Antenatal care

2. Antenatal Care
Introduction
Antenatal care is important because it helps to maintain the
mother in good health during pregnancy, informs the parents
about pregnancy, labor and child care and, in particular, it
provides a means of detecting problems with the pregnancy at an
early stage when the problems are treatable.

3. 
Definition of antenatal care

Antenatal care is the name of the particular
form of medical supervision given to a
pregnant woman and her baby starting from
the time of conception up to the delivery of
the baby. It includes regular monitoring of the
woman and her baby throughout pregnancy by
various means including a variety of routine
regular examinations and a number of simple
tests of various kinds.

4. 
Goals of antenatal care :

The major goals are.

To define the health status of the mother and
fetus.

To estimate the gestational age of the fetus.

To initiate a plan for continuing obstetrical
care

5. 

Best possible health status for mother and fetus.

Early detection and management of high-risk
pregnancy.

Education of the mother about:

Physiology of pregnancy,

Nutrition.

Alarming signs and symptoms.

Infant care.

Breast-feeding.

Child spacing.

Reduction of maternal and perinatal mortality and
morbidity rates.

6. 
Schedule of antenatal visits

Frequency of antenatal visits

- During the first 6 months every month.

- During the 7th and 8th months every 2
weeks.

- During the last month every week.

8. 
For high risk group:

Every 2 weeks till 28 week, then every week
till 36 week, then hospitalization(or
according to the situation)

9. 
Taking History :

Personal history:

Name.

Age.

Address.

Occupation (both partners).

Consanguinity.

Potentially harmful habits (i.e., smoking).

Menstrual history:

1st day of the last normal menstrual period (LNMP).

Calculation of gestational age, and expected date of
delivery (EDD).

10. 
The first day of last menstrual period

Added 7day and 9 months in month(1:3)

Added7day -3 months (4:12

11. 
Obstetric history:

Complication of previous pregnancies.

Mode of delivery

Number/sex of living children.

Birth weights.

Mode of infant feeding.

Date of last labor and last abortion (LL and LA).

Present obstetric history:

Symptoms of pregnancy.

Symptoms of pre-eclampsia.

Symptoms of disease in other organ systems.

Fetal movements.

Family history:

Diabetes mellitus.

Multiple pregnancy.

Hypertension

Congenital anomalies.

12. 
Medical history:

Diseases:

Diabetes mellitus.

Heart diseases.

Hypertension.

Viral infection.

Urinary tract.

Drugs/allergies.

Blood transfusion.

Rh incompatibility.

X-ray exposure.

13. 
Surgical history:

Previous operations:

Dilation and curettage.

Cesarean section.

Family planning history.

Immunization history

Breast feeding history.

14. 
Examination: Minimal Physical Parameters
to be Evaluated

General (Systemic):

Physical signs (vital signs, weight, height,
pallor, and jaundice).

Chest examination.

Breast examination.

Skeletal or neurological abnormalities.

15. 
Local (Obstetric):

Inspection:

Contour and size of abdomen.

Scars of previous operations.

Signs of pregnancy.

Fetal movements.

Varicose veins.

Edema.

Palpation:

Fundal level (FL).

Fundal grip.

Umbilical grip.

1st and 2nd pelvic grips.

17. 
Auscultation

Fetal Heart Sounds (FHS):

FHS is heard by sonicaid as early as 10th week of
pregnancy.

FHS is heard by pinard (fetal stethoscope) after the 20th
week of pregnancy.

Laboratory Investigations:

Blood analysis:

Complete blood count.

ABO grouping and Rh typing.

Hepatitis B antigen.

Rubella antibody.

Toxoplasmosis: IgM and IgG if patient has not previously tested
positive.

18. 
Periodic Visits

Examination

At each visit:

General:

Weight.

Blood pressure.

Edema of lower limbs.

Local:

Fundal level (F.L.).

Fetal lie.

Fetal presentation.

FHS.


Assessing Fetal Well-being

Maternal weight

Fetal size

Fetal movements: at least 10 movements/12 hours.

Fetal heart sounds.

Ultrasound.

19. 
At 37 Weeks

Assessment of fetal size, lie, presentation.

Assessment of pelvic capacity.

Health Education for Pregnant Women

Adequate Nutrition

Calories (2500/day):

Excess calories lead to fat deposition and obesity.

The caloric requirement is the same as in the non-pregnant
state.

During pregnancy increased metabolism is compensated for by
activity.

20. 
Protein (85 gm/day):

Animal sources: meat, fish, cheese, milk, eggs.

Plant sources: peas, beans, lentils.

Insufficient protein in diet leads to:

Fetal prematurity and IUGR.

Maternal anemia and edema.

Calcium (1.5 gm/day):

Sources: milk, cheese, yogurt. calcium carbonate.

Insufficient calcium in the diet may lead to:

Rickets in infants.

Osteomalacia in mothers.

21. 
Iron (30 mg/day):

Animal sources: liver, red meat.

Plant source: green vegetables.

Drug sources: ferrous gluconate, ferrous
fumarate, ferrous sulphate.

Insufficient iron in the diet leads to maternal
iron deficiency anemia.

22. 
Fats:

If 2/3 of proteins are taken correctly from animal sources, the intake of fats
be adequate.

Carbohydrates:

Carbohydrates can be slightly reduced to compensate for the increased
calorie value of the proteins and more severely restricted if weight reduction
is necessary.

Folic acid (1 mg tablet/day):

Megaloblastic anemia from deficiency of folic acid may occur during
pregnancy. To prevent megaloblastic anemia, it is recommended that women
take 0.4mg of folic acid a day.

It is recommended that women at high risk for neural tube defects take 4-5
mg of folic acid supplement daily prior to conception and for the first 12
weeks of pregnancy.


23. 
Clothing

Should be loose, light, and hanging from shoulders.

Avoid high heels, shoes with thin soles, belts, or corset.


Dental Care

Have teeth examined twice during pregnancy.

Brush teeth after meals.

Tooth extraction is allowed even for pregnant women with
rheumatic heart disease if prophylactic antibiotics are given.

Breast Care

Daily washes to reduce cracking.

Massage:

Express breast secretion.

Open lacteal ducts and sinuses.

Nipples:

If there is dry secretion, treat with a mixture of glycerin and alcohol.

If retracted, treat by pulling out.

Brassiere to support heavy breasts (light and not tight).

24. 
Sexual Activity

Allowed in moderation.

To be avoided in pregnant women with threatened abortion,
preterm labor, or antepartum hemorrhage (APH).


Traveling

Allowed when comfortable.

To be avoided in last month due to tendency to induce (APH) or
premature labor.

25. 
Weight Gain (10-12 kg)

1st trimester 1-2 kg

2nd trimester 6-7 kg

3rd trimester 3-4 kg


Baths

Showers are preferable over tub baths.

No vaginal douches are allowed.


Exercise

Should be mild, preferably walking.

Housework, if not overtiring, is allowed.

26. 
Rest and Sleep

Rest 8 hours at night and 2 hours in the afternoon.

Increase towards term.


Drugs

Avoid all unnecessary drugs during pregnancy.

Minor complaints should be managed without the use
of drugs whenever possible.

Smoking

Leads to spasm of placental blood vessels which can
lead to:

Fetal anoxia, LBW, IUGR.

Prematurity, PROM.

Placental abruption.

27. 
Immunization

Live attenuated vaccines are contraindicated.

Any pregnant woman who comes in contact with
rubella should be tested for rubella antibodies.

Tetanus toxoid to prevent tetanus.

28. Tetanustoxoid

29. 
Rh-prophylaxis in Rh-negative women who did not produce anti
Rh-D antibodies during pregnancy and who have given birth to
a Rh-positive infant: such women should receive anti Rh-D 200
meg within 24 hours or at the latest 72 hours postpartum. This
prevents Rh-sensitization of the mother.

Irradiation

Avoid exposure to irradiation for its teratogenic effect on
fetus.

30. 
Common Complaints of Pregnancy

Nausea and vomiting.

Heartburn and hyperacidity.

Ptyalism.

Constipation .

Hemorrhoids and varicose veins.

Edema.

Leg cramps.

Leukorrhea.

Backache.

31. 
Alarming Signs and Symptoms

Vaginal bleeding

Decrease or cessation of fetal movements

Severe edema

Escape of fluid from vagina

Severe headache

Epigastria pain

Abnormal gain or loss of weight

Blurred vision