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1. Antenatal care
BY: Dr. K.S.K Jusu
school of clinical sciences
O& G Department

2. Diagnosis of pregnancy
• Nausea and vomiting
• Frequency of micturitation
• Fatigue
• Breast tenderness
• Fetal movements
• HCG- urine or blood
– Secreted by trophoblast from 8 days, peaking at 8-12
weeks.

3. Dating a pregnancy
• LMP- Naegele’s formula
• NB. Ovulation, length of cycle, uncertain LMP
• 8-13 weeks USS = CRL
• >13 weeks = BPD, AC, FL

4. Measuring fundal height
Small for dates
Wrong dates
Oligohydramnios
Intrauterine growth restriction
Presenting part deep in the pelvis
Abnormal lie of the fetus
Large for dates
Wrong dates
Polyhydramnios
Macrosomia
Multiple pregnancy
Presence of fibroids

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

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

7. Importance of Antenatal Care
 To ensure the health of pregnant woman and
her fetus .
 To detect early complication and treat.
 Offers health education
 To prepare the woman for labor, lactation and
care of her infant

8. Schedule for Antenatal Visits:
First visit- 13 to 16weeks
Things to do
-history taking and examination
-weight,BP and height
-Hb,urinalysis,RVS,Syphilis, blood type and
Rh
-give TT1, fefol
- Do USS and TB and hepatitis screen

9. Schedule for Antenatal Visits:
second visit- 20weeks
Things to do
-history taking
-weight,FH, SFH,BP
-do urinalysis, ask for fetal movement
-give TT2, fefol,albendazole
- Give SP for IPTp2 weeks and give
monthly until deliver

10. Schedule for Antenatal Visits:
third visit- 26weeks
Things to do
-history taking
-weight,FH, SFH,BP
-do urinalysis, ask for fetal movement
-give fefol
- Give SP for IPTp3
-family planning,birth preparedness and
danger signs.

11. Schedule for Antenatal Visits:
fourth visit- 30weeks
Things to do
-history taking and examination
-weight,FH, SFH,BP
-do urinalysis, ask for fetal movement
-give fefol
- Give SP for IPTp4
-family planning,birth preparedness and
danger signs,diet &exercise.

12. Schedule for Antenatal Visits:
fifth visit- 34weeks
Things to do
-history taking and examination
-weight, BP
-do urinalysis, ask for fetal movement
-give fefol
- Give SP for IPTp5
-family planning,birth preparedness and
danger signs,diet,exercise breastfeeding&

13. Schedule for Antenatal Visits:
sixth visit- 36weeks
Things to do
-history taking and examination
-weight, BP
-do urinalysis, Hb
-give fefol
-in addition to other counselling,advise
facility delivery and postnatal care

14. Schedule for Antenatal Visits:
seventh visit- 38weeks
Things to do
-history taking and examination
-weight, BP
-do urinalysis
-give fefol
- Give SP for IPTp6
-in addition to other counselling,advise
facility delivery and postnatal care,labour

15. Schedule for Antenatal Visits:
Eighth visit
Things to do
-history taking and examination
-weight, BP
-do urinalysis
-give fefol
-refer toCEmONC for induction of labour at
41weeks

16. Frequency of antenatal appointments
 Nulliparous with an uncomplicated pregnancy,
a schedule of 10 appointments.
 Parous with an uncomplicated pregnancy, a
schedule of 7 appointments.

17. Assessment
History Examination Investigation

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

19. 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.

20. 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 (1.5 kg per week until term).

21.  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.

22. Pregnancy after 41 weeks
 Prior to formal induction of labour,
women should be offered a vaginal
examination for membrane sweeping.
 42 weeks ?!

23. Investigations(in clinic):
 Urine should be tested for ketones and protein.

24. Nausea and vomiting
•most cases of nausea and vomiting in
pregnancy will resolve spontaneously within 16
to 20 weeks.
•that nausea and vomiting are not usually
associated with a poor pregnancy outcome.
•non-pharmacological:
•ginger
•P6 (wrist) acupressure
•pharmacological:
•antihistamines.

25. Heartburn
RELIEF MEASURES:
 Eat small, more frequent meals.
 Use antacids.
 Avoid overeating and spicy foods.

26. Dependent edema
 Avoid standing for long periods.
 Elevate legs when laying or sitting.
 Avoid tight stockings.

27. Varicosities
 Rest in sims' position.
 Elevate legs regularly.
 Avoid crossing legs.
 Avoid long periods of standing

28. Hemorrhoids
RELIEF MEASURES:
Maintain regular bowel habits.
Use prescribed stool softeners.
Apply topical or anesthetic
ointments to area.

29. Constipation
RELIEF MEASURES:
Maintain regular bowel habits.
Increase fiber in diet.
Increase fluids.
Find iron preparation that is
least constipating

30. Backache
RELIEF MEASURES:
Wear shoes with low heels.
Walk with pelvis tilted forward.
Use firmer mattress.
Perform pelvic rocking or tilting

31. Leg cramps
 RELIEF MEASURES:
 Extend affected leg and dorsiflex the foot.
 Elevate lower legs frequently.
 Apply heat to muscles.

32. Faintness
RELIEF MEASURES:
•Rise slowly from sitting to standing.
•Evaluate hemoglobin and
hematocrit.
•Avoid hot environments

33. Screening

34. Asymptomatic Bacteriuria
 Women should be offered routine
screening for asymptomatic bacteriuria
by midstream urine culture early in
pregnancy. Identification and treatment
of asymptomatic bacteriuria reduces the
risk of pyelonephritis.

35. Gestational age assessment
 New Pregnant women should be offered an early ultrasound scan
between 10 weeks 0 days and 13 weeks 6 days to determine
gestational age and to detect multiple pregnancies.
 New Crown–rump length measurement should be used to
determine gestational age. If the crown–rump length is above 84
mm, the gestational age should be estimated using head
circumference.

36. Screening for gestational diabetes
 New risk factors for gestational diabetes :
 body mass index above 30 kg/m2
 previous macrosomic baby weighing 4.5 kg or above
 previous gestational diabetes (refer to 'Diabetes in pregnancy
 family history of diabetes (first-degree relative with diabetes)
 family origin with a high prevalence of diabetes:
 South Asian (specifically women whose country of family origin is India, Pakistan or
Bangladesh)
 black Caribbean
 Middle Eastern (specifically women whose country of family origin is Saudi Arabia,
United Arab Emirates, Iraq, Jordan, Syria, Oman, Qatar, Kuwait, Lebanon or Egypt).

37. Screening for haematological conditions
 New Screening for sickle cell diseases
and thalassaemias should be offered to
all women as early as possible in
pregnancy (ideally by 10 weeks).

38. Anaemia
 Screening shouldtake place early in
pregnancy (at the booking appointment).
 at 28 weeks when other blood screening
tests are being performed.
 At 36 weeks.

39.  Normal range:
 11 g/100 ml at first contact and 10.5
g/100 ml at 28 weeks) should be
investigated and iron supplementation
considered .

40. Blood grouping and red-cell alloantibodies
 Women should be offered testing for
blood group and rhesus D status in early
pregnancy.
 To give anti-D at 28 weeks and post
delivery if the baby (+)

41. Hepatitis B virus
 Serological screening for hepatitis B
virus should be offered to pregnant
women so that effective postnatal
interventions can be offered to infected
women to decrease the risk of mother-to-
child transmission.

42. Hepatitis C virus
 Pregnant women should not be offered
routine screening for hepatitis C virus
because there is insufficient evidence to
support its clinical and cost
effectiveness.

43. Nutritional Supplements

44. Folic Acid
 Start before conception and throughout the
first 12 weeks.
 reduces the risk of having a baby with a neural
tube defect (for example, anencephaly or
spina bifida).
 The recommended dose is 400 micrograms
per day.

45. Vitamin A
Vitamin A supplementation (intake above
700 micrograms) might be teratogenic
and should therefore be avoided

46. Iron
 Iron supplementation should not be
offered routinely to all pregnant women.
It does not benefit the mother's or the
baby's health and may have unpleasant
maternal side effects.

47. 
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