Antenatal care involves comprehensive health supervision and guidance for pregnant women from conception through delivery. Its goals are to reduce maternal and infant mortality and morbidity. Regular checkups are recommended which include physical exams, screening tests, health education, and monitoring for potential complications. Common discomforts of pregnancy like fatigue, back pain, and nausea are discussed along with relief measures. Screening recommendations are provided for conditions like gestational diabetes, anaemia, and infections. Nutritional supplements like folic acid and vitamin D are also addressed.

1. Antenatal Care

2. 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.

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

4. Importance of Antenatal Care
 To ensure that the pregnant woman and her
fetus are in the best possible health.
 To detect early and treat properly
complications
 Offering education for parenthood
 To prepare the woman for labor, lactation and
care of her infant

5. 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 28 w.
Once every 2 weeks till the 36 w
Once every week, till labor.

6. Frequency of antenatal appointments
 NulliparousNulliparous with an uncomplicated pregnancy,
a schedule of 10 appointments.
 ParousParous with an uncomplicated pregnancy, a
schedule of 7 appointments.

7. Assessment
History Examination Investigation

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

9. 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.

10. 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).

11. Symphysis–fundal height should be
measured and recorded at each
antenatal appointment from 24 weeks.
Fetal presentation should be assessed
by abdominal palpation at 36 weeks.

12. 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.

13. Breech presentation at term
ECV.
If is not possible to schedule at 37
weeks then ?!

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

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

16. 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

17. Common Discomforts of Pregnancy,
Etiology, and Relief Measures:
Urinary frequency
RELIEF MEASURES:
 Decrease fluid intake at night.
 Maintain fluid intake during day.
 Void when feel the urge.

18. Fatigue
RELIEF MEASURES:
 Rest frequency.
 Go to bed earlier.

19. Sleep difficulties
RELIEF MEASURES:
Rest frequency
 Decrease fluid intake at night

20. Nasal stuffiness and epistaxis
ETIOLGY: Elevated estrogen levels
 RELIEF MEASURES :
Avoid decongestants.
Use humidifiers, and normal saline drops.

21. Ptyalism (excessive
salivation(
ETIOLGY: Unknown
RELIEF MEASURES:
Perform frequent mouth care.
Chew gum.
Decrease fluid intake at night.
Maintain fluid intake during day.

22. 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:non-pharmacological:
•ginger
•P6 (wrist) acupressure
•pharmacological:pharmacological:
•antihistamines.

23. Nausea and vomiting
 RELIEF MEASURES:
 Avoid food or smells that exacerbate condition.
 Eat dry crackers or toast before rising in
morning.
 Eat small, frequent meals.
 Avoid sudden movements. Get out of bed slowly
 Breath fresh air to help relieve nausea.

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

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

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

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

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

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

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

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

32. ScreeningScreening

33. 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.

34. 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 agegestational age and to detect multiple pregnanciesdetect 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 headhead
circumference.circumference.

35. Screening for fetal anomalies
 New The 'combined test' (nuchal translucency,
beta-human chorionic gonadotrophin, pregnancy-
associated plasma protein-A) should be offered to
screen for Down's syndrome between 11 weeks 0
days and 13 weeks 6 days.

36.  For women who book later in pregnancy the most
clinically and cost-effective serum screening test
(triple or quadruple test) should be offered between
15 weeks 0 days and 20 weeks 0 days.

37. 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).

38. 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).

39. 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.

40. Normal range:
 11 g/100 ml11 g/100 ml at first contact and 10.510.5
g/100g/100 ml at 28 weeks) should be
investigated and iron supplementation
considered .

41. 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 (+)

42. 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.

43. Hepatitis C virus
Pregnant women should notnot be offered
routine screening for hepatitis C virus
because there is insufficient evidence to
support its clinical and cost
effectiveness.

44. Rubella
Rubella susceptibility screening should
be offered early in antenatal care to
identify women at risk of contracting
rubella infection and to enable
vaccination in the postnatal period for
the protection of future pregnancies.

45. Nutritional SupplementsNutritional Supplements

46. 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.

47. Vitamin D
New women at greatest risk are following advice to take this daily
supplement. These include:
 women of South Asian, African, Caribbean or Middle Eastern family origin
 women who have limited exposure to sunlight, such as women who are
predominantly housebound, or usually remain covered when outdoors
 women who eat a diet particularly low in vitamin D, such as women who
consume no oily fish, eggs, meat, vitamin D-fortified margarine or
breakfast cereal
 women with a pre-pregnancy body mass index above 30 kg/m2
.

48. Vitamin A
Vitamin A supplementation (intake above
700 micrograms700 micrograms) might be teratogenic
and should therefore be avoided

49. Iron
Iron supplementation should notnot 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.

51. Antenatal care

52. Pre conception counselling
 Smoking
 Alcohol
 Drugs
 Diet
 Exercise
 Folic acid

53. Pre conception counseling
 Family history
 Personal history
 Past obstetric history
 Folic acid
 Rubella status

54. First visit
 LMP EDD
 POH
 MH
 PMH
 Drugs
 Allergies

55. First visit
 Smoking
 Alcohol
 FH
 Advise
 Exemption card
 Referral

56. Low risk pregnancies
 12-14/52 hosp visit
 Routine blood tests
Blood group + rhesus factor
Fbc + haemoglobinopathies if indicated
Randon blood sugar
Treponemal antibody
Hep b
Hiv
pappa

57. Low risk pregnancies
 Hosp visit 12-14/52
 History
 Nuchal transluceny scan

58. Low risk pregnancy
 15 weeks
 Serum AFP and downs screening
 If booking scan not done before 14 weeks

59. Low risk pregnancy
 23 weeks – anomally scan
 26 weeks – midwife/gp
 28 weeks – fbc + antibodies
 30 weeks – midwife/gp
 34/36/38/40 weeks – midwife/gp
 41 weeks - hosp

60. Exercise
 Non – contact sport only after 16/52
 Intensity decreased by 25%
 HR under 140/min
 Core temp < 38
 Strenuous exercise limited to 15-20 mins

61. Antenatal visits
 Weight gain 12-15kg in total
 BP dias. >90 or increase > 20 from first visit is
significant
 Urinalysis watch for protein glucose uti
 Fetal movements
 Uterine size
 Fetal lie presentation

62. Common discomforts
 Pelvic pains – ligamental stretch
 Urinary frequency - ? Uti
 Ankle swelling – ivc compression
 Varicosities – support stockings
 Heartburn – posture antacids
 Constipation – fluids, fibre, fybogel

63. Common discomforts
 Low back pain – posture and relaxin
 Dental decay – see dentist
 Skin changes – chloasma
 Itch – iron def, cholestasis antihistamines
 Stretach marks - moisturisers

64. First trimester
 Ectopic preg
 Sharp pain
 Irregular vaginal bleeding
 Abdo tenderness
 Dizziness or fainting

65. Ectopic pregnancy
 Diagnosis
 Pos preg test
 Serial hcg levels they increase more slowly
 Progesterone level lower than normal
 Ultra sound scan vaginally/abdominally

66. Ectopic pregnancy risk factors
 PID
 Previous tubal preg or tubal surgery
 Endometriosis
 IUD
 Multiple induced abortions
 Drugs that stimulate ovulation

67. Ectopic pregnancy treatment
 Tube not ruptured
 Methotrexate
 Salpinostomy flushng the tube out
 Laparoscopic removal

68. Ectopic pregnancy treatment
 Tube ruptured
 Laparoscopic removal of embryo and tube

69. Miscarriage
 Symptoms
 Pv bleeding
 Colicky pain
 Refer to EPAU

70. hyperemesis
 1 in 300 preg
 Weeks 8-20
 Cause unknown – high oestrogen & hcg
 More commom multiple preg obesity first babies

71. Treatment
 Exclude other causes
 Drink small amounts frequently
 Diet high in cho and proteins
 Admit for iv fluids if severe, dehydrated or
electrolyte imbalance
 Drugs -

72. Anaemia
 Symptoms
 Fatigue weakness
 Pallor
 Dizziness or fainting
 SOB
 palpitations

73. Anaemia
 Treatment
 Diet
 Pregaday
 Does not alter outcome in most cases

74. Infection in pregnancy
 Chicken pox – only 2% of infections age > 20yrs
 3% risk of fetal damage in first 20/52
 If mum’s rash develops 1/52 before delivery or to 4/52 after
baby can get sever infection needs protection
 No risk between 20/52 and term
 If no history of cp check varicella antibodies
 If non immune needs VZ Ig no later than 10 days from exposure

75. Infections in pregmnancy
 Rubella – 2-10/52 90% chance of featal damage
 Toxoplasma gondii 89% adults not immune
 If fetus infected 10% chance of fetal damage
 Avoid kittens particularly litter trays
 Eat well cooked meat
 Wash vegetables
 Listeria – soft cheeses, pate. Cookchill foods

76. Pre eclampsia
 Raised BP
 Proteinura
 XS swelling

77. Pre eclampsia
 3-4% pregnancies
 !% very severe
 50,000 deaths world wide

78. Pre eclampsia
 Risk factors
 Young mothers teenagers
 Older mothers > 35 yrs
 Family history
 First pregnancy
 New father
 Diabetes
 hypertension

79. Pre eclampsia
 Serious adverse effects
 Fits
 Stroke
 Pulmonary oedema
 Kidney failure
 Liver damage
 D I C

80. Pre eclampsia
 Warning signs
 Raised bp
 Proteinuria
 Xs swelling
 Headcahe
 Flashing lights
 Vomiting
 Upper abdo pain

81. Pre eclampsia
 Treatment
 Lower bp
 Magnesium sulphate
 Deliver baby
 Aspirin
 Metabolic syndrome

82. Gestational diabetes
 Plenty of insulin, but insulin malfunctioning
 Macrosomia > 4500g
 Problems with labour and delivery
 Newborn has low blood sugar
 Increased risk stillbirth
 Proper management prevents increased risk
ofcomplications

83. Risk factors
 Incidence 1%-3% pregnancies
 Family history
 Obesity
 Maternal age > 30 yrs
 Previous large baby
 Prior icidence of gestational diabetes
 Ethnic group – south asians, mexican american

84. Treatment
 Control blood sugar
 Exercise
 Diet
 Blood glucose monitoring
 A few will need insulin

85. Intra uterine growth retardation
 Birth weigth < 2500g
 Causes
 Smoking
 Poor nutrition
 Placental factors
 Maternal ill health

86. Risk factors
 Smoking
 Drug and alcohol use
 Severe malnutrition
 Maternal high bp, or pre eclampsia
 Infections – cmv, rubella, toxoplasma
 Chronic maternal disease – diabetes,
rheumatological

87. Diagnosis
 Fundal height – 18-34/52 height = distance in cm
 Ultra sound – ratio of head circumference to abdo

88. Treatment
 Stop smoking
 Good nutrition
 Bed rest on left side
 Fetal movement chart
 Serial ultrasound scans
 Volume of amniotic fluid

89. Hydatidiform mole
 Incidence 1 in 2000 preg
 Increased risk with age
 Abnormalities in sperm chromosome
 Abnormalities of egg

90. Hydatidiform mole
 Signs
 Uterus larger than date
 Vaginal bleeding
 Diagnosis
 Ultrasound
 Hcg higher than normal

91. Hydatidiform mole
 Treatment
 Suction curettage
 Monitor hcg for several months due to risk of choriocarcinoma
 Postpone preg for a year

92. APH
 Placenta abruptio
 1% of all deliveries
 Vaginal bleeding in 3rd
trimestre
 Constant back or abdo pain
 Contractions tenderness or rigidity of uterus

93. Risk factors
 Smoking
 Pergnancy induced hypertension
 Alcohol or drug use
 Increased maternal age >40 yrs
 Premature rupture of membranes
 Injury to mother

94. Diagnosis
 No clear test
 May or may not show on ultrasound
 Exclusion of other causes of bleeding – placenta
praevia

95. Treatment
 Evaluate maternal well being
 Monitor
 Evaluate fetal well being
 If severe bleeding or fetal distress cesarean

96. Placenta previa
 4-8% placentas low lying
 Only 10% remain low
 Marginal – placenta near edge of os
 Partial – placenta covers cervical opening
 Total – placent completely covers os
 All need cesarean

97. Placenta previa
 Signs
 Painless bright red vaginal bleeding
 Risk factors
 Smoking
 First preg after lscs
 Previous placenta previa
 Advanced maternal age

98. Placenta previa
 Diagnosis
 Ultrasound
 Treatment
 lscs

99. Post term pregnancy
 > 42/52
 Risks
 Reduced amniotic fluid increased risk of cord
compression
 Meconium in liquor inhlaed by baby causing
pneumonia
 Too large baby > 4500g

100. Management
 Monitor baby
 Too large baby
 Decreased amniotic fluid
 Deliver if cervix ripe try oxytocinon
 If cervix not ripe try prostaglandin gel
 Otherwise lscs

101. Pre term labour
 Labour before end of 36th
week preg
 Low birth weight < 2500g
 8-12% of all pregnancies

102. Signs and symptoms
 Regular uterine contractions for more than 1 hr
 Backache
 Intestinal cramping with or without diarrhoea
 Spotting or blood tinged discharge
 Thin cervix, dilation beyond 1 cm, contractions

103. Risk factors
 Smoking alcohol drugs
 Previous pre term delivery
 3 or more 1st
trimestre miscarriages
 Cervical incompetence
 Placenta previa
 Serious maternal infection
 Low maternal weight < 45 kg

104. Postnatal care
 Maternal
 Lochia xs bleeding = pph admit
 Breasts – engorgement lasts 2-3 days mild temp
fell fluey
 Nipple pain- camomile creams daktarin if
candidal
 Mastitis – empty breast flucloxacillin

105. Postnatal care
 Blood pressure
 Fundal height
 Perineum
 Symptoms of depression
 Contraceptive advice

106. Postnatal care
 Fetal
 Method of delivery
 Length of gestation
 Weight
 Feeding
 concerns

107. Postnatal care
 Fetal examination
 Fontanelles
 Eyes- cataract
 Sclera – jaundice
 Hs
 Lungs
 Abdo - masses

108. Postnatal care
 Fetal exam
 Genitalia
 Hips
 Femoral pulses
 Spine
 Birth marks

109. 6 week exam
 Maternal
 Feeding
 Depression
 Lochia
 Contracption
 Bp
 Abdo exam
 Smear if due

110. 6 week exam
 Fetal
 According to chs schedule