ANTENATAL CARE

MATERNAL AND CHILD HEALTH RNB30404

 LEARNING OBJECTIVES:
At the end of the session, the students should
be able to:
● state the aims of antenatal care;
● explain antenatal care to the mother;
● explain about estimating date of delivery;
● explain management during antenatal care.
 AIMS OF ANTENATAL CARE

● To promote and maintain mother’s health physically

and mentally during pregnancy
● To detect early and treat promptly any abnormality
and to prevent complication
● To ensure birth of a mature, life and healthy infant.
● To educate the mother and prepare her for the role of
motherhood
● To reduce maternal and prenatal mortality and
morbidity rate
• To promote breast feeding and give advice on choice
of infant feeding
 ANTENATAL CLINIC ACTIVITIES

First Visit:
1. REGISTRATION
- Personal
Particulars are
Recorded
 ANTENATAL CLINIC ACTIVITIES (cont..)

2. HISTORY TAKING
To identify risk factor which will effect pregnancy,
delivery and puerperium to prevent
complication

- Social history
- Menstrual history
- Medical history
- Surgical history
- Family history
- Past obstetric history
- Present obstetric history
 ANTENATAL CLINIC ACTIVITIES (cont..)

History-taking
- Menstrual history: LMP
flow/cycle. Regular/Irregular
Age of menarche

- Duration of marriage,
previous infertility (and its treatment)

- Contraceptives- Pills, IUCD, etc.

- Obstetric history – G/P/A

 ANTENATAL CLINIC ACTIVITIES (cont..)

• Status of current pregnancy-

LMP/EDD/POA

• Medical history- h/o asthma, diabetes,

hypertension

• Personal habits- smoking, gum

sniffing, drinking, etc.
Calculate Expected date of Delivery (EDD)
Using the rule known as Naegele's rule

 ADD 7 DAYS TO THE LAST (Use this calculation formula for

patients whose LMP falls between
MENSTRUAL PERIOD DATE April-Dec)
AND PLUS 9 MONTHS (LMP  Subtract 3 months from the LMP
Jan-March) (Add 7 Days to the LMP
 Add 1 Year

 14 . 2 .21  14. 4. 21
+ 7+ 9 + 7 -3
= 21 .11.21 = 21 .1 .22
 Calculate Expected date of
Delivery (EDD)
 LNMP: 25 March 2021

 25 . 3 .21
+7 +9
= 32.12.21
 December has 31 days, so need to add another
month
32-31= 1
Therefore EDD is on 1 January 2022
INITIAL PRENATAL LABORATORY TESTS

FIRST VISIT

 HAEMOGLOBIN %-monthly
if less than10gm- anaemia

• BLOOD GROUP- for blood

transfusion during emergency

• RHESUS FACTOR- positive

or negative( has to be referred
to Dr)

• VDRL- Active or Non-active

 URINE TEST FOR PROTEIN AND GLUCOSE

 Every visit – check for sugar and protein

 Protein may indicate pre- eclampsia
/Urinary tract infection
 Glucose may indicates gestational diabetes-
Modified glucose tolerance test (MGTT) will be done
to confirm.
 ROUTINE EXAM
 HEIGHT
- Once during
First visit, if 145 cm
And below is
associated with
Small pelvis

 WEIGHT
- First visit as a baseline ,
- Subsequent visit - to detect whether weight
gain is normal or not.

(Average weight gain :12- 12.5 kg per

pregnant)

 1st 20 weeks= 0.5 kg/ per month

 2nd 20 weeks= 0.5 kg/ per weeks
 BLOOD PPRESSURE
First visit as a baseline,
then every visit

● Systolic pressure of >130

● Diastolic pressure>90
- may lead to Pregnancy
Induced Hypertension
(PIH).
 EXAMINATION
● STUDY ANTENATAL RECORD – To detect
abnormality or risk factor from previous pregnancy
● Medical condition
● Operation or injury
● Family history
● Previous obstetric history-GID, PIH, LSCS,
Instrumental del., abnormal baby
● Abnormal pregnancy-presentation, lie, placenta
previa
● Health status of mother and baby- through out last
pregnancy
 INTERVIEW
To detect minor disorders and assess
health status such as:
 Eating and appetite
 Rest and sleep
 Elimination-urine and bowels
 Discomforts and to advise
 OBSERVATION
 Observe gait, any limps as pt walks in to
clinic.
 General Appearance- tired, worried, happy,
anxious.
 Before exam. loosen clothing, lie on the
couch-supine position, provide privacy.
 Reassurance allows mother to relax.
 PHYSICAL EXAMINATION - HEAD TO TOE

● Hair- healthy, clean

● Dental caries
● Thyroid gland- enlargement
● Prominent jugular veins- heart involvement
● Edema- hands, grasp her hand for tightness,
observe her ring for edema, examine nails-
pink or pallor.
 BREAST EXAMINATION

BREAST suitable for breast feeding:-

- Nipples – protruding, flattened or inverted.
- Signs of pregnancy- size, prominent veins and
Montgomery tubercles, primary areola darkened,
secondary areola prominent.
- Check for lumps, size, shape, position of nipple,
puckering of skin, unusual rash, nipple discharge,
lump or nodule in any part of breast.
 EXAMINATION

EXAMINE OF LEGS
- Check for edema by
pressing thumbs at:
 Dorsal pedis
 Ankle
 Pretibia
 Tibial region

Check for varicose veins

at lower limbs
 VAGINAL DISCHARGE
 Increases in pregnancy
 Enquire regarding
- amount
- colour
- odour
- any irritation

If excessive, foul smelling and itchy, refer to Dr.

 ABDOMINAL EXAMINATION
AIMS OF ABDOMINAL EXAMINATION:
 To obs. signs of pregnancy
 To assess fetal size and growth
 To assess fetal health and well
being
 To recognise location of fetal
parts.
 ABDOMINAL EXAMINATION (cont..)

INSPECTION
Shape, size, scar, skin changes (striae
gravidarum, linea nigra, any surgery scar)

PALPATION
Fundal palpation- palpation of height of fundus by
outstretched left palm.
Fundal palpation- nurses faces the women’s face.
Uterine fundus is palpated by both palms to
determine soft pole of fetus or hand fetal head is
felt.
 ABDOMINAL EXAMINATION (cont..)

Lateral palpation- uterus is felt to determine fetal back on

one side and irregular limbs on the other in vertex and
breech presentation.

Pelvic palpation- fetal pole at lower part of uterus is

palpable by both palms. Hard fetal head is felt in vertex,
soft breech in breech presentation.

Pelvic palpation
Pawlik’s grip: Fetal head- In vertex presentation. Fetal
head is gripped at lower part of pregnant uterus. ( Not
Encourage )
 ABDOMINAL EXAMINATION (cont..)

AUSCULTATION

• Fetal heart sound is heard by stethoscope

at the site of fetal back on the spino-
umbilical line or on the flanks in vertex
presentation.

• Fetal heart rate heard at 120-150/min

ensures fetal well-being.
 ABDOMINAL EXAMINATION (cont..)

Uterine size especially

after 36 in accordance
with dates and
ultrasound
Abdominal Palpation of pregnant women
FETAL HEART BEAT

 You may never hear it

with a stethoscope
 12-14 weeks with
Doppler
 5-6 weeks with
ultrasound
ROUTINE VISITS

 Every 4 weeks until

28 weeks
 Every 2 weeks,
28-36 weeks
 weekly, 36-delivery
 HEALTH EDUCATION
IMPORTANT
1. Gives more confidence
2. Helps to have a healthy, happy baby
3. Prepares mother for the reality of labour
4. Integrates her into a group having
similar problems
5. Prepares her for motherhood
 1.DIET AND SUPPLEMENTS
One of the best ways to
increase chances of having
a healthy baby is to eat
properly.

Education on a healthy, well

balanced diet-protein, vitamins,
minerals and iron
Food rich in fiber and fruits will
also help to prevent constipation
 2. REST AND SLEEP
 Take frequent rests or naps of 15
minutes to a half-hour whenever
possible.
3. DRUGS
Avoid all kinds of medication
unless ordered by Dr.
Herbal medication should
not be taken.
 3. CLOTHING
 Loose and comfortable
 Attractive maternity wear
 Constricting clothes should be
avoided
 Shoes should be flat or 1 inch,
comfortable
4. SMOKING, ALCOHOL, DRUGS
 Smoking and alcohol should be
discontinued or reduce.

 Advise minimizing chemical and

infection exposure in general
- which includes occupational
exposure.
 HEALTH EDUCATION (cont..)

5. Breast care and breast feeding

6. Preparation for Delivery
7. How to bathe a baby
8. Minor disorders of pregnancy
 IMMUNIZATION
 ANTI TETANUS TOXOID is administered
to mother to protect the baby and mother from
tetanus neonatorum
 1st dose- 20 – 24 weeks of pregnancy or
after quickening (primigravida)
 2nd dose – 4 to 6 weeks later after the first
dose
 subsequent pregnancy if mother has been
immunized within a year, the booster dose
is at 20 th week.
 ANTENATAL EXERCISES
Purposes of antenatal exercise
 Antenatal exercise aims at
preventing low back pain
and enhancing physical and
psychological preparation
for delivery by means of
joint stretching and muscle
strengthening.
 ANTENATAL EXERCISES (cont..)
 Overcome the fear-tension-pain
cycle through education and
relaxation training, muscle
stretching, breathing, massage
 Increases role of the
husband/father
 TYPES OF ANTENATAL
EXERCISE
Pelvic floor exercise
 Sit on a chair with your back against the seat back

 Tighten vaginal, urethral and anal muscles as if

trying to withhold urination or defecation

 You can also do this exercise in a standing position

 BACK AND ABDOMINAL EXERCISE

 Sit on a chair with your back against the

seatback
 Breathe naturally
 Tighten the abdomen and then press the pelvis
downwards to flatten your low back against the
seatback.
 Hold for 5 seconds, and relax
 This exercise helps you by correcting the low
back and pelvic posture. It strengthens your
abdominal muscles and prevents back pain.
 ANKLE EXERCISE
 Sit on a chair with your back against the seatback- start
with one ankle and turn the foot upwards and
downwards.
 Each up-and-down movement is counted as one time.
Repeat ten times- rotate the ankle to draw an inward or
outward circle.
 Each circular movement is counted as one time. Repeat
ten times- repeat the same steps at the other ankle-
ankle exercise helps reduce leg swelling and varicose
vein, thus alleviating the problem of leg cramps