Prenatal care lecture 5

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Prenatal care lecture 5

  1. 1. At the end of this session student will be able to: • To demonstrate how to make an immediate general assessment of the pregnant woman • To apply the process flow of providing antenatal care services • To discuss the importance Antenatal care
  2. 2. Antenatal Care/Prenatal Care ANC is the care of the woman during pregnancy to achieve a healthy mother and a health baby.
  3. 3. Providers of Antenatal care • Doctor • Nurse • Midwife/auxiliary midwife
  4. 4. Goals of antenatal care 1. The main goal is the safety and welfare of the mother and her fetus. 2. The preparation of mother for labor, and lactation. 3. The early detection and appropriate treatment of highrisk conditions. 4. The reduction of maternal and infant mortality, and prematurity.
  5. 5. Components of antenatal care A) Registration B) History taking C) Obstetric Examination D) Clinical service E) Health Education F) Immunization
  6. 6. 1- Registration of AN visits • Booking visit: to be at 6th week of gestation • 6th – 28th week : to be very 4 weeks • 29th – 36th week: to be every 2 weeks • 36th up to delivery: to be weekly
  7. 7. ANC4  The World Health Organization (WHO) recommends a minimum of four antenatal visits. At least 4 routine antenatal visits 1st visit: before 4 months 2nd visit: 6 months 3rd visit: 8 months 4th visit: 9 months
  8. 8. Visits to Prenatal Care Make the woman comfortable. Greet her, make sure she is comfortable and ask how she is feeling. If first visit, register the woman and issue a Mother and Child Book (antenatal record form)
  9. 9. 2- OBSTETRIC HISTORY     1-General information Name, age , gravidity, parity, LMP, EDD Gravidity no. of pregnancies including current pregnancy (regardless of the outcome N or abortion) Parity no. of births beyond 24 wk gestation 2-Current problem/ complaint 3-History of current complaint 4-History of current pregnancy  details of the 1st ,2nd & 3rd trimester lab tests & U/S scanspattern
  10. 10. OBSTETRIC HISTORY 5-Menstrual & gynecological history       LMP details ( was it conform to the usual in terms of timing, volume, and appearance) Regular or irregular cycles Length of the cycle Surgical procedures Hx of infertility Sexually transmitted diseases
  11. 11. OBSTETRIC HISTORY 6-Past obstetric history  Outcome of previous pregnancies in details including the abortions  Any significant antenatal, intrapartum or postpartum events  Previous maternal complications  Mode of delivery  Baby Wt  Life & health of the baby
  12. 12. OBSTETRIC HISTORY 7-Past medical/ surgical Hx Some medical conditions may have impact on the course of the pregnancy or the pregnancy may have an impact on the medical condition examples:        Heart disease Hypertension DM Epilepsy Thyroid disease Bronchial asthma Any previous surgery.        Kidney diseases UTI Autoimmune disease Psychiatric disorders Hepatitis Venereal diseases Blood transfusion
  13. 13. OBSTETRIC HISTORY 8. Drug Hx 9. Family Hx - Hereditary illness → DM., thalassemia, sickle cell disease, hemophilia - Congenital defects eg. neural tube defects, Down syndrome - Twins 10. Social Hx → Cigarette smoking, illegal drug use, domestic violence, housing condition.
  14. 14. 3- OBTETRIC PHYSICAL EXAMINATION  General exam -Ht. Wt., BMI -BP in 2nd trimester -Pulse  -Head, eyes, ears, nose & throat no changes -Thyroid diffuse enlargement -Skin pigmentation of the face (chloasma), abdomen (linea nigra) Stretch marks on the abdomen, thighs & breasts
  15. 15. OB PHYSICAL EXAM  General exam -Breast nodularity -CVS HR   COP -Lungs Elevation of the diaphragm  total lung capacity
  16. 16. Abdominal exam 1-Inspection shape & size  asymmetry  fetal movement surgical scars cutaneous signs of pregnancy linea nigra, striae gravidarum, umbilicus flat or everted, superficial veins
  17. 17. Abdominal exam 2-Palpation  Fundal Height  Fundal Grip
  18. 18. Abdominal exam 2-Palpation:  Lateral Grip  Pelvis Grip
  19. 19. 2-Palpation:  Deep pelvic grip
  20. 20. 3-Ascultation fetal heart at 13-14 wks 4-Percussion polyhydramnious
  21. 21. Vulval &Vaginal exam not routinely performed -Hyper pigmentation -Look for abnormalities  Varicose veins/ hemorrhoids,Warts or herpes - vaginal secretions -Cx Softer, pigmented -Uterus enlarged
  22. 22. Provision of AN visits ON ALL VISITS: Check duration of pregnancy (AOG). Ask for bleeding/danger signs during this pregnancy Check record for previous treatments received during this pregnancy Prepare birth and emergency plan Ask patient if she has other concerns Give education and counseling on family planning and breastfeeding
  23. 23. 4- Clinical Services during ANC Get baseline laboratory information of the woman on the first or following the first visit. Hemoglobin, blood group Urinalysis VDRL or RPR to screen for syphilis
  24. 24. Check for pallor or anemia. On 1st visit, check hemoglobin & blood type. The normal hemoglobin cut-off level for a pregnant woman is 11g/dl. On subsequent visits:    Look for conjunctival pallor. Look for palmar pallor. Count number of breaths in one minute.
  25. 25. Check for hypertension/ pre-eclampsia. Measure BP in sitting position. If diastolic BP is 90 mm Hg or higher repeat measurement after 1 hour rest. If diastolic BP is still 90 mm Hg or higher ask the woman if she has: • Severe headache • Blurred vison • Epigastric pain Check urine for protein.
  26. 26. 5- Immunize against tetanus. Tetanus Toxoid Immunization Schedule Vaccine TT1 Minimum Interval at first contact with woman 15-49 yrs or at first ANC visit Duration of Protection NIL – no protection TT2 at least 4 weeks after TT1 •Infants born to the mother will be protected from neonatal tetanus •3 years of protection for the mother TT3 at least 6 months after TT2 •Infants born to the mother will be protected from neonatal tetanus •5 years of protection for the mother TT4 at least 1 year after TT3 •Infants born to the mother will be protected from neonatal tetanus •10 years of protection for the mother TT5 at least 1 year after TT4 •Infants born to the mother will be protected from neonatal tetanus •Lifetime protection for the mother
  27. 27. 6- Provide health information, advice HEALTH INFORMATION: 1.Nutrition 2.Self-care during pregnancy 3.Effect of tobacco, alcohol & drugs 4.Breastfeeding 5.Birth & Emergency situations 6.Schedule of appointment
  28. 28. Advise on Danger Signs 1. Vaginal bleeding 2. Convulsions 3. Severe headache 4. Severe abdominal pain 5. Fast or difficult breathing 6. Fever or burning urination

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