antenatal and intranatal care

1. Antenatal
&
Intra-natal
DR. Jagannath S Shete
Assistant Professor, Community
Medicine, DYPMC, Kolhapur

2. • Maternal health care includes Antenatal, Intranatal care and Postnatal
care. Quality intra-natal care is very important.
• Maternal Death : death of a woman, while pregnant or within 42 days
of termination of pregnancy, irrespective of the duration and site of
pregnancy, from any cause related to or aggravated by pregnancy or its
management but not from accidental or incidental causes. (ICD-10)
• Late Maternal Death : death of a woman from direct or indirect
obstetric causes, more than 42 days but less than one year, after
termination of pregnancy.
• Maternal Mortality Ratio : This represents the risk associated with each
pregnancy, i.e. the obstetric risk. It is calculated as the number of
maternal deaths during a given year per 100,000 live births during the
same period. This is usually referred to as rate though it is a ratio.
• Maternal Mortality Rate: It measures both the obstetric risk and the
frequency with which women are exposed to this risk. It is calculated as
the number of maternal deaths in a given period per 100,000 women of
reproductive age (usually 15- 49 years).

3. Antenatal Care
• Care of women during pregnancy is called antenatal care.
• Antenatal care includes visit to antenatal clinic, examination,
investigations, immunization, supplements (Iron, Folic acid,
Calcium, Nutritional) and interventions as required.
• Preconception care refers to physical and mental preparation of
both parents for pregnancy and childbearing in order to improve
the pregnancy outcome. Antenatal (Prenatal) care formally begins
with the diagnosis of pregnancy and includes ongoing assessment
of risk, education and counselling and identifying, managing
problems if they arise.
• Pregnancy tracking: to ensure complete ANC registration ANM
estimates expected no. of live births in her area, by multiplying
birth rate & population of that area divided by 1000.

5. • Frequency : regular antenatal health check once a month during
first seven months, twice a month for 8th month and every week
thereafter till delivery. However, a minimum of four visits are
essential.
• Essential Antenatal Care: Early registration by 12-16 weeks
followed by visits at 20, 32 and 36 weeks. At least one home visit
by health worker must be made. Immunization with tetanus
toxoid and Iron Folic Acid supplements for 100 days. Deworming
with mebendazole in areas endemic areas during 2nd/3rd
trimester. .
• History Taking and Examination : detailed medical, psychosocial
and immunization history followed by measurement of height,
weight, pelvimetry, gen. examination. Important laboratory tests
include hemoglobin, urinalysis, PAP smear, VDRL. There is an
opportunity for health promotion like cessation of tobacco,
alcohol, manage pre-existing medical disorders, appropriate
immunization and pregnancy planning and family planning.

6. Identification of “High Risk” Pregnancies:
• Maternal Factors (i) Age- <18 years or > 30 years (especially in
primigravida) (ii) Multiparity (>4) (iii) Short stature (<140 cms)
(iv) Weight < 40 Kg/weight gain < 5 Kg (v) Rh negative
• Bad Obstetric History (i) Recurrent abortions(2x1st trimester
or 1 mid-trimester) (ii) Intrauterine death or intrapartum
death/stillbirth (iii) Prolonged labour, birth asphyxia, early
neonatal death (iv) Previous caesarean section/scar
dehiscence (v) Postpartum haemorrhage, manual removal of
placenta (vi) Baby which is LBW, premature/SFD or large for
date, congenitally malformed (vii) Malpresentation,
instrumental delivery, ectopic pregnancy (viii) Twins,
hydramnios, pre-eclampsia
• Medical Disorders (i) Cardiac (RHD, CHD, Valve defects),
Renal, Endocrine (Thyroid) or Gastrointestinal disease.(ii)
Infections - TB, Leprosy, Malaria etc. (iii) Hypertension,
Diabetes, IHD and Seizures (iv) Anaemia

7. • Health Education: prenatal advice regarding (a)Diet & Rest (b)
Personal Hygiene and Habits as smoking/alcohol (c) Sexual
intercourse (d) Drugs/Radiation (e) Exercise (f) Travel (g) Care of
Breasts (h) Weight Gain (i)B.P
• Woman should be educated on warning signs during pregnancy
which should not be ignored. Signs as (i) Swelling of feet (ii)
Convulsions/ unconsciousness (iii) Severe headache (iv) Blurring
of vision (v) Bleeding or discharge per vaginum (vi) Severe
abdominal pain.
• Pregnancy with HIV: Treatment with AZT 300 mg every 12 hours
is given from 36 weeks of pregnancy till onset of labour and
thereafter 300mg every 3 hours. Alternatively, Nevirapine 200
mg single dose as early as possible in labour and 50 mg in oral
solution form to the newborn within 72 hours is recommended
to prevent mother to child transmission. Breast feeding
recommended with doctors advise.
• Pregnancy with HBV, Syphilis, Rubella....

8. • Intranatal Care
• Objectives of Intranatal Care - 1. Thorough Asepsis (“The Five
Cleans” - clean hands, surface, blade, cord, tie,perineum). 2.
Minimum injury to mother and child . 3. To deal with any
Complications during labour. 4. Care of the Newborn.
• Disposable delivery kit given to health worker/TBA contains gauze,
ligatures, blade, cotton, soap, antiseptic lotion, chloramphenicol
applicap
• Danger maternal signals as obstructed labour, bleeding,
convulsions, fever, collapse and danger signals of fetus as
meconium stained liquor, change in fetal heart rate, prollapse of
cord should be monitored.
• Use of partograph which has sections as fetal heart rate, cervical
dilatation & descent of head, uterine contractions, maternal vitals.
• Domicialiary care Vs Institutional care
• Rooming in- keeping baby’s crib by side of mother, opportunity for
mother to know baby, ease for breast feeding, relieves anxiety .