Antenatal care, also known as prenatal care, is the care that a woman receives during pregnancy to ensure the health of both the mother and the fetus. This care typically begins as soon as a woman suspects or confirms that she is pregnant and continues throughout the pregnancy. The main goal of antenatal care is to detect and manage any potential problems or complications early on, in order to optimize the health of the mother and baby. This care includes regular check-ups with a healthcare provider, as well as laboratory tests and imaging studies to monitor the health of the fetus and mother. During antenatal care, healthcare providers typically check for signs of conditions such as gestational diabetes, hypertension, and pre-eclampsia, as well as assess the baby's growth and development. They also provide guidance on nutrition, exercise, and lifestyle changes to support a healthy pregnancy. Antenatal care also includes education on childbirth and postpartum care, as well as opportunities for the expectant mother to ask questions and discuss any concerns they may have. It is important for women to receive adequate antenatal care to increase the chances of a healthy pregnancy and delivery, and to prevent any potential complications.

1. Antenatal care

2. Aim of antenatal care
• To optimize pregnancy outcomes for women and babies.
• To prevent, detect and manage those factors that adversely affect the health of
mother and baby.
• To provide advice, reassurance, education and support for the woman and her
family.
• To deal with the ‘minor ailments’ of pregnancy.
• To provide general health screening

3. Dating the pregnancy by LMP
• Assuming the cycle is regular ,the EDD is calculated by taking the date of
the LMP, counting forward by 9 months and adding 7 days.
• If the cycle is longer than 28 days, add the difference between the cycle
length and 28 to compensate

4. Examples on EDD
• A patient with regular cycle of 28 days her LMP was on 1.2.2020
Her EDD is : 8/10/2020
• A patient with a cycle of 35 days on 1.2.2020 , we add 9 months and 7 days
plus the 7 days difference from the 28 days (14 days )
EDD = 15.10.2020
• A patient with a cycle of 21 days , her LMP on 1.2.2020 her LMP will be by
adding only 9 months , EDD = 1.10.2020

5. How to write gravida and para on history ?
• Gravida (G ) is how many times she got pregnant , whatever the outcome
was .
• Para (p) is all deliveries happened after 23+6 weeks (live or not )
• Plus : are the miscarriages happened (before 24 weeks ) whatever the location
was

6. Examples …..
• A patient who is pregnant 16 weeks now , she has one son who is 12years old and
a daughter who is 9 years old , she had 2 miscarriages the first was in the first
trimester and was completely miscarried and the other missed abortion of at 15
weeks who had a medical termination of pregnancy for it , the patient told you that
she had one stillbirth at 30 weeks GA and one infant who was died when he was
3 years of age due to congenital heart disease .
• By asking her on a small 3 scars on her abdomen she told you she had a surgery for
one ectopic pregnancy when her tube was removed laparoscopically

7. G8P4+3

8. Leopold maneuvers

9. Antenatal visits
• In low risk multiparas women 7 visits are recommended
• In low risk primigravida 10 visits are recommended

10. Antenatal visit (NHS )
First trimester Second trimester 3rd trimester
Dating booking 10-13+6 weeks 16 weeks visit 28 weeks visit (Hb and growth )
Education
Full history , LMP , dating , NT
18-21 weeks visit
(detailed anomalies scan )
34 week visit (anti D )
Screening test of aneuploidy
Hb , multiple gestation ?
Full history , LMP , dating , NT
Additional visit at 25 weeks for
Primigravidas
38 week visit
( council about prolonged
pregnancy)
Maternal screening tests 41 week visit
(membrane sweeping and book
for induction of labor )
Additional visits for PG at 25
and 31 weeks

11. Other schedules for visits
• Monthly in the first 7 months (30 weeks )
• Twice weekly in the 8th and 9th month (till 38 weeks )
• Once weekly after that (38 weeks and above )

12. First visit
• Screening to detect high risk population
by history examination and proper investigations , review of medications if was not done
prenatally
Risks for GDM , PET , IUGR and the need for timed tests and modified supplements and
medications (to be discussed later )
• Pregnancy dating by LMP and most accurately ultrasound (CRL )
 (to be discussed later in role of ultrasound in obstetrics )

13. Weight assessment
• BMI should be measured in the first visit
• For normal weight women (BMI 18.5–24.9 kg/m2) the recommended total
weight gain in pregnancy is 11–16 kg
• for overweight women (BMI 25–29.9 kg/m2) 7–11 kg
• for obese (≥30 kg/m2) women 5–9 kg

14. Effect of obesity
• Difficult ultrasound (more undetected congenital anomalies )
• GDM , PET , VTE
• Difficult anesthesia
• Difficult fetal monitoring
• More cs and difficult instrumental deliveries
• Wound infections
• Postnatal depression
• Macrosomia
• Still birth and miscarriage
• Fetal injuries and shoulder dystocia
• Childhood obesity

15. General pregnancy dietary advice
• Do not eat for two; maintain your normal portion size and try and avoid snacks.
• Eat fiber-rich foods such as oats, beans, lentils, grains, seeds, fruit and vegetables as well as whole
grain bread, brown rice and pasta.
• Base your meals on starchy foods such as potatoes, bread, rice and pasta, choosing whole grain
where possible.
• Restrict intake of fried food, drinks and confectionary high in added sugars, and other foods high
in fat and sugar.
• Eat at least five portions of a variety of fruit and vegetables each day.
• Dieting in pregnancy is not recommended but controlling weight gain in pregnancy is advocated
• Caffeine intake less than 200 mg/ day
• Avoid undercooked food and soft cheese ,pate ,undercooked food

16. Advice on smoking
• Increases the risk of :
SGA
ABRUPTIO PLACENTA
OVERALL PERINATAL MORTALITY

17. General exercise advice
• Aerobic and strength conditioning exercise in pregnancy is considered safe
and beneficial.
• NOT scuba diving !!

18. Booking tests and infection screening
• Bp assessment (at first visit and every visit )
• CBC (booking , 28 weeks and additional at 20-24 if multiple gestation )
• BG and Rh status (booking and 28 weeks to detect sensitization )
• Infections hepatitis B , syphilis , HIV
• MSU every visit to detect asymptomatic bacteriuria (midstream urine )
• Ultrasound scan : dating(10-13+6 weeks ) , number of sacs , fetal heart …
• First trimester screening test

19. Other test in specific situations
• OGTT for GDM if she had GDM in previous pregnancy
• Thalassemia and sickle cell disease in high risk ethnic groups
• Rubella IgG (not anymore in UK )

20. Supplements
• Folic acid 400 mcg for all ideally 3 months before pregnancy till 12 weeks
• Higher folic acid supplementation (5 mg ) if DM , sickle cell ,on AED,
thalassemia , history of NTD (family , personal , sons )
• Vitamin D : 10 mcg (400iu ) for all
• Higher dose of it D (1000 iu ) if : obese ,dark skin, not exposed to sun ,
history of PET (calcium and vit D 800 iu )

21. PET risk assessment
Aspirin 75 mg
should be given if
one major or more
than one moderate
risk starting from 12
weeks and before 20
weeks

22. Risk assessment
IUGR
Major risk
Serial growth scan from 26 weeks
3 or more minor risks
Uterine artery doppler at 20-24 weeks
Low risk
SFH

23. Second trimester
• Detailed anomalies scan 20-22 week
• GDM screening (24-28 weeks )
• Second trimester aneuploidy screening
• Fetal growth for high risk population

24. GDM screening
• BMI above 30 kg/m2
• previous macrosomic baby weighing 4.5 kg or above
• previous gestational diabetes
• family history of diabetes (first-degree relative with diabetes)
• Ethnic group of a high prevalence of diabetes:
South Asian, black Caribbean, Middle Eastern

25. OGTT
• all previous population categories should be screened using 2 hour 75 g
OGTT test at 24-28 weeks
• Patients with a history of GDM should be screened as soon as
possible
GDM diagnosed if one of the reading is abnormal :
Fasting more than 5.3 mmol (95 mg-dl)
2 hours more than 7.8 mmol (140 mg-dl )

26. Medications in pregnancy

27. Vaccines

28. Important teratogenic drugs
• Anticonvulsants
• Antibiotics
• Anticoagulants
• Antimetabolites
• Antipsychotics
• Androgens
• Acne drugs
• Alcohol
• Anti hypertensives

30. Teratogenic drugs
• Phenytoin , phenobarbital , valproic acid (fetal hydantoin syndrome )
• Warfarin (stippled epiphysis ,hypoplastic nasal bone , heart )
• ACE inhibitors (lisinopril) and ARBs (losartan) : renal and oligohydramnios
• Isotretinoin (neurological and facial )
• Lithium : ebstein anomaly
• Androgens : androgenizing a female fetus
• Chemotherapy (IUGR , sterility ….)
• Radiotherapy (leukemia , pregnancy loss , neurodevelopmental ,IUGR ,loss )
• Fetal alcohol syndrome

31. Teratogenic antibiotics
Antibiotic effect
Chloramphenicol Gray baby syndrome (cardiac collapse )
Tetracycline Teeth staining
Trimethoprim Neural tube defect (antifolate)
Aminoglycosides (streptomycin) Ototoxic (8th nerve ) nephrotoxic
Nitrofurantoin and sulfonamides 3rd trimester (hemolysis , kernicterus )
Quinolone (ciprofloxacin ) C Cartilage