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1. Importance of Antenatal
care
Presented by:
Captain Nishat Fatema Nipun
MBBS (AFMC)
MO, CMH, Chittagong,
Bangladesh

2. What is Antenatal care
• Periodic and regular supervision including
examination and advice of a woman during
pregnancy is called Antenatal care.
• The supervision should be of a regular and
periodic nature in accordance with the need
of the individual.

3. Aims
The aims are-
•To screen the high risk cases
•To prevent or detect or treat at the any earliest
complication
•To ensure continued medical surveillance and
prophylaxis
•To educate the mother about the physiology of
pregnancy and labour by demonstrations, charts
and diagrams so that fear is removed and
psychology is improved

4. Aims (cont’d)
• To discuss with the couple about the place,
time and mode of the delivery, provisionally
and care of the newborn
• To motivate the couple about the need of
family planning
• To advice the mother about breast-feeding,
post-natal care and immunization

5. Objectives
To ensure a normal pregnancy with
delivery of a healthy baby from a
healthy mother

6. Criteria of normal
pregnancy
Delivery of a single baby in good
condition at term with no maternal
complication

7. Services
As per WHO recommendation at least 4 visit-
•1st
visit around 16 weeks
•2nd
visit between 24-28 weeks
•3rd
visit at 32 weeks
•4th
visit at 36 weeks

8. Services (cont’d)
Generally-
•At interval of 4 weeks up to 28 weeks
•At interval of 2 weeks up to 36 weeks
•At weekly interval up to EDD

9. Antenatal care comprises of-
• Careful history taking and examination and
investigation
• Advice given to the pregnant woman

10. THE FIRST VISIT
• History taking
• Examination
• Investigation

11. History taking
1. Particulars of the patient
2. Chief complaints with duration
3. Past history
4. Obstetric history
5. Menstrual history
6. Family history
7. Drug History
8. History of immunization
9. Socio-economic history
10.Contraceptive history
11.History of allergy

12. Particulars of the patient
2.Name
3.Age
4.Address
5.Marital status
6.Date of Admission
7.Date of Examination

13. Chief complaints with duration
1. Period of amenorrhea
2. Nausea & vomiting, vertigo
3. Increased frequency of micturition
4. Constipation
5. Heaviness of breast
6. Rise of temperature
7. Edema
8. Pain in the abdomen
9. Backache
10. Vaginal bleeding

14. Past history
2.HTN
3.DM
4.BA
5.Renal Disease
6.Psychiatric illness
7.IHD
8.Any previous operation

15. Obstetrical History
• Duration of marriage
• Gravida
• Para
• ALC

16. Menstrual History
Age of menarche
Menstrual period
Menstrual cycle
LMP
EDD

17. Family history
b)HTN
c)DM
d)Multiple pregnancy

18. Drug History
Antihypertensive
Hypoglycemic
Antidepressant
Corticosteroid
Anticoagulant

19. Physical examination
General examination
Abdominal examination

20. General examination
• Appearance
• Height of patient
• Weight of patient
• Anemia
• Jaundice
• Edema
• Cyanosis
• Clubbing
• Koilonychia
• Leuconychia

21. General examination (cont’d)
• Temperature
• Pulse
• BP
• RR
• Breast
• Heart sound
• Lungs

22. Abdominal examination
Inspection
Palpation
percussion
Auscultation

23. Inspection
Shape of the uterus
Striae
scar mark

24. Palpation
• Assessment of fundal height
• Lie
• Abdominal girth
• Fundal grip
• Lateral grip
• First pelvic grip
• Second pelvic grip

25. Auscultation
Normal FHR is 120-160 b/m
Causes of foetal tachycardia (>160 b/m)
Causes of foetal bradycardia (<120 b/m)

26. Causes of foetal tachycardia
(>160 b/m)
1. Maternal high fever
2. Foetal distress
3. Maternal tachycardia

27. Causes of foetal
bradycardia (<120 b/m)
1. Foetal distress
2. Foetal cardiac conduction defect

28. Investigation
• CBC
• Blood grouping & Rh typing
• Urine R/E
• RBS
• VDRL
• HBS Ag
• Ultrasound

29. Ultrasound
early pregnancy (preferably at 10-13 weeks) to:
•Determine gestational age
•Detect multiple pregnancies
•Help with later screening for Down's syndrome

30. Ultrasound (cont’d)
At 11-14 weeks:
offer nuchal translucency screening for Down's
syndrome, with other tests if available.
At 18-20 weeks:
offer screening with ultrasound for congenital
anomalies.
At 36 weeks:
for foetal maturity, placenta praevia.

31. In subsequent visit
• Patient complains
• General examination
• Gestational age to be calculated
• Identification of problem
• Foetal movement
• SFH measurement
• Health education
• Prophylaxis & treatment of anemia
• Developing individualized birth plan

32. Second visit (24-28 weeks)
SFH measurement
To detect Multiple pregnancy

33. Third visit (32 weeks)
Screen for-
.2 Preeclampsia
.3 Multiple pregnancy
.4 anemia
.5 IUGR

34. Fourth visit (36 weeks)
• Identification of foetal
.2 Lie
.3 Presentation
.4 Position
• Update birth plan

35. Antenatal advice
Principles:
.2 To impress the patient about the importance of
regular check up
.3 To maintain or improve the health status of the
woman to the optimum till delivery by judicious
advice regarding diet, drugs and hygiene
.4 To improve and tone up the psychology and ot
remove the fear of pregnancy by talking
sympathetically to the patient and explaining the
principle changes and events likely to occur during
pregnancy

36. Antenatal advice (cont’d)
• Diet
• Rest & sleep
• Bowel
• Personal cleanliness
• Clothing, shoes & belt
• Dental care
• Care of breast
• Coitus
• Travelling
• Smoking & alcohol
• Immunization
• Drug
• Mental preparation
• Exercise
• Child care
• Birth plan
• Warning sign
• Family planning
Following advices are to be given:

37. Diet
Diet should be:
.2 nutritious
.3 balanced
.4 light
.5 easily digestible
.6 rich in protein, mineral and vitamin
.7 with woman’s choice

38. DDA of a woman during pregnancy (2nd
half)
Food element pregnancy
Kilocalories 2500
Protein 60 gm.
Iron 40 mg
Folic acid 400 µg
Calcium 1000 mg
Vitamin A 6000 I.U.

39. Diet for a pregnant woman (3000 Kcal)
Early morning:
•Tea or coffee – 1 cup
•Biscuit – 2 pcs
Breakfast:
•Chapatties – 2 pcs
•Egg – 1 poached or boiled
•Vegetable – 1 cup
Midmorning:
•Milk – 250 ml or 1 glass
•Biscuit – 2 pcs
•Apple or orange – 1 pc

40. Diet for a pregnant woman (3000 Kcal)
Lunch:
.2 Cooked rice – 4 cup
.3 Meat or fish – 3 pcs or 120 gm.
.4 Cooked Dal – 2 cups
.5 Vegetable – 1 cup
.6 Leafy vegetable – ½ cup
.7 Salad – tomato, carrot, cucumber

41. Evening:
•Biscuits – 2 pcs
•Fruits – on choice
Dinner:
•Cooked rice – 3 cup
•Meat or fish – 3 pcs or 120 gm.
•Cooked Dal – 2 cups
•Vegetable – 1 cup
Bed time: one glass of milk
Diet for a pregnant woman (3000 Kcal)

42. Early morning:
•Tea or coffee – 1 cup (without sugar)
•Salted Biscuit – 2 pcs
Breakfast:
•Chapatties – 2 pcs / Atta – 60 gm.
•Egg – 1 poached or boiled
•Vegetable – ½ cup
•Milk – 150 ml or 1 cup
Midmorning: apple or sweet lime
Diet for a pregnant diabetic woman (2200 Kcal)

43. Lunch:
.2 Cooked rice – 1.5 cup / rice – 60 gm.
.3 Meat or fish – 1 pcs or 40 gm.
.4 Cooked Dal – 1 cup
.5 Leafy vegetable – ½ cup
.6 Salad – tomato, carrot, cucumber
Evening: (4 pm)
•Salted Biscuits – 2 pcs
•Milk – 150 ml or 1 cup
Diet for a pregnant diabetic woman (2200 Kcal)

44. Dinner:
•Chapatties – 3 pcs / Atta – 90 gm.
•Meat or fish – 1 pcs or 40 gm.
•Cooked Dal – 1 cup
•Vegetable – ½ cup
Bed time: one cup of milk
Diet for a pregnant diabetic woman (2200 Kcal)

45. Restricted food:
•sugar
•Molasses
•Honey
•Jam / jelly
•Sweet
•Chocolate
•Ice-cream
•juice
Diet for a pregnant diabetic woman
(2200 Kcal)

46. Rest and sleep
• 8 hour sleep at night
• At least 2 hour sleep after mid-day
meal
• Hard strenuous work should be
avoided in first trimester and last 4
weeks

47. Bowel
• Regular bowel movement may be facilitated
by regulation of diet, taking plenty fluid,
vegetable and milk
Coitus
Should be avoided in
•1st
trimester
•last 6 weeks

48. Travelling
Should be avoided in
•1st
trimester
•last 6 weeks
Air travelling is contraindicated in
•Placenta praevia
•Preeclampsia
•Severe anemia

49. Immunization
Indicated-
•TT
•HAV
•HBV
•Rabies
Contraindicated-
•Live virus vaccine (rubella measles, mums,
varicella)

50. Warning sign
.1 Headache
.2 Blurring of vision
.3 Convulsion
.4 Vaginal bleeding
.5 Fever

51. Preconceptional care
 Preconceptional care is the one step ahead of
antenatal care.
 When a couple is seen and counseled about
pregnancy, its course and outcome before the
time of actual conception, is called
Preconceptional care.
 Objective: to ensure that, a woman enters
pregnancy with an optimal state of health
which would be safe both to herself and the
fetus.

52. Preconceptional care includes:
 Identification of high risk factor
 Basal level health status including BP recording
 Rubella & Hepatitis immunization
 Folic acid supplementation
 Maternal health is optimized preconceptionally
such as overweight anemia
 Patient with medical disease like hypertension,
diabetes are stabilized in an optimal state by
intervention

53. Preconceptional care includes: (cont’d)
 Drugs used before pregnancy are verified and
changed if required to prevent any adverse effect of
the fetus; e.g., warfarin is replaced with heparin, oral
anti-diabetic drug with insulin
 Advise to stop smoking, alcohol and drug abuse
 Proper counseling to those with history of recurrent
foetal loss or family history of congenital
abnormalities
 Counseling regarding health care cost
 Find out supporting or helping people to help the
mother and care of the new born