obstetrical condition

1. Antenatal care

2. Introduction
• Antenatal care is the medical supervision of women
during pregnancy, from the time of conception until
the labor. During antenatal period, maternal as well
as fetal monitoring is done on a regular basis. Early
diagnosis during pregnancy can prevent maternal ill-
health , injury, maternal mortality, foetal death,
infant mortality and morbidity.

3. OBJECTIVES
• Assess the health status of the mother and fetus.
• Promote and maintain health status of the mother during
antenatal period.
• Screen the high risk pregnancy and prevent and treat any
untoward complications.
• Orient mother with physiology of pregnancy and labor.
• Remove anxiety and fear associated with pregnancy.
• Reduce maternal and infant morbidity and mortality.
• Discuss with the couple about time, place and mode of
delivery.
• Motivate the couple about need of family planning.
For a normal pregnancy, generally 5 check ups are advised at
10th
week, 18th
week, 24th
week, 30th
week, and 36th
week.

4. Antenatal assessment
– Assessment of maternal and fetal well being is
done during antenatal period is done through
history taking, physical examination and
abdominal examination of mother.
– History and physical examination;
– During the 1st
visit, a detailed history is taken
from the mother. It includes the following
– Vital stastitcs
– Name
– Address
– Date

5. • Age – a women who becomes pregnant for
the first time, after 30years of age, is called
as elderly primigravida.
• Gravida and parity
• L.M.P and E.D.D – last menstrual period
and expected date of delivery
EDD is calculated from lmp+9months+7 days
Religion
Duration of marriage
Occupation of mother
Occupation of father

6. History of the present pregnancy
• Any complaint made by the mother during
the present pregnancy should be noted. Any
complication arising in any of the three
trimesters should be noted.
• For example- 1st
trimester- hyperemisis
gravidarum
2nd
trimester- threatened
abortion
3rd
trimester- antepartum
haemorrhage

7. Obstetrical history
• GRAVIDA – the number of times woman
gets pregnant. It does not matter how many
babies were born in a pregnancy, or at what
time it was terminated.
• PRIMIGRAVIDA – it is the mother who
got pregnant for the first time.
• MULTIGRAVIDA- if women gets pregnant
second time.
• NULLIGRAVIDA – women who has never
been pregnant.

8. • Para – number of pregnancies that ended in
the birth of the baby after reaching the
period of viability
• Primipara – a woman who has given birth to
a fetus after reaching the period of viability.
• Multipara – a woman who has given birth to
2 or more babies.
• Nullipara – a woman who has not carried a
pregnancy.

9. Menstrual history
• It is taken from the mother stating her age at
menarrche; frequency, duration and amount
of menstrual blood flow and any
dysfunctional uterine bleeding. LMP is
noted.

10. Family history
• Any diseases which run in the families,
should be noted, such as hypertension,
diabetus, tuberculosis, multiple pregnancy.
• Past medical and surgical history – any
history of past medical diseases or previous
surgeries to be noted.
• Personal history – any history of smoking
or alcohol habits has to be noted. Using any
contraceptive methods prior to pregnancy .

11. PHYSICAL EXAMINATION
– It is done during early antenatal period to find
out any abnormalities or diseases.
– HEIGHT : it is taken as soon as mother comes
for her first antenatal check up.
– WEIGHT : weight should be taken from the
weighing machine.
– GENERAL BUILD : obesity/ thin/ average
– EYES : inspect anaemia from conjuctiva/
jaundice from the sclera
– EARS : look for ache, discharge, tinnitus

12. • Oral cavity : gossitis/ stomatitis
• Neck : thyroid/ lymph node
• Breasts : flat / inverted or cracked nipple
• Vital signs : TPR & B.P
• Lower extremities : odema/ varicosities
• Blood tests : HB/ ABO AND RH FACTOR,
VDRL , HIV.

13. ANTENATAL EXAMINATION
• Before performing the obstetric examination of the
mother , she should be asked to evacuate the
bladder. After making her in dorsal position she is
made to flex her knees. It should be done fully
exposed the abdomen and the examiner stands on
the right side of the mother
• - INSPECTION
• - PALPATION
• - MEASUREMENT
• - ASCULTATION

14. INSPECTION
• Breast : primary areola , secondary areola
present.
• Montogomere’s tubercle present
• Any cracked nipple.
• Palpation : breast engorgement present or
not.
• Colostrum secreted or not.

15. •ABDOMEN :
- Size : big/ small
- Shape : round/ ovoid/ spherical
- Contour : flankfull / not flankfull
- Umblicus : dimpled / protruded
- Skin changes : straie
- Fetal movements

16. •PALPATION
1.FUNDAL PALPATION 2. LATERAL
PALPATION 3.PELVIC PALPATION
- FUNDAL PALPATION: it is done by facing
the mother. Both hands are palced on the
women fundus and fingers are curved
around the top of the fundus. Round , hard
and movable head suggest of fetal head. If
soft and irregular mass suggest then it
breech.

17. • LATERAL PALPATION: RIGHT AND
LEFT
• Right lateral palpation: examiner continues
facing the mother. One hand should be put
pressure on one side and other side should be
palpated. A smooth , curved and resistent
feel suggests of fetal back.
• Left lateral palpation: if there is feel of
irreguler mass , which moves when pressed
suggest fetal limbs.

18. • PELVIC PALPATION
• – external ballotment and internal
ballotement
• Fetal Head engaged or not engaged

19. Signs of previous child
• Perineium : one can see marks or scars
from previous pregnancies. The marks of
previous episiotomy or pernieal laceration
may be found.
• Introitus: there is gaping in the introitus.
One can also see the presence of carunculae
myrtiformes (torn of hymen)
• Vagina: the rugae of vagina are little
strechted . Vagina of a woman who has
already given birth is more spacious.

20. • Cervix: for parous woman is cylindrical and
the external os may admit to the tip of the
finger.
• Wall of the uterus: it is not rigid as of
nulliparous woman and the contour of the
uterus is broad and round.
• Abdomen : wall of the abdomen becomes
loose in multipara.