antenatal care

1. By:
Talal Al-Halabi
Wael Sabe Ayon
Karim Abouljoud

2. Definition
 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.
 Mainly, the aim is to
deliver a healthy baby
to a healthy mother.

3. Aims
1. Monitor the progress of pregnancy  ensure
maternal health and normal fetal development.
2. Recognize deviations from the normal 
Management
3. Ensure that the woman is physically and emotionally
prepared for delivery.
4. Identify high risk pregnancy  Management
5. Prevent maternal perinatal mortality and morbidity.
6. Prepare the mother for breast feeding & parenting.

4. Antenatal care comprises
1. Registration of pregnancy
2. History taking
3. Antenatal examinations
(general & obstetrical)
4. Laboratory investigations
5. Health education: LAMAZE

5. History Taking
 Age  Identify high risk patients
 Parity  Complications of Primigravida vs. Multigravida
 Menstrual history  Identify EDD & AOG by LMP
 Medical history  Consider risks and complications
 Surgical history  Myomectomy, Cx Conization
 Socio-background  Infections?
 Obstetric history  C-sec? Pre-eclampsia? PPH?
Abortions? Cephalopelvic Disproportion
 Gynecological History  Cancer, Fibroids, Polyps, Ulcers
 Special Habits  Alcohol, Smoking, Drug Abuse
 Drug History  Teratogenesis & Effect on the Conceptus

6. Antenatal Examination
 General Examination
 Face & Eyes  Anemia?
 Teeth  Hygene
 Thyroid gland
 Chest: Lungs, Heart and
Breasts (Nipple Disease?)
 Abdomen
 Straia (Especially Straia
Album  Elasticity Index)
 Linea Nigra
 Nipple and Areola
Obstetrical Examination
•Fundal Level by Grips
•Vaginal Inspection(Infections?)
•Fetal Heart Auscultation
•Abdominal Size (Polyhydraminos?)
•Weight
•Blood Pressure
•Pulse
•Respiratory Rate

8. Laboratory Tests
 Maternal
 ABO & Rh
 CBCD
 Serology (HIV,Rubella,CMV)
 Toxoplasma& GBS
 Coagulation Profile
 Urine Analysis
 Gonorrhea & Chlaydia
 ECG & LFTs & TFTs
 Kidney function tests
 Blood Glucose
Fetal
•Ultrasound
•Choriovillous Sampling
•Alfa – Fetoprotein
•Amniocentesis
•Cordocentesis
•Genetic U/S Scan

9. First Trimester
 First Visit (Few After 1st Missed Period)
 U/S  Confirm viable Pregnancy (Yolk Sac) & AOG by Gestational Sac
Volume
 Quantitative h-CG  Confirm Pregnancy
 Determination of EDD using U/S & LMP
 Early Diagnosis of Molar or Ectopic Pregnancy by U/S
 Signs of Early Abortion (Chromosomal Anomalies?)
 Signs of Multiple Pregnancy
 Advice to Take Folic Acid, Vitamins, Iron + Good & Balanced Diet
Second Visit (By the 8th Week)
•U/S  Fetal Movements & FHS + AOG by CRL
•Consider CVS if Chromosomal Anomalies are suspected
•Check maternal BP & Weight gain
•Confirm Fetal Viability & EDD

10. Second Trimester
 First Visit (By the 14th week)
 U/S  Confirm EDD & AOG (BPD, HC, AC, FL) + Placentography + Confirm
Viabilty (FHS) + Early Diagnosis of Hydrops Fetalis + Dx of NTD
 Consider U/S guided Amniocentesis (14th  16th ) if chromosomal
anomalies are suspected
 Consider Genetic U/S scanning (11th  13th)
 Check maternal BP & Weight Gain
 Check for signs of Impeding Pre-eclampsia & Gestational DM &
Anemias
 Check for signs of 2nd trimester Abortions
 Check Fundal Level (slightly above the SP)
Second Visit ( by the 18th  20th week)
•U/S  Confirmation of EDD & AOG + Viability + Fetal Sex
•Listen to Fetal Heart Sounds
•Funal Level Examination
•Maternal BP & Weight Gain & Blood Glucose

11. Third Trimester
 First Visit (24th  28th week)
 U/S  Confirm viability, AOG & EDD, IUGR or IUFD,
Oligohydraminos/ Polyhydraminos
 Consider the Fetal Biophysical Profile
 Check Maternal BP, Weight Gain, Glucose Levels
 Check Fundal Level (umbilicus or a bit higher)
Second Visit ( by the 32nd  36th week)
•U/S  Confirm Viability, EDD, AOG
•Check Fundal Level
•Check for Placenta Praevia
•Check Maternal BP, Weight gain, Glucose
•Listen to FHS
•Check for signs of Maternal Heart Failure
•Consider Fetoscopy if Needed

12.  Third & Last Visit (By the 36th  38th week)
 U/S  Confirm Viability, EDD, Fetal Lie and position
 If breech  Consider External Cephalic Version
 Check Maternal BP, Weight Gain & Glucose
 Review Risks of NVD is present
 Prepare the Mother for Delivery. Consider Lamaze
Classes
 Check Fundal Level (Near or at Xiphy Sternum)
 Clinical Assesment of the bony pelvis
 GBS & Toxoplasmosis Testing
 Education about Breast feeding

13. Education about Pregnancy
 Stages of Pregnancy and Body Changes (Especially In
Primigravida)
 Body Changes with pregnancy may and may not go back to
prepregnant states
 Possible complications and their signs
 Importance of a well balanced diet & Dietary Suppliments
 Lamaze classes: The goal of Lamaze is to increase a
mother's confidence in her ability to give birth; classes help
pregnant women understand how to cope with pain in
ways that both facilitate labor and promote comfort,
including focused breathing, movement and massage