antenatal care
TRANSCRIPT
DR.N.MONISHA
What is it?The care of the pregnant woman with the aim
of achieving a healthy pregnancy and delivery of a normal,healthy baby
Good antenatal care helps a woman to face labour in good health and in optimum condition
AIMS OF ANTENATAL CARE
•Promote, protect & maintain the health of mother•Detect high-risk cases•Proactive approach to complications•Remove the anxiety and dread associated with pregnancy•Reduce maternal and infant mortality and morbidity rate•Teach mother the elements of child care, nutrition, personal hygiene & environmental sanitation
Schedule For Antenatal VisitsMonthly up to 28 weeksTwo weekly between 28 and 34 weeksWeekly 34 weeks onwards.
High-risk cases more frequent
visits
Booking Visit ??First visit that the woman makes to the health
care facility.
Should be as early possible and preferably in the first trimester :
To detect high-risk cases To offer counselling if unplanned pregnancy
Aims of Booking VisitoGet detailed history & assess if high risk
oEstablish correct gestational age and date pregnancy
oProvide information about what is to expected, the danger signals etc. which she should know of
oPerform baseline investigations likeHB, blood group, Rh typing & urine Analysis, Serology
Routine Investigations Name First done Repeated Interpretation 1. Hb, PCV Booking Once every
trimester<10 g/dL or < 11 g/dL (WHO) FOGSI<10g/dlconsider as anemia
2. Blood group & Rh typing
Booking --- If Rh –ve, husband’s group & ICT
3. HbsAg, HIV, VDRL
Booking --- If +ve, refer for counselling & PPTCT
4. Urine routine examination
Booking Every visit Pus cells> 5, do a cultureAlb+ or >, consider pre-eclampsia
5. GCT
6.DIPSI
24-28 weeks
24-28 weeks
--- 130 mg/dL or more, do a GTT<140mg/dl
History & ExaminatioinHistory takingSystemic & obstetric examination
Palpation: symphyseofundal height on every visit
GRIPS: FUNDAL GRIP SECOND GRIP/UMBLICAL GRIP FIRST PELVIC/PAWLIK’S GRIP SECOND PELVIC GRIP
Immunizations in PregnancyTetanus toxoid – safe& mandatory
1st dose- at booking visit & then 6 weeks later If already takes within last 3 years, booster at 36 weeksUsually others not given
Safe Only in epidemics
C.I
Tetanus Typhoid Rubella Hepatits Cholera MMRRabies Varicella
BCGYellow fever
Medications 1. Folic acid – 5mg during 1st trimester ( if not
begun preconceptionally)
2. Fe & Ca started at 13 wks continued for 3 months after
pregnancyFe- 100mg Ca- 1g/day
Health Education for the Pregnant womanDiet
need extra 300kcal/day from 2nd trimester onwards Protein Salt Iron Calcium : 1.5 g daily Vit. C, folic acid, Vit. B12 + tablets
Continued.. Weight gain: total of 11 kg. 500 g/wk during 2nd trimester Rest and sleepActivity & ExerciseClothes : loose clothing is preferredCoitus Smoking & alcohol and drugs Care of breastsTravel
Warning signals !!!Bleeding p/v at any time in pregnancyHead ache, blurring vision, epigastric pain &
oliguriaPedal oedema, severe, not subsiding with rest, or
on face & handsDecrease/ loss of fetal movementsAbdominal painUrinary infection with vulvovaginitisClear fluid p/v PROM
Common Symptomatology in pregnancyNausea & vomitingBackache Varicose veinsHemorrhoidsVaginal dischargeAcidity & heart burnConstipation
Antenatal care up to 28 weeksWoman should seek care every monthWeight, bp & urine checked at each visit
Quickening, anemia, oedema (!!)
Symphyseofundal height
Others: Targeted ultrasound scan for anomalies (18-20 wks)…….
Antenatal care after 28 weeksCrucial period: pre-eclampsia, GDM, growth
disorders
bp, weight, urine routine, Hb
Symphyseofundal height: detect IUGR & macrosomia
Vaginal examination
Ultrasound in Pregnancy..First trimester scan- helps to detect early
pregnancy,accurate dating,number of foetus….Booking scan : 10-14 wks confirm gestational
age assess nuchal
translucency
• 2nd trimester :anomaly scan• 3rd trimester : growth scan
Preconceptional / Prepregnancy Councelling1. General advice for all women:• Preconceptional folate• Rubella & Hep B vaccine • Weight reduction in obesity• Cessation of smoking / alcohol• Advice regarding drug intake• Rule out STDs, & HIV counseling • Avoid teratogens
Continued..2. Medical disorders• Preconceptional glycemic control in diabetes• Remission in chronic diseases like SLE &
chronic renal disease• Cardiac surgery prior to pregnancy• Avoiding pregnancy in certain cardiac
diseases• Changing teratogenic drugs as in epilepsy
Continued..3. Recurrent pregnancy loss• Checking for antiphospholipid antibody
syndrome• Correction of uterine septum by
hysteroscopic septal resection
4. Genetic problems• Parental karyotyping• Carrier screening based on ethnicity or family
history• Dietary advice in PKU
Thank You…..