Antenatal care


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Antenatal care

  1. 1. Antenatal Care<br /><br />
  2. 2. Objectives<br />* Prevention, early detection and treatment of pregnancy <br />related complications as pre-eclampsia, eclampsia and haemorrhage.<br />* Prevention, early detection and treatment of medical disorders as anaemia and diabetes.<br />* Detection of malpresentations, malpositions and disproportion that may influence the decision of labour.<br /> * Instruct the pregnant woman about hygiene, diet and warning symptoms.<br />* Laboratory studies of parameters may affect the foetus as blood group, Rh typing, toxoplasmosis and syphilis.<br /><br />
  3. 3. Frequency of antenatal visits<br />>Every month during the first 6 months.<br /> >Every 2 weeks during the 7th and 8th months.<br />>Every week during the last month.<br />>More frequent visits are indicated in high risk pregnancy.<br /><br />
  4. 4. The first visit<br />* History.<br />* Examination: general, abdominal and local.<br /> * Laboratory investigations:<br /> o Blood grouping. <br /> o Rh typing.<br /> o Haemoglobin.<br /> o Toxoplasma and / or VDRL if needed. <br /> o Urine analysis particularly for albumin and sugar.<br /><br />
  5. 5. Return visits<br /> History: ask the patient about any complaint.<br /> Examination:<br /> o Blood pressure.<br /> o Weight.<br /> o Oedema. <br /> o Abdominal examination.<br /> Investigation: urine for albumin and sugar.<br /><br />
  7. 7. Diet<br />The daily requirements are:<br /> * Calories: 2500 Kcal.<br /> * Proteins: 60 gm.<br /> * Carbohydrates: 200- 400 gm.<br /> * Lipids: should be restricted.<br /> * Vitamins:<br /> o Vitamin A: 5000 IU.<br /> o Vitamin B1 (Thiamine): 1mg.<br /> o Vitamin B2 (Riboflavin): 1.5 mg.<br /> o Nicotinic acid: 15mg.<br /> o Ascorbic acid (vit. C): 50mg.<br /> o Vitamin D: 400 IU.<br /> o Folic acid: 0.5 mg.<br /> * Minerals:<br /> o Iron: 15 mg.<br /> o Calcium: 1000 mg.<br /><br />
  8. 8. So the suggested daily diet should include:<br /> * One litre of milk or its derivatives,<br /> * 1-2 eggs,<br /> * fresh vegetables and fruits.<br /> * 2 pieces of red meat replaced once weekly by sea fish and once by calf ’s liver.<br /> * Cereals and bread are recommended also.<br />Coffee and tea: should be restricted.<br /><br />
  9. 9. Smoking: should be avoided as it may cause intrauterine growth retardation or premature labour.<br />Rest and sleep: 2 hours in the midday and 8 hours at night.<br />Exercises: violent exercises as diving and water sports should be avoided. House work short of fatigue and walking are encouraged.<br /><br />
  10. 10. Clothing<br />* Lighter and looser clothes of non synthetic materials are more comfortable due to increased BMR and sweating.<br />* Clothes which hang from the shoulders are more comfortable than that requiring waste bands.<br />*Breast support is required.<br />* Avoid tight elastic hosiery or its bands.<br /><br />
  11. 11. Bathing: Shower bathing is preferable than tube or sea bathing for fear of ascending infection. Vaginal douching should be avoided.<br /><br />
  12. 12. Shoes: High - heeled shoes should be discouraged as they increase lumbar lordosis, back strain and risk of falling.<br /><br />
  13. 13. Breasts: to reduce the incidence of retracted and/ or cracked nipples postpartum, the patient is instructed to massage them with a mixture of glycerine and alcohol during the last 6 weeks of pregnancy.<br /><br />
  14. 14. Bowels: Constipation is avoided by increasing vegetables, fluids and milk intake and mild exercise. Liquid paraffin should not be used for long period as it interferes with absorption of fat- soluble vitamins (A and D).<br /><br />
  15. 15. Coitus: Whenever abortion or preterm labour is a threat, coitus should be avoided. Otherwise, it is allowed with less frequency and violence. Some obstetricians advise abstinence in the last 4 weeksof pregnancy for fear of ascending infection.<br /><br />
  16. 16. Travelling: long and tiring journeys should be avoided particularly ifthe woman is prone to abortion or preterm labour. Flying is not contraindicated but not the long ones and near term.<br /><br />
  17. 17. Medications: not to be taken without obstetrician advice due to risk of teratogenicity<br /><br />
  18. 18. Exposure to infections: is to be avoided particularly those of documented teratogenicity e.g. rubella, cytomegalovirus, herpes hominis and varicella zoster viruses.<br /><br />
  19. 19. Exposure to irradiation: is to be avoided whether diagnostic or therapeutic.<br /><br />
  20. 20. The warning symptoms: which indicate immediate contact to the obstetrician are:<br /> * vaginal bleeding,<br /> * gush of fluid per vagina,<br /> * abdominal pain,<br /> * persistent headache,<br /> * blurring of vision,<br /> * oedema of lower limbs or face,<br /> * persistent vomiting.<br /><br />