The document provides information about antenatal advice presented by Ms. Komal ekare. It begins with objectives of the class which are to gain in-depth knowledge of antenatal advice and apply skills in clinical and teaching practice. It then defines antenatal care and discusses the aims, objectives, procedures for first and subsequent visits. It describes antenatal advice regarding diet, hygiene, drugs and provides general advice. It discusses values and drawbacks of antenatal care and limitations. It summarizes two research articles, one on knowledge and practices of antenatal care and another on maternal height as a predictor of vaginal delivery.

2. ANTENATAL
ADVICE
Presented by,
Ms. Komal ekare

4. • At the end of the class the student will be
to gain the in-depth knowledge regarding
antenatal advice and able to apply the
skill in clinical area and teaching
practice.

5. Specific objective
At the end of the class the student will be able
to….
1. Define antenatal care.
2. Explain the aims and objective of antenatal care.
3. Describe the procedure at the first visit.
4. Discuss the procedure at the subsequent visit.
5. Describe the antenatal advice
6. Discuss the values of antenatal care

6. DEFINITION

7. AIMS AND OBJECTIVES
AIMS
1.To scree the high risk cases.
2.To prevent or to detect and treat at the earliest
any complication.
3.To ensure continued risk assessment and to
provide ongoing primary prevention health care.
4.To educate to mother.

8. 5. To discuss with the couple.
6. To motivate the couple.
OBJECTIVE
To ensure a normal pregnancy with delivery of a
healthy baby from healthy mother.

9. PROCEDURE AT FIRST VISIT

10. Objectives
1.To assess the health status of the mother and fetus.
2.To assess the fetal gestation age and to obtain
baseline investigation.
3.To organize continued obstetric care and risk
assessment.

11. HISTORY TAKING
Vital statistics
• Name
• Date of first examination
• Address
• Age
• Gravida
• Parity
• Duration of marriage
• Religion
• Occupation
• Occupation of husband

12. • Period of gestation
Naegeles formula
The rule estimates the expected date of delivery (EDD)
(also called EDC, for estimated date of confinement) from
the first day of the woman's last menstrual period (LMP)
by adding one year, subtracting three months, and adding
seven days to that date. The result is approximately 280
days (40 weeks) from the start of the last menstrual period.
Example:
LMP = 8 May 2009
+1 year = 8 May 2010
−3 months = 8 February 2010
+7 days = 15 February 2010

13. Modified McDonald’s Rule
• McDonald’s Rule or method is used to determine the
age of gestation by measuring from the fundus
(obtaining the fundal height) to the symphysis pubis.
The distance in centimeters will determine the age of
gestation from 16-38 weeks.
• Johnson’s Rule
Johnson’s rule is used to estimate the weight of the fetus
in grams. To determine this, a standard formula is used.

14. Bartholomew’s Rule of fourths
This method estimates the age of gestation relative to the
height of the fundus of the uterus above the symphysis
pubis.

15. • Complaints
• History of present illness
• History of present pregnancy
• Obstetric history
• Menstrual history
• Past medical history
• Past surgical history
• Family history
• Personal history

16. EXAMINATION
General physical history
• Body build-obese/ average/ thin.
• Nutrition – good / average / poor.
• Height
• Weight
• Pallor
• Jaundice
• Tongue
• Neck
• Edema on legs
• Pulse
• Blood pressure

17. Systemic examination
Heart , lungs, liver and spleen
• Breast
Obstetrics examination
• Abdominal
Vaginal examination

18. ROUTINE EXAMINATION

21. • Ultrasound examination
Repetition of the investigations
• Hemoglobin estimation
• Urine test

22. PROCEDURE AT THE SUBSEQUENT VISIT

23. Objectives
A.To assess
i.Fetal well being
ii.Lie, presentation, position and number of fetuses.
iii.Anemia, pre- eclampsia, amniotic fluid volume and fetal
growth.
B. To select – time for ultrasonography, amniocentesis or chorion
villus biopsy when indicated.

24. ❖ History
❖ Examination
• general
• Abdominal examination
- Inspection
- Palpation
In second trimester
In third trimester
❖ Vaginal examination

25. ANTENATAL ADVICE

26. Principle
1.To counsel the women about the importance of
regular check up.
2.To maintain or improve, the health status of the
women to the optimum till delivery by judicious
advice regarding diet, drugs and hygiene.
3.To improve the psychology and to remove the
fear of the unknown by counseling the women.

27. 1. During pregnancy there is increased caloric
requirement due to increase growth of the
maternal tissues, fetus , placenta and increase
Basel metabolic rate.
2. The increase caloric requirement is to the
extent of 300 over the non- pregnancy state
during second half of pregnancy

28. 3. The pregnancy diet ideally should be
light, nutritious , easily digestible and
rich in protein ,minerals and vitamins .
4. In other additional requirement are 1
liter of milk (contain about 1 gm of
calcium) ,plenty of water, green
vegetable and fruits

29. Daily dietary allowances for a
women of reproductive age,
pregnancy and lactation
Non
pregnant
Pregnancy
2 nd half
Lactation sources
Energy
(k cal)
2200 k
cal
2500 k cal 2600 k cal CHO, PROTEIN
,FAT
Protein (gm) 50 gm 60 gm 65 gm MEAT,FISH
POULTARY
PTODUCT
Iron (mg) 18 mg 40mg 30 mg MEAT ,EGG
,GRAINS

30. Non pregnant Pregnancy 2nd
half
Lactation Sources
calcium(mg) 500 gm 1000 mg 1500 mg Dairy products
Iodine (ug) 150 ug 175 ug 200 ug Iodides salt and
see food
Vit A (I.U) 5000I.U 6000 I.U 8000 I.U Vegetable liver,
fruits
Vit D (I.U) 200 I.U 400 I.U 400 I.U Dairy product
Thamine (mg) 1.1 mg 1.5 mg Almost Grains, cereals
Riboflavin (mg) 1.1 mg 1.6mg Same as Meat ,liver,
grains
Ascorbic acid
(mg)
60 mg 70 mg In Citrus fruits,
tomato
Folic acid (mg) 200 ug 400 ug Pregnancy Leafy
vegetable,liver
D
Vit B12 (ug) 2 ug 2.2 ug Animal protein

31. • Dietetic advice should be given with due
consideration to the socioeconomic
condition food habits and taste of the
individual.

32. Supplementary nutritional therapy

33. • Supplementary iron therapy is needed for all
pregnant mothers from 16 weeks onwards.
About 10 gm % of hemoglobin ,1 tablet of
ferrous sulphat (fersolute )contain 60 mg of
elemental iron is enough

34. Antenatal Hygiene
• Rest and sleep::

35. Bowel

36. Bathing
• The patient should take daily bath
but be care full slipping in the
bathroom due to imbalance

37. Clothing, shoes & belt

38. Dental care

39. Care of the breast

40. Coitus

41. Travelling

42. Smoking and alcohol

43. Immunization

44. DRUGS

45. GENERAL ADVICE

46. Values of antenatal care
1.To screen the high risk cases.
2.Detection of high risk factors.
3.Pregnancy should be regularly supervised.
4.Antenatal care is said to be the strategy.
5.Acceptance of advice.
6.It is opportunity to make the patient realize.
7.The net effect is marked reduction in maternal mortality.

47. DRAWBACKS
1.Trifling abnormality may be exaggerated for which
unnecessary medication or risky operative interference
prescribed.
2.Quality is not always maintained specially in the developing
countries with increasing population.
3.Faulty dietary advice and prescription of harmful drugs
produce injurious effect on the mother and or the baby.

48. LIMITATIONS

49. SUMMARY

50. RESEARCH ARTICLES

51. A study on knowledge and practices of antenatal
care among pregnant women attending antenatal clinic at a
Tertiary Care Hospital of Pune, Maharashtra.
Objectives: This study aimed to determine the level of
knowledge, attitude, and practice on ANC among pregnant
women attending the antenatal clinic at a Tertiary Care Hospital
in Pune and their association with various sociodemographic
factors.
Materials and Methods: A cross-sectional study was carried
out among 384 pregnant women in their 3 rd. trimester attending
the antenatal clinic in a Tertiary Care Hospital of Pune,
Maharashtra during October 2011 to September 2012. Pretested
questionnaire was used for collecting data by interview after
obtaining informed consent. Statistical analysis was performed
using SPSS version 20 and Epi Info Software.

52. Results: Study reveals that about 58% women had adequate
knowledge regarding ANC. It was found that almost all the
variables such as age, education, occupation, parity, type of
family, and socioeconomic status (SES) had a significant
association with awareness about ANC. 100% women were
having a positive attitude toward ANC. Around 70%, women
were practicing adequately, and variables such as education
and SES had a significant association with practices about
ANC. Conclusion: These findings can be used to plan a
Health Intervention Program aiming to improve the maternal
health practices and eventually improve the health status of
the women.

53. MATERNAL HEIGHT AS A PREDICTOR OF VAGINAL
DELIVERY.
OBJECTIVE:
The purpose of the study was to establish a relationship between
maternal height and vaginal delivery.
METHOD:
A prospective study of 900 primigravidas in labor in the
Department of Obstetrics and Gynecology, Korle-Bu Teaching
Hospital was conducted. A questionnaire was developed and
administered by research assistants. The results were analyzed
using the X2-test.

54. RESULTS:
Of the 900 patients who delivered, 538 were studied. The
remaining patients were excluded from the study because of
factors described under exclusion criteria. A critical height of
154 cm was chosen as the screening height for 'at risk' of
cephalopelvic disproportion (CPD). This height would identify
71.1% of women who would develop CPD.
CONCLUSION:
Short women with heights up to 150 cm are at risk of failing
spontaneous vaginal delivery and should be referred to
hospitals where labor could be closely monitored and cesarean
section performed if necessary.

55. CONCLUSION

56. BIBLIOGRAPHY