The document outlines the objectives and care practices for antenatal sessions, detailing the definition, aims, and required visits during the three trimesters of pregnancy. It includes information on calculating the expected date of delivery, signs of pregnancy, necessary immunizations, nutritional supplements, and the father's role. Additionally, it lists danger signs of pregnancy that require immediate attention.

1. Antenatal
Care

2. Session Objectives
• Define antenatal care
• Discuss the aims of antenatal care
• Discuss the number of visits in each trimester
• Calculate EDD
• Review the common terminologies
• Discuss the signs of pregnancy
• List the danger signs of pregnancy
• Describe care during pregnancy

3. Antenatal Period
 Covers the time of pregnancy from the first day of LMP to
the start of true labour
 Duration of pregnancy: approx. 280 days, 40 weeks
 Divided into 3 trimesters:
1st trimester : 1 to 12 (12 weeks)
2nd trimester: 13 to 27(13 weeks)
3rd trimester: 28 to 40 (15 weeks)

4. AIMS OF ANTENATAL CARE
⦁ T
o monitor progress of pregnancy
⦁ T
o monitor maternal & fetal well being
⦁ To prepare mother for pregnancy,labour & postnatal
period
⦁ T
o prepare mother for lactation
⦁ T
o vaccinate
⦁ T
o rule out risk factors
⦁ To perform early referral to prevent morbidity &
mortality

5. NUMBER OF ANTENATAL VISITS
At least 4 RoutineVisits
⦁ FirstVisit --------Within Four Months Or As SoonAs
Possible
⦁ SecondVisit ------At Sixth Month
⦁ ThirdVisit ---------At Eighth Month
⦁ FourthVisit ------ In Ninth Month

6. Nägele’s Rule
Calculate Expected Date of Birth (EDB,EDD)
⦁ First day of last menstrual period (LMP)
⦁ Add 7 days
⦁ Subtract 3 months
⦁ OR
⦁ First day of LMP+9M +7 DAYS

7. ⦁ Gravida
The term gravid comes from the Latin word gravidus. It is used to describe a
female who is pregnant and is also a medical term for the total number of
confirmed pregnancies a female has had, regardless of the outcome of the
pregnancy
Para
Parity, or "Para", indicates the number of births (including live births and
stillbirths) where pregnancies reached viable gestational age. A multiple
pregnancy (e.g., twins, triplets, etc.) carried to viable gestational age is still
counted as 1
TPAL
T
erm,Preterm,Abortion,Living & Still birth
⦁

8. Maternal Anatomical & Physiological Changes
Physiological and Hormonal changes Indicative of
Pregnancy:
• Presumptive Signs:of pregnancy are maternal physiological changes that the
women experience
• Probable Signs:maternal physiological and anatomical changes that are
detected upon examination and documented by the examiner
• Positive signs:directly attributable to the fetus

9. Signs of
Pregnancy
Presumptive
*Amenorrhea
*Fatigue
*Nausea and vomiting
*Urinary frequency
*Breast changes – Darkened
areola,enlarged
Montgomery’
s tubules
*Quickening– slight fluttering
movements ofthe fetus felt
by a woman,usually between
16 to 20 weeks ofgestation.
*Uterine enlargement
*Linea nigra
*Chloasma (mask of
pregnancy)
Probable
*Abdominal enlargement related
to changes in uterine size,shape,
and position
*Cervical changes
*Hegar’
s sign – softening and
compressibility of lower uterus
*increased vascularity of the
area
*Positive pregnancy test
*Fetal outline felt by examiner
Positive
*Fetal heart sounds
*Visualization offetus by
ultrasound
*Fetal movement palpated by
an experienced examiner

10. Montgomery’s tubules

11. Quickening – slight fluttering

13. Chloasma

14. Hegar’s sign

15. Anatomical Changes/ Uterine Enlargement
Changes Reason
Uterine
Growth
(effect of
Estrogen &
Progesterone)
Uterine growth by hyperplasia (increased number of
cells)
Uterine walls increased strength
Increase number of elastic tissues
Chadwick’s
Sign
Goodell’s sign
 in size of uterine blood vessels and lymphatics
 Vascularityand edema
Braxton Hicks
contraction
 Caused due to stretching of uterine muscle cells

16. Care during Pregnancy
History taking:
⦁ Client Name
⦁ Age
⦁ Husband Name
⦁ Cast
⦁ Religion
⦁ Address
⦁ Telephone Number
⦁ Client Occupation
⦁ Husband Occupation
⦁ Marital Hx
⦁ Blood Group
⦁ Reason Of Visit
⦁ Chief Complain (IfAny) & Its
Detail

17. Assessment & Examination
⦁ General Survey
⦁ Head toT
oe Examination
⦁PerAbdominal Examination:
Leopold Maneuver

18. Leopold Maneuver

19. Investigations
Initial visit
⦁ Complete Blood Count
⦁ ABO blood group
Urine Detail Report
⦁ Fasting Blood Sugar
⦁ Hep.B & C
⦁ U/S:First trimester--- fetal
viability scan
Follow-up visit
⦁ Hemoglobin
⦁ Oral GlucoseT
olerance
T
est---Second trimester
U/S:
⦁ Anomaly scan---18-20wks
⦁ Growth scan--- 32-33wks

20. Birth & Emergency Plan
Involvement of husband is highly
important
Birth Plan
⦁ Hospital or home
⦁ Obstetrician,midwife
⦁ Companion in birth
⦁ Arrangement for birth
⦁ Feeding
Emergency Plan
⦁ Money
⦁ Vehicle
⦁ Place of birth
⦁ Care provider
⦁ Blood donor

21. 27
Fetal lie and Presentation

22. Fetal Lie
The relationship of long
axis of fetus to long axis
of uterus e.g longitudinal,
transverse, oblique

23. Immunization
• administration of two doses of Td injection is an important step in
the prevention of maternal and neonatal tetanus.
• The first dose of Td should be administered as soon as possible
preferably when the woman register for ANC.
• The second dose is to be given one month after the first
preferably at least one month before the EDD.
• If the woman receives the first dose after 38 weeks of pregnancy
,then the second dose may be given in the postnatal period, after
a gap of four weeks.
• If the woman has been previously immunized with two dose
during a previous pregnancy within the past three years, then give
her only one dose as early as possible in this pregnancy.

24. Dose of Td
• o.5 ml by deep intramuscular injection.
• It should be given in the upper arm and not in the buttocks as this
might injure the sciatic nerves.
• Inform the woman that there may be a slight swelling pain and or
redness at the site of the injection for a day or two.

25. Nutritional supplements
• IFA Supplementation
• Help preventing the complication due to anemia.
• besides recommending IFA supplementation counsel the woman
to increase her dietary food of iron rich foods such as green leafy
vegetables, whole pulses , jiggery, meat , poultry and fish.
Prophylactic dose :- 180 tab IFA OD starting after the first trimester
at 12 weeks of gestation until delivery.
Therapeutic dose :- (Hb less than 11 gm% /dl ) or has pallor 200 tab
IFA , BD . If it does not rise in spite, refer the woman to the MO
(medical officer ) at the PHC

26. Counselling for IFA
• IFA tab must be taken regularly, preferably early in the morning
on an empty stomach .
• In case the woman has nausea and pain in the abdomen, she may
take the tablet after meals or at night . This will help avoid nausea
dispel.
• The myths and misconceptions r/t to IFA and convince the
woman about the importance of IFA supplementation. An
example of a common myths is that the consumption of IFA may
affect the baby’s complexion.
• t is normal to pass black stool while consuming IFA. Tell the
woman not to worry about it. In case of constipation, the woman
should drink more water and add roughage to her diet. IFA tab
should not be consumed with tea, coffee, milk or calcium tab, as
these reduce the absorption of iron.

27. • Ask the woman to return to you if she has problems taking IFA
tablets.
• Refer her to the MO for further management.
• Emphasis the important of a high protein diet, including items
such as black gram, ground nuts, whole grains, milk, eggs, meats
and nuts for anemic women . Encourage the woman to take
plenty of fruits and vegetables containing vitamin ‘c’( e.g.:-
mango, guava, orange and sweet lime) as these enhance the
absorption.

28. Care during Pregnancy
Pregnancy care:
• Minor discomforts of pregnancy
• Nutrition during pregnancy and
after delivery
• Preparation for breastfeeding
• Antenatal exercises
• Psychological adjustments
during pregnancy
The Father’
s Role:
• The father’
s role throughout the
transition to parenthood
• Father’
s concerns.
Labor and birth:
• Process of labor and birth
• Pain relief in labor
• Companionship in labor
• Common interventions
used in many labors
• Caesarean section
• Psychological adjustments
to labor and birth
• Skin-to-skin contact with
the newborn and early
breastfeeding.

29. Antenatal exercises

30. Danger Signs of Pregnancy
⦁ Bleeding /Gush of fluid from vagina
⦁ Abdominal pain
⦁ Temp > 38.3° (101°F) & chills
⦁ Persistent vomiting
⦁ Dysuria/ oliguria
⦁ Dizziness, blurred vision, double vision,
⦁ Severe headache
⦁ Edema of face, hands including legs & feet
⦁ Convulsions (muscles contract and relax quickly and
cause uncontrolled shaking of the body)
⦁ Decreased or absent fetal movement

31. References
⦁ Fraser, D.M., & Cooper, M.A., (2014). Myles Text Book
For Midwives. (16th ed.). Churchill Living Stone Elsevier.
⦁ WHO. (2002).Essential Antenatal, Perinatal and Post-
Partum Care. World Health Organization, Regional
Office for Europe, Family and Reproductive Health Unit.
⦁ WHO. (2012). Guideline: Daily iron and folic acid
supplementation in pregnant women. Geneva.
⦁ Marchofdimes.com

32. Thank You