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Antenatal care
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What is Antenatal care

 Periodic and regular supervision including examination and advice of a

woman during pregnancy is called Antenatal care.

 The supervision should be of a regular and periodic nature in accordance

with the need of the individual.
+ Aims
The aims are-

 To screen the high risk cases

 To prevent or detect or treat at the any earliest complication

 To ensure continued medical surveillance and prophylaxis

 To educate the mother about the physiology of pregnancy and labour by

demonstrations, charts and diagrams so that fear is removed and psychology
is improved
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Aims (cont’d)

 To discuss with the couple about the place, time and mode of the delivery,
provisionally and care of the newborn

 To motivate the couple about the need of family planning

 To advice the mother about breast-feeding, post-natal care and

immunization
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Objectives
To ensure a normal pregnancy with
delivery of a healthy baby from a
healthy mother
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Criteria of normal
pregnancy

Delivery of a single baby in good

condition at term with no maternal
complication
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Services
As per WHO recommendation at least 4 visit-

• 1st visit around 16 weeks

• 2nd visit between 24-28 weeks

• 3rd visit at 32 weeks

• 4th visit at 36 weeks

+ Services (cont’d)

Generally-

• At interval of 4 weeks up to 28 weeks

• At interval of 2 weeks up to 36 weeks

• At weekly interval up to EDD

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Antenatal care comprises of-

 Careful history taking and examination and investigation

 Advice given to the pregnant woman

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THE FIRST VISIT

History taking
Examination

Investigation
+ History taking
1. Particulars of the patient

2. Chief complaints with duration

3. Past history

4. Obstetric history

5. Menstrual history

6. Family history

7. Drug History

8. History of immunization

9. Socio-economic history

10. Contraceptive history

11. History of allergy

+ Particulars of the patient

1. Name

2. Age

3. Address

4. Marital status

5. Date of Admission

6. Date of Examination
+ Chief complaints with duration
1. Period of amenorrhea

2. Nausea & vomiting, vertigo

3. Increased frequency of micturition

4. Constipation

5. Heaviness of breast

6. Rise of temperature

7. Edema

8. Pain in the abdomen

9. Backache

10. Vaginal bleeding

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Past history
1. HTN
2. DM
3. BA
4. Renal Disease
5. Psychiatric illness
6. IHD
7. Any previous operation
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Obstetrical History

Duration of marriage
Gravida

Para

ALC
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Menstrual History

Age of menarche
Menstrual period
Menstrual cycle
LMP

EDD
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Family history

a) HTN
b) DM
c) Multiple pregnancy
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Drug History

Antihypertensive

Hypoglycemic

Antidepressant

Corticosteroid

Anticoagulant
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Physical examination

General examination

Abdominal examination
+ General examination

• Appearance • Clubbing
• Height of patient • Koilonychia
• Weight of patient • Leuconychia
• Anemia
• Jaundice
• Edema
• Cyanosis
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General examination (cont’d)

 Temperature

 Pulse

 BP

 RR

 Breast

 Heart sound

 Lungs
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Abdominal examination

Inspection

Palpation

percussion

Auscultation
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Inspection

Shape of the uterus

Striae

scar mark
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Palpation

 Assessment of fundal height

 Lie

 Abdominal girth

 Fundal grip

 Lateral grip

 First pelvic grip

 Second pelvic grip
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Auscultation

Normal FHR is 120-160 b/m

Causes of foetal tachycardia (>160 b/m)
Causes of foetal bradycardia (<120 b/m)
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Causes of foetal tachycardia
(>160 b/m)

1. Maternal high fever

2. Foetal distress
3. Maternal tachycardia
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Causes of foetal
bradycardia (<120 b/m)

1. Foetal distress
2. Foetal cardiac conduction defect
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Investigation
 CBC

 Blood grouping & Rh typing

 Urine R/E

 RBS

 VDRL

 HBS Ag

 Ultrasound
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Ultrasound
early pregnancy (preferably at 10-13 weeks) to:
• Determine gestational age
• Detect multiple pregnancies
• Help with later screening for Down's syndrome
+ Ultrasound (cont’d)
At 11-14 weeks:

offer nuchal translucency screening for Down's syndrome, with other tests if
available.

At 18-20 weeks:

offer screening with ultrasound for congenital anomalies.

At 36 weeks:

for foetal maturity, placenta praevia.

+ In subsequent visit

• Patient complains

• General examination

• Gestational age to be calculated

• Identification of problem

• Foetal movement

• SFH measurement

• Health education

• Prophylaxis & treatment of anemia

• Developing individualized birth plan

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Second visit (24-28 weeks)

SFH measurement

To detect Multiple pregnancy

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Third visit (32 weeks)

Screen for-
1. Preeclampsia
2. Multiple pregnancy
3. anemia
4. IUGR
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Fourth visit (36 weeks)

• Identification of foetal
1. Lie
2. Presentation
3. Position
• Update birth plan
 + Antenatal advice
Principles:

1. To impress the patient about the importance of regular check up

2. To maintain or improve the health status of the woman to the

optimum till delivery by judicious advice regarding diet, drugs
and hygiene

3. To improve and tone up the psychology and ot remove the fear of

pregnancy by talking sympathetically to the patient and
explaining the principle changes and events likely to occur during
pregnancy
+ Antenatal advice (cont’d)
Following advices are to be given:
 Diet • Smoking & alcohol
 Rest & sleep • Immunization
Bowel

• Drug
Personal cleanliness

• Mental preparation
Clothing, shoes & belt

• Exercise
Dental care

• Child care
 Care of breast
• Birth plan
 Coitus
• Warning sign
 Travelling
• Family planning
+ Diet

Diet should be:

1.nutritious

2.balanced

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 60 gm.

Iron 40 mg

Folic acid 400 mg

Calcium 1000 mg

Vitamin A 6000 I.U.

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Rest and sleep
8 hour sleep at night
At
least 2 hour sleep after mid-day
meal
Hardstrenuous work should be
avoided in first trimester and last 4
weeks
+ Bowel

 Regularbowel movement may be facilitated by

regulation of diet, taking plenty fluid, vegetable and
milk

Coitus
Should be avoided in
• 1st trimester
• last 6 weeks
+ Travelling

Should be avoided in

 1st trimester

 last 6 weeks

Air travelling is contraindicated in

 Placenta praevia

 Preeclampsia

 Severe anemia
+ Immunization
Indicated-

 TT

 HAV

 HBV

 Rabies

Contraindicated-

 Live virus vaccine (rubella measles, mums, varicella)

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Warning sign
1. Headache
2. Blurring of vision
3. Convulsion
4. Vaginal bleeding
5. Fever
+ Preconceptional care

 Preconceptional care is the one step ahead of antenatal care.

 When a couple is seen and counseled about pregnancy, its
course and outcome before the time of actual conception, is
called Preconceptional care.
 Objective: to ensure that, a woman enters pregnancy with an
optimal state of health which would be safe both to herself
and the fetus.
+ Preconceptional care includes:
 Identification of high risk factor

 Basal level health status including BP recording

 Rubella & Hepatitis immunization

 Folic acid supplementation

 Maternal health is optimized preconceptionally such as overweight anemia

 Patient with medical disease like hypertension, diabetes are stabilized in an

optimal state by intervention
+ Preconceptional care includes:

 Drugs used before pregnancy are verified and changed

if required to prevent any adverse effect of the fetus;
e.g., warfarin is replaced with heparin, oral anti-diabetic
drug with insulin
 Advise to stop smoking, alcohol and drug abuse
 Proper counseling to those with history of recurrent
foetal loss or family history of congenital abnormalities
 Counseling regarding health care cost
 Find out supporting or helping people to help the
mother and care of the new born