antenatal care for 3rd year bsc nsg 2013

8/11/2019 Antenatal Care for 3rd Year Bsc Nsg 2013

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ANTENATALCARE Sindhu Sebastian

LecturerFmcon


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Periodic and regular supervision includingexamination and advice of a womanduring pregnancy is called Antenatalcare.

The supervision should be of a regularand periodic nature in accordance with

the need of the individual.


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The aims are- To screen the high risk cases To prevent or detect or treat at the anyearliest complication To ensure continued medical surveillanceand prophylaxis To educate the mother about the physiology

of pregnancy and labour by demonstrations,charts and diagrams so that fear is removedand psychology is improved


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To discuss with the couple about theplace, 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 andimmunization


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To ensure a normal pregnancywith delivery of a healthy baby

from a healthy mother


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Delivery of a single baby ingood condition at term with

no maternal complication


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As per !" recommendation at least # visit- $ st visit around $% weeks &nd visit between -&' weeks ( rd visit at (& weeks # th visit at (% weeks


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ullipara is one who has never completed apregnancy to the stage of viability.

Primiparous is one who has delivered one viablechild

ultigravida is one who has previously beenpregnant. /he may have aborted or have

delivered viable baby.Parturient is a woman in labour.ulligravida is one who is not now and never has

been pregnant.Primigravida is one who is pregnant for the 0rst

timeultipara is one who has delivered two or more

children


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!istory taking *xamination 2nvestigation


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$. Particulars of the patient&. 1hief complaints with duration(. Past history#. "bstetric history3. enstrual history%. 4amily history5. +rug !istory'.

!istory of immunization6. /ocio-economic history$7. 1ontraceptive history$$. !istory of allergy


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$. ame&.Age

(. Address#. arital status3. +ate of Admission%.+ate of *xamination


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$. Period of amenorrhea&. ausea 8 vomiting, vertigo(. 2ncreased fre9uency of micturition#. 1onstipation3. !eaviness of breast%. :ise of temperature5. *dema'. Pain in the abdomen6. ;ackache$7.


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$. !T&.+(. ;A#. :enal +isease3. Psychiatric illness%.2!+5. Any previous operation


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+uration of marriage )ravida Para A=1


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Antenatal history - 2trimester

22trimester

222trimesterPast obstetrical history


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1 st Trimester Ask about nausea, vomiting ther associated s!m"toms such as #ever Abdominal$"elvic$back "ain, burning micturition %aginal discharge &leeding "er vagina 'se o# #olic acid tablets (small !ello) colored"ills* +as an ultrasound done at or -)ks ( atingscan*

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/ nd Trimester Ask about regular use o# #olic acid, iron and calcium su""lements 'ltrasound at 10 //)ks (Anomal! scan* 2uickening3 #etal movements (normall! #elt around /4 )eeksgestation* Fever, rash, abdominal "ain

5 rd Trimester Tetanus to6oid vaccine at /0 )ks 7 5/ )ks Regular doctor checku"s 'ltrasound

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Age of menarche

enstrual periodenstrual cycle

= P*++


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a?!Tb?+c? ultiple pregnancy


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Antihypertensive

!ypoglycemicAntidepressant

1orticosteroidAnticoagulant


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)eneral examinationAbdominal examination


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Obtain consent to examine patient Inform and explain to the patient what you intend to do Warn patient to inform you if the examination becomes

uncomfortable at any time. Always look at the patients face during the examination to

identify any signs of pain or discomfort elicited during the

examination. Make sure that the patient has recently emptied her bladder.

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GENERAL ASSESSMENT !"#"$A% APP"A$A#&" '"I!'(

R: Maternal height and labour outcome. ) Obstet!ynaecol. *++* ,ep-** /01/234/(here was a statistically significant positi e correlation

between height and birth weight and a negati e association between height and incidence of caesarean sections.

W"I!'( 5MI 6I(A% ,I!#,

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'AI$1 7ryness 8 poor nutrition"9",1 "dema with swollen optic disk 8 PI'

#O,"1 #asal congestion"A$,1 7ampening of soundMO:(';(""(' A#7 ('$OA(1

&racked corner of mouth4 itamin A deficiencyPin point lesions with an erythematous base4 herpesinfection

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7ental caries1R: Maternal dental caries and pre4term birth Acta Odontol ,cand. *+22 )ul-01*>?4/$'>$# &'


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Inspection 1 ,ymmetry Primary areola ,econdary areola Montgomerys

#ipple retracted @flat @erectile@

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Palpation1 lumps@ axillary lymph node6A$IO:, M"('O7,

&ircular techni ue Wedge (echni ue Wheel ,poke0 6ertical strip

"xpression of colostrum1

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Abdominal palpation

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*nsure the patient has emptied her bladderbefore examining her abdomen.

Patient should lie in the supine position with apillow under the head and arms by her side.

/he is slightly rolled to the left side to preventcompression of the inferior vena cava by theenlarged uterus @inferior venacaval syndromeor supine hypotensive syndrome?.

Ask for any tender area before palpating theabdomen.

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/he is made to ex her knees whiledoing pelvic palpation.

*xamination is performed by fully

exposing the abdomen. *xaminer stands on right side of mother.

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2nspection

Palpation

Auscultation

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INSPECTION ,iBe

,hape ,kin changes ,car marks Cetal mo ements Clanks :mbilicus

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- +escribe the abdominaldistension @pyriform?.

- Previousoperative@1aesarean?scars

- =inea nigra- /triae gravidarum or

stretch marks- $'>$# (5


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Cundal height Abdominal girth Cundal grip I

%eopold0 -4etalpoles

%ateral grip II%eopold; :mbilicalgrip0 4Cetal lie

Pel ic grip I6%eopold0

Fetal Attitudeandengagement

Pawliks grip III%eopold0 8resenting "art

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arm hands before palpation


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1entralize uterus,place ulnar border of

left hand on uppermost level of fundusand measure till

symphysis pubis withhelp of an inch tape. 4undal height CCcm

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easure around abdomen at the level ofumbilicus

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Leo"old9s :aneuvers are a commonand systematic way to determine theposition of a fetus inside thewomanEs uterusF they are named afterthe gynecologist Christian ;erhardLeo"old.


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are a common andsystematic way to determinethe position of a fetus insidethe womanEs uterusF they are

named after thegynecologist Christian;erhard Leo"old .


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The uterinefundus is

palpated todeterminewhich fetal

part occupiesthe fundus.

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;oth hands placed over thefundus and the contentsof the fundus determined.

A hard smooth, round poleindicates a fetal head.

-A softer triangular polecontinuous with the fetalbody is the fetalbuttocks@breech?.

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F'N AL8AL8AT< N3

The uterine fundus is

palpated todetermine whichfetal part occupiesthe fundus.


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- ove both hands ina downwarddirection from thefundus along thesides of the uterusto determine theGlieG of the foetus.

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*ach side of thematernal abdomen ispalpated todetermine which side

is the fetal spine andwhich is theextremities.

/pine smoothcurved and resistentfeel

=imbs small knoblike irregular parts

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+etermine whichside the foetal backis situated byfeeling the 0rmregular surface ofthe foetal back onone side and theirregular.

foetal limbs =umpy surface as

the on the other

side.

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=ieG is the relationshipbtw the longitudinal

axis of the foetus andthe longitudinal axis ofthe mother.

longitudinal aby is lying length-

wise in the same

direction asmotherEslongitudinal axis.

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Transverse lie@fetus lies acrossthe long. axis of

mother? and"bli9ue lie @foetus liesat an obli9ue angleto the motherEs

long. axis?.-

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LATERAL 8AL8AT< N3 *ach side of the

maternal abdomen ispalpated to determinewhich side is the fetalspine and which is theextremities.

/pine smooth curvedand resistent feel

=imbs small knob likeirregular parts


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"ne hand applies pressureon the fundus while Thethumb and middle 0ngers

of the right hand areplaced wide apart overthe suprapubic area todetermine the presenting

part to con0rmpresentation andengagement.

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http://www.brooksidepress.org/Products/Military_OBGYN/Textbook/LaborandDelivery/Labor/Leopold3.jpg


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Presenting part offetus is the lowestmost part of thefetus at the inlet ofthe pelvis@the lowerfetal pole asopposed to thefetal pole in thefundus?.

1ephalic or breechpresentationdistinguished fromeach other

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"ne hand appliespressure on thefundus while theindex 0nger andthumb of the otherhand palpate thepresenting part tocon0rmpresentation andengagement.


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The area above thesymphysis pubis ispalpated to locate thefetal presenting part andthus determine how farthe fetus has descendedand whether the fetus isengaged. 2f hands areconverging indicatesunengagement Fdiverging indicatesengagement of head.


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-The examiner turns aroundto face patients feet.

-*ach hand placed on eitherside of the fetal trunklower down.

-The hands moveddownwards towards thefetal head.

- ote made as to whichhand 0rst touches thefetal head @This pointcalled cephalicprominence?.

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The area above thesymphysis pubis ispalpated to locate thefetal presenting partand thus determinehow far the fetus hasdescended andwhether the fetus isengaged. 2f hands are

converging indicatesunengagement Fdiverging indicatesengagement of head.


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1*The attitude o# the #etalhead3

-The examiner turns around toface patients feet.-*ach hand placed on either

side of the fetal trunk lowerdown.

-The hands moved downwardstowards the fetal head.

- ote made as to which hand0rst touches the fetal head@This point called cephalicprominence?.

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1ephalic prominence helps determine theattitude @i.e. exion, de exed or extended? offetal head.

-2f cephalic prominence is on the opposite side offetal back, fetal head is well exed @normalposition?.

-2f cephalic prominence on the same side as fetal

back, fetal head is extended @abnormalposition?.-2f examiners hands reach the fetal head e9ually

on both sides, fetal head is de exed @E ilitary

position, indicating mal-position?76>$'>$# %&


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PALPATION Cundal height Abdominal girth Cundal grip I %eopold0 %ateral grip II %eopold; :mbilical grip0 Pel ic grip I6 %eopold0

Pawliks grip III %eopold0

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-+uring the examination note any foetalmovements @kicks and rolling motions?.

-!ealthy foetuses move, sick or sleepy

foetuses donEt move.

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EXTREMITIES "dema of the legs 8

Medial malleolus and anterior surface of the lower2@3 of the tibia.

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8erineum"edema of vulva+ischarge

/oreness of vulva$'>$# 5$


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Name First done Re"eated d= or I $$ g>d=@ !"? consider asanemia

&. ;lood group 8:h typing

;ooking --- 2f :h Bve, husbandJsgroup 8 21T

(. !b s Ag, !2


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http://en.wikipedia.org/wiki/File:Ultrasound_image_of_a_fetus.jpg


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At $$-$# weeks oMer nuchal translucency screening for+ownEs syndrome, with other tests ifavailable.

At $'-&7 weeksoMer screening with ultrasound forcongenital anomalies.

At (% weeksfor foetal maturity, placenta praevia.
http://en.wikipedia.org/wiki/File:3dultrasound_20_weeks.jpghttp://en.wikipedia.org/wiki/File:Ultrasound_image_of_a_fetus.jpg


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Patient complains )eneral examination )estational age to be calculated

2denti0cation of problem 4oetal movement /4! measurement

!ealth education Prophylaxis 8 treatment of anemia +eveloping individualized birth plan


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/4! measurement To detect ultiple pregnancy


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/creen for-

$. Preeclampsia&. ultiple pregnancy(. anemia#. 2L):


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2denti0cation of foetal$. =ie&. Presentation(. Position

Lpdate birth plan


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Principles

$. To impress the patient about the importance ofregular check up&. To maintain or improve the health status of thewoman to the optimum till delivery by Nudiciousadvice regarding diet, drugs and hygiene(. To improve and tone up the psychology and otremove the fear of pregnancy by talking

sympathetically to the patient and explainingthe principle changes and events likely to occurduring pregnancy


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+iet :est 8 sleep ;owel Personal cleanliness 1lothing, shoes 8

belt

+ental care 1are of breast 1oitus Travelling

/moking 8alcohol

2mmunization +rug ental

preparation *xercise 1hild care

;irth plan

4ollowing advices are to be given


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+iet should be$. nutritious&.balanced(. light#. easily digestible3. rich in protein, mineral andvitamin%.with womanJs choice


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Food element "regnanc!Oilocalories &377

Protein %7 gm.

2ron #7 mg

4olic acid #77 g

1alcium $777 mg


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*arly morning Tea or coMee B $ cup ;iscuit B & pcs;reakfast 1hapatties B & pcs *gg B $ poached or boiled


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=unch$. 1ooked rice B # cup&. eat or 0sh B ( pcs or $&7 gm.

(. 1ooked +al B & cups#.


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*vening ;iscuits B & pcs 4ruits B on choice+inner 1ooked rice B ( cup eat or 0sh B ( pcs or $&7 gm. 1ooked +al B & cups


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=unch$. 1ooked rice B $.3 cup > rice B %7 gm.&. eat or 0sh B $ pcs or #7 gm.(. 1ooked +al B $ cup#. =eafy vegetable B cup3. /alad B tomato, carrot, cucumber*vening @# pm?

/alted ;iscuits B & pcs ilk B $37 ml or $ cup


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+inner 1hapatties B ( pcs > Atta B 67 gm. eat or 0sh B $ pcs or #7 gm. 1ooked +al B $ cup


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:estricted food sugar olasses

!oney Qam > Nelly /weet 1hocolate 2ce-cream Nuice


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' hour sleep at night At least & hour sleep

after mid-day meal !ard strenuous work

should be avoided in0rst trimester and last# weeks


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:egular bowel movement may befacilitated by regulation of diet, takingplenty uid, vegetable and milk

Coitus/hould be avoided in $ st trimester last % weeks


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/hould be avoided in $ st trimester last % weeksAir travelling is contraindicated in Placenta praevia Preeclampsia /evere anemia


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Tetanus toxoid B safe8 mandatory$ st dose- at booking visit 8 then % weeks later2f already takes within last ( years, booster at (% weeks

'suall! others not given

Sa#e nl! ine"idemics

C.day


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*xercise should be simple. alking is ideal, but long period of walking

should be avoided. The pregnant woman should avoid lifting

heavy weights such as mattresses furniture,as it may lead to abortion.

/he should avoid long period of standingbecause it predisposes her to varicose vein.S/he should avoid setting with legs crossedbecause it will impede circulation.

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$. To develop a good posture. &. To reduce constipation 8 insomnia. (. To alleviate discomfortable, postural back

ache8 fatigue.#. To ensure good muscles tone8 strength

pelvic supports.S3.To develop good breathing habits, ensure

good oxygen supply to the fetus.

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%.To prevent circulatory stasis in lowerextremities, promote circulation, lessenthe possibility of venous thrombosis

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$. !eadache&. ;lurring of vision(. 1onvulsion#.


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ausea 8 vomiting ;ackache


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Thank ou ..


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1.;eneral advice #or all )omen3 Preconceptional folate

:ubella 8 !ep ; vaccine eight reduction in obesity

1essation of smoking > alcohol Advice regarding drug intake :ule out /T+s, 8 !2

antenatal care for 3rd year bsc nsg 2013

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