obstetrics & gynecology,

1. Usman zafar
Batch ‘J’
final year
mBBs

2. Antenatal Care

4. Definition of Antenatal care
comprehensive health supervision of a
pregnant woman before delivery
Or it is planned examination, observation
and guidance given to the pregnant
woman from conception till the time of
labor.

5. Goals
To reduce maternal and perinatal
mortality and morbidity rates
To improve the physical and mental
health of women and children

6. Importance of Antenatal Care
 To ensure that the pregnant woman and her
fetus are in the best possible health.
 To detect early and treat properly
complications
 Offering education for parenthood
 To prepare the woman for labor, lactation and
care of her infant

7. Schedule for Antenatal Visits:
The first visit or initial visit should be made
as early is pregnancy as possible.
Return Visits:
Once every month till 7th month.
Once every 2 weeks till the 9th month
Once every week during the 9th month,
till labor.

9. Assessment
History Examination Investigation

10. History
Personal history
Family history
Medical and surgical history
Menstrual history
Obstetrical history
History of present pregnancy

11. Physical Examinations
Height of over 150 cm indication of an
average-sized pelvis
The approximate weight gain during
pregnancy is 12 kg.; 2kg in the first 20
weeks and 10 kg in the remaining 20
weeks (1.5 kg per week until term).

12. Obesity (more than 20 kg above the
weight-height formula) leads to an
increased risk of gestational diabetes,
pregnancy-induced hypertension and
thrombo-embolic disorders

13. Local Examination
The uterus may be higher than expected
due to large fetus, multiple pregnancy,
polyhydrammnios or mistaken date of last
menstrual period.
The uterus may be lower than expected due
to small fetus, intrauterine growth
retardation, oligohydramnios or mistaken
date of last menstrual period.

14. Fetal heart sound is heard by sonicaid
as early as 10thweek of pregnancy.
Fetal heart sound is heard by Pinard' s
fetal stethoscope after the 20thweek of
pregnancy.
The normal fetal heart rate is 120-160
beats/min

15. Investigations:
Urine should be tested for sugar,
ketones and protein.
Hemoglobin will be repeated:
At 36 weeks of gestation.
Every 4 weeks if Hb is < 9 g/dl.

16. Fetal kick count
The pregnant woman reports at
least 10 movements in 12 hours.
Absence of fetal movements
precedes intrauterine fetal death
by 48 hours.

17. Prevention of neonatal tetanus
Clean delivery practices
3cleans : clean hands, clean delivery
surface, clean cord care
Tetanus toxoid protects both mother & child
Unimmunized pregnant women : 2 doses
tetanus toxoid
•1st
dose as early as possible during
pregnancy
•2nd
dose – at least a month later / 3 wks
before delivery

18. Health Teaching during the First
Trimester
 Physiological changes
during pregnancy
 Weight gain
 Fresh air and sunshine
 Rest and sleep
 Diet
 Daily activities
 Exercises and relaxation
 Hygiene
 Teeth
 Bladder and bowel
 Sexual counseling
 Smoking :
 Medications
 Infection
 Irradiation
 Occupational and
environmental hazards
 Travel
 Follow up
 Minor discomforts
 Signs of Potential
Complications

19.  Exercise should be simple, mild exercise avoid
lifting heavy weights
 A tooth can be extracted during pregnancy,
but local analgesia is recommended
 Catheter and enema should be avoided.
 Smoking may lead to ptyalism, nervousness
and hyper emesis and make pregnant woman
at increased risk of chest infections and
thrombo-embolic disorders

20.  Pregnant woman should avoid contact with
infectious diseases especially rubella or
(German measles) because it has deleterious
effects on the fetus
 Pregnant woman should avoid exposure to x-
ray or irradiation because of possible
teratogenic effects on the fetus such as birth
defects or childhood leukemia

21. Common Discomforts of Pregnancy,
Etiology, and Relief Measures:
Urinary frequency
RELIEF MEASURES:
 Decrease fluid intake at night.
 Maintain fluid intake during day.
 Void when feel the urge.

22. Fatigue
RELIEF MEASURES:
 Rest frequency.
 Go to bed earlier.

23. Sleep difficulties
RELIEF MEASURES:
Rest frequency
 Decrease fluid intake at night

24. Breast enlargement and
sensitivity
RELIEF MEASURES:
 Wear a good supporting bra.
 Assess for other conditions.

25. Nasal stuffiness and epistaxis
ETIOLGY: Elevated estrogen levels
 RELIEF MEASURES :
Avoid decongestants.
Use humidifiers, and normal saline drops.

26. Ptyalism (excessive
salivation(
ETIOLGY: Unknown
RELIEF MEASURES:
Perform frequent mouth care.
Chew gum.
Decrease fluid intake at night.
Maintain fluid intake during day.

27. Nausea and vomiting
 RELIEF MEASURES:
 Avoid food or smells that exacerbate condition.
 Eat dry crackers or toast before rising in
morning.
 Eat small, frequent meals.
 Avoid sudden movements. Get out of bed slowly
 Breath fresh air to help relieve nausea.

28. Shortness of breath
RELIEF MEASURES:
 Use extra pillows at night to keep more upright.
 Limit activity during day

29. Heartburn
RELIEF MEASURES:
 Eat small, more frequent meals.
 Use antacids.
 Avoid overeating and spicy foods.

30. Dependent edema
 Avoid standing for long periods.
 Elevate legs when laying or sitting.
 Avoid tight stockings.

31. Varicosities
 Rest in sims' position.
 Elevate legs regularly.
 Avoid crossing legs.
 Avoid tight stockings.
 Avoid long periods of standing

32. Hemorrhoids
RELIEF MEASURES:
Maintain regular bowel habits.
Use prescribed stool softeners.
Apply topical or anesthetic
ointments to area.

33. Constipation
RELIEF MEASURES:
Maintain regular bowel habits.
Increase fiber in diet.
Increase fluids.
Find iron preparation that is
least constipating

34. Leucorrhea
RELIEF MEASURES:
Take a daily bath or shower.
Wear cotton underwear.

35. Backache
RELIEF MEASURES:
Wear shoes with low heels.
Walk with pelvis tilted forward.
Use firmer mattress.
Perform pelvic rocking or tilting

36. Leg cramps
RELIEF MEASURES:
 Extend affected leg and dorsiflex the foot.
 Elevate lower legs frequently.
 Apply heat to muscles.
 Evaluate diet.

37. Faintness
RELIEF MEASURES:
•Rise slowly from sitting to standing.
•Evaluate hemoglobin and
hematocrit.
•Avoid hot environments

38. Its begging of the end…….