Prenatal care involves regular examinations and advice during pregnancy to monitor the health of the mother and fetus. It aims to screen for high-risk cases, prevent or treat complications early, provide health education, and discuss delivery plans. Preconception counseling identifies risks and optimizes health before pregnancy. Prenatal visits assess health status, growth, and provide preventative care. Postnatal care ensures the rapid recovery of both mother and baby and provides family planning services and education.

2. PRENATAL CARE
Systematic supervision (examination and advice) of a woman during or
before pregnancy is called antenatal (prenatal)
care.
The supervision should be regular and periodic in nature according to the
need of the individual.
Actually prenatal care is the care in continuum that starts before
pregnancy and ends at delivery and the postpartum period.
Antenatal care comprises of:
• Careful history taking and examinations (general and obstetrical)
• Advice given to the pregnant woman

3. • The aims are:
(1) To screen the ‘high risk’ cases
(2) To prevent or to detect and treat at the earliest
any complications.
(3) To ensure continued risk assessment and to provide ongoing primary
preventive health care.
(4) To educate the mother about the physiology of pregnancy and labour by
demonstrations, charts and diagrams (mother craft classes), so that fear is
removed and psychology is improved.
(5) To discuss with the couple about the place, time and mode of delivery,
provisionally and care of the newborn.

4. PRECONCEPTIONAL COUNSELING AND CARE
When a couple is seen and counseled about pregnancy, its course and
outcome well before the time of actual conception is called Preconceptional
counseling.
Things you can do before and between pregnancy to increase the chances of
having a healthy baby refer to Preconceptional care.
Objective is to ensure that a woman enters pregnancy with an optimal state
of health which would be safe both for herself and fetus.
In preconceptional phase, risk factors are identified and care is provided to
reduce or eliminate them to improve pregnancy outcome.

5. PRECONCEPTIONAL VISIT ,RISK ASSESSMENT AND EDUCATION
• Identification of high risk factors by detailed evaluation of obstetric,
medical ,family and personal history.
• Base level health status including Blood pressure is recorded.
• Rubella and hepatitis immunization in a nonimmune woman is
offered.
• Folic acid supplementation (4mg/day) starting 4 weeks prior to
conception is advised. This can reduce the incidence of neural tube
defects, example is Spinal bifida.

6. • Maternal health is optimized during preconceptional period.
Problems of overweight, underweight and anemia are evaluated and
treated appropriately.
• Fear of incoming pregnancy is removed by preconceptional
education.
• Patients with medical complications should be educated about the
effects of disease on pregnancy and effects of pregnancy on the
disease. In extreme situation, pregnancy is discouraged. Preexisting
chronic diseases(hypertension,diabetes,epilepsy) are stabilized in an
optimal state by intervention.

7. • Drugs used before pregnancy are verified and changed if required to
avoid any adverse effect on fetus during the period of organogenesis.
For example, oral antidiabetic drugs are replaced with insulin.
• Woman should be urged to stop smoking, taking alcohol and abusing
drugs.
• Inheritable genetic disease(sickle cell disease, cystic fibrosis) are
screened before conception and risk of passing on the condition to
the offspring is discussed.

8. • Importance of prenatal diagnosis for chromosomal or genetic disease
is discussed.
• Couples with history of current fetal loss or with family history of
congenital abnormalities(genetic, chromosomal or structural)are
investigated and counseled appropriately. There may be some
untreatable factors.
• The objective is to ensure a normal pregnancy with delivery of a
healthy baby from a healthy mother

9. Unfortunately, only a small percentage of women take the advantage of
preconceptional care. The important reasons are :
1. Lack of public awareness
2. Many pregnancies are unplanned

10. Diagnosis of pregnancy
• Presumptive signs
Breast tenderness nausea and vomiting increased skin pigmentation , skin
striae
• Probable signs
Enlargement of the uterus, maternal sensation of uterine contractions ,
softening of the cervix and human chorionic gonadotrophin test
• Positive signs
Hearing fetal heart rate, sonographic visualization of fetus and x ray show
fetal skeleton

11. Procedures at first visits
• assess the health status of the mother and fetus.
• assess the fetal gestational age and to obtain baseline investigations.
• organize continued obstetric care and risk assessment.
Components of routine prenatal care are recorded in a standardized
pro forma (antenatal record book) which include history taking and
physical examination

12. • History taking involves all informations about the patient which
include.
Vital statics ; which include bio data, gravida and parity,
duration of marriage, religion, occupation, occupation of
husband, period of gestation
Complaints
History of present illness

13. History of present pregnancy
Obstetric history (This is only related with multigravidae): The
obstetric history is to be summed up as: Status of gravida, parity,
number of deliveries (term, preterm), miscarriage, pregnancy
termination

14. Menstrual history
Past medical history
Past surgical history: Previous surgery—general or gynecological, if any,
is to be enquired
Family history
Personal history

15. • Examination
• General examination which include
Build: obese /average / thin
Nutrition: good/average/poor
Pallor , jaundice ,edema of legs , tongue , teeth , gum , and tonsils
Neck: Slight physiological enlargement of the thyroid gland occurs
during pregnancy in 50% of cases.

16. • Systemic examination
• Obstetric examination
• It includes abdominal and vaginal examination

17. Abdominal:
• presence of any incisional scar or presence of herniation and skin condition of
the abdomen are to be looked for.
• Fundus of the uterus is just palpable above the symphysis pubis at 12 weeks.
Vaginal: Examination is done in the antenatal clinic when the patient attends the
clinic for the first time before 12 weeks.it is done to;
• to exclude any pelvic pathology.

18. • 2nd and 3rd ANC VISITS
 SP and ITN as Intermittent Preventive Treatment (IPTp)
 Give single dose of Mebendazole (DOT) after 1st trimester
 Confirm fetal heart sounds
 Detect, treat and manage any abnormalities such as multiple gestation,
pre-eclampsia and anaemia
 Confirm lie of the foetus Remind about Individual Birth Plan and
danger signs.

19. 4th ANC Visit
• Confirm whether the pregnant woman has received all services which
should be provided in previous visits.
• Confirm lie and presentation of the fetus. In case of any mal-
presentation take apropriate action.
• Detect, manage and refer any abnormalities such as multiple
gestations, pre-eclampsia and anaemia.
• Remind the pregnant woman about the Individual Birth Plan, danger
signs and complication preparedness

20. Antenatal advise
• Diet
• Antenatal hygiene
• Immunization (tetanus)
• Take prenatal vitamins
• Avoids alcohol and caffein
• Exercise
WHO recommend at least 4 visits first in the second trimester
around 16 weeks ,second between 24-28 weeks and the third visit at
32 weeks and fourth visit at 36 weeks

21. Normal pregnancy events
• First trimester
Assuming 40 menstrual week pregnancy ,the first trimester is assumed to
extend from conception through 13 weeks
Normal symptoms seen in the majority of pregnancies include nausea,
vomiting, fatigue, breast tenderness and frequent urination
Spotting and bleeding occur in 20% of pregnancy.50% of which continue
successfully
Average weight gain is 5-8 pound
Complications :spontaneous abortion

22. Investigation
• Blood : Hemoglobin, hematocrit, ABO, Rh grouping, blood
glucose and VDRL are done. Serology (antibody) screening
is done in all cases.
• Cervical cytology: by Papanicolaou stain

23. • Urine
Protein, sugar and pus cells.
Presence of nitrites and/or leukocyte esterase by dipstick
indicates urinary tract infection.
• Serological tests for rubella, hepatitis B virus and HIV

24. Ultrasound examination during early pregnancy,
• expected dating,
• number of fetuses,
• gross fetal anomalies
• any uterine pathology

25. Second trimester
Assuming 40 weeks pregnancy ,the second trimester start from 13
through 26 weeks
Normal symptoms are improved feeling of general wellbeing
Round ligament pain is common
Braxton hicks contractions are painless, low intensity ,long lasting that
can be palpated as early as 14 weeks
Quickening (maternal awareness of fetal movement is detected at 18-
20 weeks in primigravida and 16-20 weeks by multigravida
Average weight gain is 20 pound per week

26. Investigations
• Maternal serum alpha fetoproteins( increase in dating era, NTD, twins
and decrease in IUGR, stillbirth and preeclampsia
• Ultrasound
• Quadruple marker screening (MS-AFT, hCG, estriol and inhibin A)
Trisomy 21(MS-AFP and estriol are decreased and hcg and inhibin A
increase
Trisomy 18 all 4 markers decrease
• Amniocentesis for karyotyping
• Percutaneous umbilical blood sampling

27. • Complications include
Preterm labor.
Preterm premature rupture of membrane.
Cervical incompetence.
Pre eclampsia.

28. Third trimester
Assuming 40 weeks pregnancy, third trimester start from 26 to 40
weeks
Normal symptoms includes decreased libido , lower back and leg pain,
and Braxton hick contractions
Lightening due to descent of the fetal head into maternal pelvis
resulting to easier maternal breathing ,pelvic pressure
Bloody show describe vaginal passage of bloody endocervical mucus ,
the result of cervical dilation before labour
Average weight gain is 1 pound per week after 20 weeks

29. Investigations
• Diabetic testing(FBG, OGTT)
• CBC(Anaemia and platelets count)
• Atypical antibody screening(coombs test)
• Ultrasound

30. Complications includes
• Gestation diabetes
• Preeclampsia
• Urinary tract infections
• Anaemia
• Preterm labour
• PROM

31. POSTNATAL CARE
Care given up to 6 weeks following childbirth to ensure best health condition
for both mother and baby
Its responsible for obstetrician and paediatrician and its called perinatology
The objectives are
• To prevent complications of post natal period
• To provide care for rapid restoration of the mother to optimal health
includes post natal examinations, anaemia ,nutrition ,post natal exercise
and psychological factors
• To check adequacy of breast feeding

32. • To provide family planning services
• To provide basic health educations to mother and family in relations
to
Hygiene
Immunizations
Feeding for mother and infant
Birth registration
Importance of health check up

33. Complications of post natal care
• Puerperal sepsis
• Pueperal psychosis
• Secondary PPH
• Mastitis
• UTI

34. References
• Dc Dutta textbook of obstetrics
• USMLE Step 2 CK Lecture Notes Obstetrics Gynacology
• Mayoclinic

35. • THANKS