Sajad Abdulredha Ali
Halwer Medical University- Iraq
Every year there are an estimated 200 million
pregnancies in the world, each of these pregnancies is
at risk for an adverse out come for the woman and her
While risk can not be totally eliminated, they can be
reduced through effective and acceptable maternity
To be most effective, health care should begin early in
pregnancy and continue at regular intervals.
It is the education, supervision and treatment to a pregnant
woman so that her pregnancy and labour will terminate with
delivery of a mature healthy living baby, without injury to
the mind or body of the mother.
1. Assessment and
management of maternal
risk and symptoms.
2. Assessment and management of fetal risk
3. Prenatal diagnoses and management of fetal
4. Diagnoses and management of perinatal complications
5. Decision regarding timing and mode of delivery
6. Parental education regarding pregnancy and childbirth
7. Parental education regarding child-rearing
WHO recommends a minimum of four ANC visits
• First visit: On confirmation of pregnancy
• Second visit: 20-28 weeks
• Third visit: 34-36 weeks
• Fourth visit: before expected date of delivery
or when the pregnant woman feels she
needs to consult health worker
Every women should have a record file and every event
should be written in it.
If pregnancy is passing uneventfully these visits are
enough but if complications arise we need more visits
First Trimester Visit
•confirm intrauterine pregnancy and assess
the gestational age.
•We have to deal with complications that
present with vaginal bleeding and abdominal
history,examination,biochemical testing &
transvaginal U/S to exclude non-viable
pregnanacy.ectopic pregnanacy or hydatiform
Second Trimester Visit
Assessment of maternal health & fetal growth
results of tests performed at 1st
trimester visit are reviewed with the mother
The results of the U/S scan for fetal
abnormality are also reviewed.
Any incidental maternal symptoms are dealt
with ,this period is also important in insuring
the education of the woman regarding the rest
of pregnancy & her delivery,
Third Trimester Visit
The primary objective of this visit is to
Uterine fundal height ,fetal lie, presentation &
position are mandatory.
Vaginal examination will help us to check for
any abnormaity in the pelvis, cervical status
,fetal presenting part,station & position.
Mode of delivery & planned contraception after
delivery shoud be discussed at this time.
Post Dates Visit [ 41 – 42 weeks ]
With accurate pregnancy dating, true post
dates pregnancy are identified,
At this visit , a joint decision is taken as to
whether an induction of labour is
appropriate, this is current practice
because of the
between post dates pregnancy &
Induction of labour usually performed by
the 42nd week.
In summery at each visit the following
procedure and examination should be
past medical and surgical hx,
•Height: patients measuring 5 feet or less
are more likely to have a small pelvis that
may cause difficulty during delivery.
•Weight gain (11-16 kg)
• Normal weight women should
gain 11.5-15 kg
• Underweight women should gain
• Obese women should gain no
more than 7 kg.
Blood Pressure, Pallor, Jaudice,
Mouth, Legs, Breasts, and
3- Investigations:, PAP Smear,
CBC, GUE, RBS, U/S.. And
further investigations if required.
4- Health Education.
Calories (2500 cal/day)
Calcium (1.2 gm /day)
Folic acid (400 µg/day)
Supplementary iron therapy is needed
for all pregnant mothers from 20 weeks
(30 mg of ferrous / day)
(60-100 mg/day) is given for large women, twin, and those
women who book for ANC late in pregnancy
•Anemic woman should take (200 mg/day).
Daily bath is recommended, as it stimulation refreshing
Avoid hot water bath.
Vaginal Douches not favorable.
As there is increase chance of constipation,
regular bowel movement may be facilitated
by regulation of diet taking plenty of fluids,
vegetables and milk.
Wash the breast with clean tap water.
Walk in moderation.
Avoid lifting heavy things.
Avoid long time standing.
Avoid sitting with crossed
legs as this may impede circulation.
Regular sleep is advised, 8 hrs sleep per day
toward term is recommended.
Sleeping on the left side is preferable.
Travel is allowed when comfortable
Car safety belts have to be adjusted to be comfortable for
Those traveling more than four hours must take a break
every 4 hours and walk for about of minutes to decrease the
risk of DVT
Sexual intercourse is allowed with moderation, it’s
completely safe and normal unless the woman has vaginal
bleeding or rupture memb.
Sexual activity is avoided in early pregnancies in woman
with previous history of Preterm labor
One to two doses of tetanus toxoid is given to immunize
against tetanus infection.
Tight clothes and belts are avoided
The patient should wear
loose but comfortable dresses.
High heel shoes are better avoided.
Alcohol, smoking and drugs should be avoided as the
may affect the fetal wellbeing
Alarming Symptoms and signs
Escape of fluid from the vagina
Abnormal gain or loss of weight
Decrease or cessation of fetal movement
Antenatal care is an essential aspect of health care delivery for
improving pregnancy out come.
By this service we can detect high risk pregnancies and we can
direct them for proper management
1. Obstetrics by ten teachers, 19th edition, by Philip N
Baker and Louise C Kenny.
2. Prevention and Recognition of Obstetric Fistula
Training Package: FACILITATOR’S MANUAL.
3. National Institute for Health and Clinical Excellence,
Issue date: March 2008.