The document discusses antenatal assessment, which involves the systematic supervision of a pregnant woman. It involves determining risk factors through a comprehensive history and physical exam. Regular checkups are recommended, starting with monthly visits until week 28, then twice monthly until week 36, and weekly during the last 4 weeks. The assessments monitor maternal and fetal health and wellbeing through tests, exams, ultrasounds and more. The goal is to promote a healthy pregnancy and delivery.

1. Antenatal
Assessment
Dr. Kailash Nagar
Assistant Professor
Dept. Community health

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

4.  Determines the wellbeing of the newborn and
chance for survival (mother history)

5.  Pre-conception counselling
 Assessment of risk factors
 Ongoing assessment of fetal well-being
 Ongoing assessment of complications
 Education
 Discussion of birthing care options

6.  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.  > Detailed Health History
 > Physical Examination
 > Breast and Pelvic Examination

8.  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.  Present ob. History:
◦ Diagnosis?
◦ Planned/unplanned
◦ Minor disorders
◦ Immunization
◦ Exposure to drugs/radiation

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

20. 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. 
Problems in Placenta, UC,
and Fetal Membrane:
 premature rupture : causes 50% of preterm
births.
 UC : Prolapse, short, single artery (3%)
 Placental problems

22.  Height
 Weight
 Pallor
 Jaundice
 Vital signs

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

24. INVERTED
NIPPLES
Grade 1

27.  Inspection
 Size
 Shape
 Contour
 Flank
 Skin
 Bladder
 Fetal movements

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

32.  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.  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. 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.  Identify pregnancy.
 Determine fetal age.
 Observe amniotic fluid
abnormalities.
 Detect fetal anomalies.
 Identify placental abnormalities.
 Determine fetal position.
 Examine fetal HR, and RR

37. 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. 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.  Diet
 exercise
 Rest and sleep
 Bowel
 Bathing
 Clothing
 Dental care
 Coitus
 Care of breast
 Immunisation

40. FHR Monitoring