Antenatal care involves the clinical examination and monitoring of pregnant women to ensure the health of both mother and baby, aiming to reduce mortality and complications. It includes a schedule of visits, clinical assessments, and necessary investigations, as well as addressing common discomforts and dietary recommendations. Post-term pregnancies may lead to labor induction or a cesarean section if necessary.

2. Antenatal care
Antenatal care is the clinical examination, observation, and
follow up of the mother and fetus during pregnancy, for the
purpose of obtaining the best possible health for the mother and
child.
Goals:
- To reduce the rate of the mother and
baby death and abnormality.
- To improve the physical and mental
health of the mother and the baby.

3. Why it is important?
- To ensure that the pregnant
woman and her baby in the best
possible health.
- To detect any problem early; so
the treatment becomes easier.
- To prepare the mother for labor,
lactation, parenthood, and care of
her baby.

4. Schedule for antenatal visits
The first visit should be as early is pregnancy as possible.
The return visits should be:
- Once every month during the first two trimesters (from week
1–28).
- Once every 2 weeks (from week 28 – 36).
- Once every week after 36th until delivery (delivery at week
38–42).

5. Frequency of antenatal appointments
- Nulliparous: 10 appointments in normal pregnancy at
least.
(Nulliparous is a woman who has never given birth to
infant).
- Parous: 7 appointments in normal pregnancy at least.
(Parous is a woman who had gave a birth to infant or
more before).

6. Clinical assessment
1- History.
2- Physical examination.
3- Investigation and tests.
4- Normal discomforts of pregnancy.
5- Diets.

7. 1-History:
- Personal history; smoking, drinking, any present diseases.
- Family history; medical history of family, pregnancy loss, down’s
syndrome.
- Medical and surgical history; if she had any problem before (such as
diabetes, hypertension, heart problems, asthma, hepatitis…etc.), or
used and drugs (such as antibiotics, cortisones…etc.)
- Menstrual history; the last menstrual period (LMP) to calculate the
date of labor.
- Obstetrical history; did the mother gave a birth before.
- History of present pregnancy; if she has any problem in this pregnancy
or used any medication.

8. 2- Physical examination:
- Abdominal and uterus examination: Palpation before 20th week, and in
centimeters after 20th week (number of week ± 2), after week 36
(number of week ± 3).
- Weight gain: the approximate weight gain during pregnancy is 12 kg;
2kg in the first 20 weeks and 10 kg in the remaining 20 weeks (1.5 kg
per week until term).
- Pelvic examination (examination of the external female reproductive
system).
- Heart, lung, and breast examination.
- Fetal movement and position, and heart beat.

9. - External cephalic version (ECV), is a procedure used to
turn a fetus from a (breech) position or lying sideways
(transverse) position into a head-down (vertex) position
before labor begins. We are doing it by using hands. We
can do it at (36th – 38th) week.
- Sometimes we can't do this technique because it may
become dangerous for the mother, or the fetus, or both.
Fetus normal position

11. Vertex (normal)BreechExternal cephalic version (ECV),

12. Vertex (normal)Breech

13. - Fetal heart sound is heard by sonicaid Doppler
as early as 10th week of pregnancy.
- Fetal heart sound is heard by Pinard' s fetal
stethoscope after the 20th week of pregnancy.
- The normal fetal heart rate is 120-160 beats/min.
Fetus heart beat

14. Pinard' s fetal stethoscope Sonicaid Doppler

15. - Fetus started moving at 7 or 8 weeks.
- Mother can not feel the movement until sometime
between 16 and 22 weeks.
- The pregnant woman reports at least 10 movements in 12
hours.
- Most babies move at least 10 times within two hours.
- Absence of fetal movements precedes intrauterine fetal death
by 48 hours.
Fetus movement

16. 3- Investigation and tests:
- Syphilis serology.
- Human immunodeficiency virus (HIV).
- Hepatitis B.
- Urine should be tested for sugar, ketones and protein.
- Blood examination: sugar, group, pressure, hemoglobin.
- Down’s syndrome.
Down’s syndrome

17. 4- Normal discomforts of pregnancy:
• Urinary frequency:
Etiology:
- Hormones changes.
- Enlarged uterus press the bladder.
Relief measures:
- Decrease fluid intake at night.
- Empty the bladder often.

18. • Nausea and vomiting:
Etiology:
- Low blood sugar
- High levels of hormones
- Enlarge utreus
Relief measures:
- Eat small, frequent meals.
- Avoid foods with strong smell or tastes.
- Eat dry crackers, banana before rising in morning.
- Avoid sudden movements; get out of bed slowly.
- Drink ginger.

19. • Heartburn :
Etiology:
- Anatomical and hormonal changes.
- Delayed emptying of stomach contents.
Relief measures:
- Eat small, frequent meals, rather than three large meals.
- Avoid spicy, fatty foods.
- Simple Exercise.

20. • Constipation :
Etiology:
- Iron supplements.
- Low fiber foods.
- Delayed emptying of stomach contents.
Relief measures:
- Drink 8 glasses of water at least every day.
- Maintain regular bowel habits.
- Increase fiber in diet.
- Change the type of iron supplements.
- Exercises.

21. • Faintness:
Etiology:
- Hot weather.
- Low Glucose.
- Anemia.
Relief measures:
- Rise slowly from sitting to standing.
- Evaluate hemoglobin and glucose.
- Avoid hot environments

22. • Shortness of breath:
Etiology:
- High level of progesterone.
- The pressure of the growing uterus on the diaphragm.
Relief measures:
- Use extra pillows at night to keep more upright.
- Exercises.
- Do not eat too much.
- Do not smoke.
- Take deep breath.

23. • Nasal stuffiness and bleeding:
Etiology:
Increased hormones result in increased blood flow to the nose.
Relief measures:
Use humidifiers in the nose, and normal saline drops.

24. • Leg cramps:
Etiology:
- Impaired circulation.
- Imbalance of calcium/phosphates ratio
Relief measures:
- Extend the leg and move the foot up and down.
- Do massage to the leg.
- Elevate lower legs frequently.
- Apply heat to muscles.
- Reduce Phosphorus and regulate calcium.

25. • Backache:
Etiology:
Increase the weight of the growth fetus.
Relief measures:
- Wear supportive shoes with low heels.
- Exercises.
- Massage the lower back and apply a heat.

26. • Sleep difficulties and Fatigue:
Etiology:
- Physiologic changes
- Fetal movement and kicking.
- High level of hormones.
Relief measures:
- Rest frequency.
- Decrease fluid intake at night.
- Go to bed earlier.
- Exercise.
- Warm milk and warm shower/baths before go to the bed.

27. • Varicosities (swollen veins) :
Etiology:
Increases pressure in the legs due to
increase in weight.
Relief measures:
- Exercises.
- Elevate legs regularly.
- Avoid crossing legs.
- Avoid tight socks and pants.
- Avoid long periods of standing

28. 5- Diets (healthy good nutrition):
Most essential nutrients for the fetus:
- Folate and folic acid (vitamin B); prevent birth defects.
- Calcium and vitamin D; strengthen bones.
- Protein; promote growth and development.
- Omega3 and vitamin B; Brain development.
- Complex Carbohydrates; Energy for the fetus and mother (Glucose).
- Iron (with water, potassium); prevent anemia.
- Vitamin C; promote wound healing, tooth and bone development, and
metabolic processes.
- Water; carry the nutrition for the fetus and reduce pregnancy
discomforts for the mother.

29. Pregnancy after the 40th week (Post-term)
1.Wait until week 41.
2.If nothing happen; induce labor (Induction of
Labor).
3.If mother doesn’t agree to Induce labor; we
make (caesarean section).