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Antenatal Checkup History Taking
- 1. Ms. Reshma Rawat Sister In-Charge, GYNEC WARD, SVBCH, Silvassa 1/1/2021 SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 1
- 3. History Taking Points to be taken care of : Ensure privacy Ensure calm and quiet atmosphere Make the woman comfortable and relaxed Maintain confidentiality Establish rapport Record all facts on Mother & Child Protection (MCP) card Highlight abnormal findings SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA
- 4. History Taking Start with Age of woman Order of pregnancy Birth interval Record LMP (1st day of woman’s last Menstrual period) and calculate Expected Date of Delivery EDD = LMP + 9 months +7 days SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 4 1/1/2021
- 5. History Taking Ask for symptoms What are normal symptoms during pregnancy? Nausea & vomiting Heart burn Constipation Increased frequency of urination These symptoms may cause discomfort to the woman SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 5 1/1/2021
- 6. History Taking What are the symptoms of complications? Fever Persistent vomiting with dehydration Palpitations, tiredness Breathlessness at rest / on mild exertion Generalized swelling of body / facial puffiness Severe headache and/ or blurring of vision Passing smaller amount of urine or burning micturition Leaking or bleeding per vaginum Abnormal vaginal discharge / itching Decreased or absent fetal movements SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 6 1/1/2021
- 7. History Taking Obstetric history No. of previous pregnancies Date (month / year) Mode (vaginal / caesarian) Outcome (live birth, still birth, preterm, abortion, ectopic, vesicular mole) SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 7 1/1/2021
- 8. History Taking Obstetric history Any past obstetric complications, Recurrent pregnancy loss, Post abortal complications, APH, Hypertensive disorders of pregnancy, Malpresentation, Obstructed labor, PPH, Third degree tears, Puerperal sepsis, Thrombo- embolism etc Any past obstetric procedures, Cesarean section, Instrumental delivery, Manual removal of placenta SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 8 1/1/2021
- 9. History Taking Any current / past systemic illnesses High BP Diabetes Heart disease : Breathlessness on exertion, palpitation Tuberculosis : Cough> 2 wks , blood in sputum, prolonged fever Renal disease Epilepsy : Convulsions Asthma : Attacks of breathlessness Jaundice Malaria Any other history suggestive of RTI / STI ; HIV / AIDS SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 9 1/1/2021
- 10. History Taking Family history of systemic illness Hypertension Diabetes Tuberculosis Thalassemia or repeated blood transfusions Multiple pregnancies Intake of alcohol or tobacco or smoking Drug intake or allergies Domestic violence SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 10 1/1/2021
- 11. General Physical Examination What does GPE include? Pallor Jaundice Pulse rate Respiratory rate Edema Blood pressure Weight Breast examination SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 11 1/1/2021
- 12. Where do you look for pallor? SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 12 Conjunctiva Nails Tongue and oral mucosa Palms 1/1/2021
- 13. Comparing normal with abnormal findings SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 13 Normal Anemic Patient 1/1/2021
- 14. Pulse What is the normal pulse rate? Normal pulse rate 60 – 90 beats / min SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 14 1/1/2021
- 15. Respiratory rate (R.R.) What is the normal respiratory rate ? Normal R R 18 – 20 breaths / min Respiratory rate > 30 breaths / min indicates that the woman may have anemia / heart disease /medical problem and needs referral SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 15 1/1/2021
- 16. Edema Normal edema Occurring late in pregnancy, appearing in the evening and disappearing after rest may be normal Abnormal edema Edema of face, hands, abdominal wall and vulva is abnormal When associated with high BP, heart disease, anemia or proteinuria is an indication for referral to MO Non pitting edema indicates hypothyroidism or filariasis SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 16 1/1/2021
- 17. Blood pressure Measure at each visit to rule out hypertensive disorder of pregnancy Hypertension is diagnosed when systolic BP is ≥ 140 mm Hg and /or diastolic BP of ≥ 90 mm Hg, on 2 consecutive readings SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 17 1/1/2021
- 18. Weight Weight at each visit Normal weight gain during pregnancy is 9 – 11 kg After the first trimester weight gain is approx. 2 kg / month Low weight gain points towards IUGR and excessive weight gain ( > 3kg / mth) should arouse suspicion of pre-eclampsia / multiple pregnancies / diabetes Standard weighing scale should be used at every antenatal check up if possibleSHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 18 1/1/2021
- 19. Breast Examination Observe the size and shape of nipples for inverted or flat nipples Flat nipples can be pulled out easily and do not interfere with breast feeding Truly inverted nipples can not be pulled out easily and are retracted Breasts are also palpated for any lumps or tenderness SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 19 1/1/2021
- 20. Correction of inverted / retracted nipples in the postnatal period SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 20 1/1/2021
- 21. Abdominal Examination What does it include? Measurement of fundal height Assessment of fetal lie and presentation Assessment of fetal movement Auscultation of fetal heart sounds Inspection for scars Other relevant abdominal findings SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 21 1/1/2021
- 22. Foetal movements Fetal movement are reliable sign of foetal well - being These are felt around 18-22 wks of pregnancy (felt earlier in multigravida than primigravida) Normally 10-12 fetal movements should be felt by the pregnant woman in a day Decreased fetal movements may be an indication of fetal distress Pattern of fetal movement may change prior to labour due to reduced space But fetal activity should continue throughout pregnancy and labour SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 22 1/1/2021
- 23. Fetal heart sound (FHS) and rate (FHR) FHS is heard per abdomen by stethoscope / fetoscope after 24 weeks of pregnancy Normal FHR is 120 – 160 beats per min FHR < 120 beats per min or > 160 beats per min : Indicates fetal distress and calls for referral Confirm that you are listening to the FHS and not maternal pulse SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 23 1/1/2021
- 24. Auscultation of FHS Use a fetoscope or stethoscope Best heard on the side of the back of the fetus In vertex presentation FHS is best heard midway between the line joining the umbilicus and the anterior superior iliac spine on the side of the back In breech presentation FHS is heard above the umbilicus Count the FHS for one full minute (FHR) SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 24 1/1/2021
- 25. Suspicion of multiple pregnancy on abdominal examination An unexpectedly large uterus for the estimated gestational age Multiple fetal parts felt on abdominal palpation FHS is heard at more than one place SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 25 1/1/2021
- 26. ROLE OF NURSE IN ANTENATAL CLINIC Perform early antenatal registration at the first trimester Minimum 8 antenatal contacts Holistic antenatal assessment Counsel antenatal mothers on diet, rest and sleep, antenatal medications and Injections Respectful maternity care Careful conduction of delivery 1/1/2021 SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 26
- 27. Thank you SHRI VINOBA BHAVE CIVIL HOSPITAL, SSILVASSA 27 1/1/2021