4. Why is it important?
• Determines the wellbeing of the newborn and
chance for survival (mother history)
5. AREA OF CONCERNS:
• Pre-conception counselling
• Assessment of risk factors
• Ongoing assessment of fetal well-being
• Ongoing assessment of complications
• Education
• Discussion of birthing care options
6. Timing of antenatal visits:
• The first visit should not be deferred beyond
the second missed period.
• Once a month until 28 weeks.
• Twice a month until 36 weeks.
• Every week during the last 4 weeks of
pregnancy.
7. PROCEDURE AT THE FIRST VISIT
• > Detailed Health History
• > Physical Examination
• > Breast and Pelvic Examination
8. Vital statistics:
• Name
• Age
• Ward/unit
• IP no
• Address
• Religion
• Occupation
• Education
• LMP
• EDC
• GA
• Obstetric score
• Blood group
13. Maternal History and Risk Factors
• Comprehensive maternal history and physical
examination is important to point out the risk
factors.
• Risk factors can be related to mother, during
pregnancy, during labor and delivery, or after
delivery.
• Antenatal assessment starts with determination of
risk factors.
• Better knowledge about risk factors better
preparation to care for the patient.
14. abortion
• 31% of pregnancies end in miscarriage
• Only rarely would an abortion cause problems
in a subsequent pregnancy
• increased risk of miscarriage only in women
who have had multiple induced abortions.
15. Risk Factors
• Preterm Birth:
• What is considered preterm??
• The second greatest cause of morbidity and mortality
in neonates.
• Previous preterm birth increases the subsequent
preterm birth:
• 1 prior = 15% of subsequent preterm birth.
• 2 prior = 32% of subsequent preterm birth.
16. Risk Factors
• Incompetent Cervix:
• Caused by cervical trauma, previous surgery, or may
be congenital.
• Usually leads to membrane rupture and premature
delivery.
• If severe, a suture around the cervical canal is
performed.
17. Risk Factors
• Maternal Smoking and Alcohol Intake:
• In the US, about 10% of pregnant mothers smoke, drink
alcohol or use drugs.
• Maternal intake of alcohol leads to fetal growth
problems.
• Smoking HBCO decreases availability of oxygen to
placenta and fetus.
18. Risk Factors
• Maternal Hypertension
• Complicates 6-8% of pregnancies.
• Hypertension during pregnancy (after W24) is termed:
Preeclampsia.
• Preeclampsia (High BP, proteinuria, edema)
• Can lead to placental abruption, and preterm delivery.
19. Risk Factors
• Diabetes:
• Increase the risk for CV and CNS malformations, and
metabolic disturbances.
• When appears during pregnancy (Gestational
Diabetes Mellitus, GDM).
• Treatment: glycemic control.
20. Risk Factors
• Infections Diseases:
• Infections can be transmitted to fetus.
• Early screening and detection of the infection is
important.
• Complicated by the rupture of the membrane.
21. Risk Factors
• Problems in Placenta, UC, and Fetal
Membrane:
• premature rupture : causes 50% of preterm
births.
• UC : Prolapse, short, single artery (3%)
• Placental problems
23. BREAST EXAMINATION
• flat (nipple does not protrude with
stimulation)
• retracted (nipple pulls back slightly)
• inverted (nipple pulls inward when
compressed)
32. Investigations
• First visit: Hb, Blood group, Rubella, Hep B and
C and HIV screening.
• 10-12 weeks: Chorionic villous sampling
• 15-18 weeks: USG, serum AFP/triple test ,
amniocentesis
• 28 weeks: Hb ,TC/DC, ferritin, GTT, and low
vaginal swab to exclude Group B strep.
• 36 weeks: Hb
33. Antenatal chart should record the
following:
• Weight gain (12-15 kg in total)
• BP (a diastolic pressure>90, or increase of >20 from
first visit is significant)
• Urinalysis (watch for protein, glucose, and UTIs)
• Fetal movements
• Uterine size in accordance with dates and ultrasound
• Fetal lie, presentation, and engagement, especially
after 36 weeks
34. Antenatal Assessment
ULTRASOUND
• Uses high frequency sound waves.
• Hand-held transducer is placed directly over the
mother’s abdomen, and reflected waves are
recorded on screen image.
• Can give valuable information about pregnancy and
fetus
37. Antenatal Assessment
AMNIOCENTESIS
• Is the procedure of obtaining a sample of amniotic fluid.
• Usually performed after W15 (w15-20).
• A needle is inserted through the skin and uterine wall to
the amniotic sac.
• Insertion is guided by Ultrasound.
• Sample from amniotic fluid is obtained for analysis.
• Very safe procedure (complication rate <1%).
38. Antenatal Assessment
FETAL HEART RATE (FHR) MONITORING
• Heart starts to beat between W16-W20, but beats can
be detected as early as W8.
• Normal 120-160 bpm.
• Becomes very common test.
39. Antenatal advices
• Diet
• exercise
• Rest and sleep
• Bowel
• Bathing
• Clothing
• Dental care
• Coitus
• Care of breast
• Immunisation