Introduction

 The prenatal period is a preparatory time for the

mother to prepare herself both physically and
psychologically.
 It is a time of immense anxiety, excitement, and
learning.
 The best way to ensure the health of both the
expectant mother and her infant is through early
and attentive prenatal care.
 Close supervision will allow health care
professionals to identify and possibly treat
maternal disorders that may have been
preexistent or developed during the pregnancy.
 TERMINOLOGY

• GRAVIDA- any pregnancy, regardless of

duration
• PRIMIGRAVIDA-a woman who is pregnant
for the first time
• MULTIGRAVIDA-pregnant for her second
or any subsequent pregnancy.
• PARA- Birth after 20 weeks gestation,
regardless of whether infant is alive or
dead
• STILLBIRTH – a fetus born dead after
20 weeks gestation
• ABORTION – birth that occurs before
the end of 20 weeks gestation
• GESTATION- the number of weeks
since the first day of the last menstrual
period (LMP)
• ABORTION- birth that occurs before the
end of 20 weeks gestation
• TERM-The normal duration of pregnancy
(38 to 42 weeks gestation).
• PRETERM OR PREMATURE LABOR-
Labor that occurs after 20 weeks but
before completion of 37 weeks gestation

• POSTTERM LABOR- labor that occurs

after 42 weeks gestation
• ANTEPARTUM- Time between conception and
the onset of labor; prenatal period

• INTRAPARTUM- time from the onset of true

labor until the birth of the infant and placenta.

• POSTPARTUM-Time from birth until the

woman’s body returns to an essentially
prepregnant condition
 GRAVIDA AND PARA

• Relate to number of pregnancies, not to

number of fetuses
• Thus twins etc. counted as one
pregnancy and one birth
• Pregnant with first baby= G1 P0 ab0
• Delivered first baby= G1 P1 ab 0
• TPAL
– T= Term infants born
– P= number of preterm infants born
– A= number of spontaneous or elective
abortions
– L= number of living children

– G 6 T3 P2 Ab0 L3
 Determination Of Due Date
• EDC – EDD:
– From LMP
– Nagele’s rule
– Uterine size: first 10-12 weeks
– Quickening
– Auscultation of Fetal Heart tones
– Ultrasound
 ANTENATAL CARE
DEFINITION:
 Antenatal care refers to the care that is given
to an expectant mother from the time that
conception is confirmed until the beginning of
labour.
systematic supervision (examination and
advice) of a woman during pregnancy is called
antenatal (parental) care.
Antepartal or prenatal care refers to the
medical and nursing supervision and care
given to the pregnant woman during the
period between conception and the onset of
 Components of Antenatal care

1. Prevention early detection and treatment

of medical disorders as anaemia and
diabetes.

2. Detection of malpresentations,
malpositions and disproportion that may
influence the decision of labour.
3. Instruct the pregnant woman about
hygience, diet and warning symptoms.

4. Laboratory studies of parameters may

affect the foetus as blood group, Rh
typing, toxoplasmosis and syphilis.
 Aims of antenatal care

To support and encourage a family’s

healthy psychological adjustment to
childbearing.

To promote an awareness of the

sociological aspects of childbearing and
the influences that these may have on the
family.
To build up a trusting relationship
between the family and their caregivers
which will encourage them to participate in
and make informed choices about the care
they receive.

To monitor the progress of pregnancy

in order to ensure maternal health and
normal fetal development.
To recognize deviation from the normal
and provide management or treatment as
required.

To ensure that the woman reaches the

end of her pregnancy physically and
emotionally prepared for the birth of her
baby.
To help and support the mother in her
choice of infant feeding to promote breast
feeding in a sensitive manner and give
advice about preparation for lactation
when appropriate.

To offer the family advice on

parenthood either in a planned
programme or on an individual basis.
 Procedures at the visit
 The first visit should not be deferred beyond the
second missed period.
 It may be earlier if the patient desires to
terminate the pregnancy.
Frequency of antenatal visits.
 every month during the first 6 months.
 every 2 weeks during the 7th and 8th months.
 every week during the last month.
 More frequent visits are indicated in high risk
pregnancy.
 The initial visit
it should take place as soon as possible after
pregnancy has been conformed.
Objectives for the initial assessment
To assess levels of health by taking a detailed
history and to employ screening tests as
appropriate.
To ascertain baseline recordings of weight,
height, blood pressure and hemoglobin level in
order to assess normality. These values are
used for comparison as the pregnancy
progresses.
To identify risk factors by taking accurate details
of past and present obstetric and medical
history.
To provide an opportunity for the woman
and her family to express any concerns
they might have regarding this pregnancy
or previous obstetric experiences.
To give advice on general health matters
and those pertaining to pregnancy in order
to maintain the health of the mother and
the healthy development of the fetus.
To begin building a trusting relationship in
which realistic plans of care are discussed.
 History taking
 Identification data
 General health
 Social history
 Obstetrical history
(a) Last menstrual period (LMP) and
menstrual history.
• EDC – EDD:
– From LMP
– Nagele’s rule
– Uterine size: first 10-12 weeks
– Quickening
– Auscultation of Fetal Heart tones
– Ultrasound
(b) Contraceptive history
* Were birth control pills used?
* Did the patient become
pregnant
immediately after cessation of
pills?
* How long after cessation of
pills?
(c) Reproductive history (for example, number of
previous pregnancies and their outcomes,
complications).
(d) Exposure or treatment for any sexually
transmitted diseases (STDs).
(e) Problems with the current pregnancy (for
example, bleeding, nausea, and headaches).
 Medical history
 Family history
 Personal history
 Examination of the mother:
i. General examination
ii. Obstetrical examination
General examination:
1) Vital signs are taken to include:
 Temperature, pulse, respiration, and blood
pressure.
 Fetal heart tones. Document if obtained with a
doppler or fetoscope.
 Built
 Nutritional status
 Height and weight
 Head to foot examination
investigation
 Urine analysis
 Blood test – Haemoglobin, VDRL, HIV,
rubella immune status , other blood
disorders and screening for fetal
abnormality.
 Ultrasound examination
 Special investigations – MSAFP,
serological test for rubella and hepatitis
ii. Obstetrical examination:
Abdominal examination
Vaginal examination
Abdominal examination
Aims are
 To observe signs of pregnancy
 To assess fetal size and growth
 To assess fetal health
 To diagnose the location of fetal parts
 To detect any deviation from normal.
Preparation:
 Explain procedure to the mother
 Ask the mother to empty the bladder within
30 minutes before abdominal palpation.
 Provide privacy to the mother
 Loosen the clothes enough to allow
access to the abdomen
 Women should be lying comfortably with
her arms by her side.
 Method
a. Inspection –
 The size of the uterus
 The shape of the uterus
 Fetal movement
 Contour of the abdominal wall
 Skin changes
b. Palpations
 Hands should be clean and warm before doing
palpations –
 as cold hands do not have the necessary acute sense
of touch
 they tend to induce contraction of the uterine muscles
and the mother resents the discomfort.
 Arms and hands should be relaxed and
the pads, not the tips, of the fingers used
with delicate precision.
 The hands are moved smoothly over the
abdomen in a stroking motion in order to
avoid causing contractions.
 Estimating the period of gestation
 Fundal palpation
 Lateral palpation
 Pelvic palpation
 Fundal palpation

First maneuver
 Face the patient and warm your hands.
 Place them on her abdomen to determine
fetal position in the uterine fundus.
 Curl your fingers around the fundus.
 With the fetus in vertex position, the
buttocks feel irregularly shaped and firm.
 With the fetus in breech position, the head
feels hard, round, and movable.
Fundal palpation
 Second maneuver / lateral palpation

 Move your hands down the sides of the

abdomen, and apply gentle pressure.
 If the fetus lies in vertex position, you'll feel
a smooth, hard surface on one side — the
fetal back.
 Opposite, you'll feel lumps and knobs —
the knees, hands, feet, and elbows.
 If the fetus lies in breech position, you
may not feel the back at all.
 Third maneuver
 Spread apart the thumb and fingers of one
hand.
 Place them just above the patient's
symphysis pubis.
 Bring your fingers together. If the fetus lies
in vertex position and hasn't descended,
you'll feel the head.
 If the fetus lies in vertex position and has
descended, you'll feel a less distinct mass.
 Fourth maneuver
 Use this maneuver in late pregnancy when
the fetus is in cephalic presentation.
 The purpose of the fourth maneuver
is to determine flexion or extension of the
fetal head and neck.
 Place your hands on both sides of the
lower abdomen.
 Apply gentle pressure with your fingers as
you slide your hands downward, toward
the symphysis pubis.
 If the head and neck are flexed, your
hands will meet obstruction — the cephalic
prominence — on the side opposite the
fetal back.
 If the head and neck are extended, the
cephalic prominence will be palpated on
the same side as the fetal back. Flexion of
the fetal head and neck facilitates vaginal
delivery.
Palpation will help to
identify
 Fundal height
 Lie
 Presentation
 Attitude
 Position
 Engagement – it
means the descent
of the biparietal
diameter through
the pelvic brim.
 c. Auscultation
 The fetoscope and the Doppler
stethoscope are basic instruments for
auscultating fetal heart tones and
assessing fetal heart rate.
Fetoscope
 This instrument can detect fetal heartbeats
as early as the 20th gestational week.
 As an assessment tool during labor, the
fetoscope is helpful for hearing fetal heart
tones when contractions are mild and
infrequent.
Doppler stethoscope:
 This instrument can detect fetal heartbeats
as early as the 10th gestational week.
 Useful throughout labor, the Doppler
stethoscope has greater sensitivity than
the fetoscope.
 FETAL ASSESSMENT
• Fundal height
• Fetal activity: quickening and beyond
• Fetal heart tones
VAGINAL EXAMINATION
 pelvic examination
A pelvic examination is a complete physical
exam of a woman's pelvic organs by a health
professional.
Why It Is Done
 A pelvic exam may be done:
 As part of a woman's regular physical
checkup. A Pap test may be done during the
pelvic exam. For more information, see the
medical test Pap Test.
 To detect vaginal infections, such as
yeast infections or bacterial vaginosis.
 To help detect sexually transmitted
diseases (STDs), such as chlamydia,
herpes, gonorrhea, trichomoniasis, or
human papillomavirus (HPV).
 To help determine the cause of
abnormal uterine bleeding.
 To evaluate pelvic organ abnormalities,
such as uterine fibroids, ovarian cysts,
or uterine prolapse.
 To evaluate abdominal or pelvic pain.
 Before prescribing a method of birth
control (contraception). Some methods
of birth control, such as a diaphragm or
intrauterine device, require a pelvic
exam to make sure the device fits
properly.
 Collect evidence in cases of suspected
sexual assault.
Uses of pelvic examination – pregnancy
 A pelvic examination is performed to
confirm the pregnancy and to
determine gestation.
 look for signs of pregnancy
-- Chadwick's sign
-- Goodell's sign
-- Hegar's sign
 To evaluate the size of the uterine and the
fundal height.
 to identify a presenting part which cannot
be confidently identified abdominally.
 Estimate of pelvic size
 Estimate of pelvic size.
 evaluate the position of the ischial spines
and tuberosities.
 evaluate diagonal conjugate to estimate
pelvic canal size and whether it will allow
passage of the fetus at the time of birth.

NOTE: One vaginal birth is not proof of

adequate pelvic space for all subsequent
deliveries.
 Palpation of pelvic contents is done to
identify any abnormal
 To assess maturity in early pregnancy.
 To exclude suspected abnormalities such
as incarcerated retroversion of the uterus
or ovarian tumour.
 To exclude or confirm gross degrees of
contraction (in very small patients).
 To assess the ripeness of the cervix near
term.
Vaginal examination –
procedure
Important considerations during the
examination include
• respecting the patient's privacy,
• providing simple explanations for her and
her support person,
• maintaining eye contact when possible,
and using sterile technique.
• Collecting necessary information. This
enables the examination to proceed
precisely and efficiently.
Contraindications:
to a vaginal examination include
 excessive vaginal bleeding, which may
signal placenta previa.
Equipment
 Sterile gloves
 sterile water-soluble lubricant or sterile water
 mild soap and water, or cleaning solution
 linen-saver pads
 antiseptic solution
 sterile gauze.
 glass slide,
 culture tube with sterile cotton-tipped applicator,
 exam light
 spatula for cervical scraping,
 speculum,
 Pelvimetry
 Nursing responsibilities
1. Assemble necessary equipment.
2. Explain the procedure to the patient,
3. Have the patient empty her bladder so she is
more comfortable - A distended bladder may
interfere with accurate examination findings.
4.Have the patient to remove her clothing and to
put on a patient gown. Allow for patient privacy
while changing.
5. Position the patient on the exam table in the
lithotomy position with a drape to cover her.
Patient in the lithotomy position, draped for
pelvic exam.
5 Reassure and encourage the patient to
relax during the exam. The patient can
relax by taking two to three breaths and
letting them out slowly through her mouth.
6. Place a linen-saver pad under the
patient's buttocks, and put on sterile
gloves.
7. Inform the patient when you're about to
touch her to avoid startling her.
8, Clean the perineum with mild soap and
water or cleaning solution, spreading the
labia with your independent hand to avoid
contaminating your examining hand.
9.Lubricate the index and middle fingers of
your examining hand with sterile water or
sterile water-soluble lubricant to facilitate
insertion. If the membranes are ruptured,
use an antiseptic solution.
10. Ask the patient to relax by taking several
deep breaths and slowly releasing the
air.
11. Then insert your lubricated fingers
(palmar surface down) into the vagina.
12. Keep your uninserted fingers flexed to
avoid the rectum.
13. Palpate the cervix, keeping in mind that
it may assume a posterior position in
early labor and be difficult to locate.
When you find the cervix, note its
 consistency: The cervix gradually
softens throughout pregnancy, reaching a
buttery consistency before labor begins.
To assess pelvic capacity:
 The diagonal conjugate may be measured if the
sacral promontory can be reached, in which
case the pelvis is smaller than normal.
 The intertuberous diameter should be as wide as
the normal fist.
 Prominence of the ischial spines and the width
of the subpubic arch can be assessed.
 There is no doubt that some idea of the pelvic
shape and size can be obtained after much
practice by the palpation, but there is a wide
margin of error.
To identify a presenting part:
 After identifying the presenting fetal part
and position,
 evaluating dilation and effacement,
 assessing fetal engagement and station,
and verifying membrane status,
 gently withdraw your fingers.
 Let the patient clean her perineum herself
with sterile gauze if she can walk to the
bathroom.
 If she's confined to bed, you can clean her
perineum and change the linen-saver pad.
 To encourage the patient and help reduce
her anxiety.
 Allow for patient's privacy when
redressing.
 Clean up room and dispose of used
materials properly.
 Steps of vaginal examination

 Inspection
 Speculumm examination – vaginal swab
 Bimanual – cervix, uterus, adnexae ( mass
felt through the fornix.
Speculumm examination
 Laboratory studies
performed are as follows:
(a) CBC, Hgb, or Hct-to detect anemia.
(b) Sickle cell on black women-to identify
patients with sickle cell anemia.
(c) VDRL-to identify patients with untreated
syphilis.
(d) Rh factor, blood type-to determine if the
patient is Rh negative.
(e) Rubella antibody titer-to determine
immunity to rubella.
(f) Hepatitis screen-is done if patient history
indicated cause for suspicion.
(g) HTLVIII (AIDS)-screening for AIDS may
begin as a common part of the initial visit.
 Cultures taken
8) Cultures taken at the time of the pelvic
exam are as follows:
(a) Papanicolaou (PAP) Smear is done to
detect any abnormalities of cell growth.
(b) Gonorrhea culture is done to screen the
patient for possible infection to protect
herself, her partner, and the fetus.
(c) Herpes simplex culture is done if there is
a history or any lesions noted to rule out
active herpes.
 On going antenatal care
It enable a decision to be made about the
subsequent care offered to the pregnant
woman and her family.
• In the developing countries, as per
WHO recommendation, the visit may be
curtailed to at least 4;
 first in second trimester around 16 weeks,
 second between 24-28 weeks,
 the third visit at 32 weeks and
 the fourth visit at 36 weeks.
 Purpose of continuing antenatal care
To continue to observe for maternal health
and freedom from infection.
To assess fetal well-being.
To ascertain that the fetus ha adopted a lie
and presentation that will allow vaginal
delivery.
To offer an opportunity to express any
fears or worries about pregnancy or
labour.
To ensure that the mother and family are
confident to decide when labour has
commenced.
To discuss any views about the conduct of
labour and formulate a birth plan if
required.
 Antenatal advice
Principles:
 To impress the patient about the importance of
regular check up.
 To maintain or improve, if necessary, the health
status of the woman to the optimum till delivery.
 To improve and tone up the psychology and to
remove the fear of the unknown.
 explain the principal changes and events likely
to occur during pregnancy and labour.
 Basic patient teaching considerations
1. prenatal visit

Instruct the patient on the importance of regularly

scheduled follow-up visits
(1) Once a month until the seventh month.
(2) Every two weeks during the seventh and eight
month.
(3) Weekly during the ninth month until delivery.
(4) Patient teaching must continue on each visit.
 2. Nutrition

(1) A well-nourished mother and baby are

thought to be far less the victims of
obstetric and prenatal complications, such
as:
(a) Preeclampsia.
(b) Prematurity.
(c) Growth retardation.
(d) Significant residual neurologic damage
(that is, cerebral palsy, mental deficiency,
or behavior disorders in the child).
The diet during pregnancy should be
adequate to provide
 Maintenance of maternal health
 Needs of growing fetus
 Strength and vitality required during labour
 Successful lactation
The diet during pregnancy should be light,
nutritious, easily digestible and rich in
protein, minerals and vitamins.
Dietetic advice should be given with due
consideration to the socioeconomic
condition, food habits and taste of the
individual.
Supplementary nutritional therapy.
– if there is negative iron balance during
pregnancy and
- the dietetic iron is not enough to meet
daily requirement in the second half
pregnancy.
Daily dietary allowance for a woman of reproductive
age, pregnancy & lactation
Non – Preg Lactation Sources
preg
Kilocalori 2200 2500 2600 Protein, fat,
es carbohydrate

Protein 50 gm 60 gm 65 gm Meat, fish,

poultry, diary
product
Iron 18 gm 40 mg* 30 mg* Meat, egg,
grains (* to be
supplemented)
Calcium 500 mg 1000 1500 mg Diary products
mg
Zinc 12 mg 15 mg 19mg Meat, egg,
seafood
 Non – Preg Lactation Sources
preg
Vitamin A 5000 IU 6000 IU 8000 IU Vegetables, liver,
fruits
Vitamin D 200 IU 400 IU 400 IU Diary products

Thiamine 11 mg 15 mg Grains, serials

Riboflavine 11 mg 15 mg Meat, liver, grains

Nicotinic 15 mg 17 mg Al most Meat, nuts, serials

acid
Ascorbic 60 mg 70 mg same as Citrus fruits, tomato
acid in
Folic acid 200 ug 400 ug Pregnanc Leafy vegetables,
y lliver
Vitamin B12 2 Ug 2 ug Animal proteins
 3. Rest and Sleep.

(1) Pregnancy will cause the patient to tire

more easily.
(2) Prevention of fatigue through short rest
periods is vital to good health.
(3) The amount of rest or sleep required will
vary with the individual and stage of her
pregnancy.
2 hours in the midday and 8 hours at night.
4. precautions to take during pregnancy

(1) Decrease smoking or stop altogether if

possible.
(2) Restrict or limit alcohol intake.
(3) Avoid children with measles or other
contagious diseases.
(4) Do not eat raw meats to prevent
toxoplasmosis.
 5. Potential danger signs of pregnancy

 This would necessitate mother

contacting physician.
a. Any vaginal bleeding, regardless of how
small - may indicate
 possible miscarriage or abortion,
 placenta previa, or
 placenta abruptio
Various degrees of placenta previa
Various degrees of placenta abruptio
b. Preeclampsia:
The symptoms are:
(a) Severe continuous headache.
(b) Dimness or blurring of vision.
(c) Swelling of the face or hands, especially when
present after resting all night.
(d) Scotoma- lashes of lights or dots before the
eyes.
(e) Persistent vomiting.
(f) Sharp pain in the abdomen.
(g) Epigastric pain.
c. Weight gain greater than 4 pounds in one
week.
d. Chills and fever.
e. Burning upon urination.
f. Sudden escape of fluid from the vagina.
The patient should report immediately to
the physician or the hospital. She should
not wait for uterine contractions to start.
g. Lack of fetal movement over a 24-hour
period once "quickening" has been
established.
h. Regular uterine contractions less than 5
minutes apart for an hour for anyone less
than 37 weeks pregnancy.
 6. PERSONAL HYGIENE
Bathing:
 shower bathing is preferable than tub or
sea bathing for fear of ascending
infection.
a. Skin Care.
 The glands of the skin may be more
active during pregnancy and the patient
may tend to perspire more.
 Frequent baths or showers are
recommended.
b. Hair Care.
 The hair tends to become oily more
frequently during pregnancy due to over
activity of oil glands of the scalp and may
require shampooing more frequently.
 The hair may grow faster during
pregnancy.
c. Breast Care
 It is important to begin preparing the
breast for breastfeeding during the
prenatal period.
(i) A well-fitting support bra should be worn
at all times.
 This will provide good support for the
enlarging breasts.
 As the breasts enlarge, an increase in
bra and cup size should be worn.
(ii) Pads may be worn inside the bra cups to
 absorb possible colostrum leakage from
the nipples.
 The pads should be changed if they
become wet from leakage.
 Prolonged moisture against the nipples
may lead to tenderness and cracking once
the newborn infant begins nursing.
(iii) The breasts should be washed daily (without
soap)
 to remove dried colostrum and
 to prevent irritation to the nipples.
 Lanolin may be applied to the nipples to prevent
evaporation of perspiration, thereby softening
the skin.
 Wet tea bags may be placed on the nipples, as
the tea will release tannic acid, which will
toughen the skin.
 The nipples should be air dried or blow dried
after washing
 to help toughen them, especially if the patient
plans to breastfeed.
d. Dental Care.
 The patient must maintain normal, daily
dental care.
 There is no documentation that supports
increased dental cavities during
pregnancy.
(1) Minor dental work, such as fillings and
simple extractions, may be done during
pregnancy; however, patients are advised
to avoid anesthetics.
(2) Major dental work:
 to include all dental surgery, should be
postponed until after the pregnancy
because of the need to use anesthetics.
 Anesthetics may affect the developing
fetus and
 the need to use analgesics may also affect
the fetus.
e. Bowel Elimination.
(1) Patients who normally had no problems
with bowel elimination habits will usually
experience little or no change in the daily
routine.
(2) Patients who have a tendency toward
constipation become noticeably more
irregular during pregnancy because of:
(a) Decreased physical exertion.
(b) Relaxation of bowel as a response to
hormone.
(c) Pressure on the bowel from the gravid
uterus.
(d) Constipating effect of iron supplements.
(3) To prevent or to relieve constipation, you
should encourage the patient to eat a diet
high in fiber, maintain an adequate fluid
intake, and to exercise--especially walking.
f. Vaginal Douching:
 Explain to the patient that normal vaginal
secretions are usually intensified during
pregnancy due to increased circulation
and hormone.

(1) Vaginal douching should only be done

with a physician's order for treatment of a
specific condition.
 There is potential for introduction of
infection and development of an air
embolism.
(2) Vaginal douching should never be done
after a rupture or even suspected rupture
of the membrane.
3) Feminine hygiene deodorant sprays
should not be used due to
 increased chance of perineal irritation,
cystitis, and urethritis.
 Undesirable odors can be controlled with
daily use of soap and water.
(4) If a douche is ordered, it should be done
slowly using a gravity bag.
 Bulb syringe and
 "squeeze" operated pre-packaged douches
should be avoided, - as they are capable of
producing too much force.
(a) Douche while sitting on a toilet to decrease
the risk of injury by falling.
(b) The tip is not to be inserted deeper than 3
inches.

(c) The bag should not be higher than 2 feet

above the level of the vagina. The bag higher
than 2 feet above will increase the force of
pressure.
g. Clothing.
 The clothes should be
 lightweight,
 nonconstrictive,
 adjustable,
 absorbent, and
 enhance the sense of well-being of the
patient.
 No constrictive round garters or girdles
should be used due to interference in the
blood's circulation from the legs.
h. The shoes:
 Comfortable and well-fitting,
 easy to apply,
 especially in the last trimester when it is
difficult to bend over to tie or buckle.
 They should also have a good solid base
of support (broad heel) to avoid tottering,
which may lead to a fall.
 7. Activity modifications during
pregnancy
a. Employment.

 Whether mother can or should continue to work

depends on
 the physical activity involved,
 the industrial hazards,
 toxic environment (chemical dust particles,
gases, such as inhalation anesthesia),
 medical or obstetrical complications, or
 employment regulations of the company.
 Activities that are dependent on
 a good sense of balance
 should be discouraged, especially during
the last half of pregnancy.
 Excessive fatigue is usually the reason
for employment termination.
 This may be prevented by modification of
the job requirements temporarily and
adequate rest periods during the day.
 Patients who have sedentary jobs:
 need to walk around at intervals and
 should never sit or stand in one position
for long periods.
 Chairs should provide adequate back
support.
 A footstool can help prevent pressure on
veins, relieve strain on varices, and
minimize swelling of the feet.
b. Travel:
 Traveling should be discussed with the
physician,
 Extensive trips should be approved by the
physician.
 Traveling is not a cause of abortion or
premature labor.
 Lowered oxygen levels may cause fetal
hypoxia in high-attitude regions.
 The patient should take frequent rest
periods; stop and walk around every two
hours if traveling by auto.
 Drink plenty of fluids to prevent
dehydration.
 These steps will help prevent fatigue,
relieve tension, and increase circulation.
 Consider traveling by air for long trips to
reduce travel time.
Wear seat belts at all times
 8. Sexual Relations
 It has been suggested, but not proven, that
premature delivery may be induced
 by the effect of oxytocin released during
maternal response of organs,
 orgasmic contractions, and
 prostaglandin in the male ejaculate.
Effects
 The fetal heart rate decreases during orgasm.
 There are no restrictions on sexual
intercourse during pregnancy except for
 those patients who have a history of
ruptured membranes,
 vaginal spotting, or
 have been treated for preterm labor during
this pregnancy.
 Patients with a history of repeated
abortions may be advised to avoid
intercourse during the period of gestation
when previous abortions occurred.
 Modifications in regard to sexual positions
may be required as the pregnancy
progresses.
 9. Alcohol Consumption.
alcohol should be avoided during
pregnancy
 to prevent the possibility of fetal alcohol
syndrome, which includes
 growth retardation,
 mental deficiency, and
 craniofacial or musculoskeletal
abnormalities.
 10. Smoking
 Smoking, or frequent exposure to a
smoke-filled environment is harmful to the
fetus.
 Smoking causes vasoconstriction of the
blood vessels to include those of the
placenta.
 It also decreases oxygen and nutrients to
the infant.
 There is direct correlation between
smoking and low infant birth weight.
 There is a tendency toward depressed
growth and low weight gain to continue
even after birth.
 increased number of upper respiratory
infections in the infant during the first year
of life.
 11. Exercise

Exercise is vital for

good maternal health,
healthy birth, and
recovery.
Physical exercise helps:
adjust to the
 hormonal and
 physical change of pregnancy
 the emotional and psychological changes.
 safe and healthful as long as the patient feels
comfortable.
 Moderate exercise is recommended.
Activities continued
 to a point of exhaustion or
 fatigue compromises uterine profusion and
 fetoplacental oxygenation.
These activities are discouraged.
The amount of exercise:
is dependent on
 the health,
 previous exercise habits, and
 obstetric history of the individual
As pregnancy continues:
 the center of gravity changes so
 the patient may become clumsy and
 increase the risk of injury.
 12. Medication
 Not to be taken without obstetrician adivce
due to risk of teratogenicity.

13.Exposure to infections

 to be avoided particularly those or

documented tertogenicity
 e.g. rubella, cytomegalovirus, herpes
huminis and varicella zoster viruses.
 14. Exposure to irradiation
 to be avoided whether diagnostic or
therapeutic.
15. Immunization
 In the developing countries immunization
in pregnancy is a routine for tetanus,
 others are given when epidemic occurs or
traveling to an endemic zone or for
traveling overseas.
 Live virus vaccines (rubella, measles,
mumps, ericella, yellow fever) are
contraindicated.
 Rabies, Hepatitis A and B vaccines,
toxoids can be given as in non-pregnant
state.
Tetanus:
 Immunization against tetanus not only
protects the mother but also the neonates.
unprotected women:
 0.5 ml – T.T IM at 4 weeks interval for 2
* the first one to be given between 16-24
weeks.

Women who are immunized in the past

 a booster dose of 0.5 ml I.M. is given in
the last trimester.
 Values of antenatal care
 Screen the high risk cases
 Detection of high risk factors
 Supervise pregnancy regularly
 Promote safe delivery
 Provide antenatal advice
 opportunity to make the patient to realize
that the childbirth is a physiological
process
 Reduce maternal mortality & morbidity