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1. ANTENATAL CARE

2. Objectives
At the end of this lecture, the students will be able to :
1. Identify the aim and components of antenatal care.
2. Determine the component of weight gain during pregnancy
3. Teaching advice for pregnant women during ANC
4. Recognize the danger signs during pregnancy

3. ANTENATAL CARE
 Antenatal care refers to the care that is given to the pregnant
woman from time of conception until the beginning of labor.
 It is periodic and regular supervision including examination
and advice of a woman during pregnancy.
 It is a preventative and cost effective service.

4. Goals of Antenatal Care
1. To reduce maternal and perinatal mortality and morbidity rates.
2. To improve the physical and mental health of women and children.
3. To prepare the woman for labor, lactation, and care of her infant.
4. To detect early and treat properly complicated conditions that
could endanger the life or impair the health of the mother or the
fetus.
5. To Educate women on danger and emergency signs & symptoms.
6. To educate and counsel on family planning

5. Traditional Schedule for Antenatal care
Every four weeks up to 28 weeks gestation
Every 2 weeks from 29 weeks until 36 weeks of gestation
Every week from 37 weeks until delivery
More frequent visits may be required if
complications arise

6. First Antenatal Visit
• During the firs visit, assessment and physical
examination must be completed.
Including:
 History.
 Physical examination.
 Laboratory data.
 Psychological assessment.
 Nutritional assessment.

7. History
 Personal history
 Menstrual history
 Obstetrical history
 Family history
 Medical and surgicalhistory
 History of present pregnancy
Personal and social history
This include: woman's name, age, Education, occupation ,address ,
year of marriage, and phone number.

8. History Continued
 Menstrual history
A compete menstrual history is important to establish the estimated
date of delivery. It includes:
- 1-Last menstrual period (LMP).
- 2-Regularity and frequency of menstrual cycle.
- 3-Contraception method used .
- 4-Calculate expected date of delivery (EDD) Naegle's rule
As 1stday of LMP −3 months +7 days, and change the year.
Example: calculate EDD if LMP was August 30, 2021.=June 6, 2022.

9. History Continued
 Obstetrical history
This provides essential information about the previous
pregnancies that may alert the care provider to possible
problems in the present pregnancy. Which includes:
 Gravida, para, abortion, and living children.
 Weight of infant at birth & length of gestation.
 Labor experience, type of delivery, location of birth, and type
of anesthesia.
 Maternal or infant complications.

10. History Continued
 Family history
Family history provides valuable information about the general
health of the family, and it may reveal information about
patters of genetic or congenital anomalies.
Including:
- D.M.
- Hypertension.
- Heart disease.
- Cancer.
- Anemia.

11. History Continued
 Medical and SurgicalHistory
1. Chronic condition such as Diabetes mellitus, Hypertension, and
Renal disease
2. Prior operation: as cesarean section, genital repair, and
cervical cerclag.
3. Allergies, and medications should be documented.
4. Accidents involving injury of the bony pelvis

12. History Continued
 History of present pregnancy
Ask the patient if she has any current problem, such as:
- Nausea & vomiting.
- Abdominal pain.
- Headache.
- Urinary complaints.
- Vaginal bleeding.
- Edema.
- Backache.
- Heartburn.
- Constipation.

13. Physical Examination

14. Physical Examination

15. Physical Examination
1. To detect previously undiagnosed physical problems that may
affect the pregnancy outcome.
2. To establish baseline levels that will guide the treatment of the
expectant mother and fetus throughout pregnancy

16. Vital signs Physical Examination
1. Blood pressure:
It is taken to ascertain normality and
provide a baseline reading for a
comparison throughout the
pregnancy.
2. Pulse:
The normal pulse rate = 60-90 BPM.
Tachycardia is associated with anxiety,
hyperthyrodism, or infection.

17. Vital signs Physical Examination
3. Respiratory rate:
The normal is 16-24 BPM.
Tachypnea may indicate respiratory infection, or cardiac disease.
3. Temperature:
normal temperature during pregnancy is 36.2C to 37.6C.
Increased temperature suggests infection

18. Cardiovascular system Physical Examination
 Venous congestion:
Which can develop into varicosities,
venous congestion most
commonly noted in the legs,
vulva, and rectum.
 Edema:
Edema of the extremities or face
necessitates further assessment
for signs of pregnancy-induced
hypertension.

19. Musculoskeletal system Physical Examination
 Posture and gait
Body mechanics and changes in posture
and gait should be addressed. Body
mechanics during pregnancy may
produce strain on the muscles of the
lower back and legs.

20. Height & weight Physical Examination
An initial weight is needed to establish a baseline for weight gain
throughout pregnancy.
 Maternal height and weight measurements to determine body
mass index(BMI).
Preconception:
 Wt. lower than 45kg, or Ht. under 150 cm is associated with
preterm labor, and low birth weight infant.
 Wt. higher than 90 kg is associated with increased incidence
of gestational diabetes, pregnancy induced hypertension,
cesarean birth, and postpartum infection.

21. weight Physical Examination
 Recommendation for weight gain during pregnancy
are often made based on the woman’s body mass
index.

22. Weight gain during pregnancy Physical Examination
Weight Gain (kg)
Pre-Pregnancy BM I
12.5- 18
Less than 18.5
11.5- 16.0
18.5- 24.9
7.0 – 11.5
25 .0- 29.9
5.0 – 9.0
30 or grater

23. Check of Weight gain Physical Examination
 The average weight gain during pregnancy is 11-12 Kg. (normal =
0.5 kg/wk > 20 wks)
 Range of wt gain:
 0.5 - 1.5kg during the 1st trimester
 1.5 - 4 kg during the 2nd trimester
 4- 6 kg during the 3rd trimester
 Components of increased weight:
Fetus (3.5 k gm), placenta (0.5 k gm), uterine growth (0.5 k gm),
amniotic fluid (1 k gm ),breast growth (0 .5 k gm), blood volume(l.5
L), protein retention (2 k gm) and water retention (2kgm).

24. Pelvic measurement Physical examination
The bony pelvis is evaluated early in the pregnancy to determine
whether the diameters are adequate to permit vaginal delivery.

25. Abdomen Physical examination
 The size of the abdomen is inspected for:
The height of the fundus, which determines the period of the gestation.
 Fetal lie & position.
The abdomen is longer if the fetal lie is longitudinal as occurs in 99.5% of cases.
The abdomen is lower & broad if the lie is transverse.
Fetal heart rate is inspected as evidence of fetal life

26. Laboratory investigations Physical examination
Test Purpose
Blood group To determine blood type.
Hgb & Hct To detect anemia.
(RPR) rapid plasma reagin To screen for syphilis
Rubella To determine immunity
Urine analysis To detect infection or renal disease.
Papanicolaou (pap) test To screen for cervical cancer
Chlamydia To detect sexual transmitted disease.

27. Laboratory investigations Physical examination
TORCH
T: toxoplasmosis
O:other (hepatitis A & group B streptococcus
R: Rubella
C: Cytomegaloviruses
H: Herps

28. Health Teaching During
Pregnancy
• Hygiene
1. Daily all over wash is necessary because it is stimulating,
refreshing, and relaxing.
2. Warm shower or sponge baths is better than tub bath.
3. Hot bath should be avoided because they may cause fatigue.
4. Regular washing for genital area, axilla, and breast due to
increased discharge and sweating.
5. Vaginal douches should avoided except in case of excessive
secretion or infection.

29. Health Teaching During
Pregnancy
Breast care
• Wear firm, supportive bra with wide straps to spread weight
across the shoulder.
• Wash breasts with clean tap water (no soap, because that could be
drying).
• Daily to remove the colostrum & reduce the risk of infection.
• It is not recommended to massage the breast, this may stimulate
oxytocin hormone secretion and possibly lead to contraction.

30. Health Teaching During
Pregnancy
Dental care
• The teeth should be brushed carefully in the morning and after
every meal.
• Encourage the woman the to see her dentist regularly for routine
examination & cleaning.
• Encourage the woman to snack on nutritious foods, such as fresh
fruit & vegetables to avoid sugar coming in contact with the teeth.
• A tooth can be extracted during pregnancy, but local anesthesia is
recommended.

31. Health Teaching During
Pregnancy
Dressing
 Woman should avoid wearing tight
cloths such as belt or constricting bans
on the legs, because these could impede
lower extremity circulation.
 Suggest wearing shoes with a moderate
to low heel to minimize pelvic tilt &
possible backache.
 Loose, and light clothes are the most
comfortable

32. Health Teaching During
Pregnancy
Sexual activity
 Sexual intercourse is allowed with moderation, is absolutely
safe and normal unless specific problem exist such as: vaginal
bleeding or ruptured membranes,
 If a woman has a history of abortion, she should avoid sexual
intercourse in the early months of pregnancy.

33. Health Teaching During
Pregnancy
Exercises
 Exercise should be simple. Walking is ideal, but long period of walking should
be avoided.
 Stop exercising if you experience vaginal bleeding, dizziness, chest pain,
headache, muscle weakness, calf pain or swelling, uterine contractions, decreased
fetal movement, or fluid leaking from the vagina.
 The pregnant woman should avoid lifting heavy weights such as: mattresses
furniture, as it may lead to abortion.
 She should avoid long period of standing because it predisposes her to varicose
vein.
 She should avoid setting with legs crossed because it will impede circulation.

34. Health Teaching During
Pregnancy
Sleep
 The pregnant woman should lie down to relax or sleep for 1 or 2 hours during the
afternoon.
 At least 8 hours sleep should be obtained every night & increased towards term,
because the highest level of growth hormone secretion occurs at sleep.
 Advise woman to use natural sedatives such as: warm bath & glass of warm milk.
 Avoid lying on your back after the fourth month, which may compromise
circulation to the uterus.
 Avoid sharply bending your knees, which promotes venous stasis below the
knees.
 Keep anxieties and worries out of the bedroom

35. Health Teaching During
Pregnancy
Travel
 Early in normal pregnancy, there are no restrictions while Late in pregnancy,
travel plans should take into consideration the possibility of early labor.
 Bring along a copy of the prenatal record if your travel will be prolonged in
case there is a medical emergency away from home.
 Always wear a three-point seat belt, apply a non padded shoulder strap
properly; it should cross between the breasts and over the upper abdomen,
• above the uterus

36. Dangerous signs During
Pregnancy
1. Vaginal bleeding.
2. Generalized edema
3. Sharp abdominal pain or cramping
4. Leakage of fluid from the vagina.
5. Severe or prolonged nausea or vomiting.
6. Symptoms of UTI; Painful urination, dysuria, and severe
backache.
7. Frequent regular uterine contraction before 36weeks.
8. No movement of the fetus.
9. High fever over 37.7 degrees Celsius.
10. Blurred vision and severe headache.