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Importance of antenatal care


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Importance of antenatal care: prepared by Abir Chowdhury, Chittagong, Bangladesh

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Importance of antenatal care

  1. 1. Importance of Antenatal care Presented by: Captain Nishat Fatema Nipun MBBS (AFMC) MO, CMH, Chittagong, Bangladesh
  2. 2. What is Antenatal care <ul><li>Periodic and regular supervision including examination and advice of a woman during pregnancy is called Antenatal care. </li></ul><ul><li>The supervision should be of a regular and periodic nature in accordance with the need of the individual. </li></ul>
  3. 3. Aims <ul><li>The aims are- </li></ul><ul><li>To screen the high risk cases </li></ul><ul><li>To prevent or detect or treat at the any earliest complication </li></ul><ul><li>To ensure continued medical surveillance and prophylaxis </li></ul><ul><li>To educate the mother about the physiology of pregnancy and labour by demonstrations, charts and diagrams so that fear is removed and psychology is improved </li></ul>
  4. 4. Aims (cont’d) <ul><li>To discuss with the couple about the place, time and mode of the delivery, provisionally and care of the newborn </li></ul><ul><li>To motivate the couple about the need of family planning </li></ul><ul><li>To advice the mother about breast-feeding, post-natal care and immunization </li></ul>
  5. 5. Objectives <ul><li>To ensure a normal pregnancy with delivery of a healthy baby from a healthy mother </li></ul>
  6. 6. Criteria of normal pregnancy <ul><li>Delivery of a single baby in good condition at term with no maternal complication </li></ul>
  7. 7. Services <ul><li>As per WHO recommendation at least 4 visit- </li></ul><ul><li>1 st visit around 16 weeks </li></ul><ul><li>2 nd visit between 24-28 weeks </li></ul><ul><li>3 rd visit at 32 weeks </li></ul><ul><li>4 th visit at 36 weeks </li></ul>
  8. 8. Services (cont’d) <ul><li>Generally- </li></ul><ul><li>At interval of 4 weeks up to 28 weeks </li></ul><ul><li>At interval of 2 weeks up to 36 weeks </li></ul><ul><li>At weekly interval up to EDD </li></ul>
  9. 9. Antenatal care comprises of- <ul><li>Careful history taking and examination and investigation </li></ul><ul><li>Advice given to the pregnant woman </li></ul>
  10. 10. THE FIRST VISIT <ul><li>History taking </li></ul><ul><li>Examination </li></ul><ul><li>Investigation </li></ul>
  11. 11. History taking <ul><li>Particulars of the patient </li></ul><ul><li>Chief complaints with duration </li></ul><ul><li>Past history </li></ul><ul><li>Obstetric history </li></ul><ul><li>Menstrual history </li></ul><ul><li>Family history </li></ul><ul><li>Drug History </li></ul><ul><li>History of immunization </li></ul><ul><li>Socio-economic history </li></ul><ul><li>Contraceptive history </li></ul><ul><li>History of allergy </li></ul>
  12. 12. Particulars of the patient <ul><li>Name </li></ul><ul><li>Age </li></ul><ul><li>Address </li></ul><ul><li>Marital status </li></ul><ul><li>Date of Admission </li></ul><ul><li>Date of Examination </li></ul>
  13. 13. Chief complaints with duration <ul><li>Period of amenorrhea </li></ul><ul><li>Nausea & vomiting, vertigo </li></ul><ul><li>Increased frequency of micturition </li></ul><ul><li>Constipation </li></ul><ul><li>Heaviness of breast </li></ul><ul><li>Rise of temperature </li></ul><ul><li>Edema </li></ul><ul><li>Pain in the abdomen </li></ul><ul><li>Backache </li></ul><ul><li>Vaginal bleeding </li></ul>
  14. 14. Past history <ul><li>HTN </li></ul><ul><li>DM </li></ul><ul><li>BA </li></ul><ul><li>Renal Disease </li></ul><ul><li>Psychiatric illness </li></ul><ul><li>IHD </li></ul><ul><li>Any previous operation </li></ul>
  15. 15. Obstetrical History <ul><li>Duration of marriage </li></ul><ul><li>Gravida </li></ul><ul><li>Para </li></ul><ul><li>ALC </li></ul>
  16. 16. Menstrual History <ul><li>Age of menarche </li></ul><ul><li>Menstrual period </li></ul><ul><li>Menstrual cycle </li></ul><ul><li>LMP </li></ul><ul><li>EDD </li></ul>
  17. 17. Family history <ul><li>HTN </li></ul><ul><li>DM </li></ul><ul><li>Multiple pregnancy </li></ul>
  18. 18. Drug History <ul><li>Antihypertensive </li></ul><ul><li>Hypoglycemic </li></ul><ul><li>Antidepressant </li></ul><ul><li>Corticosteroid </li></ul><ul><li>Anticoagulant </li></ul>
  19. 19. Physical examination <ul><li>General examination </li></ul><ul><li>Abdominal examination </li></ul>
  20. 20. General examination <ul><li>Appearance </li></ul><ul><li>Height of patient </li></ul><ul><li>Weight of patient </li></ul><ul><li>Anemia </li></ul><ul><li>Jaundice </li></ul><ul><li>Edema </li></ul><ul><li>Cyanosis </li></ul><ul><li>Clubbing </li></ul><ul><li>Koilonychia </li></ul><ul><li>Leuconychia </li></ul>
  21. 21. General examination (cont’d) <ul><li>Temperature </li></ul><ul><li>Pulse </li></ul><ul><li>BP </li></ul><ul><li>RR </li></ul><ul><li>Breast </li></ul><ul><li>Heart sound </li></ul><ul><li>Lungs </li></ul>
  22. 22. Abdominal examination <ul><li>Inspection </li></ul><ul><li>Palpation </li></ul><ul><li>percussion </li></ul><ul><li>Auscultation </li></ul>
  23. 23. Inspection <ul><li>Shape of the uterus </li></ul><ul><li>Striae </li></ul><ul><li>scar mark </li></ul>
  24. 24. Palpation <ul><li>Assessment of fundal height </li></ul><ul><li>Lie </li></ul><ul><li>Abdominal girth </li></ul><ul><li>Fundal grip </li></ul><ul><li>Lateral grip </li></ul><ul><li>First pelvic grip </li></ul><ul><li>Second pelvic grip </li></ul>
  25. 25. Auscultation <ul><li>Normal FHR is 120-160 b/m </li></ul><ul><li>Causes of foetal tachycardia (>160 b/m) </li></ul><ul><li>Causes of foetal bradycardia (<120 b/m) </li></ul>
  26. 26. Causes of foetal tachycardia (>160 b/m) <ul><li>Maternal high fever </li></ul><ul><li>Foetal distress </li></ul><ul><li>Maternal tachycardia </li></ul>
  27. 27. Causes of foetal bradycardia (<120 b/m) <ul><li>Foetal distress </li></ul><ul><li>Foetal cardiac conduction defect </li></ul>
  28. 28. Investigation <ul><li>CBC </li></ul><ul><li>Blood grouping & Rh typing </li></ul><ul><li>Urine R/E </li></ul><ul><li>RBS </li></ul><ul><li>VDRL </li></ul><ul><li>HBS Ag </li></ul><ul><li>Ultrasound </li></ul>
  29. 29. Ultrasound <ul><li>early pregnancy (preferably at 10-13 weeks) to: </li></ul><ul><li>Determine gestational age </li></ul><ul><li>Detect multiple pregnancies </li></ul><ul><li>Help with later screening for Down's syndrome </li></ul>
  30. 30. Ultrasound (cont’d) <ul><li>At 11-14 weeks: </li></ul><ul><li>offer nuchal translucency screening for Down's syndrome, with other tests if available. </li></ul><ul><li>At 18-20 weeks: </li></ul><ul><li>offer screening with ultrasound for congenital anomalies. </li></ul><ul><li>At 36 weeks: </li></ul><ul><li>for foetal maturity, placenta praevia. </li></ul>
  31. 31. In subsequent visit <ul><li>Patient complains </li></ul><ul><li>General examination </li></ul><ul><li>Gestational age to be calculated </li></ul><ul><li>Identification of problem </li></ul><ul><li>Foetal movement </li></ul><ul><li>SFH measurement </li></ul><ul><li>Health education </li></ul><ul><li>Prophylaxis & treatment of anemia </li></ul><ul><li>Developing individualized birth plan </li></ul>
  32. 32. Second visit (24-28 weeks) <ul><li>SFH measurement </li></ul><ul><li>To detect Multiple pregnancy </li></ul>
  33. 33. Third visit (32 weeks) <ul><li>Screen for- </li></ul><ul><li>Preeclampsia </li></ul><ul><li>Multiple pregnancy </li></ul><ul><li>anemia </li></ul><ul><li>IUGR </li></ul>
  34. 34. Fourth visit (36 weeks) <ul><li>Identification of foetal </li></ul><ul><li>Lie </li></ul><ul><li>Presentation </li></ul><ul><li>Position </li></ul><ul><li>Update birth plan </li></ul>
  35. 35. Antenatal advice <ul><li>Principles: </li></ul><ul><li>To impress the patient about the importance of regular check up </li></ul><ul><li>To maintain or improve the health status of the woman to the optimum till delivery by judicious advice regarding diet, drugs and hygiene </li></ul><ul><li>To improve and tone up the psychology and ot remove the fear of pregnancy by talking sympathetically to the patient and explaining the principle changes and events likely to occur during pregnancy </li></ul>
  36. 36. Antenatal advice (cont’d ) <ul><li>Diet </li></ul><ul><li>Rest & sleep </li></ul><ul><li>Bowel </li></ul><ul><li>Personal cleanliness </li></ul><ul><li>Clothing, shoes & belt </li></ul><ul><li>Dental care </li></ul><ul><li>Care of breast </li></ul><ul><li>Coitus </li></ul><ul><li>Travelling </li></ul><ul><li>Smoking & alcohol </li></ul><ul><li>Immunization </li></ul><ul><li>Drug </li></ul><ul><li>Mental preparation </li></ul><ul><li>Exercise </li></ul><ul><li>Child care </li></ul><ul><li>Birth plan </li></ul><ul><li>Warning sign </li></ul><ul><li>Family planning </li></ul>Following advices are to be given:
  37. 37. Diet <ul><li>Diet should be: </li></ul><ul><li>nutritious </li></ul><ul><li>balanced </li></ul><ul><li>light </li></ul><ul><li>easily digestible </li></ul><ul><li>rich in protein, mineral and vitamin </li></ul><ul><li>with woman’s choice </li></ul>
  38. 38. DDA of a woman during pregnancy (2 nd half) Food element pregnancy Kilocalories 2500 Protein 60 gm. Iron 40 mg Folic acid 400  g Calcium 1000 mg Vitamin A 6000 I.U.
  39. 39. Diet for a pregnant woman (3000 Kcal) <ul><li>Early morning: </li></ul><ul><li>Tea or coffee – 1 cup </li></ul><ul><li>Biscuit – 2 pcs </li></ul><ul><li>Breakfast: </li></ul><ul><li>Chapatties – 2 pcs </li></ul><ul><li>Egg – 1 poached or boiled </li></ul><ul><li>Vegetable – 1 cup </li></ul><ul><li>Midmorning: </li></ul><ul><li>Milk – 250 ml or 1 glass </li></ul><ul><li>Biscuit – 2 pcs </li></ul><ul><li>Apple or orange – 1 pc </li></ul>
  40. 40. Diet for a pregnant woman (3000 Kcal) <ul><li>Lunch: </li></ul><ul><li>Cooked rice – 4 cup </li></ul><ul><li>Meat or fish – 3 pcs or 120 gm. </li></ul><ul><li>Cooked Dal – 2 cups </li></ul><ul><li>Vegetable – 1 cup </li></ul><ul><li>Leafy vegetable – ½ cup </li></ul><ul><li>Salad – tomato, carrot, cucumber </li></ul>
  41. 41. <ul><li>Evening: </li></ul><ul><li>Biscuits – 2 pcs </li></ul><ul><li>Fruits – on choice </li></ul><ul><li>Dinner: </li></ul><ul><li>Cooked rice – 3 cup </li></ul><ul><li>Meat or fish – 3 pcs or 120 gm. </li></ul><ul><li>Cooked Dal – 2 cups </li></ul><ul><li>Vegetable – 1 cup </li></ul><ul><li>Bed time: one glass of milk </li></ul>Diet for a pregnant woman (3000 Kcal)
  42. 42. <ul><li>Early morning: </li></ul><ul><li>Tea or coffee – 1 cup (without sugar) </li></ul><ul><li>Salted Biscuit – 2 pcs </li></ul><ul><li>Breakfast: </li></ul><ul><li>Chapatties – 2 pcs / Atta – 60 gm. </li></ul><ul><li>Egg – 1 poached or boiled </li></ul><ul><li>Vegetable – ½ cup </li></ul><ul><li>Milk – 150 ml or 1 cup </li></ul><ul><li>Midmorning: apple or sweet lime </li></ul>Diet for a pregnant diabetic woman (2200 Kcal)
  43. 43. <ul><li>Lunch: </li></ul><ul><li>Cooked rice – 1.5 cup / rice – 60 gm. </li></ul><ul><li>Meat or fish – 1 pcs or 40 gm. </li></ul><ul><li>Cooked Dal – 1 cup </li></ul><ul><li>Leafy vegetable – ½ cup </li></ul><ul><li>Salad – tomato, carrot, cucumber </li></ul><ul><li>Evening: (4 pm) </li></ul><ul><li>Salted Biscuits – 2 pcs </li></ul><ul><li>Milk – 150 ml or 1 cup </li></ul>Diet for a pregnant diabetic woman (2200 Kcal)
  44. 44. <ul><li>Dinner: </li></ul><ul><li>Chapatties – 3 pcs / Atta – 90 gm. </li></ul><ul><li>Meat or fish – 1 pcs or 40 gm. </li></ul><ul><li>Cooked Dal – 1 cup </li></ul><ul><li>Vegetable – ½ cup </li></ul><ul><li>Bed time: one cup of milk </li></ul>Diet for a pregnant diabetic woman (2200 Kcal)
  45. 45. <ul><li>Restricted food: </li></ul><ul><li>sugar </li></ul><ul><li>Molasses </li></ul><ul><li>Honey </li></ul><ul><li>Jam / jelly </li></ul><ul><li>Sweet </li></ul><ul><li>Chocolate </li></ul><ul><li>Ice-cream </li></ul><ul><li>juice </li></ul>Diet for a pregnant diabetic woman (2200 Kcal)
  46. 46. Rest and sleep <ul><li>8 hour sleep at night </li></ul><ul><li>At least 2 hour sleep after mid-day meal </li></ul><ul><li>Hard strenuous work should be avoided in first trimester and last 4 weeks </li></ul>
  47. 47. Bowel <ul><li>Regular bowel movement may be facilitated by regulation of diet, taking plenty fluid, vegetable and milk </li></ul>Coitus <ul><li>Should be avoided in </li></ul><ul><li>1 st trimester </li></ul><ul><li>last 6 weeks </li></ul>
  48. 48. Travelling <ul><li>Should be avoided in </li></ul><ul><li>1 st trimester </li></ul><ul><li>last 6 weeks </li></ul><ul><li>Air travelling is contraindicated in </li></ul><ul><li>Placenta praevia </li></ul><ul><li>Preeclampsia </li></ul><ul><li>Severe anemia </li></ul>
  49. 49. Immunization <ul><li>Indicated- </li></ul><ul><li>TT </li></ul><ul><li>HAV </li></ul><ul><li>HBV </li></ul><ul><li>Rabies </li></ul><ul><li>Contraindicated- </li></ul><ul><li>Live virus vaccine (rubella measles, mums, varicella) </li></ul>
  50. 50. Warning sign <ul><li>Headache </li></ul><ul><li>Blurring of vision </li></ul><ul><li>Convulsion </li></ul><ul><li>Vaginal bleeding </li></ul><ul><li>Fever </li></ul>
  51. 51. Preconceptional care <ul><li>Preconceptional care is the one step ahead of antenatal care. </li></ul><ul><li>When a couple is seen and counseled about pregnancy, its course and outcome before the time of actual conception, is called Preconceptional care. </li></ul><ul><li>Objective: to ensure that, a woman enters pregnancy with an optimal state of health which would be safe both to herself and the fetus. </li></ul>
  52. 52. Preconceptional care includes: <ul><li>Identification of high risk factor </li></ul><ul><li>Basal level health status including BP recording </li></ul><ul><li>Rubella & Hepatitis immunization </li></ul><ul><li>Folic acid supplementation </li></ul><ul><li>Maternal health is optimized preconceptionally such as overweight anemia </li></ul><ul><li>Patient with medical disease like hypertension, diabetes are stabilized in an optimal state by intervention </li></ul>
  53. 53. Preconceptional care includes: (cont’d) <ul><li>Drugs used before pregnancy are verified and changed if required to prevent any adverse effect of the fetus; e.g., warfarin is replaced with heparin, oral anti-diabetic drug with insulin </li></ul><ul><li>Advise to stop smoking, alcohol and drug abuse </li></ul><ul><li>Proper counseling to those with history of recurrent foetal loss or family history of congenital abnormalities </li></ul><ul><li>Counseling regarding health care cost </li></ul><ul><li>Find out supporting or helping people to help the mother and care of the new born </li></ul>