The document provides information on antenatal care (ANC), including its definition, aims, objectives, procedures at initial and subsequent visits, and antenatal advice. ANC involves screening, monitoring, and promoting the well-being of the mother and fetus through health education, counselling, and treatment. The goals are to ensure a normal pregnancy resulting in a healthy baby and mother. Procedures include taking medical history, conducting physical exams, routine tests, and providing advice on diet, hygiene, immunizations, and warning signs.

2. INTRODUCTION
Antenatal care (ANC) means
“care before birth”& includes
•Giving health education
•counselling
•Screening
•Treatment & care to monitor & to promote
the well-being Of the mother And foetus.

3. DEFINITION
Systematic supervision (examination and advice) of a
woman during pregnancy is called antenatal (prenatal) care.
Actually prenatal care is the care in continuum that starts
before pregnancy and ends at delivery and the postpartum
period. Antenatal care comprises of:
1 Carefull history taking and examinations (general and
obstetrical)
2.Advice given to the pregnant woman.

4. AIMS & OBJECTIVES
AIMS:
•to screen the “high risk” cases.
•to prevent or to detect and treat at the earliest any complication
•to ensure continued risk assessment and to provide ongoing primary
preventive health care,
•to educate the mother about the physiology of pregnancy and labor
by demonstrations, charts and diagrams (mothercraft classes), so that
fear is removed and psychology is improved
•to discuss with the couple about the place, time and mode of
delivery, provisionally and care of the newborn
•to motivate the couple about the need of family planning and also
appropriate advice to couple seeking medical termination of
pregnancy.

5. OBJECTIVES:
The objective is to ensure a normal pregnancy with
delivery of a healthy baby from a healthy mother.
The criteria of a normal pregnancy are delivery of a
single baby in good condition at term (between
38 and 42), with fetal weight of 2.5 kg or more and
with no maternal complication.

6. PROCEDURE AT THE FIRST VISIT
OBJECTIVES:
• (1) To assess the health status of the mother and fetus.
• (2) To assess the fetal gestational age and to obtain baseline
investigations.
• (3) To organize continued obstetric care and risk assessment.

7. HISTORY TAKING
Vital statistics
•Name: ........................................................
•Date of first examination: ..................................
•Address:....................................................................
•Age: (>30 or 35 yrs : elderly primigravida)
•Gravida and parity:
Gravida is defined as the no. of times that a woman has been pregnant.
Parity is defined as the no. of times that she has given birth to a fetus with a
gestational age of 24 weeks or more, regardless of whether the child was
born alive or was stillborn.

8. TERMINOLOGY
✓ A nullipara is one who has never
completed a pregnancy to the stage
of viability. She may or may not have
aborted previously.
✓A primipara is one who has
delivered one viable child.
✓A multigravida is one who has
previously been pregnant. She may
have aborted or have delivered a
viable baby.
✓A parturient is a women in labor.
✓A nulligravida is one who is not now
and never has been pregnant.
✓A primigravida is one who is
pregnant for the First time.
✓ Multipara is one who
hascompleted two or more
pregnancies to the stage of viability
or more.
✓ A puerpera is a woman who has
just given birth.

9. •Duration of marriage: high fecundity/low fecundity (Low fecundity-unlike to
conceive frequently)
•Religion: ...................................
•Occupation: excess physical work/Stress/occupational hazards.
•Occupation of the husband:(a)low social status such as anemia,
preeclampsia, prematurity, etc. (b) to give reasonable and realistic
antenatal advice during family planning guidance.
•Period of gestation: counting is to be done from the first day of last normal
menstrual period (LNMP)(eg: 22 june 2020)
•Complaints:Sleep, appetite, bowel habit and urination.
•History of present illness:onset, duration, severity,use of medications
HISTORY TAKING (CONT.)

10. • Obstetric history:Status of gravida, parity, number of deliveries
(term, preterm), miscarriage, pregnancy termination (MTP) and living
issue
[e.g:(P2+0+1+2) G4, P2, miscarriage 1, living 2 at 36 weeks of present
pregnancy].
The minimum spacing--should be 2 years.
•Menstrual history: Cycle, duration, amount of blood flow and first day
of the last normal menstrual period (LNMP)
Calculation of the expected date of delivery (EDD): This is done
according to Naegele’s formula(1812)
LNMP- 22 June 2020
. (+7dys) (-3months) (+1yr)
EDD= 29 March 2021 {EDD=29March2021}
•Past medical & surgical history; Family history; personal history
HISTORY TAKING (CONT.)

11. PHYSICAL EXAMINATION
A) VITAL SIGNS
1. Blood pressure- slight drop in 2nd TRI,returns to normal in 3rd TRI.
2. Pulse- increases by about 10bts/Mon due to increased cardiac workload.
3. Respiratory Rate- shortness of breath and dyspnea in late pregnancy.
4. Temperature- slight elevation In early pregnancy due to Thermogenic effect
of progesterone,returns to normal at 16 weeks
B) PHYSICAL ASSESSMENT
• Head and scalp
• Eyes- pale conjunctiva/Edema of eyelids(PIH)
• Nose- normal nasal congestion Occurs as a result of Estrogen stimulation.
• Ears
• Mouth and teeth- swollen gums due to Estrogen stimulation. Cracked Cornwrs
of mouth due to vitamin deficiency Which pregnant women are prone to
develop. Dental caries, tooth extraction.

12. • Neck- slight thyroid enlargement due to increased BMR.
• Breast – tenderness/ size increase/primary and secondary areola/ colostrum .
• Skin- {Melasma/chloasma-mask of pregnancy (face)}, linea Nigra, striae, Spider
nevi,Palmar erythem;Pallor,jaundice,rashes and skin lesions are abnormal findings.
• Musculoskeletal system-exagerrated lumbar curve in late pregnancy.
• Urinary system- increased frequency of urination(1st 12weeks)
• Rectum- constipation, hemorrhoids in late pregnancy.
• Extremities- leg edema/ ankle swelling/waddling gait: normal,Edema of upper
extremities,face and hands-abnormal.
• Nervous system- N/V,mental irritability,post-partum blues.
• CHANGES
• In pelvis: jacquemeir’’,osciander’s and goodell’s sign.
• In uterus: piskacea’s,Hegar’s and Palmer’s sign.

13. OBSTETRICAL EXAMINATION
C) Abdominal palpation (leopold’s manuever)-
INSPECTION-pregnancy marks,incisional scar Or any herniation.
PALPATION-fundus height,lie, position, presentation, engaged/not.
AUSCULTATION- fetal heart rate.

14. D) Internal Examination or Vaginal Examination
•It is done: (1) to diagnose the pregnancy, (2)to corroborate the size of the uterus
with the period of amenorrhea
• (3)to exclude any pelvic pathology.
>Ultrasound examination has replaced routine internal examination.
STEPS OF VAGINAL EXAMINATION
1. Inspection(Jacquemier’s sign Or Chadwick’s sign)
2. Speculum examination
3. Bimanual

15. INSPECTION

16. SPECULUM EXAMINATION BIMANUAL

17. Routine investigations:
• Blood: Hemoglobin, hematocrit, ABO, Rh grouping, blood glucose,VDRL.
• Urine: Protein, sugar and pus cells.
• Cervical cytology study
Special investigations:
(a) Serological tests for rubella, hepatitis B virus and HIV
(b) Genetic screen: Maternal serum alpha-fetoprotein (MSAFP), triple test
(c) Ultrasound examination:transabdominal (TAS) or transvaginal (TVS)
(d)Booking (18–20 weeks) scan
Repetition of the investigations: (1) Hb estimation is repeated at 28th and 36th week.
(2) Urine is tested (dipstick) for protein and sugar at every antenatal visit.

18. PROCEDURE AT THE SUBSEQUENT VISITS
• Generally, checkup is done at interval of 4 weeks up to 28 weeks; at interval
of 2 weeks up to 36 weeks and thereafter weekly till delivery.
• As per WHO recommendation, the visit may be curtailed to at least 4; 1st in
2nd trimester around 16 weeks, 2nd btwn 24 & 28 weeks, the 3rd visit at 32
weeks & the 4th visit at 36 weeks.
Objectives: (A) To assess: (1) fetal well-being, (2) lie, presentation, position and
number of fetuses,
(3) anemia, preeclampsia, amniotic fluid volume and fetal growth, (4) to
organize specialist antenatal clinics for patients with problems like cardiac
disease and diabetes.
(B) To select, time for ultrasonography, amniocentesis or chorion villus biopsy
when indicated.
History: To note: (1) appearance of any new symptom (headache, dysuria),
(2) date of quickening.

19. EXAMINATION
•General:(1) weight,(2) pallor, (3) edema legs, (4) blood pressure.
Abdominal examination
•Inspection: Enlargement,marks-linea Nigra,striae,surgical scars
•Palpation: Ht of fundus,(2nd TRI-identify the fetus by external
ballottement,fetaL parts&auscultation of fetal heart sounds)
~(3rdTRI-fetal lie,presentation,position,growth pattern, volume of liquoR &
also any abnormality).
~Abdmnl girth-increases by about 2.5 cm per week beyond 30 weeks & at
term, measures about 95–100 cm.
~Fetal activity (movements) is also recorded.
Vaginal examination:
Warning signs
~Leakage of fluid from vagina ,Vaginal bleeding,Abdominal pain:
distressing in nature
~Headache, visual changes,Decrease or loss in fetal movements,fever,
rigor, excess vomiting, diarrhea

20. ANTENATAL ADVICE
• PRINCIPLES: (1) To counsel the women about the importance of regular
checkup.(2) To maintain or improve the health status of the woman to the
optimum till delivery(3) To improve the psychology and to remove the fear
of the unknown by counseling the woman.
• DIET: Should be adequate to provide: (a) good maternal health,
(b) optimum fetal growth, (c) the strength and vitality required during labor.
(d) successful lactation.
~Woman with (normal BMI-11kg),(overwt-BMI 26 to 29-limit to 7kg)
(Obese- BMI>29-gain less weight).(complications-fetal macrosomia)
~The pregnancy diet ideally should be light, nutritious, easily digestible and
rich in protein,minerals and vitamins.
Supplementary nutritional therapy: supplementary iron therapy is needed for
all pregnant mothers from 16 weeks onwards.
~Supplementary vitamins are to be given daily from 20th week onwards.

21. ANTENATAL HYGIENE
• Rest &sleep: (10hrs- last 6weeks,late pregnancy- lateral posture)
• Bowel: constipation is common.
• Bathing •Clothing,shoes & belt •Dental care
• Care of breasts •Coitus •travel •smoking & alcohol
IMMUNIZATION•Live virus vaccines (rubella, measles, mumps, varicella, yellow
fever) are contraindicated.
• Tetanus: Immunization against tetanus not only protects the mother but also
the neonates.{0.5ml-IM:16-24weeks(1st)& last TRI(booster)}.
• Tdap vaccine & Flu vaccine {CDC} •Hep-A,B • Hib
• Prenatal classes •Drugs

22. GENERAL ADVICE
• The patient should be persuaded to attend for antenatal checkup
positively on the schedule date of visit.
• She is instructed to report if symptoms arise such as intense headache,
disturbed sleep with restlessness, urinary troubles, epigastric pain,
vomiting and scanty urination.
• She is advised to come to hospital for consideration of admission in the
following circumstances:
• Painful uterine contractions at interval of about 10 minutes or earlier and
continued for at least 1 hour—suggestive of onset of labor.
• Sudden gush of watery fluid per vaginam—suggestive of premature
rupture of the membranes.
• Active vaginal bleeding

23. MINOR AILMENTS IN PREGNANCY
• Nausea & vomitting •Backache. •Constipation •Leg cramps
• Acidity and heartburn. •Varicose veins •Hemorrhoids
•Carpal tunnel syndrome (10%) •Ptyalism •Syncope •Ankle edema
• Vaginal discharge
EXERCISE IN PREGNANCY
~sholud be regular and done in cool area
~ avoid ,if breathlessness,Fatigue or dizziness appear
~Prolonged supine position, any compression to the uterus or risk of injury (fall)
should be avoided.
Contraindications of Exercise and to Limit Physical activity
•Fetal growth restriction (FGR)• Cardiac or pulmonary disease
• Cervical insufficiency•Vaginal bleeding (APH)•HTN in pregnancy
•Risk for preterm labor

24. VALUES OF ANTENATAL CARE
• To screen the high risk cases.
• Boosts up the psychology of mother
• Marked reduction in maternal mortality (1/7th) and morbidity,perinatal
mortality(1/5th). • To detect &treat early complications.
• To ensure that the pregnant women & her fetus in best possible health.
• To prepare the woman for labour, lactation & Care of her infant.
DRAWBACKS1.Trifling abnormality may be exaggerated for which
unnecessary medication or risky operative interference is prescribed.
2. Unless quality of care is maintained,the benefits of antenatal care are not
obtained.
3. It alone cannot reduce maternal and neonatal mortality and morbidity
unless the woman gets good care during labor and postnatal period.
LIMITATIONS: Availability of emergency obstetric care (EmOC) should be
there to combat the complications. Therefore good antenatal care and
efficient EmOC are complementary to each other for successful obstetric
outcome.

25. ANTENATAL PREPARATION
• It includes the following:-
~Antenatal counseling
~Diet✓
~Antenatal exercise✓
~Substance abuse✓
~Education for child birth
~Preparation for safe confinement
~Prevention from radiation.
DIET
~Beetroot consumed in any form is an excellent source of iron. Beetroot Juice &
apple juice can be consumed together to make it palatable!
~High calorie & high protein diet is preferable!
~Iron rich diet is also adviced during pregnancy.

27. ANTENATAL EXERCISE
• AIMS:- To promote and maintain good Physical and mental health.
~ To have good posture,sense of smart and good looking.
It include:
A) Transverse exercise B)Pelvic tilting or rockin C)Pelvic floor exercise
D)Foot and leg exercis E)Breathing exercise F)Kegel exercise
TRANSVERSE
Tones the deep transverse
Abdominal muscles,which
Are main postural support
Of spine and prevent
Backache in future.

28. • PELVIC TILTING or ROCKING
~Reduces back pain and increases
flexibility.
~ some women even use tilts to induce
labour.
~prevent & treat gestational diabetes.
• WALL SLIDES
~Strengthen arm muscles,Relieves back pain And
Improves balance.

29. • FOOT AND LEG EXERCISE
~ Helps to prevent problems such as
varicose veins,cramps & edema.
~ Improves circulation.
• BREATHING EXERCISE
~plentiful supply of O2 to both mother and
Child.
~purifies and calms nervous system.
~induces feeling of pleasant well-being.

30. SUBSTANCE ABUSE
• Smoking- it Passes nicotine and other cancer causing drugs to baby.
It restricts the Bany from getting nourishment and raise the Risk of stillbirth Or
premature birth.
• Alcohol- It can cause life-long Physical and behavioural problems in children
including Fetal alcohol syndrome.
• Drugs- Cause underweight babies,Birth defects Or withdrawal symptoms after
birth.

31. • SUMMARY
• CONCLUSION
• BIBLIOGRAPHY
✓ HIRLAL KONAR- DC DUTTA’S TEXTBOOK OF OBSTETRICS- 8th
EDITION- 2015-JAYPEE BROTHERS (P) LTD- NEW DELHI.
✓ Dr.M.LOKESWARI- A TEXTBOOK OF MIDWIFERY AND
GYNECOLOGICAL NURSING- VIJAYAM PUBLICATIONS- VIJAYAWADA.
✓ NET REFERENCES