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1. ANTENATAL CARE
Presented By:-
Ratna Parmar

2. INTRODUCTION
Antenatal care is the systemic
examination & advices given to the
pregnant women at regular & periodic
intervals based on the individual needs
starting from the beginning of pregnancy
till delivery. Antenatal examination is
carried out whenever visit the clinical the
clinical for antenatal check up.

3. DEFINITION
Antenatal care refers to the care given to the
expectant mother from the time the
conception is confirmed until the beginning
of labor.

5. AIMS AND OBJECTIVE
• To screen the high risk cases
• To prevent or to detect and treat at the earliest any
complications.
• To ensure continued medical surveillance and
prophylaxis.
• To educate the mother about the physiology of
pregnancy and labor by demonstrations, charts and
diagrams , so that fear can be removed and
psychology is improved.

6. • To discuss with the couple about the place,
time, and mode of delivery.
• To motivate the couple about to the need of
family planning and also appropriate advice to
couple seeking medical termination of
pregnancy
• The objective is to ensure a normal pregnancy
with delivery of a healthy baby from a healthy
mother.

7. PROCEDURE AT THE FIRST VISIT
• To assess the health status of the mother and
fetus, to screen out the risk pregnancy and to
formulate the plan of subsequent
management
• To obtain a baseline information against which
the subsequent changes are assessed and
which are of importance in the determination
of the gestational age.

8. FREQUENCY OF VISITS TO THE ANTENATAL
CLINIC
• Ideally the mother should visit the antenatal
clinic once a month during the first seven
months (28 weeks) twice a month during the
eighth month (upto 32 weeks) and thereafter
once a week if everything is normal.

9. HISTORY TAKING
 VITAL STATISTICS:- It includes measuring the respiration,
pulse, blood pressure,temperature of mother.
 OBSTETRIC HISTORY:- It includes-
 Past Pregnancy: Number of child, no. of live births, no. of
conception,no. of pregnancies etc.
 Present Pregnancy: Duration of amenorrhea, eating and
sleeping habits, bowel and bladder pattern, minor
disorders.
 MENSTRUAL HISTORY:- Age of menarche, frequency,
duration and amount of menstrual flow, dysfuntional
uterine bleeding.

10.  PAST MEDICAL HISTORY : Medical condition that require
special care
- Urinary tract infection
- Essential hypertension
- Asthma, Epilepsy
- Diabetes
- Cardiac condition

11.  Past surgical history: If any surgery occurred or past
LSCS history
 Family history: History of conditions that are genetic
in origin, familial or racial.
- Diabetes in first degree relative
- Hypertension
- Multiple pregnancies
- Sickel cell anemia
- Congenital anomalies

12.  Personal history:- Patient Name, Age, Religion,
Occupation.
 Spouse: Name, Age, Occupation, Family income, and
Address.

13. • Period of gestation:- The duration of pregnany
is to be expressed in terms of completed
weeks. A fraction of week of more than 3 days
is to be considered as completed week. In
calculating the weeks of gestation in early part
of pregnancy, countin is to be done from the
first day of last normal menstrual period
(L.N.M.P) and in later months of pregnancy,
counting is to be done from expected date of
delivery.

14. • Calculation of expected date of delivery
(EDD):- Naegele’s Formula- By adding 9
months and 7 days to the first day of last
normal period. Eg: If patient have 1st day of
last menstrual period on 1st january. By adding
9 months it comes to 1st October and then add
7 days i.e. 8th October, which becomes the
expected date of delivery.

15. EXAMINATION
• Built :- Obese/Average/Thin.
• Nutrition:- Good/Average/ Poor.
• Height:- Short stature is likely to be associated
with a small pelvis.
• Weight:- It shold be checked at every single visit
in the same wieghing machine.
• Pallor : The sites to be noted are lower palpebral
conjuntiva,dorsum of the tounge and nail beds.
• Jaundice:- under surface of tongue,hard palate
and skin.

16. • Neck : Neck veins, thyroid gland or lymph
glands are looked for any abnormality.
• Oedema of legs: Both legs are to be
examined. The sites for oedema are over the
medical malleolus and anterior surface of the
lower 1/3rd of the tibia. The area to be
pressed with the thumb for at least 5 seconds.

18. • Blood pressure: High blood pressure is not good.
Pre- eclampsia 140/90. Eclamsia more than
140/90.
• Breasts:- Examination of breast is mandotory not
only to note the presencs of pregnancy changes
but also to note the nippels (cracked or
depressed) and skin condition of the areola. The
purpose is to correct the abnormality, if any, so
that there will be no difficulty in breast feeding
immediately following delivery.

19. Obstetric examination
• Abdominal:- Tone of abdominal muscles,
presence of any incisional scar.
• Vaginal:- It is done to 1) to diagnose the
pregnancy 2) to corroborate the size of the
uterus with the period of amenorrhea 3) to
exclude any pelvic pathology.

20. • Steps of Vaginal Examination:- The patient
should be empty bladder.
1) Inspection:- By separating the labia using
the left two fingers (thumb and index) the
character of vaginal discharge.
2) Bimanual examination:- Two fingers index
and middle of the right hand are introduced
deep into the vagina while separating the
labia by left hand.

21. • Gentle examination is done to note:-
• Cervix- Consistency, direction and any
pathology.
• Uterus- Size shape position
Routine examination:- Examination of blood-
Hb, blood glucose, ABO RH grouping.
Urine is examined for urine sugar, protine, pus
cells. For this midstream urine is collected.

22. Methods of Obstetrical Examination
• Inspection :- To note:
• Whether the uterine ovoid is longitudinal or
transverse or oblique
• Contour of the uterus- fundal notching,
convex or flattened anterior wall, cylindrical or
spherical shape

23. Palpation:-
• Height of the uterus: The uterus is to be
centralized if it is deviated. The ulnar border
of the left hand is placed on the upper most
level of the fundus and an approximate
duration of pregnancy is ascertained in terms
of weeks of gestation.

25. Obstetric Grips:
• Palpation should be conducted with utmost
gentleness. During Braxton –hicks contraction
or uterine contraction in labour, palpation
should be suspended.

26. • Fundal Grip:- The palpation is done facing the
patient”s face. The whole of the fundal area is
palpated using both hands laid flat on it to find out
which pole of the fetus is lying in the fundus: (a)
broad , soft and irregular mass suggestive of
breech ,(b) smooth , hard and globular mass
suggestive of head. In transeverse lie, neither of
the fetal poles are palpated in the fundal area.

27. • Lateral or umbilical Grip:- The palpation is done
facing the patient’s face. The hands are to be
placed flat on either side of the umbilicus to
palpate one after the other, the sides and front of
the uterus to find out the position of the back ,
limbs and the anterior shoulder. The back is
suggested by smooth curved and resistant feel. The
limb side is comparatively empty and there are
small knob like irregular parts.

28. • First pelvic Grip :- The examination is done facing
the patient’s feet. Four fingers of both the hands
are placed on either side of the midline in the
lower pole of the uterus and parallel to the inguinal
ligament. Fingers are pressed downwards and
backwards in a manner of approximation of finger
tips to palpate the part occupying the lower pole of
the uterus (presentation). If the head, the
characteristics to note are:
– Precise presenting area
– Attitude
– Engagement.

29. Pawlik’s Grip (Second pelvic grip) :- The examination
is done facing towards the patient’s face. The over
stretched thumb and four fingers of the right hand
are placed over the lower pole of the uterus keeping
the ulnar border of the palm on the upper border of
the symphysis pubis. When the fingers and the
thumb are approximated, the presenting part is
grasped distinctly, if not engaged, and also the
mobility from side to side is tested. In transverse lie,
Pawlik”s grip is empty. The grip is also known as third
maneuver of Leopold.

30. Auscultation-
• Locate the fetal heart by identifying the fetal
position and presentation. Use of a hand held
Doppler allows the woman to hear the fetal
heart beat. It is often difficult to hear the fetal
heart before twenty eight weeks with a
Pinards.

31. Documentation-
• Document the palpation, fetal activity and
fetal heart rate in the woman’s notes. Note if
the amniotic fluid volume appears normal for
the gestation.

32. ANTENATAL ADVICE
• DIET
• ANTENAL HYGIENE
• REST AND SLEEP
• Bowel
• Clothing, shoes and belt
• Dental care
• Care of the breasts
• Coitus

34. • Travel
• Smoking and alcohol
• Immunization
• Contraceptive advice
• Well- baby care

35. BIBLIOGRAPHY
• Dutta,D.C.(2004). Text book of Obstetrics.(ed-
6th). Culcutta: New Central Book Agency.
• Fraser, Diane M., Cooper, Margret A. (1999).
Myle’s Textbook For Midwives. (ed- 14th).
London: Churchill Livingstone.
• Kumara Neelam, Sharma Shivani, Gupta
Preeti.(2009) A textbook of midwifery and
gynaecological nursing. Delhi. PV publications
.