Antenatal assessment

1. INJETY VINEELA,
ASSOCIATE PROFESSOR,
MSc Nursing OBG

2. Antenatal Care
• Antenatal care is the medical supervision of
pregnant women from the time conception till
actual commencement of labour.

3. objectives
• Assess the health status of mother and fetus.
• Promote and maintain health status of the mother
during antenatal period.
• Screen the high-risk pregnancy and prevent and treat
any untoward complications.
• Regular antenatal checkups.
• Orient mother about physiology of pregnancy and
prepare her for the birth process.
• Remove anxiety and fear associated with pregnancy and
delivery.
• Motivate about need of family planning.
• Reduce maternal and infant mortality and morbidity.

4. Five check ups
• 10-12 weeks
• 24th week
• 30-32 week
• 36-38 week

5. History Collection
• Detailed history is collected
• Age: after 30 years is called elderly primigravida.
• Obstetrical score: GTPAL
• Last Menstrual period: Nageles Formula
• Expected Date of Delivery:
• Gestational age in weeks:
• Religion:
• Age at marriage:
• Duration of marriage:
• Education of mother and occupation:
• Occupation of spouse/husband:
• History of Present Pregnancy: according to trimester wise
• Past obstetrical history

6. • Menstrual history
• Family/hereditary history
• Past medical and surgical history
• Personal history: diet, sleep, physical activity.
• Drug and immunization history

7. General examination
• Body built: obese/average/thin
• Nutrition: good/average/poor
• Height:
• Weight:
• Pallor: tongue, teeth, gums
• Neck: thyroid gland and lymph glands
• Oedema of legs
• Vital signs
• Breasts: Inspection and Palpation
• Abdominal examination.

8. Examination And Investigations
Obstetrical Examination
Abdominal Examination:
This is done to establish and affirm that growth is
consistent with gestational age during pregnancy.
Aims:
1. Observe signs and symptoms of pregnancy
2. Assess fetal size and growth
3. Auscultate fetal heart sounds
4. Locate and palpate fetal parts.
5. Detect any deviation from normal.

9. Preparation
• Explain the procedure to the pregnant
women.
• Provide privacy
• Ensure the women empty her bladder before
procedure.
• Advise to flex the legs slightly towards
abdomen.

10. • Measurement of fundal height:
• In order to determine the fundal height the
midwife places her hand just below the
xiphisternum, pressing gently.
• She moves her hand down the abdomen until
she feels the curved upper border of fundus,
noting the number of finger breadths that can
be accommodated between the two
alternatively, the distance between fundus
and symphysis pubis can be determined with a
tape measure.
• This is called Mc.Donalds measurement and is
not accurate before 20 weeks of gestation.

13. Methods of Abdominal Examination
• Inspection
• Palpation and
• Auscultation

14. Inspection
• Check for the presence of scars, rashes,
lesions, dilated veins, pulsations, irritation and
the condition of umbilicus, incisional scar
marks.
• The presence of linea nigra and striae gravida.
• Assess the size, shape of uterus or abdomen.

15. Abdominal Palpation
Preparation:
Abdominal palpation permits the examiner to
feel parts through the abdominal wall and
uterus in late pregnancy.
• Use warm hands before touching
• Use palmar surfaces of the fingers.
• Hands must be moved smoothly over the
abdomen
• Place the women in lithotomy position.

16. Notes
• Lie: the lie refers to the relationship of the
long axis of the fetus to the long axis of the
centralized uterus or maternal spine.
• The most common lie being longitudinal
(99.5%)
• The lie may become transverse or oblique or
sometimes unstable.

18. Presentation
• Presentation: the part of the fetus which
occupies lower pole of the uterus.
• Accordingly the presentation maybe
cephalic(96.5%) or podalic or shoulder and
other.

20. Attitude
• The relation of the different parts of the fetus
to one another is called attitude of the fetus.
• The universal attitude is flexion.

22. Denominator
• It is an arbitrary bony fixed point on the
presenting part which comes in relation with
various quadrants of pelvis.
• Following are denominators: occiput in vertex,
mentum(chin) in face, frontal eminence in
breech and acromion in shoulder.

25. Position
• It is the relation of the denominator to the
different quadrants of pelvis.
• The pelvis is divided into equal segments of 45
degree to place denominator in each segment.
• Thus theoretically there are 8 positions.

26. Obstetric grips or Leopold Maneuvers
• Fundal grip : 1st
• Lateral or umbilical grip: 2nd
• Pawliks grip : 3rd
• Pelvic grip : 4th

27. Fundal Grip
• The palpation is done facing patients face.
• The whole of the fundal area is palpated using
both hands laid flat on it and find which pole
of fetus is lying in the fundus.
• Broad, soft and irregular mass suggestive of
head.
• Smooth, hard and globular mass suggestive of
head.

29. Lateral Grip
• The palpation is done facing the patients face.
• The hands are to be placed flat on either side
of umbilicus to palpate one after the other.
• This is to find out position of the back, limbs
and anterior shoulder.
• The back is suggested by smooth curved and
resistant feel.
• The limbside is comparatively empty and
there are small knob-like irregular parts.

30. Pawliks grip
• The overstretched thumb and four fingers of
the right hand are placed over the lower pole
of the uterus keeping the ulnar border of the
palm on the upper border of the symphysis
pubis.
• The presenting part is grasped distinctly if not
engaged.
• And also mobility from side to side is tested.

31. Pelvic Grip
• The examination is done facing patients feet.
• Four fingers of both hands are placed on
either side of the midline in the lower pole of
the uterus parallel to the inguinal ligament.
• The fingers are pressed downwards and
backward in a manner of approximation of
finger tips to palpate the part occupying lower
pole of uterus.
• Engagement is ascertained.

32. Auscultation
• Fetal heart sounds
• These are best audible at left scapular region
in vertex.
• The maximum intensity is below umbilicus.

33. investigations
• Pregnancy tests
• Human chorionic Gonadotropin test
• Immunological test
• Radio-immunoessay test
• Radio receptor test
• Home pregnancy test
• Ultrasound diagnosis of pregnancy

35. Health Education and Counseling
• Antenatal diet
• Personal hygiene
• Breast care
• Perineal care
• Antenatal exercises

37. Drugs and Immunization
• Tetanus toxoid injection of 2 doses
• Iron and folic acid supplementation
• Calcium supplementation