Antenatal care refers to medical care provided to women during pregnancy. The goals of antenatal care are to optimize health outcomes for mothers and babies, detect and manage risk factors, and provide education and support. Key aspects of antenatal care include initial visits to establish medical history and due date, subsequent visits for monitoring and screening tests, and education on nutrition, danger signs, and birth preparation. Regular antenatal care aims to prevent issues like anemia and infection while promoting a healthy pregnancy.

1. ANTENATAL CARE
Presenter: CYIMANA H. Albert
Supervisor: Dr HAVUGIMANA Theophille

2. OUTLINE
• Definitions
• aim of antenatal care
• Terminology of reproductive history
• diagnosis of pregnancy
• Initial visit
• Subsequent visits
• Lab exam and screening
• Supportive and prophilactic treatment
• Patient education
• References

3. INTRODUCTION
• Antenatal care refers to the medical and nursing care provided to
women and their babies during pregnancy

4. The aims of antenatal care are:
• To optimize pregnancy outcomes for women and babies.
• Detect earlier, prevent, and manage those factors that adversely
affect the health of mother and baby.
• To provide advice, reassurance, education and support for the woman
and her family.
• To prepare the woman the mode of delivery
• To provide general health screening.

5. Key definitions
• Gestational age (GA): The
time of pregnancy counting
from the first day of the last
menstrual period
• First trimester: 0 to 14 weeks
• Second trimester: 14 to 28
weeks
• Third trimester: 28 weeks to
birth
• Embryo: Fertilization to 8
weeks.
Fetus: 8 weeks until birth
 Previable: Before 24 weeks
 Preterm: 24 to 37 weeks
 Term: 37 to 42 weeks
Early term:37w0d-38w6d
Full term: 39w0d-40w6d
Late term: 41w0d-41w6d
Post term: from 42w

6. DIAGNOSIS OF PREGNANCY

7. The New Schedule of ANC contacts
•

8. INITIAL VISIT
1 Maternal Full History
1 Identification
• Names, age, home address, contact address, phone number, next of kin and his/her
address and phone number
2 Obstetric and Gynaecological history
• Gravidity, LMP, GA estimation , EDD, blood group ,HIV status.
• Previous pregnancies mode of delivery and outcomes on each;
• Problems and complications including bleeding; gestation, term pregnancy,
premature deliveries, recurrent abortions, still births/death immediately after birth,
postpartum haemorrhage in the past, previous retained placenta, c/sections,
ruptured uterus, pre-eclampsia/eclampsia.
• If at 26 week and above ask also about foetal movement rule out rupture of
membrane

9. Medical history:
• hypertension, asthma, convulsions, heart diseases, diabetes,
anaemia, tuberculosis, and other past and current medical problems;
current medications including use of medications and
herbal/traditional remedies, drug history including allergies
• Immunisation history
Family history
Genetic disease
Diabete
HTN

10. 2.Physical exam
• Complete physical examination including abdominal palpation,
• After 1st trin ask check also symphysis fundal height measurement

12. Pregnancy dating
BY LMP
• Determine gestational age (GA) by dates from the first day of the LMP (if
regular periods and sure dates)
By ultrasound scan
• If LMP unsure, get a dating ultrasound
• The most accurate dating ultrasound scan is done between 7-14 weeks of
GA: measure the Crown Rump Length(CRL)
• from 14weeks and above you measure : Head circumference(HC),
Biparietal diameter(BPD) and femur length(FL).

13. Estimated date of delivery

14. Ultrasound also helps to know
Fetal cardiac activity
• multiple pregnancy,
• ectopic,
• molar pregnancy,
• brighted ovum…

15. Fetal assessment
• Fetal cardiac activity
• Fetal heart rate (FHR) must be monitored in all pregnant women. A
normal FHR is 110 – 160 beats/minute; while an Abnormal FHR is
persistently <110 b/m or >160 b/m.
• enquire about fetal movements from 20 weeks.

16. Laboratory investigations and screening
• Screen for Pre-eclampsia, Anaemia and Asymptomatic Bacteriuria, TB,
Malaria, HIV, Syphilis, Hepatitis, gestational diabetes, substance abuse
and IPV ,urine dipstick, Blood group and Rh; FBC ,Cervical cancer
screening
• Urine dipstick, HIV and syphilis re-test for those who were negative,
And Malaria test, FBC for each visit

17. PREVENTIVE MEASURE
• Preventive measures about:
• Asymptomatic Bacteriuria(ASB),
• Tetanus,
• Iron, Folic Acid, calcium & other supplementation
• nutritional anemia,
• HIV,
• Intestinal worms
• Malaria.

18. PREVENTIVE MEASURES con’t
• Treatment for asymptomatic bacteriuria (ASB)
• Defined as bacteriuria in the absence of specific symptoms of acute urinary
tract infection
• Refers to the detection of a high number of bacteria in a urine sample.
• Urine culture is the gold standard for accurate diagnosis. The choice of
antibiotics should be based on culture and sensitivity results.
• First choice o Nitrofurantoin 100 mg (per os and two times daily) for 7 days
(avoid in first trimester and near term)
• Alternative o Amoxicillin 500mg TDS (Three times daily) PO for 7 days or
• Co-amoxiclav (Augmentin) 625mg TDS PO for 7 days

19. Schedule for Tetanus Toxoid administration.
TT1 At first contact No protection
TT2 4 weeks after TT1 Three years
TT3 At least 6 months after TT2 Five years
TT4 At least one year TT3 Ten years
TT5 At least one year after TT4 For thirty years
DOSE TIME OF ADMINISTRATION DURATION

20. Iron, Folic Acid, calcium & other supplementation
• During pregnancy, women have additional requirements for all nutrients
and micronutrients.
• Prescribe a daily dose of oral iron (60mg) and folic acid supplementation
(400mcg =0.4 mg) to prevent maternal anaemia, puerperal sepsis, low birth
weight, and preterm birth.
• If a woman is diagnosed with anaemia during pregnancy increased to 120
mg until her Hb concentration rises to normal (Hb 110 g/L or higher)
• vitamin C (e.g. citrus fruits) and vitamin A rich foods (e.g. orange fresh
foods such as mangos, whole milk, butter, egg yolk, palm oil)
Deworming
• Give Mebendazole (500 mg) once during second or third trimester of
pregnancy to every woman

21. • Malaria in Pregnancy prevention
Provision of ITNs and Counselling on other malaria prevention
measures

22. SCREENING FOR GESTATIONAL DIABETES MELLITUS(GDM)
• For pregnant woman not known with Diabetes Mellitus, GDM is
screened between 24-28 weeks of GA
• When GDM is detected treatment should be initiated such as
Nutritional counselling, diet, oral glucose lowering drugs and insulin if
necessary to reduce risk of poor outcome

23. COUNSELING
• Diet, physical activity, rest, adherence to prescribed medecine
• Avoid caffeine, alcohol and others substances consumption:
• Smoking should be stopped as well as avoidance of second hand
smoking.
• Avoidance of unspecified medicinal plants without qualification from
a recognized institution
• Domestic animals precaution (toxo)

24. CONT
• Common complications of pregnancy managed conservatively:
 Low back and pelvic pain
 Constipation
 Nausea and vomiting
 Heart burn
 Leg edema and varicose vein

25. • Emphasize on the importance of coming for each appointment and
being adherent to given medications and instructions
• Discuss about family planning
• Discuss on way of delivery

26. Advise on danger signs
• Teach the pregnant woman and her family to report any of the following
conditions immediately:
• Vaginal bleeding
• Sudden gush of fluid or leaking of fluid from vagina
• Severe headache not relieved by simple analgesics (e.g. paracetamol)
• Dizziness and blurring of vision
• Sustained vomiting
• Swelling (hands, face, etc.)
• Decrease or Loss of fetal movements
• Convulsions
• Premature onset of contractions (before 37 weeks)
• Severe or unusual abdominal pain
• Chills or fever

27. REFERENCE
• First Aid for the OBGYN Clerkship
• USMLE Obstetrics & Gynecology lectures
• Antenatal Care Guidelines for Rwanda
• Williams Obstetrics 25th edition

28. THANK YOU!