniotic fluid.
-glucosuria
-bacteriuria.
Natal care(Intranatal):
This is characterized by short duration but very dangerous because if
delivery was without proper care then complications will threaten life
of mother & her infant.
The aims of good intranatal care are
1-Thorough asepsis.
2-Delivery with minimum injury to the infant and mother.
3-Readiness to deal with complications such as prolonged labor, APH,
convulsions malpresentations , prolapse of the cord.
4-Take care of the baby at delivery-resuscitation ,care of the cord, care
of the eyes.
The mother might develop complications such as:
-bleeding
-may be exposed to surgical interventions,
-risk of infections,
-risk of trauma.
Examples of some problems the infant exposed during delivery:

1-Asphexia: which leads to bleeding& brain damage resulting in

death or life long disability as cerebral palsy.
2-Infection: tetanus it occurs through infection to umbilical cord
by contaminated instruments or applying dirty materials over the
umbilicus.
3-hypothermia,
4-trauma(birth trauma).
The solution of these problems is through training of doctors,
midwives& traditional birth attendants(TBA).

On discharge from maternity hospital(actually less than 50% of

birth occur in hospital) a mother should be supplied a card
containing information about the birth should be sent to the health
center(PHC).
Postnatal care
Duration: is 6weeks after delivery, with 2 examinations:
-1st examination 2 weeks after delivery,
-2nd examination 4---6 weeks after delivery.

Broadly this care falls into two areas:

A-Care of the mother which is primarily the responsibility of the

obstetrician.
B-Care of the newborn, which is the combined responsibility of
obstetrician and paediatrician ,this combined responsibility is also
known as perinatology
Care of the mother
The objectives of postnatal care are:
1-To prevent complications of the postpartum period.
2-To provide care for the rapid restoration of the mother to optimum
health.
3-To check adequacy of breast feeding.
4-To provide family planning services.
5-To provide basic health education to mother/family
Complications of postnatal period
1-Puerperal sepsis.
2-Thrombophlebitis.
3-Secondary haemorrhage.
4-Others(UTI,mastitis).
It’s extremely important to look for these complications in the
postpartum period and prevent or treat them promptly
Neonatal care
EARLY NEOATAL CARE: the first week of life is the most crucial
period in the life of the infant.
The objective of early neonatal care is to assist the newborn in the
process of adoption to an alien environment which involves:
i-Establishment and maintenance of the cardiorespiratory functions.
ii-Maintenance of body temperature.
iii-Avoidance of infection
iv-Establishment of satisfactory feeding regimen.
v-Early detection and treatment of congenital and acquired
disorders ,especially infection
Thank you