Antenatal examination, health-care practices, antenatal history taking, care to be provided to antenatal mother

2. •Gravida
•number of times a female has got pregnant
irrespective of the duration of pregnancy and
outcome
•Para
•number of PAST pregnancies which have crossed
the period of viability (22 weeks)

3. • Abortion
• expulsion or extraction from its mother of an embryo or fetus
weighing 500g or less when it is not capable of independent survival
• Still birth
• birth of a newborn after 28 completed weeks (weighing 1000g or
more) when the baby doesn’t breathe or show any signs of life
after delivery

4. • This is calculated by adding nine calendar months and seven days to the first
day of last normal menstrual (LMP) period provided menses are regular and
normal 28 days cycle.
• This is called Naegele’s rule.
• If the cycles are longer, extra days beyond 28 is added for calculation of EDD.
•Eg:1st Jan is LMP -EDD is 9 calendar months and 7days
i.e. 1st oct plus 7days…8th oct
•Eg:5th march is LMP – EDD is dec 12th

5. • Case 1: A 27 yr old pregnant lady comes for ANC ,the period of
gestation is 6months.She has two live children. No h/o
abortions
• The obstetric score is G3 P2 L2 A0
• Case 2: A 30yr old lady comes for check up .She has three live
children. No h/o abortions.
• Her obstetric score is P3 L3 A0

6. • Case 3: A 25 yr old pregnant woman comes for ANC at 6th
month. She has three living children. During first pregnancy
she delivered twins (both male) and second pregnancy she
delivered a female baby.
• Her obstetric score is G3 P2 L3 A0
• Case 4: A 30 yr old pregnant woman comes for ANC at 29
weeks POG .She has two live children and she had one
abortion at 12 weeks.
• Her obstetric score is G4 P2 L2 A1

7. History of present pregnancy: (trimester wise, number of visits, immunization,
IFA + Ca tablets , Ultrasound scans and advice)
•Hyper emesis, threatened abortion , fever with rash, bleeding pv -1st trimester
•Anemia ,pre-eclampsia , bleeding pv, white discharge -2ND trimester
•h/o radiation exposure – 1st trimester
•Medical and surgical events during pregnancy

8. • Pulse:
• BP:
• Pallor:
• Edema:
Lower palpebral conjunctiva, nail beds and dorsum of tongue
•Physiological
•Pre eclampsia
•Anemia and hypoproteinemia
•Cardiac failure
•Nephrotic syndrome

9. • Jaundice:
• Lymphadenopathy:
• Thyroid: enlarged in 50% cases
• Varicose veins:
• Height: short stature
• Weight:
• Examination of breast:
•Bulbar conjunctiva
•Under surface of tongue
•Hard palate

10. • CVS
• RS
• CNS

11. •Attitude
•Lie
•Presentation
•Presenting part
•Denominator
•Position
•Obstetric grips
Obstetric examination

12. • Attitude:
• is the relation of different parts of the fetus to each other, UNIVERSAL attitude-
FLEXION.
• Lie :
• is in relation of the long axis of the fetal spine with that of the long axis of
centralized uterus or maternal spine.
• Longitudinal
• Oblique
• Transverse

13. • Presentation:
• is the foetal part that occupies lower pole of the uterus
• Cephalic
• Podalic or breech
• Shoulder
• Presenting part:
• part of the presentation which overlies the internal os .eg: vertex/face in
cephalic presentation

14. •Denominator:
•is the arbitrary fixed point on the presenting part which comes in
relation with the various quadrants of maternal pelvis
•Occiput in vertex, mentum in face, frontal eminence in brow, sacrum in
breech, acromion in shoulder
•Position:
•is relation of denominator to different quadrants of the pelvis.
•LOA, ROA, ROP, LOP, OP, OA, LOT,ROT

18. • The care of the woman during pregnancy

19.  Healthy mother and a healthy baby

20. • Once a month for first 7
months
• Twice a month during the
next month
• Once a week thereafter
•1st visit: Within 12 weeks
•2nd visit: 14-26 weeks
•3rd visit: 28-34 weeks
•4th visit: 36 weeks and term
Ideal? Minimum

21. •History
•Physical examination
•Lab. Examinations – routine
blood and urine examinations
• Physical examination
• Hemoglobin estimation,
• Urine examination
 At first visit  On subsequent visits

22. Self careDelivery and
parenthood
Referral
services
Iron tablets
TT injection
Nutrition
Family planning
Visit by female health worker

23. Diet
• 350 kcal over and above normal requirement per day
Lactation
•0-6 months : Extra of 600 kcal/day
•6-12 months : Extra of 520 kcal/day

24. •Personal cleanliness
•Rest and sleep
•Bowel habits
•Exercise
•Child care
•Smoking and alcohol
•Dental care
•Sexual intercourse
•Drugs and Radiation

25. •Swelling of the feet
•Fits
•Headache
•Blurring of vision
•Bleeding or discharge per
vagina
•Any other unusual symptoms
Warning signs

26. • Anemia
• HIV
• Tetanus
• Syphilis
• German measles
• Rh status
• Prenatal genetic screening

27. •Mental preparation
•Family planning
•Paediatric component

28. • Elderly primi(30 years and over)
• Short stature( 140 cm and below)
• Malpresentation
• APH
• Anemia
• Pre eclampsia
•Twins , Hydramnios
•Previous still birth, IUD, manual
removal of placenta
•Medical disorders associated with
pregnancy- kidney, liver diseases
•History of previous caesarian section