Antenatal assessment

1. PRESENTED BY,
MR. KAILASH NAGAR
ASSIST. PROF.
DEPT. OF COMMUNITY HEALTH NSG.
DINSHA PATEL COLLEGE OF NURSING, NADIAD

2. What do we mean by …….
Antenatal Assessment??

3. Antenatal/prenatal care
• Systematic supervision of a woman during
pregnancy is called antenatal (prenatal care)

4. Why is it important?
• Determines the wellbeing of the newborn and
chance for survival (mother history)

5. AREA OF CONCERNS:
• Pre-conception counselling
• Assessment of risk factors
• Ongoing assessment of fetal well-being
• Ongoing assessment of complications
• Education
• Discussion of birthing care options

6. Timing of antenatal visits:
• The first visit should not be deferred beyond
the second missed period.
• Once a month until 28 weeks.
• Twice a month until 36 weeks.
• Every week during the last 4 weeks of
pregnancy.

7. PROCEDURE AT THE FIRST VISIT
• > Detailed Health History
• > Physical Examination
• > Breast and Pelvic Examination

8. Vital statistics:
• Name
• Age
• Ward/unit
• IP no
• Address
• Religion
• Occupation
• Education
• LMP
• EDC
• GA
• Obstetric score
• Blood group

9. • Gravida:
nulligravida
primigravida
multigravida
• Parity:
nullipara
primipara
multipara
grandmultipara

10. Maternal history
• Present ob. History:
– Diagnosis?
– Planned/unplanned
– Minor disorders
– Immunization
– Exposure to drugs/radiation

11. Pregnancy tests

13. Maternal History and Risk Factors
• Comprehensive maternal history and physical
examination is important to point out the risk
factors.
• Risk factors can be related to mother, during
pregnancy, during labor and delivery, or after
delivery.
• Antenatal assessment starts with determination of
risk factors.
• Better knowledge about risk factors better
preparation to care for the patient.

14. abortion
• 31% of pregnancies end in miscarriage
• Only rarely would an abortion cause problems
in a subsequent pregnancy
• increased risk of miscarriage only in women
who have had multiple induced abortions.

15. Risk Factors
• Preterm Birth:
• What is considered preterm??
• The second greatest cause of morbidity and mortality
in neonates.
• Previous preterm birth increases the subsequent
preterm birth:
• 1 prior = 15% of subsequent preterm birth.
• 2 prior = 32% of subsequent preterm birth.

16. Risk Factors
• Incompetent Cervix:
• Caused by cervical trauma, previous surgery, or may
be congenital.
• Usually leads to membrane rupture and premature
delivery.
• If severe, a suture around the cervical canal is
performed.

17. Risk Factors
• Maternal Smoking and Alcohol Intake:
• In the US, about 10% of pregnant mothers smoke, drink
alcohol or use drugs.
• Maternal intake of alcohol leads to fetal growth
problems.
• Smoking HBCO decreases availability of oxygen to
placenta and fetus.

18. Risk Factors
• Maternal Hypertension
• Complicates 6-8% of pregnancies.
• Hypertension during pregnancy (after W24) is termed:
Preeclampsia.
• Preeclampsia (High BP, proteinuria, edema)
• Can lead to placental abruption, and preterm delivery.

19. Risk Factors
• Diabetes:
• Increase the risk for CV and CNS malformations, and
metabolic disturbances.
• When appears during pregnancy (Gestational
Diabetes Mellitus, GDM).
• Treatment: glycemic control.

20. Risk Factors
• Infections Diseases:
• Infections can be transmitted to fetus.
• Early screening and detection of the infection is
important.
• Complicated by the rupture of the membrane.

21. Risk Factors
• Problems in Placenta, UC, and Fetal
Membrane:
• premature rupture : causes 50% of preterm
births.
• UC : Prolapse, short, single artery (3%)
• Placental problems

22. Antenatal assessment
• Height
• Weight
• Pallor
• Jaundice
• Vital signs

23. BREAST EXAMINATION
• flat (nipple does not protrude with
stimulation)
• retracted (nipple pulls back slightly)
• inverted (nipple pulls inward when
compressed)

24. Breast examination
INVERTED
NIPPLES
Grade 1

25. Grade 2:
the nipple is inverted
or retracted under
the areola

26. Grade 3
There is no projection of
the nipple, elements of
nipple are usually buried
under the breast and will
not come out.

27. Abdominal examination
• Inspection
• Size
• Shape
• Contour
• Flank
• Skin
• Bladder
• Fetal movements

28. palpation

30. Measuring SFH
After 14 weeks gestation the SFH in centimeters = Number of
weeks of gestation + 3 cm.

31. Antenatal schedule

32. Investigations
• First visit: Hb, Blood group, Rubella, Hep B and
C and HIV screening.
• 10-12 weeks: Chorionic villous sampling
• 15-18 weeks: USG, serum AFP/triple test ,
amniocentesis
• 28 weeks: Hb ,TC/DC, ferritin, GTT, and low
vaginal swab to exclude Group B strep.
• 36 weeks: Hb

33. Antenatal chart should record the
following:
• Weight gain (12-15 kg in total)
• BP (a diastolic pressure>90, or increase of >20 from
first visit is significant)
• Urinalysis (watch for protein, glucose, and UTIs)
• Fetal movements
• Uterine size in accordance with dates and ultrasound
• Fetal lie, presentation, and engagement, especially
after 36 weeks

34. Antenatal Assessment
ULTRASOUND
• Uses high frequency sound waves.
• Hand-held transducer is placed directly over the
mother’s abdomen, and reflected waves are
recorded on screen image.
• Can give valuable information about pregnancy and
fetus

35. Clinical Uses of Ultrasound
• Identify pregnancy.
• Determine fetal age.
• Observe amniotic fluid
abnormalities.
• Detect fetal anomalies.
• Identify placental abnormalities.
• Determine fetal position.
• Examine fetal HR, and RR

36. Embryo at 6 weeks

37. Antenatal Assessment
AMNIOCENTESIS
• Is the procedure of obtaining a sample of amniotic fluid.
• Usually performed after W15 (w15-20).
• A needle is inserted through the skin and uterine wall to
the amniotic sac.
• Insertion is guided by Ultrasound.
• Sample from amniotic fluid is obtained for analysis.
• Very safe procedure (complication rate <1%).

38. Antenatal Assessment
FETAL HEART RATE (FHR) MONITORING
• Heart starts to beat between W16-W20, but beats can
be detected as early as W8.
• Normal 120-160 bpm.
• Becomes very common test.

39. Antenatal advices
• Diet
• exercise
• Rest and sleep
• Bowel
• Bathing
• Clothing
• Dental care
• Coitus
• Care of breast
• Immunisation

40. FHR Monitoring