This document provides an overview of antenatal care principles and practices. It defines antenatal care as the planned supervision of pregnant women to ensure a healthy pregnancy and delivery. The objectives are outlined as predicting and preventing problems to deliver a healthy baby from a healthy mother. Key components of care discussed include prepregnancy counseling, booking visits, routine examinations and tests, education, and individualized risk-based care. Warning signs, fetal growth benchmarks, and presentations are reviewed. The document also discusses models of antenatal care and classifications of drugs in pregnancy.

1. THE PRINCIPLES OF
ANTENATAL CARE
(Including PA& Teratogenic
Drugs)
PROF. DR. IRAM CHAUDHRY
FCPS(OBS. & GYNAE) MHPE.
BAHAWALPUR.

2. Definition
‘A planned program of observation,
education, and medical management of
pregnant women directed toward making
pregnancy and delivery a safe and
satisfying experience.’ (American college
of O&G)

3. WHAT IS ANTENATAL CARE
Care of women during pregnancy
Or
“Periodic and regular supervision
including examination and advice of
a woman during pregnancy is called
Antenatal care”

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

5. Principles
 To predict problems on the basis of history
 and physical examination.
 To prevent or reduce the severity of
problems by prophylactic measures
 To detect and treat conditions having
harmful effects on the mother or fetus.
 To provide education, information and
reassurance for mother and partner.

6. Current Approach
• Prepregnancy counselling
• Booking visit
• Routine antenatal visits
• Antenatal education classes
• Inpatient care

7. Prepregnancy Counselling
 Conditions requiring referral
 Maternal- Diabetes, other endocrine
disorders, HTN, Infections; herpes, HIV.
 Genetic disease
 Age
 Drug exposure
 Abnormal nutrition-obese/skinny
 Previous adverse obstetric history
(preg. loss, preterm delivery, IUGR,
congenital defects)
Tab. Folic Acid

8. Prepregnancy Counselling
General principles.
Folic Acid.
Avoid smoking and drugs.
Exercise and BMI
Folic acid supplements: 6 wks prior to
conception and continue till 14 wks.

9. Antenatal care comprises -
1.Registration of pregnancy
2. History taking
3.Antenatal examinations
[general and obstetrical]
4. Laboratory investigations
5. Health education

10. Booking Visit- history
Ideally at 10-12 wks
Includes
Detailed History
Clinical Examination
Investigations.

11. History
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. Complete Examination
• Weight, height, BMI
• BP
• Full CVS and resp exam
• Breast check- inverted nipples
• Abdominal Examination:
• SFH: Palpable after 12 wks
• Fundus at umbilicus- 20 wks
Xiphisternum - 36 wks.

13. Investigations
Booking- blood tests:
• FBC
• Blood group and antibody screen
• Hep B & C, syphilis, rubella, HIV serology
• Triple test at some centers
• For at risk; sickle test, Hb electrophoresis
• Urine dip- protein and glucose

14. Genetic Risk
• Maternal age > 35yrs
• Afro-Caribbean- sickle cell
• Mediterranean or Asian- thalassemia
• Previous child with abnormality
• Inherited diseases- hemophilia

15. Screening Tests
10-12 weeks booking scan
Confirm IU preg, foetal HR
11-13 wks nuchal translucency
Together with age, estimates likelihood of
Downs (normally 1/500)
14-20 wks. serum screening for Downs
(triple test not used at PRH; CVS or
amniocentesis instead)

16. Screening Tests
 anomaly scan: 18-20 wks. x
 20-22 wks.
 Accurate assessment of gestational age.
 Multiple pregnancy detection.
 Placental site localization
 Detection of congenital abnormalities:
all 4 chambers of heart

17. • Timing variable but traditionally
- Every 4 wks until 28wks
- 2 wks until 36wks
- Weekly thereafter
• BP and urine checked at each visit
• Abd. presentation assessed from 32wks
after 36wks breech needs managing
fetal head engages at 36-38wks in
primigravida
Subsequent Visits

18. Subsequent Visits
• Patient complains & Identification of problem
• General examination
• Gestational Age
• Foetal movement
• SFH measurement
• Health education
• Prophylaxis & treatment of anemia
• Developing individualized birth plan

19. Subsequent Visits
• Blood tests:
- Rhesus neg women have titres
measured at 30 and 36wks. Anti-D given
at 28 and 34 wks?

20. 50% IUGR remain undetected
 Clinical assessment
Fetal movements
 Ultrasound Assessment, used in series
 Biophysical profile
Limb and body movements, breathing, tone,
amniotic fluid vol, HR variability on CTG
 Fetoplacental Blood Flow ( Doppler Studies)
 Cordocentesis, for blood transfusions too
Assessment of fetal Growth and Wellbeing

21. Models of ANC
• Focused ANC- also called “new” or “WHO”
models
– Evidence based interventions and visit patterns
that benefited mothers and their fetus and were
cost effective as well
– 4 routine visits, with a few evidence based
diagnostic and intervention modalities.
– at 16,28,32 and 36 weeks
– Additional visits on individual basis

23. Visit First Visit Second visit Third visit Fourth visit
Gestational
age
<16 weeks 28 weeks 32 weeks 36 weeks
Activities •Classification to
either the basic or
specialized
component
•Clinical exam
•Hgb test
•GestationalAge
determination
•Blood pressure
•Weight/Height
•Syphilis/STIs
•Urinalysis
•ABO/RH
•TT administration
•Iron
supplementation
•Document on
ANC
•Clinical exam for
anemia
•Gestational age;
FH; FHB exam
•Blood
pressure
•Weight-only
if underweight
at
initial visit
•Urinalysis- for
nullipara or
pr. pre-eclampsia
•Iron supplement
•Complete on
ANC
card
•Hgb test
•TT second dose
•Instructions for
birth planned
•Recommendations
for
lactation/contrace
ption
•Document on
ANC card
•Examine for breech
presentation
•Document on
ANC card

24. Elderly primi (30 yr. and above)
Short statured primi (140 cm and
below)
Mal presentations
APH, threatened abortion
Pre – eclampsia, eclampsia
Risk Approach

25. Risk Approach
• Anaemia
• Twins, hydramnios IUFD, Still
birth
• Elderly grand multiparas
• Prolonged pregnancy
• H/o past caesarean or instrumental delivery Treatment
for infertility

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

27. Fundal height at different gestational period

29. Measurement of distance between upper limit
of uterus and superior border of symphysis
pubis

30. Fundal grip

31. Umbilical/ Lateral grip

32. Obstetrical grips

33. Location of fetal heart in different
presentations

34. Different fetal presentations

35. FDA CLASSIFICATION OF DRUGS IN PREGNANCY

37. Fetal alcohol syndrome
is the most severe fetal alcohol spectrum
disorder. These are a group of birth defects that
can happen when a pregnant woman drinks
alcohol. Other fetal alcohol syndrome
disorders (FASDs) include:
•Partial fetal alcohol syndrome
•Alcohol-related birth defects
•Alcohol-related neurodevelopment disorder
•Neurobehavioral disorder associated with
prenatal alcohol exposure