Antenatal care

Antenatal Care
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Objectives
* Prevention, early detection and treatment of pregnancy
related complications as pre-eclampsia, eclampsia and haemorrhage.
* Prevention, early detection and treatment of medical disorders as anaemia and diabetes.
* Detection of malpresentations, malpositions and disproportion that may influence the decision of labour.
* Instruct the pregnant woman about hygiene, diet and warning symptoms.
* Laboratory studies of parameters may affect the foetus as blood group, Rh typing, toxoplasmosis and syphilis.

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 first visit
* History.
* Examination: general, abdominal and local.
* Laboratory investigations:
o Blood grouping.
o Rh typing.
o Haemoglobin.
o Toxoplasma and / or VDRL if needed.
o Urine analysis particularly for albumin and sugar.

Return visits
History: ask the patient about any complaint.
Examination:
o Blood pressure.
o Weight.
o Oedema.
o Abdominal examination.
Investigation: urine for albumin and sugar.

INSTRUCTIONS TO THE PREGNANT WOMAN

Diet
The daily requirements are:
* Calories: 2500 Kcal.
* Proteins: 60 gm.
* Carbohydrates: 200- 400 gm.
* Lipids: should be restricted.
* Vitamins:
o Vitamin A: 5000 IU.
o Vitamin B1 (Thiamine): 1mg.
o Vitamin B2 (Riboflavin): 1.5 mg.
o Nicotinic acid: 15mg.
o Ascorbic acid (vit. C): 50mg.
o Vitamin D: 400 IU.
o Folic acid: 0.5 mg.
* Minerals:
o Iron: 15 mg.
o Calcium: 1000 mg.

So the suggested daily diet should include:
* One litre of milk or its derivatives,
* 1-2 eggs,
* fresh vegetables and fruits.
* 2 pieces of red meat replaced once weekly by sea fish and once by calf ’s liver.
* Cereals and bread are recommended also.
Coffee and tea: should be restricted.

Smoking: should be avoided as it may cause intrauterine growth retardation or premature labour.
Rest and sleep: 2 hours in the midday and 8 hours at night.
Exercises: violent exercises as diving and water sports should be avoided. House work short of fatigue and walking are encouraged.

Clothing
* Lighter and looser clothes of non synthetic materials are more comfortable due to increased BMR and sweating.
* Clothes which hang from the shoulders are more comfortable than that requiring waste bands.
*Breast support is required.
* Avoid tight elastic hosiery or its bands.

Bathing: Shower bathing is preferable than tube or sea bathing for fear of ascending infection. Vaginal douching should be avoided.

Shoes: High - heeled shoes should be discouraged as they increase lumbar lordosis, back strain and risk of falling.

Breasts: to reduce the incidence of retracted and/ or cracked nipples postpartum, the patient is instructed to massage them with a mixture of glycerine and alcohol during the last 6 weeks of pregnancy.

Bowels: Constipation is avoided by increasing vegetables, fluids and milk intake and mild exercise. Liquid paraffin should not be used for long period as it interferes with absorption of fat- soluble vitamins (A and D).

Coitus: Whenever abortion or preterm labour is a threat, coitus should be avoided. Otherwise, it is allowed with less frequency and violence. Some obstetricians advise abstinence in the last 4 weeksof pregnancy for fear of ascending infection.

Travelling: long and tiring journeys should be avoided particularly ifthe woman is prone to abortion or preterm labour. Flying is not contraindicated but not the long ones and near term.

Medications: not to be taken without obstetrician advice due to risk of teratogenicity

Exposure to infections: is to be avoided particularly those of documented teratogenicity e.g. rubella, cytomegalovirus, herpes hominis and varicella zoster viruses.

Exposure to irradiation: is to be avoided whether diagnostic or therapeutic.

The warning symptoms: which indicate immediate contact to the obstetrician are:
* vaginal bleeding,
* gush of fluid per vagina,
* abdominal pain,
* persistent headache,
* blurring of vision,
* oedema of lower limbs or face,
* persistent vomiting.

Antenatal care

by raj kumar

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