ANC - Pedogoy

1. ANTE NATAL CARE
Presenter: Dr. Sindhu Shankar
1st yr Post Graduate
Dept of Community Medicine

2. Objectives
• Detailed Antenatal history taking.
• Clinical Examination of the mother during
Antenatal visits.
• Laboratory investigations done during
antenatal visits.
• Taayi card.
• Health education.

3. Introduction
• Antenatal : period of time from conception to till the
onset of true labor pains.
• Antenatal care: defined as the care provided by
skilled health-care professionals to pregnant women
in order to ensure the best health conditions for both
mother and baby during pregnancy.

4. Objectives of ANC
• Promote, protect and maintain the health of the
mother.
• Self care .
• Detect high risk cases and provide necessary care.
• Educate women.
• Prepare women for labor and lactation.
• Provide early diagnosis and treatment for any
medical condition/complication.
• Provide health care to any child accompanying the
mother.

5. Visits during Antenatal period.
• Minimum antenatal visits:
According to RCH program : Minimum - 4 visits.
1st visit: within 12weeks
2nd visit: between 14 and 26 weeks
3rd visit: between 28 and 34weeks
4th visit: between 36weeks and term.
Ideally: once a month during 1st 7 months, twice a month
during 8th month and once a week till term.
According to WHO: 8visits minimum.
1st visit at 12 weeks and subsequent visits at
20,26,30,34,36,38 and 40 weeks of gestation (WOG).

6. 1st VISIT
• Ideally at 8 weeks(latest by 12 weeks).
• Important for:
a. Confirmation of pregnancy.
b. Baseline investigations.
c. Screening of high risk pregnancies.
d. Initiation of iron and folic acid supplementation.
e. Health education for mother on pregnancy and
childbirth.

7. Details about months of Amenorrhea
• Gravidity
• Parity
• Abortion
• Last menstrual period(LMP)
• Expected date of delivery(EDD)

8. Detailed Antenatal history
• General information:
Name:
Age:
Occupation:
Address:
Husband’s occupation:

9. Chief complaints
• Period of amenorrhoea.
• Nausea and vomiting, vertigo.
• Increased frequency of micturition.
• Heaviness of breast.
• Edema.
• Backache.
• Vaginal bleeding.
• Constipation.

10. Menstrual history
• Age at menarche
• Regular / not , No of days/ Amount of
bleeding(mild/moderate/severe).
• Foul smelling : present or absent/ with or without
pain.

11. Obstetric History
• Age at the time of marriage.
• Age at 1st pregnancy.
• Interval between two pregnancies.
• Details of previous delivery.

12. Medical history
• Diabetes
• Hypertension
• Thyroid disorders
• Anemia
• Coagulopathies
• Seizures
• Asthma
• HIV
• Cardiovascular diseases.

13. Contraceptive history
• Method being used currently for family planning.
• Rationale behind opting out that particular
contraceptive method.

14. Family and Psychosocial history
• Systemic illness such as diabetes, hypertension,
tuberculosis, thalassemia, delivery of twins and or
delivery of infants with congenital malformation.
• Abuse of tobacco and alcohol, poor dietary habits,
personal hygiene habits, any mental disorders.

15. Drug History
• Antihypertensive.
• Hypoglycemic.
• Antidepressants.
• Corticosteroids.
• Anticoaguants.

16. Clinical Examination
• Physical examination: height, weight, pulse, blood
pressure(BP), respiratory rate and examination of
pallor and generalize edema.
• Breast examination.
• Vaginal examination: confirmation of pregnancy and
gestational age.
• Discharge PV: Per speculum examination.
• Abdominal examination: Monitor progress of
pregnancy, fetal lie/ presentation and fetal growth.
• Pelvis : last ANC visit to assess the adequacy for
vaginal delivery.

17. Abdominal Examination
• Inspection.
• Palpation.
• Auscultation.

18. Inspection
• Shape of the uterus.
• Striae gravidarum
• Linea Niagra
• Scar mark.
• Fetal movement.

19. Palpation
• The Fundal Height
• The Lie
• The Presentation
• Engagement
• Fetal Heart Rate
• Leopald’s Maneouvre.

21. Auscultation
• Checked by Pinard stethoscope or Doppler.
• Normal FHR: 120-160 bpm.
• Foetal tachycardia(more than 160 bpm).
• Foetal bradycardia(less than 120 bpm)

22. Laboratory investigations
• Urine Pregnancy Test(UPT).
• Ultrasound.
• Hemoglobin.
• Urine analysis(proteins, sugar and bacteria).
• Blood grouping and Rh typing
• RBS
• Serology- VDRL, HIV, HBsAg

23. Antenatal Card
• Unique identification number
• Demographic details of the women and relevant
history.
• Progress of gestation- weight, fundal height,
hemoglobin, immunization and medicines provided.

24. Taayi card

25. Health education
• Total kilo calories : 2500
• Protein: 60gm
• Iron: 40mg.
• Folic acid: 400 micro gram.
• Calcium: 1000mg.

26. Intake of micronutrients
• Daily oral iron and folic acid supplementation with
30 mg to 60 mg of elemental iron and 400 µg (0.4
mg) folic acid .
• Folic acid should be commenced as early as
possible (ideally before conception) .
• Daily calcium supplementation (1.5 g–2.0 g oral
elemental calcium)

27. • Hard strenuous work should be avoided in first
trimester and last 4 weeks.
• Coitus should be avoided in 1st trimester and last 6
weeks.
• Care of the breast .
• Travelling should be avoided in 1st trimester and last
6weeks.
• Smoking and alcohol are completely contraindicated.
• Immunization: TT, HepB vaccine, Rabies. (C/I- live virus
vaccines - Rubella, Measles,Mumps,Varicella).

28. Questions
• Long essay : ANC care(10 marks).
• List the objectives of Antenatal Care(5marks)
• Taayi card (3 marks).
• Enumerate in detail about clinical examination
of the pregnant lady in 3rd trimester (5 marks).

29. Thank you