Antenatal Care
DR. FOUZIA SHAIKHASSOCIATE PROFESSOR
LUMHS
Definition of Antenatal care
comprehensive health supervision of a pregnant woman before delivery
Or it is planned examination, observation and guidance given to the pregnant woman from conception till the time of labor.
Goals
To reduce maternal and perinatal mortality and morbidity rates
To improve the physical and mental health of women and children
Importance of Antenatal Care
To ensure that the pregnant woman and her fetus are in the best possible health.
To detect early and treat properly complications
Offering education for parenthood
To prepare the woman for labor, lactation and care of her infant
Schedule for Antenatal Visits:
The first visit or initial visit should be made as early is pregnancy as possible.
Return Visits:
Once every month till 7th month.
Once every 2 weeks till the 9th month
Once every week during the 9th month, till labor.
Assessment
History Examination Investigation
History
Personal historyFamily history Medical and surgical history Menstrual history Obstetrical history History of present
pregnancy
Physical Examinations
Height of over 150 cm indication of an average-sized pelvis
The approximate weight gain during pregnancy is 12 kg.; 2kg in the first 20 weeks and 10 kg in the remaining 20 weeks (1.5 kg per week until term).
Obesity (more than 20 kg above the weight-height formula) leads to an increased risk of gestational diabetes, pregnancy-induced hypertension and thrombo-embolic disorders
Local Examination
The uterus may be higher than expected due to large fetus, multiple pregnancy, polyhydrammnios or mistaken date of last menstrual period.
The uterus may be lower than expected due to small fetus, intrauterine growth retardation, oligohydramnios or mistaken date of last menstrual period.
Fetal heart sound is heard by sonicaid as early as 10thweek of pregnancy.
Fetal heart sound is heard by Pinard' s fetal stethoscope after the 20thweek of pregnancy.
The normal fetal heart rate is 120-160 beats/min
Investigations:
Urine should be tested for sugar, ketones and protein.
Hemoglobin will be repeated: At 36 weeks of gestation.Every 4 weeks if Hb is < 9 g/dl.
Fetal kick count
The pregnant woman reports at least 10 movements in 12 hours.
Absence of fetal movements precedes intrauterine fetal death by 48 hours.
Health Teaching during the First Trimester
Physiological changes during pregnancy
Weight gain Fresh air and
sunshine Rest and sleep Diet Daily activities Exercises and
relaxation Hygiene Teeth Bladder and bowel Sexual counseling
Smoking : Medications Infection Irradiation Occupational and
environmental hazards
Travel Follow up Minor
discomforts Signs of
Potential Complications
Exercise should be simple, mild exercise avoid lifting heavy weights
A tooth can be extracted during pregnancy, but local analgesia is recommended
Catheter and enema should be avoided. Smoking may lead to ptyalism,
nervousness and hyper emesis and make pregnant woman at increased risk of chest infections and thrombo-embolic disorders
Pregnant woman should avoid contact with infectious diseases especially rubella or (German measles) because it has deleterious effects on the fetus
Pregnant woman should avoid exposure to x-ray or irradiation because of possible teratogenic effects on the fetus such as birth defects or childhood leukemia
FOCUSED ANTENATAL CARE
The high risk approach
intended to classify pregnant women as “low risk” or
“high risk” based on predetermined criteria and involved
many ANC visits. This approach was hard to implement
effectively since many women had at least one risk factor,
Focused or goal oriented
ANC services provide specific evidence-based
interventions for all women, carried out at certain critical
times in the pregnancy.
The essential elements of a
focused approach to antenatal care
• Identification and surveillance of the pregnant woman
and her expected child
• Recognition and management of pregnancy-related
complications, particularly pre-eclampsia
• Recognition and treatment of underlying or concurrent
illness
• Screening for conditions and diseases such as anaemia,
STIs (particularly syphilis), HIV infection, mental health
problems, and/or symptoms of stress or domestic
violence
Preventive measures, including tetanus toxoid
immunisation, de-worming, iron and folic acid,
Intermittent preventive treatment of malaria
• Advice and support to the woman and her family for
developing healthy home behaviours and a birth and
emergency preparedness plan to:
o Increase awareness of maternal and newborn
health needs and self care during pregnancy and the
postnatal period, including the need for social support
during and after pregnancy
recognition of danger signs for the woman and the
newborn as well as transport and funding plans in
case of emergencies
o Help the pregnant woman and her partner prepare
emotionally and physically for birth and care of their
baby, particularly preparing for early and exclusive
breastfeeding and essential newborn care
Promote postnatal family planning/birth spacing
How many visits
A recent multi-country randomized control trial led by the WHO17 and a systematic review showed that essential interventions can be provided over
four visits at specified intervals, at least for healthy
women with no underlying medical problems.
• First visit: On confirmation of pregnancy
• Second visit: 20-28 weeks
• Third visit: 34-36 weeks
• Fourth visit: before expected date of delivery
or when the pregnant woman feels she
needs to consult health workerLeading causes of maternal mortal
Common Discomforts of Pregnancy, Etiology, and Relief
Measures :Urinary frequency
RELIEF MEASURES: Decrease fluid intake at night.
Maintain fluid intake during day.
Void when feel the urge.
Fatigue
RELIEF MEASURES:
Rest frequency.
Go to bed earlier.
Sleep difficulties
RELIEF MEASURES:
Rest frequency Decrease fluid intake at night
Breast enlargement and sensitivity
RELIEF MEASURES:
Wear a good supporting bra.
Assess for other conditions.
Nasal stuffiness and epistaxisETIOLGY: Elevated estrogen levels
RELIEF MEASURES :
Avoid decongestants.Use humidifiers, and normal
saline drops.
Ptyalism (excessive salivation)ETIOLGY: UnknownRELIEF MEASURES:
Perform frequent mouth care.
Chew gum.Decrease fluid intake at night.
Maintain fluid intake during day.
Nausea and vomiting
RELIEF MEASURES: Avoid food or smells that exacerbate condition.
Eat dry crackers or toast before rising in morning.
Eat small, frequent meals.
Avoid sudden movements. Get out of bed slowly
Breath fresh air to help relieve nausea.
Shortness of breath
RELIEF MEASURES:
Use extra pillows at night to keep more upright.
Limit activity during day
Heartburn
RELIEF MEASURES:
Eat small, more frequent meals.
Use antacids.
Avoid overeating and spicy foods.
Dependent edema
Avoid standing for long periods.
Elevate legs when laying or sitting.
Avoid tight stockings.
Varicosities
Rest in sims' position. Elevate legs regularly. Avoid crossing legs. Avoid tight stockings. Avoid long periods of
standing
Hemorrhoids
RELIEF MEASURES:
Maintain regular bowel habits.
Use prescribed stool softeners.
Apply topical or anesthetic ointments to area.
Constipation
RELIEF MEASURES:
Maintain regular bowel habits.
Increase fiber in diet.Increase fluids.Find iron preparation that is least constipating
Leucorrhea
RELIEF MEASURES:Take a daily bath or shower.
Wear cotton underwear.
Backache
RELIEF MEASURES:Wear shoes with low heels.Walk with pelvis tilted forward.
Use firmer mattress.Perform pelvic rocking or tilting
Leg cramps
RELIEF MEASURES:
Extend affected leg and dorsiflex the foot.
Elevate lower legs frequently.
Apply heat to muscles.
Evaluate diet.
Faintness
RELIEF MEASURES:•Rise slowly from sitting to standing.•Evaluate hemoglobin and hematocrit.•Avoid hot environments