Antenatal care

‫الرحيم‬ ‫الرمحن‬ ‫هللا‬ ‫بسم‬
َ‫ك‬َ‫ن‬‫ا‬َ‫ح‬ْ‫ب‬ُ‫س‬ ْ‫ا‬‫و‬ُ‫ل‬‫ا‬َ‫ق‬َ‫ل‬ َ‫م‬ْ‫ل‬ِ‫ع‬ َ‫ال‬ّ‫ال‬ِ‫إ‬ ‫آ‬َ‫ن‬
ّ‫ن‬ِ‫إ‬ ‫آ‬َ‫ن‬َ‫ت‬ْ‫م‬ّ‫َل‬‫ع‬ ‫ا‬َ‫م‬َ‫ع‬ْ‫ال‬ َ‫ت‬ْ‫ن‬َ‫أ‬ َ‫ك‬ُ‫م‬‫ي‬ِ‫ل‬
ُ‫م‬‫ي‬ِ‫ك‬َ‫ح‬ْ‫ال‬
‫العظيم‬ ‫اهلل‬ ‫صدق‬
‫سورة‬‫البقرة‬‫أية‬32
4/5/2018 Dr. Soad Abd El Salam Ramadan 1

Ante natal
Care

3
Dr. Soad Abd El Salam Ramadan
• Chairman of obstetrics &woman health
nursing department
• Pre. Vice dean for students &Education
Affairs
Faculty of nursing
Benha University
4/5/2018 Dr. Soad Abd El Salam Ramadan

Pregnancy
A normal physiologic event that may complicated
by pathologic processes dangerous to the health
of the mother and fetus in only 5-20% .
When a woman is pregnant, the period of time
from conception until the baby is born is called the
antepartum (prenatal or antenatal) period .
ante- and pre- mean “before”
partum and natal mean “birth”
Postpartum - after delivery

Terms related to Pregnancy
 Gravida- a woman has been pregnant
(including this pregnancy), regardless of
duration or outcome.
 Para- pregnancies a woman has
completed past 20 weeks, regardless of
whether infant is born alive or dead (refers to
number of pregnancies, not fetuses).

 Multipara- a woman who has given birth 2
or more times over 20 weeks gestation
 Multigravida- a woman who has been
pregnant more than once
 Nullipara- a woman who has never
completed a pregnancy past 20 weeks
 Primipara- a woman giving birth for the first
time of a pregnancy that has lasted at least 20
weeks
 Primigravida- a woman who is pregnant for
the 1st time

Definition of Antenatal care
comprehensive health supervision of a
pregnant woman before delivery
Or it is planned examination, observation
and guidance given to the pregnant
woman from conception till the time of
labor.

Goals
 To reduce maternal and perinatal
mortality and morbidity rates
 To improve the physical and mental
health of women and children

Objectives
1- To ensure that the pregnant woman and her fetus are in
the best possible health.
2-Early detection and prevention of complications of
pregnancy.
3-Educate women on danger and emergency signs &
symptoms.
4-Prepare the woman and her family for childbirth
5- Give education & counseling on family planning

 The antepartum period lasts
approximately 9 months (280 days-40
weeks) and is divided into three
trimesters of 3 months each

Trimesters
Gestation - period of time for intrauterine
fetal development ( GW)
 1st trimester
0-3months(13WK)
 2ndTrimester
4-6 months(14-26WK)
 3rdTrimester
7-9 months(27-40WK)

Schedule for Antenatal Visits:
The first visit or initial visit should be made
as early is pregnancy as possible.
Return Visits:
 Once every month till 7th month.
 Once every 2 weeks till the 9th month
 Once every week during the 9th month,
till labor.

Assessment
History Examination Investigation

History
 Personal history
 Family history
 Medical and surgical history
 Menstrual history
 Obstetrical history
 History of present pregnancy

Menstrual history
-Ask about
-1-Last menstrual period (LMP).
-2-Regularity and frequency of menstrual cycle.
-3-Contraception method used .
-4-Calculate expected date of delivery (EDD) as
1st day of LMP −3 months +7 days, and change the
year.

Estimating due date
 EDD- (estimated date of delivery)
 Nagele’s Rule
 Subtract 3 months
 Add 7 days from the 1st day of the LMP
 Correct the year if necessary
 Example- LMP September 20th, 2016.
 Subtract 3 months- June 20th
 Add 7 days- June 27th
 Change the year if necessary- EDD= June
Dr. Soad Abd El Salam Ramadan4/5/2018 17

Obstetric History
Gravidity? Parity? abortion, and living
children.
➢ Weight of infant at birth & length of
gestation.
➢ Type of delivery, location of birth, and type
of anesthesia.
➢ Maternal or infant complications.

1-Chronic conditions : as diabetes mellitus,
hypertension, and renal disease ,cardiac
disease.
2-Prior operation: as cesarean section,
genital repair, and cervical cerclag.
3-Allergies, and medications.
4-Accidents involving injury of the bony
pelvis
Medical and surgical history:

History of present pregnancy
 History suggesting e.g. Diabetes,
hypertension and ante partum hemorrhage.
 Ask about episodes of fever or chills
 Ask about pain or burning sensation on
urination.
 Abnormal vaginal discharge, itching at the vulva
or if partner has a urinary problem.

IMMEDIATE ASSESSMENT
for emergency signs.
Vaginal bleeding
Severe abdominal or pelvic pain
Severe headache with visual disturbance
Persistent vomiting
Unconscious/Convulsion
Severe difficulty in breathing
High grade Fever
Looks very ill

Assessment and physical
examination

Weight measurement
 Maternal height and weight measurements to
determine body mass index(BMI).
 Maternal weight should be
measured at each
antenatal visit


Check for pallor or anemia.
1-Look for palmar pallor.
2-Look for conjunctival pallor
3-Count respiratory rate in
one minute.

Blood pressure measurement
Measure BP in sitting position.
If diastolic BP is 90 mm Hg or
higher repeat measurement after
6 hour rest.
If diastolic BP is still 90 mm Hg or
higher ask the woman if she has:
• Severe headache
• Blurred vision
• Epigastric pain
Check urine for protein.

Physical Examinations
 Height of over 150 cm indication of an
average-sized pelvis
 The approximate weight gain during
pregnancy is 12 kg.; 2kg in the first 20
weeks and 10 kg in the remaining 20
weeks ( 0.5 kg per week until term).

 Obesity (more than 20 kg above the
weight-height formula) leads to an
increased risk of gestational diabetes,
pregnancy-induced hypertension and
thrombo-embolic disorders

Local Examination
 The uterus may be higher than expected
due to large fetus, multiple pregnancy,
polyhydrammnios or mistaken date of last
menstrual period.
 The uterus may be lower than expected due
to small fetus, intrauterine growth
retardation, oligohydramnios or mistake
date of last menstrual period.

Uterine Size :-
 12 weeks- Symphysis pubis
 16 weeks- Midway between symphysis pubis and umbilicus
 20-22 weeks- Umbilicus
 20-32 weeks- 1 cm above umbilicus
for every 1 week
 By the end of 36th week should
touch the xiphoid process and can
make breathing difficult
 About 2 week before term (38 week) for
 a primigravida the fetal head settle into
 the pelvis to prepare for birth, this termed lightening.

 Fetal heart sound is heard by sonicaid as
early as 10thweek of pregnancy.
 Fetal heart sound is heard by Pinard' s
fetal stethoscope after the 20thweek of
pregnancy.
 The normal fetal heart rate is 120-160
beats/min

At each visit

Symphysis Fundal hieght
•LMP plus 280 days
•Add 7 days,
subtract 3 months
•MacDonald's Rule
(cm = weeks)

At third trimester
Do
Leopold’s exam

Investigations:
 Urine should be tested for sugar,
ketones and protein.
 Hemoglobin will be repeated:
At 36 weeks of gestation.
Every 4 weeks if Hb is < 9 g/dl.

Fetal kick count
The pregnant woman reports at
least 10 movements in 12 hours.
Absence of fetal movements
precedes intrauterine fetal death
by 48 hours.

Health Teaching during the First
Trimester
 Physiological changes
during pregnancy
 Weight gain
 Fresh air and sunshine
 Rest and sleep
 Diet
 Daily activities
 Exercises and relaxation
 Hygiene
 Teeth
 Bladder and bowel
 Sexual counseling
 Smoking :
 Medications
 Infection
 Irradiation
 Occupational and
environmental hazards
 Travel
 Follow up
 Minor discomforts
 Signs of Potential
Complications

 Exercise should be simple, mild exercise avoid
lifting heavy weights
 A tooth can be extracted during pregnancy,
but local analgesia is recommended
 Catheter and enema should be avoided.
 Smoking may lead to ptyalism, nervousness
and hyper emesis and make pregnant woman
at increased risk of chest infections and
thrombo-embolic disorders

 Pregnant woman should avoid contact with
infectious diseases especially rubella or
(German measles) because it has deleterious
effects on the fetus
 Pregnant woman should avoid exposure to x-
ray or irradiation because of possible
teratogenic effects on the fetus such as birth
defects or childhood leukemia

Supplementation
 1-Folic acid 0.4 mg tab daily
 2- iron (ferrous sulphate or gluconate )300
mg/daily
 3- Ca 1200mg /daily
4-
•-Those with a normal balanced diet
•probably don’t need extra vitamins

Medications During Pregnancy
• Antibiotics - some OK, some not
• Local anesthetics - OK
• Local with epinephrine - not OK
• Aspirin - not OK
• Immunizations - some are OK,
some are not
• Antimalarial - some OK, some are
not
• Narcotics - OK except for addiction
issue

Provide advice on each visit
1.Diet and weight gain
2.Medication
3.Avoid Radiation exposure
4.Self-care during pregnancy
5.Minor complaints.
6.Family planning Breastfeeding
7.Birth place preparation and anticipation of
complication& Emergency situations.

At each visit
 1-Questions about fetal movement
 2-Ask for danger signs during this pregnancy
 3-Ask patient if she has any other concerns

434/5/2018 Dr. Soad Abd El Salam Ramadan

Antenatal care

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