4 375921006901985281

Obstetrics Nursing
Ante natal care
u . Zahra Mahmuod Altahir
zahraalhilo707@gmail.com
20/10/2014
05/10/2012
Alaa & Mayada TA U of K, Suppervised by
Ihab Tarawa

Objectives :
 By the end of this lecture the student able to
 - know some terminology in obstetrics
 Definition of ante natal care
 - take history of pregnant woman and to
know types of history
 - examine the pregnant woman
 - know signs and symptoms of pregnancy
 Steps of conception

Obstetrics and Gynecological
nursing
TERMMONOLOGY:-
-gynae= female
-gynecology=is a branch of medicine dealingwith the
disease of women
-gynecologist= specialist in gynecology
-obstetric=is a branch of medicine dealing with
pregnancy, labor and Pureperium
-Obestetriton = specialist of obstetrics

-
TERMMONOLOGY:
-midwifery= is a branch of nursing dealing with
pregnancy, labour, Pureperium
-Midwife =is a prophesional who gives care
during pregnancy, labour and pureperium-post
natal =after
birth=during Pureperium
-pureperium = the period six weeks following
birth

-
TERMMONOLOGY:
-abortion or miscourage = is interruption
of pregnancy by vaginal bleeding before
(20) weeks of gestational age

 Maternal : means mother or female .
 Ante : before .
 Natal : birth .
 Ante natal care : is care which gives to the pregnant women .
 Maternity : is the mother hood
 Post natal care: is care which is given to the puerperal women and
her newborn .
 Puerperium : is period start immediately after delivery of the fetus ,
placenta and membrane up to six weeks .

 Gravid : any pregnancy , regardless of duration .its includes the present
pregnancy .
Para :number of birth after 20 weeks gestation regardless of whether
the infants were born alive or dead .
Primigravida : a woman pregnant for the first time .
Multigravida :a woman who is in her second or a subsequent
pregnancy .
 Primipara : a woman who has given birth to a fetus (dead or alive ) that had
reached 20 weeks gestation .
Multipara : a woman who has given birth two or more times at more
than 20 weeks gestation .
Grand multipara :a woman who has delivered more than five times .

 Elderly primigravida : is the woman who is over 35 years and
she is pregnant for the first time .
 G A : gestational age .
 L N M P : last normal menstrual period .
 E DD : expected date of delivery .
 Length of pregnancy
The average duration of pregnancy is approximately ( 280) days .
- (40) weeks (+ or -2 weeks ) , this is 10 lunar months, and (9 )
calendar months and this is divided into three trimester :

Ante natal care (A.N.C)
*Ante =pre =before
*Natal =birth
*Prenatal =before birth
*antenatal care means care during
pregnancy

Antenatal care
The WHO’s definition of antenatal care:
‘[This] includes recording medical
history, assessment of individual needs,
advice and guidance on pregnancy and
delivery, screening tests, education on
self-care during pregnancy, identification
of conditions detrimental to health during
pregnancy, first-line management and
referral if necessary.’[1]

Aims or objectives of ante natal care:-
1-To maintain and promote physical and mental
health for the pregnant woman and her fetus
during pregnancy.
2- to Raised maternal awareness regard
pregnancy and child peering and prepare the
woman physically and psychologically for (labor,
lactation, and care of her baby).

 Aims or objectives of ante natal care:-
 3- To detect any abnormalities early (control
and treat which need for control and treatment
for condition medically and obstetrically that
could in danger for health of the mother and her
fetus, and prevent the complications.
 4-To ensure a mature, life ,healthy new born .

History of the pregnant woman
When you take the history from the
pregnant woman you must be:-
-great patience
-good listener
-take the history by simple and
understandable language for the
pregnant woman
-reassure the pregnant woman

Types of history:-
1-social history : contain
#pregnant woman history:
-name
-age
-level of education
-occupation
-length of married (or date)
-residence
-tell N0
-Blood grouping

#husband history:
•-name
•-age
•-level of education
•-occupation
•-residence
•-blood grouping
•-degree of relation ship

*housing condition:
-stander of house (numbers of rooms,
water supply, electrical supply, domestic
animals=cats and dogs, location related
to transportation.
*Income or socioeconomic status
(is help to know Family health and
nutrition of the pregnant woman).

2-family history: - contain
*asks the pregnant woman from:-
-family history of twins in both woman and her
husband
•- Family history of DM
•- Family history of HTN
•- Family history of asthma
•- Family history of congenital abnormality
mainly congenital heart disease and congenital
anomalies
•- Family history of psychiatric or mental
disorders
•- Family history of blood disease like sickle
cell anemia or hemophilia

3-past medical history:- contain
Asks her about these diseases: (belonged
mother herself)
-History of DM, HTN
- History of ASTHMA
- History of rheumatic fever and rheumatic
heart disease (because affected the heart)
-asks her about History of rickets and TB
spine because affected the pelvis
- asks her about history of fracture mainly
fracture back and pelvis

3-past medical history:-
- asks her about History of mental illness
- asks her about History of chronic nephritis
- asks her about History of syphilis because can
lead to abortion
- asks her about History of previous
hospitalization and blood transfusion
- asks her about History of operation
*Drugs history:-
-asks her about History of reaction or
hypersensitivity to any drug
- asks her about History of using of long term
drugs

4-gynecological history:-
contain
Asks the pregnant woman from:
- Menarche (first menstruation) or cycle in what
age and kata 5/28days regular or not and asks
her about amount of bleeding and if associated
with pain or not
*asks her if she had history of gynecological
diseases example (ovarian cyst, fibroid)
-asks her if she had history of using
contraceptive methods

5-obstetrical history :- contain 2
history
1-previous or past history
2-present or current history
A-previous history: include
1-history of previous parity or pregnancies
(asks her about sickness or illness in the
1st, 2nd, 3rd trimester for each pregnancy
2-Previous history of abortion (cause of
abortion and gestational age at that time

-History of previous labors;-parity
-History of preterm labor and cause of
prematurity
-History of normal labor( spontaneous normal
vaginal delivery or induced labor
-Instrumental labor (obstructed or prolonged
labor ,forceps or vacuum used or not also
asks her about baby had injury or not
-History of post term labor and GA at birth
-c/s delivery and causes of c/s

4-History of previous babies :
-Asks the woman about pervious babies and
by tarn (GA, cried immediately or not, weight
at birth, alive or dead, breast feeding, fully
vaccinated or not, additional food at what
age, health and age now).
*if the baby born died ask her types of death
-IUFD =intra uterine fetal death
Which called still birth which divided in to two
types
-fresh still birth
-macerated still birth

A-previous history:
*asks the woman about causes of death,
AG, in order to help the woman in the
future
5- History of previous pureperium:
contain
Asks her about previous pureperium
normal or abnormal which called
complicated pureperium like post partum
hemorrhage, sepsis, illness…

B-current or present history:
Asks the woman about: gravity (G) parity
+abortion
Example G3P1+1
-asks her about LNMP to determined
1-or to calculate gestational age (age of
pregnancy)
2- expected date of delivery

 B-current or present history:
 3-asks the woman about (Quickening ( first
fetal movement which can be felt by the
mother at 18 weeks of GA and use this way if
the mother does not know LMP)
 -also ask and advice the mother about rest,
sleeping, diet and exercise during pregnancy)

Ante natal care (ANC)
Should be started early at six weeks of
pregnancy in the ante natal clinic( stander
measure) for follow up to assess the pregnant
women health which called Booking visit
which include. Care during the first visit:-
o 1 take the woman history and record
o 2 examination of pregnant woman from head
to toe. (A –physical examination
B- obstetric examination)

1-general physical examination:-
The examination start systematically from head
to toe (ensure from privacy of pt) and always
begin from head.
*Head and face:
Examine the head for
oThe head:-
1- the face:-
The facial appearance gives impression of physical
and mental condition.
2- the hair:-
-hair condition (normally bright, glossy and
shinny. see cleanness and dandruff.

1-Head and face:
Examine the face for:
A -Facial expressions, appearance, look in and
sometimes need to check forehead for edema
B-eyes:
-asks the mother to see down to observe sclera
for discoloration (jaundice)
- asks her to see up to examine the conjunctiva
for anemia, pallor (normally eyes clear and
bright)
C-nose:-
Examine the nose congestion and nasal

1- Head and face:
D-mouth:
Examine the mouth for
-lips ( color , dryness or any abnormality.
-And asks her to open her mouth and examine tongue for
(color, dryness and coated or not)
- gum: signs of inflammation or bleeding.
-examine the teeth for dental caries and advice her
about care and follow-up
ears:-
- check for discharge.
- ask her about pain

Head and face:
2-neck:
 Observe neck for:
 -thyroid gland enlargement (examine by
asking woman to swallow(
 -lymph node enlargement
 -observe jugular vein for distention or
congestion (this may indicate cardiac
problem
.

3-shest:
3- breast:
Examine breast by inspection first for the
-symmetry of the breast (size and shape)
-signs of pregnancy
-observe nipples (size and shape , retracted, protruding,
inverted or depress nipples) and advice the woman for
care of breast
-palpate the breast for tenderness , mass or lump
- check nipple for discharge ( color, amount, and oder ) .
4-shest:
-asculeatate over all the chest (lungs, heart sound
mainly murmur

5- Obstetric examination (abdominal
examination):-
Aims of abdominal examination:
-to observe signs of pregnancy
-to assess fetal size and growth
-to diagnose the location of fetal parts
-to asses fetal health
-to detect any deviation from normal

 5- Obstetric examination (abdominal
examination):-
 Important points
 *-before examination 30 minutes woman
should be empty her bladder
 -and the abdomen should be exposed
 -the examiner hands should be clean and
warm to prevent abdominal and uterine
contraction, also to reduce discomfort


Steps of abdominal examination:-
1-inspection
2-palpation
3-asculitation
4-percission

1-examination by inspection:-
-see size and shape of abdomen
usually the shape is oval sometimes
rounded
-observe any pigmentation (lina negra,
because in pregnancy Becomes darker
and observe striigravaderum
-observe fetal movement
-observe any scars especially previous
scar of C/S

2-palpation :( 2types)
A-Supper facial palpation:
Feel the abdomen to find out there is
mass or not, tenderness (see facial
expression) and also if had pain and
rigidity of abdomen
B-deep palpation:
-for organs
-you concentrate in liver and spleen
(enlarge or not)
-palpate the loin region (kidneys) for
(hotness, tenderness, pain)

* Obstetric examination:-
* palpate abdomen for
1-fundal level also called (fundal
height)
Fundal grip (fundal palpation)
Lateral grip (lateral palpation)
Pelvic grip (pelvic palpation) which
consist of 1st and 2nd grip
-1st pelvic grip
-2nd pelvic grip

1- fundal level (fundal height):-
Aims:
- To determined GA (size of pregnancy) by
examination
* Arms and hands of the examiner should be relaxed
and pads not tips of the fingers
*notes:
Sometimes GA does not always produce accurate
results because:
-depend on size and number of fetuses
- Amount of amniotic fluid vary
-variation in maternal size and parity

2- Fundal grip (fundal
palpation) :
- To know what inside the fundus or what
equipped the fundus. Normally thing is
preech
-to determine presentation and lie of the
fetus
*characteristics of preech:
-broad, wide, irregular, soft, not easy
balloted or not move free like head
* Characteristics of head:
-small, hard, regular, sometimes smooth

3- Lateral grip (lateral palpation):
You should located the back to determine the
passion of the fetus
**characteristics of back:
Regular one chain, hard ,resisting, a little
gives curve, board
-FHS

4-Pelvic grip (pelvic palpation):
1-First pelvic grip
To know presenting part (you facing
extremities of the mother
2-Second pelvic grip:
To know engagement of presenting part and
you facing the mother

lies:
Lie: is relationship between long axis of
the fetus to long axis of the utrus of the
mother
-normal lie is longutidonal
-abnormal lies:
Transferse, oblique (means not long axis
to the mother)

positions:-
1 -occiput anterior OA
2- occiput posterior OP
3- left occiput anterior (LOA)
4- right occiput anterior ROA
5- left occiput transverse (LOT)
6- right occiput transverse ROT
7- left occiput posterior (LOP).
8- right occiput posterior ROP
When determined the position you know shoulder and
heart

vulva examination (vagina)
Ask the woman about vaginal discharge
(amount, color normally white, smell.
Associated with itching or not
-and observe color of the vagina, edema,
varicose of the vulva or any complains
also observe lesion it may suggested
syphilis

Lower limbs examination:
Examine the lower limbs for
-deformity
-size (also observe size of feet in very small may
suggested contracted pelivs.
- And shape (bowing shape may suggested rikets).
-examine it for edema in
. Ancle
.pretibia
.dorsal of feet
-alsoexamine legs for varicose vein (hotness,
tenderness, pain, edema or calf pain

Measurement :
weight:
In the first visit the preganat woman should be
weighted in order to determine normal weight
because after 6 weeks of pregnancy weight
increasing 25/bounds in whole pregnancy.
.5/bounds in the first 20 weeks of pregnancy
.20 /bounds in second 20 weeks of pregnancy
(1/bound every week)

If the height of the pregnant woman below 5 feet may
suggested contracted pelivs
-also see the woman body for lordosis, kyphosis, or any
abnormality
blood pressure :
Check Bp of the pregnant woman because during
pregnancy BP dropped due to effect of progesterone,
estrogen hormone (in every visit) physiological changes
during pregnancy (seminar)
height:

The Investigations done to in ANC
Blood analysis:
-blood grouping and Rhesus factor
-Hb% in the:
- First visit
-at 28 weeks GA because the blood volume
increase and hem dilution which lead to
dropping of hemoglobin
-36 weeks of pregnancy to prepare and check
the mother for labour
-torches screening mainly for rubella antibodies
titer
-syphilis test , HIV test and HB test

Investigations;
note:
If Hb% low check up frequency according to
the level of Hb%
2-urin analysis:
-urine general (sugar, acetone, specific gravity,
albumin in every visit)
-urine for culture and sensitivity if she
complain
3-abdominal U/S
4-radiography after 36 weeks of pregnancy

Investigations;
note:
Any primigravida must do pelvic assessment
for pelvic capacity by:
-U/S
-Pelvic X ray

Signs and symptoms of
pregnancy
The average duration of pregnancy is approximately ( 280) days .
- (40) weeks (+ or -2 weeks ) , this is 10 lunar months, and (9 ) calendar months and this is
divided into three trimester
used to calculate excepected date of delivery EDD
-added 7days to the first day of last menstrual period (LNMP)
and subtract 3 or added 9 calendars months

- 1- Early Signs and symptoms of pregnancy
(from 6-16 weeks of pregnancy
•-Amenorrhea
•-nausea and vomiting(morning sickness)
•-breast changes (breast enlarge and become tender,
veins in breasts become increasingly visible ‘discharge
from 8 months
•-frequency of urination (frequent bathing urine from 6 to
8 months because capacity of the bladder is reduce due
to expanding uterus on the bladder
•-softness and cyanosis of the vagina and cervix due to
excessive blood supply to this area
•-urine test for pregnancy cannot give (+) ve result
100%(change in level of human chorionic
gonadotropin=hCG) in maternal plasma and urine)

2- Signs and symptoms of pregnancy
(from 16-28 weeks of pregnancy)
•-Breast:
•- nipple become larger and more pigmented
•.darken of primary areola of the breast
•.formation of secondary areola around the nipple
•. appear and enlargement of Montgomery’s tubercles
gland around the nipple
•-quickening:
•Is first fetal movement felt by the mother (16-20 weeks)

2- Signs and symptoms of pregnancy (from
16-28 weeks of pregnancy)
•-ballottement:
•Is feel part of the fetus under hands of the examiner
during examination
•-Fetal heart sound heard between 16th -20th weeks with
fetoscope (pinard’s fetooscope) or the 10th -12th week
with a Doppler sethoscope
•-progressive uterine enlargement
•-lina negra(dark vertical line on the abdomen between
the sternum and the symphysis pubis) and other
pigmentation observe from 20 weeks (mask pregnancy or
butterfly)

3-Signs and symptoms of pregnancy (from 28-
40 weeks of pregnancy)
-great abdominal and uterine enlargement
-fetal parts can be felt and fetal movement can be seen
-lina negra and stile gravidarum appear in the breasts,
abdomen, buttocks and thighs due to stretching, rupture
and atrophy of deep connective tissue of the skin
-upward pressure may cause (restlessness, heart burins)
-Note:
Before 12 weeks of pregnancy the uterus is pelvic organ
-down ward pressure may cause frequent of micturation,
also may cause varicose of the vulva due to pressure

Nutrition in pregnancy
should be providing :
1-need of the growing
2-mentinance of maternal health
3-Physical sterngth during labuor
4-successful lactation
-and food requirement should be increase
more in quality and the nurse should advice
and select the proper food

-daily requirement
Type Need calories
Protein 90 gram (4) 360 ca
Fat 100 gram (9) 900 ca
Carbohydrate 320 gram (4) 1280 ca

contin
1-Protein:
Essential for :-
1-substance built tissue
2-growth of fetus,placenta,uterus,breasts
3-increase blood volume
2-Carbohydrate
essential but should be normal intake during pregnancy
to avoid abnormal increasing weight
3-Fats:-
Should be contain mainly animal fats or types because
its contain vit A and D (according to income)

4-menerals:
1-Iron: daily requirement 15 mg/day and essential for
-need of the fetus
-to avoid break down of RBCs from bone
-loss of blood during labour
-for lactation period
Foods:
Liver ,kidney,heart,beaf,eggs, green vegetables
2-Calcium:-
Daily need 1.5g need for (fetal bones ,teeth,muscles
tone,coagulation of the blood)
#Foods:-
Beaf,dates,seesame,and the best source is milk and milk
products ,green vegetables

4-menerals:
Phosphorus:- need for
To harden fetal bones,and teeth and formation of new
cells
#Foods:
Fish,eggs,milk,cheece,vegetables
4 -iodine: need for
To control metabolism by the thyroid gland
#food:
Oliver oil,milk,cheese,fish,egg
5-sosium: (Na cl)
-Should take in normal diet and in pregnancy ,warring
the pregnant woman against additional using salt

Vitamins:-
need to:
-resistant of infection
-in case of excessive vomiting
1- vit A need for
-maintenance health
-resistance of infection
Foods:
Milk,liver,egg yolk,green

Vitamins:-
2-vit B1 need for
-muscle tone and nerve
-metabolism of carbohydrates
Foods;
-meet,liver,yeast
3-vit B2 need for
-concern for growth and health of the skin
-hemoglobin formation
-lactation
Foods:
-meet, liver, yeast

Vitamins:-
4-vit C need for
-structure of bones
-teeth
-capillaries and connective tissue
Foods:
-citrus fruits, potatoes, fishes, green vegetables
5-vit D essential for
-absorption of phosphorus produce when expose to sun light
Foods:
-milk, butter, eggs, fishes, cheese
s6-vit E believes
Is essential for continuous life of the embryo (fetus)
Food:
-whole meal flour, green vegetables,

Vitamins:-
7-vit K essential for
Coagulation of the blood
Foods:
-Cabbage, carrots, milk, butter
8- Fluids;
Very important especially during hot
weather

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