Mother and child care

1. Diagnosis of Pregnancy &
Antenatal Care
5th
year lecture
Dr. Vanilla Banda
BSc. HB, MBChB, MMed (OBGY)-[UNZA]
University Teaching Hospitals (UTHs)- Women & Newborn
Hospital
Date: 23-08-2022
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2. Outline
• Diagnosis of pregnancy
• Principles of diagnosis of pregnancy
• Symptoms of pregnancy
• Signs of pregnancy
• Investigations
• Antenatal care
• Components of individual birth plan
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3. Diagnosis of pregnancy
• Symptoms
• Signs
• Tests
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4. Principles of dx of pregnancy
• Most women ,dx is based on Hx of
amenorrhea & positive pregnancy test.
• Women with irregular menses, dx is complex.
• Other symptoms of pregnancy may alert
clinician on possibility of pregnancy.
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5. Symptoms of pregnancy
• Amenorrhoea; pregnancy may occur during
period of lactation amenorrhoea.
• Slight bleeding in early pregnancy may be
considered normal menses.
• Slight bleeding may occur at time of
implantation.
• Morning sickness: nausea, vomiting confined
to morning
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6. Symptoms cont.
• Cessation of menstruation
• Easy fatigueability & tendency to sleep.
• Emotional changes e.g. change of appetite
• ↑ frequency of micturition.
• Enlargement of breasts & sensation of heaviness.
• Abdominal enlargement
• Quickening-1st
perception of fetal movements by
woman.
• PG (18-20), MP (16-18 weeks).
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7. Signs of Pregnancy
• Chloasma gravidarum
• Butterfly face
• Pigmentation
• Breast signs– ↑pigmentation of nipple &
areola.
• Appearance of Montgomery tubercle in the
areola, dilated sebaceous glands.
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8. Abdominal signs
• Inspection - Abdominal stria, linea nigra, fetal
movements as early as 20 weeks.
• Determination of the HOF- uterine size
palpable by 12 weeks GA.
• Auscultation- FHS can be done as early as 20-
24 by pinard stethoscope.
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9. Investigations
• Detection of HCG in urine or serum confirms
pregnancy.
• Classically, urinary pregnancy test becomes +ve 7-10
days after 1st
missed period.
• By time mom has missed her 1st
menstrual period,
HCG levels are ~ 100 iu/L.
• Serum pregnancy test classically becomes +ve 5-7
days before 1st
missed period.
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10. Investigations cont.
• A quantitative serum HCG assay level of 5iu/L
will usually denote a pregnancy.
• With a normal intrauterine pregnancy, HCG
level will double approx. every 36- 48 hrs.
• Ultrasound will confirm pregnancy.
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12. • Definition: Refers to heath care provided to
pregnant woman throughout pregnancy until
beginning of labour.
• Overall purpose is to optimize outcome of
pregnancy for mom, her baby & rest of family
• Comprises: Careful history taking and
examination and advice to the pregnant
woman
Antenatal care
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13. Goals
• Ensure that the mother is health.
• Ensure delivery of a health infant.
• Anticipate problem.
• Diagnose problems early.
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14. Objectives
• Early detection & if possible, prevention of
complications of pregnancy.
• Educate women on danger & emergency signs &
symptoms.
• Prepare woman & her family for childbirth.
• Give education & counselling on family planning.
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15. Criteria
•The criterion of normal pregnancy care;
delivery of a single baby in good condition at
term (between 37-41 weeks) with a fetal weight
of 2.5 – 3.5kg & without maternal complication.
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16. Schedule of antenatal care
• Medical check up every 4 weeks up to 28
weeks gestation.
• Every 2 weeks until 36 weeks of gestation.
• Every week until delivery but not beyond 41
weeks.
• An average 8-10 antenatal visits .
• More frequent visits may be required if
complications arise.
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17. First Visit (Booking Visit)
• Should be preferably done before the second missed
period or after confirmation of pregnancy. WHO
(before 12weeks)
• Take a full history, examination & investigation.
• Objectives
– To assess the health status of the mother
– To assess the fetal viability + gestation age and to obtain
baseline investigations
– To organize continued care and risk assessment
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18. First Visit: History
• Accurate dating of gestational age
• Any symptoms – minor or major complaints
• Fetal movement perception
• ANC details – investigations & interventions
• Past obstetric history – Details of any obstetric
complications in previous pregnancies
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19. First Visit: History (Cont’d)
• Family history
– Any familial medical conditions
– Family history of congenital anomalies; multifetal
gestations and hypertensive disorders of
pregnancy
• Past medical history
– History of medical illnesses
• Social History
– Smoking, alcohol intake & habitual drugs use
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20. Menstrual history
• Ask about- last menstrual period (LMP).
• Regularity and frequency of menstrual cycle.
• Contraception method used.
• Calculate expected date of delivery (EDD) as 1st
day
of LMP -3 months+7 days & change the year.
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21. Obstetric History
• Gravidity? Parity? Abortion & living children.
• Weight of infant at birth and duration of
gestation.
• Mode of delivery .
• Maternal or infant complications.
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22. Medical and surgical History
• Chronic conditions: as DM, HTN & renal
disease, cardiac disease.
• Previous operation: cesarean section , genital
repair & cervical cerclage .
• Accidents involving injury to the bony pelvis.
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23. Minor ailments in pregnancy
• Nausea and vomiting
• Backache
• Constipation
• Leg cramps
• Acidity & heart burn
• Varicose veins
• Ankle edema
• Vaginal discharge
• Dysuria
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24. Emergency symptoms (Red flags)
• Vaginal bleeding
• Severe abdominal, epigastric or pelvic pain
• Severe headache with visual disturbance
• Persistent vomiting
• Unconsciousness/ convulsions
• Difficulty in breathing
• Fever, chills
• Absent fetal movements.
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25. First visit: Examination
• Vital signs & anthropometry (weight & height)
• Detailed physical exam from head to toe for medical
or surgical illnesses.
• Check for nutritional status of the woman.
• Check for for pallor or anemia (Palmar &
conjunctival) .
• Check for oedema .
• Urine for protein & sugar.
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26. Examination Cont.
• Abdominal exam
– Fundal height by symphysis-fundal height measurement by the tape method
– Fetal heart auscultation after 10th week by doppler or 20th week by fetal heart stethoscope
– Fetal presentation after the 28th week but malpresentations abnormal after the 34th week
• Symphysis fundal height :
LMP plus 280 days
Add 7 days , subtract 3 months
MacDonald’s Rule (cm= weeks).
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27. Investigations
• Get baseline on the first or following the first
visit.
- FBC/Hb, ABO and Rhesus, RBS,RVT,
- VDRL or RPR to screen for syphilis,
- HBsAg test.
• Imaging: Booking U/S for viability +GA.
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28. Supplementation
• Folic acid, Iron (ferrous sulphate or gluconate)
• Deworming drugs e.g. mebendazole
• Anti- malarial e.g. fansidar 1st
dose to be given at 13
weeks.
• Nutritional supplement optional
• Commencement of ART if Reactive.
• Tetanus toxoid
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29. Tetanus Toxoid
• 0.5 mL of tetanus toxoid IM.
• 5 doses give life long
protection.
• No maximum interval
between doses.
• TT doses received in school
should be included in the
required 5 doses.
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31. • Routine activities in ANC clinic: BP, weight, Urinalysis,
nutritional advise, health education messages on
pregnancy, delivery danger signs & hygiene.
• Assessment of fetal & maternal wellbeing.
• At each visit birth preparedness should be emphasized.
• Danger signs in pregnancy & importance of institutional
delivery by skilled attendant.
Routine antenatal care
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32. Components of Individual Birth Plan
• Does your client know when her baby is due?
• Has she identified a skilled birth attendant?
• Has she identified a health facility to deliver from?
• Can she list danger signs in pregnancy and delivery?
• Has she identified a decision maker in case of an
emergency?
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33. Components of Individual Birth Plan (Cont’d)
• Does she know where/how to get money in case of
an emergency?
• Does she have a transport plan in case of an
emergency?
• Does she have a support person in case of an
emergency?
• Has she collected the birth supplies for the birth?
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34. Thank you
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