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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
 Nulliparous with an uncomplicated pregnancy,
a schedule of 10 appointments.
 Parous 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:
•ginger
•P6 (wrist) acupressure
•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. Screening

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 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.

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 ml at first contact and 10.5
g/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 not 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 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 micrograms) might be teratogenic
and should therefore be avoided

49. 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.