To motivate the couple about the need of

PRENATAL CARE
o
family planning and also appropriate advice

CARE OF THE to couple seeking medical termination of

pregnancy.
To remove anxiety associated with delivery.
MOTHER o
o To improve the physical and mental health
of women and children.

OBJECTIVE
WHAT IS PRENATAL CARE ❑To ensure a normal pregnancy with delivery

of a healthy baby from a healthy mother

 “Periodic and regular supervision including
examination and advice of a woman during IMPORTANCE OF ANTENATAL CARE
pregnancy is called Antenatal care”
o To ensure that the pregnant woman and her
 The supervision should be of a regular and periodic fetus is in the best possible health.
nature in accordance with the need of the o To detect early and treat properly
individual. complications
o Offering education for parenthood
o To prepare the woman for labor, lactation
ANTENATAL CARE and care of her infant.
Antenatal care refers to the education, supervision,
treatment and care given to an expectant mother
from the time the conception is confirmed until the ANTENATAL CARE VISIT IDEAL 13
beginning of labor. VISITS
GOAL
o To screen the high-risk cases. ❑ 7 first 7 months (Once a month)
o To prevent or to detect and treat at the
earliest any complications. ❑ 2 in 8th month (Twice a month)
o To ensure continued risk assessment and to
provide ongoing primary preventive health ❑ 4 in 9th month (Four times a month or weekly)
care. MINIMUM OF 4 VISITS
o To educate the mother about the physiology
❑ First visit: confirmation of pregnancy
of pregnancy and labor by demonstration,
charts and diagrams so that fear is removed ❑ Second visit: 20-28 weeks
and psychology is improved.
❑ Third visit: 34-36 weeks
GOAL
❑ Fourth visit: before expected date of delivery or
o To discuss the couple about the place, time when the pregnant woman feels she needs to consult
and mode of delivery, provisionally and health worker.
care of the newborn.
o Decision regarding timing and mode of
delivery.
ACRONYM GP TPAL DESCRIPTION
G Gravida: number of total pregnancies (includes
current pregnancy and all term, preterm, therapeutic
abortions, and miscarriages)
P Parity/Para refers to the total number of
pregnancies that reached and delivered viability or
gestational age
T Term: all births gave at full term (i.e.: after
completion of 37wks of gestation)
P Preterm: all births gave preterm. (i.e.: from
20wks to 37wks of gestation)
A Abortion: include all miscarriages or medical
abortions and surgical abortions before 20wks of
gestation
L Living children: total number of living
children (here every child [i.e. twins, triplets] counts
individually)
1ST TRIMESTER VISIT
 Confirm intrauterine pregnancy and assess the
gestational age.
 We have to deal with complications that present
with vaginal bleeding and abdominal pain.
 Women can be investigated using history,
examination, biochemical testing & trans-vaginal
U/S to exclude non-viable pregnancy, ectopic
pregnancy or hydatiform mole.
IDENTIFICATION/REGISTRATION
12 WKS….
▪Early identification helps,
▪Assessing the health status of the mother
▪Obtain baseline information of the mother
▪Screen for factors, referral
▪Recall LMP (Last Menstrual Period) easily
▪Counsel on hygiene, diet, rest
▪Establish rapport with pregnant women
2ND TRIMESTER VISIT
 Assessment of maternal health & fetal growth &
wellbeing.
 The results of tests performed at 1st trimester
visit is reviewed with the mother
 The results of the U/S scan for fetal abnormality
are also reviewed.
 Any incidental maternal symptoms are dealt
with, this period is also important in insuring
the education of the woman regarding the rest
of pregnancy & her delivery.
WITHIN 20 WKS….
▪Screen and treat anemia
▪Initiate prophylaxis against anemia
▪Screen risk factors & medical condition
▪Develop individualized birth plan
▪Immunize with Tetanus Toxoid (TT or DT)
▪Investigate-Hgb, Blood group, urine examination,
VDRL (Venereal disease research laboratory test),
Blood grouping
3RD TRIMESTER VISIT
 The primary objective of this visit is to
anticipate any problems regarding the
prospective delivery. Uterine fundal height,
fetal lie, presentation & position are mandatory.
 Vaginal examination will help us to check for
any abnormality in the pelvis, cervical status,
fetal presenting part, station & position.
 Mode of delivery & planned contraception after
delivery should is discussed at this time.
WITHIN 28-32 WKS….
▪Aimed at the following. Detect:
▪PIH ▪Multiple gestation Emergency Plan
▪Anemia • Advise on danger signs
▪Develop individualized birth plan ❑ Where to go? How to go?
▪Give TT ▪Assess IUGR ❑ Who will go with you to health center?
▪Repeat HB estimation
❑ How much will it cost? Who will pay? How will
you pay?
WITHIN 36 WKS…. ❑ Start saving for these possible costs now.
▪PIH
❑ Who will care for your home and other children
▪Detect the following:
when you are away?
▪Identify fetal & presentation
▪Rule out CPD (Cephalo Pelvic Disproportion)
(PICTURE PAGE 21)
in primi gravida

COMPONENTS OF PRENATAL CARE

(PICTURE PAGE 16 & 17)
 Identification of pregnant women’s &
importance of early registration
BIRTH PLAN  Diagnosis of pregnancy
 Clinical Assessment
- The Birth Plan Discussed with the patient and her
 Advise during Antenatal visit
family
 Nutrition
 A written document prepared during the
first prenatal consultation COMPONENTS OF PRENATAL CARE
 Discussed with the patient and her family  Management of minor ailments
 May change anytime during pregnancy if a  Risk assessment & appropriate management
problem is detected.  Complication & management
Contains information on:  Screening for congenital malformation
during pregnancy
❑ the woman’s condition during pregnancy  Management of Anemia
❑ preferences for her place of delivery and choice NURSING DIAGNOSIS:
of birth attendant
Nursing Diagnoses Related to Physiological
❑ available resources for her childbirth and
Adaptations to Pregnancy
newborn baby

❑ preparations needed should an emergency  Deficient Knowledge related to normal

situation arise during pregnancy, childbirth and physiological changes of pregnancy
postpartum.  Constipation related to changes in gastrointestinal
tract occurring in pregnancy

BIRTH PLAN
 Imbalanced Nutrition: More than Body
Requirements related to excessive intake of
calories
 Imbalanced Nutrition: Less than Body
Requirements related to inadequate information
about nutritional needs during pregnancy
 Activity Intolerance related to fatigue from the
physiological changes of Pregnancy
NURSING DIAGNOSIS:
Nursing Diagnoses Related to Psychosocial
Adaptations to Pregnancy
•Risk for Disturbed Body Image related to
anatomical and physiological changes of
pregnancy
•Ineffective Role Performance related to taking on
new roles; changes in roles
•Risk for Situational Low Self-esteem related to
pregnancy complications, changes in body image,
roles
• Ineffective Sexuality Patterns related to
changes in libido during pregnancy
 Interrupted Family Processes related to
developmental stressors of pregnancy
NURSING DIAGNOSIS:
Nursing Diagnoses Related to Psychosocial
Adaptations to Pregnancy
 Anxiety related to fear of the unknown
 Readiness for Enhanced Family Coping related
to opportunity for growth/mastery
 Risk for Impaired Parenting related to lack of
knowledge, skills, support
 Health-seeking behaviors: developmental tasks
needed to prepare for parenthood
 Dysfunctional grieving related to stillbirth, ill
or preterm newborn, loss of the ideal of the
perfect child, loss of pregnancy, or loss of
desired labor or birth.
PLANNING AND INTERVENTION:
• HEALTH PROMOTIONAL
Health Education:
 The content would include educating the
women on the value of rest and recreation,
discouraging smoking and alcohol ingestion,
allaying anxiety, infant feeding, contraception
techniques.
 Nutrition Education - aimed at encouraging
the mother to take an adequate diet based as far
as possible on locally available food which are
cheap.
 Education on sinister signs and symptoms in
pregnancy.
 Education on improved personal hygiene and
environmental sanitation.
 PLANNING AND INTERVENTION:
PREVENTIVE
i. Anti malarials / Malaria prophylaxis
Malaria is one of the major causes of anemia in
pregnancy.
Prevention of malaria:
-Intermittent preventive treatment
(IPT) -Use of insecticide-treated nets
(ITNs) -Other methods (environment free of
breeding sites for mosquito), personal protection
ii. Haematinics - Folic acid, fersolate,
multivite.
Good compliance to haematinics has been shown to
protect pregnant women from risk of anemia
especially in developing countries where poor
nutrition and helminthiasis are prevalent.
 1. Diet

PLANNING AND INTERVENTION 2. Rest

CURATIVE/ REHABILITATIVE 3. Avoidance of unnecessary travel

 Early diagnosis and prompt treatment of 4. Preparation for delivery

medical conditions that may arise in
pregnancy. ROLE OF NURSE IN PRENATAL
 Emotional and social problems should be
CARE
promptly diagnosed and managed (I don’t
want this baby) Teenagers and single
mothers may need emotional support. 1. REGISTRATION
• NATAL CARE Aimed at ensuring that every The nurse has to do registration of the prenatal
delivery is attended by appropriately trained mother so that to assess the following condition.
personnel under sterile conditions which should
result in a healthy mother and the birth of a healthy  To assess the health status
child.  To identify and manage high risk cases
 To estimate EDD more accurately
 To give the first dose of TT/DT (after 12
weeks)
EVALUATION AND
 To help the woman for an early and safe
DOCUMENTATION
abortion (MTP) if it is required by her
 To start the regular dose of folic acid during
 EVALUATION - Determines whether client the first trimester
goals have been met, partially met, or not met.
 Ongoing evaluation is essential for the 2. PRENATAL SERVICES FOR
nursing process to be implemented MOTHERS
appropriately.
 Health history
 DOCUMENTATION - printed or written
 Physical examination
record of activities.
 Laboratory examination
 Recording and reporting are the major ways
health care providers communicate.
 Urine/Stool/Blood(count)/Hb/Serological/ blood
 The client’s medical record is a legal group/Rh also
document of all activities regarding client care.
 Pap test (if facilities)/Chest X-Ray & Gonorrhea
 Test (if needed)
(PICTURE PAGE 31)  High Risk approach
 IFA and necessary medications
IMPORTANCE OF PRENATAL CARE  TT immunization
 Health education
 To confirm pregnancy & assess the period  Home visit
of gestation.
 Referral (if needed)
 To prevent maternal & neo natal tetanus
 To facilitate health education regarding
3. MAINTENANCE RECORDS Birth Interval

➢Antenatal Card -(MHBR) Maternal Home-Based - Ideally should >3 years

Record
5. SYMPTOMS DURING THE PRESENT
➢Antenatal Register
PREGNANCY
4. ANTENATAL CHECK UP HISTORY  Symptoms indicating discomfort
I. To diagnose pregnancy  nausea and vomiting
II. To identify any complications during  heartburn
previous pregnancies  constipation
III. To identify any medical/ obstetric  frequency of urination
condition(s) that may complicate this
pregnancy.  Symptoms indicating that a complication may
be arising
CALCULATION OF EDD  fever
 vaginal discharge/ bleeding
 palpitations
 Ask for the first day of the last menstrual cycle
 breathlessness at rest
(LMP)
 generalized swelling of the body;
 Ask for the date when fetal movements were puffiness of the face
first felt (quickening)  oliguria
 Also assess the fundal height to estimate the  decreased or absent fetal movements
gestational age
 Ask for any test done to confirm pregnancy
EDD= LMP + 9months + 7 days

6. PREVIOUS PREGNANCIES/
OBSTETRIC HISTORY (TPAL)
CALCULATION OF EDD FORMULA
T- Term
 January to March (+9 months + 7 days) P- Preterm
 April to December ( -3 months + 7 days + 1 A - Abortion
year) L - Living
Example: LMP- January 15, 2020  Number of earlier pregnancies/ abortions/
Example: LMP- May 07, 2020 deliveries.
 Number of premature birth(s)/ stillbirth(s)/
neonatal deaths
Age of the woman  Hypertensive disorders of pregnancy (history
- complications when <16 years/>40 year of convulsions)
 Prolonged/ obstructed labor
Order of the pregnancy  Malpresentation
- Primigravida and multipara are at risk
CONT…
  APH/ PPH • RBS – Random Blood Sugar
 Modes of deliveries (normal/ assisted/
• VDRL – Venereal Disease Research Laboratory
caesarean section)
Test
 Birth weight of the previous baby
 Any surgery on the reproductive tract • HBsAg – Hepatitis B surface antigen
 Iso-immunization (Rh-ve) in the previous
pregnancy. (Any costly inj. Given to her • UTZ/US – Ultrasound
within 72 hours of her previous delivery)

7. HISTORY OF ANY SYTEMATIC ULTRASOUND

ILLNESS Early pregnancy (preferably at 10-13 weeks) to:
 Hypertension
 Diabetes  Determine gestational age
 Heart Disease  Detect multiple pregnancies
 Tuberculosis  Help with later screening for Down’s
 Renal Disease syndrome
 Convulsions
9. ULTRASOUND (CONT’D)
 Asthma
 Rashes  At 11-14 weeks
 Jaundice
offer nuchal translucency screening for Down’s
CONT…
syndrome, with other tests if available.
▪Family History of Systemic Illness

 Above illness  At 18-20 weeks

 Thalassemia (INHERITED BLOOD
offer screening with ultrasound for congenital
DISORDER THAT CAUSES YOUR
anomalies
BODY TO HAVE LESS
HEMOGLOBIN THAN NORMAL)  At 36 weeks
 Delivery of twins or delivery of an infant
with congenital malformation. for fetal maturity, placenta previa.

▪History of drug intake or allergies

10. ANTENATAL ADVICE 1
▪History of intake of habit-forming substances
(tobacco, alcohol) Diet should be:

1. Nutritious
2. Balanced
8. INVESTIGATION 3. Light
4. Easily digestible
The nurse should undergo following investigation-
5. Rich in protein, mineral and vitamin with
• CBC – Complete Blood Count woman’s choice
6. Iron and folic acid supplementation
• Blood grouping & Rh typing

• U/E or U/A – Urine Examination or Urinalysis

11. REST AND SLEEP
  Night 8 hours, Day 2 hours (Lt side) 16. PERSONAL HYGIENE
 Avoid heavy work (especially lifting heavy
•The nurse should advice the mother regarding the
weights)
personal hygiene and its importance
 Avoid the supine position (especially in late
pregnancy, if it is necessary, a small pillow
under the lower back at the level of the
pelvic should be used). 17. RADIATION

12. BOWEL •The nurse should advice the mother to avoid the X-
rays
• Regular bowel movement may be facilitated by
regulation of diet, taking plenty fluid, vegetable and 19. DRUGS
milk
•Sedative,
13. ABSISTENCE • Anticoagulant,
• Antithyroid,
•Should be avoided in •Hormones &
• Antibiotics should be avoided
•1st trimester

•Last 6 weeks
20. OCCUPATIONAL HAZARDS

14. TRAVELLING •Lead, mercury, X-rays & ethylene oxide

Should be avoided in

 1st trimester 21. DANGER/ WARNING SIGNS

 Last 6 weeks • High fever with/without Abd, pain, feels too weak
to get out of bed
Air travelling is contraindicated in
• Fast/ difficult breathing
 Placenta previa
 Preeclampsia • Decreased or absent fetal movements
 Severe anemia • Excessive vomiting (woman is unable to take
15. IMMUNIZATION food/ fluids)

Indicated- • Any bleeding P/V during pregnancy

 TT or DT • Heavy (>500 ml) vaginal bleeding during and

 HAV (Hepatitis A Virus) following delivery
 HBV (Hepatitis B Virus)
 Rabies
CONT…
Contradicated-
• Severe headache with blurred vision
• Live virus vaccine (Rubella Measles, Mumps,
Varicella) • Convulsions or loss of consciousness
• Labor lasting longer than 12 hours
• Failure of the placenta to come out within 30
minutes of delivery
• Preterm labor
• Premature or Pre-labor Rupture of Membranes
(PROM)
• Continuous severe abdominal pain

22. HEALTH EDUCATION

The nurse should the mother regarding –
• Breast feeding
•Nutrition
•Family planning
•Postnatal exercises
• Child care
• Dental care

CONT…
• Clothing, shoes and belt
• Care of breast
•Smoking and alcohol
• Birth plan
• Mental preparation
• Diet
•Sleep and rest
•To avoid stressor
• Minor ailments