Antenatal care

This is a planned programme for the health education

and management of a pregnant woman with the aim of making pregnancy and delivery safe and satisfying for the baby, the mother and the whole family

Purpose of antenatal care

Maintain the mother and the fetus in the best state of

health Early recognition of likely complications and abnormality Health education of the mother about physiology of pregnancy, labour and puerperium so as to promote ideal health behavior Prevent and prepare for any complications of pregnancy, labour and puerperium

Types of antenatal care

Traditional

Women seen monthly in the first 20 weeks, then twice monthly in next weeks, and weekly till delivery Refocused antenatal care A minimum of 4 times with at least once in 1ST and 2nd trimesters and twice in last trimester, with a minimum standard of care at each visit

The first antenatal visit

History taking Identification parameters Menstrual history and contraceptive use Relevant surgical, medical and gynae history Social and family history Past obstetric history History of present pregnancy Aim at identifying potential risk factors or prior abnormalities: factors that may increase morbidity.

The first antenatal visit (contd)

The first examination General: height, weight, nutritional status, general appearance, oedema, lymph nodes; Gait Eye examination for pallor, jaundice Oral examination for hygene, pallor, jaundice and thrush Breast and nipple examination Blood pressure

The first antenatal visit (contd)

Systems examination Cardiovascular Pulse, BP, praecordium and heart sounds Respiratory sounds Resp. rate, lung fields Abdominal examination Uterine size, fetal viability, lie, position, liquor amnii (Examination of the cervix and pelvis if indicated)

The first antenatal visit (investigations)

Check Hb (and full blood count if possible)
Blood group and Rhesus factor Serologic tests for syphilis[VDRL-the standard

nontreponermal antigen serologic test for syphilis Voluntary counseling and Testing for HIV and HIV screening Screen for sickle cell if family history present Urinalysis for sugar, proteins, culture

The first antenatal visit (investigations)

Others (on indication, eg hereditary disorders)
Ultrasound scan for:

Fetal gestation age, placental localization, congenital abnormalities

The first antenatal visit (management)

Treat any concurrent medical problems
Chemoprophylaxis

Haematinics, [ iron ,folic acid anti-helminthics, anti-malarials (intermittent presumptive treatment)

The first antenatal visit (health education)

1. 2. 3. 4. 5.

Nutrition Danger signs of pregnancy complications Making a birth plan where to deliver from, who will assist, how to pay for services, who will look after the womans home, needs during labour and needs for the newborn

Second visit at 20 -24 weeks

Purpose of second visit in second trimester

screen for abnormalities. It involves history taking of complaints of current pregnancy and physical examination from head to toe observations and clinical investigations such as BP and weight

Subsequent visits
Screen for any ill health
Treat any current medical problems Note any failure to gain weight

Note B.P., fetal position, fetal lie and viability

Continue with health education On-going counseling for VCT or other concerns

Relevant investigations
Admit those with risk factors

The last visit(s) after 37 weeks

Confirm birth plan

Pelvic assessment 1. for the Primigravidae 2. for those with prior CAESAREAN section 3. for those with poor obstetric history (such as FSB, NND) Arrange admission for elective caesarean section