Importance of Antenatal care

Presented by:

Captain Nishat Fatema Nipun

MBBS (AFMC)

MO, CMH, Chittagong, Bangladesh

What is Antenatal care

• Periodic and regular supervision including examination and advice of a woman during pregnancy is called Antenatal care.

• The supervision should be of a regular and periodic nature in accordance with the need of the individual.

Aims

The aims are-•To screen the high risk cases•To prevent or detect or treat at the any earliest complication•To ensure continued medical surveillance and prophylaxis•To educate the mother about the physiology of pregnancy and labour by demonstrations, charts and diagrams so that fear is removed and psychology is improved

Aims (cont’d)

• To discuss with the couple about the place, 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 and immunization

Objectives

To ensure a normal pregnancy with delivery of a healthy baby from a

healthy mother

Criteria of normal pregnancy

Delivery of a single baby in good condition at term with no maternal

complication

Services

As per WHO recommendation at least 4 visit-•1st visit around 16 weeks•2nd visit between 24-28 weeks•3rd visit at 32 weeks•4th visit at 36 weeks

Services (cont’d)

Generally-•At interval of 4 weeks up to 28 weeks•At interval of 2 weeks up to 36 weeks•At weekly interval up to EDD

Antenatal care comprises of-

• Careful history taking and examination and investigation

• Advice given to the pregnant woman

THE FIRST VISIT

• History taking• Examination• Investigation

History taking1. Particulars of the patient2. Chief complaints with duration3. Past history4. Obstetric history5. Menstrual history6. Family history7. Drug History8. History of immunization9. Socio-economic history10.Contraceptive history11.History of allergy

Particulars of the patient

1.Name2.Age3.Address4.Marital status5.Date of Admission6.Date of Examination

Chief complaints with duration1. Period of amenorrhea2. Nausea & vomiting, vertigo3. Increased frequency of micturition4. Constipation5. Heaviness of breast6. Rise of temperature7. Edema8. Pain in the abdomen9. Backache10. Vaginal bleeding

Past history

1.HTN2.DM3.BA4.Renal Disease5.Psychiatric illness6.IHD7.Any previous operation

Obstetrical History

• Duration of marriage• Gravida• Para• ALC

Menstrual History

Age of menarcheMenstrual periodMenstrual cycleLMPEDD

Family history

a)HTNb)DMc)Multiple pregnancy

Drug History

AntihypertensiveHypoglycemicAntidepressantCorticosteroidAnticoagulant

Physical examination

General examinationAbdominal examination

General examination

• Appearance• Height of patient• Weight of patient• Anemia• Jaundice• Edema• Cyanosis• Clubbing• Koilonychia• Leuconychia

General examination (cont’d)

• Temperature• Pulse• BP• RR• Breast• Heart sound• Lungs

Abdominal examination

InspectionPalpationpercussionAuscultation

Inspection

Shape of the uterusStriaescar mark

Palpation

• Assessment of fundal height• Lie• Abdominal girth• Fundal grip• Lateral grip• First pelvic grip• Second pelvic grip

Auscultation

Normal FHR is 120-160 b/mCauses of foetal tachycardia (>160 b/m)Causes of foetal bradycardia (<120 b/m)

Causes of foetal tachycardia (>160 b/m)

1. Maternal high fever2. Foetal distress3. Maternal tachycardia

Causes of foetal bradycardia (<120 b/m)

1. Foetal distress2. Foetal cardiac conduction defect

Investigation• CBC• Blood grouping & Rh typing• Urine R/E• RBS• VDRL• HBS Ag• Ultrasound

Ultrasound

early pregnancy (preferably at 10-13 weeks) to:•Determine gestational age•Detect multiple pregnancies•Help with later screening for Down's syndrome

Ultrasound (cont’d)

At 11-14 weeks: offer nuchal translucency screening for Down's syndrome, with other tests if available.

At 18-20 weeks: offer screening with ultrasound for congenital anomalies.

At 36 weeks: for foetal maturity, placenta praevia.

In subsequent visit

• Patient complains• General examination• Gestational age to be calculated• Identification of problem• Foetal movement• SFH measurement• Health education• Prophylaxis & treatment of anemia• Developing individualized birth plan

Second visit (24-28 weeks)

SFH measurementTo detect Multiple pregnancy

Third visit (32 weeks)

Screen for-1.Preeclampsia2.Multiple pregnancy3.anemia4.IUGR

Fourth visit (36 weeks)

• Identification of foetal1.Lie2.Presentation3.Position

• Update birth plan

Antenatal advicePrinciples:1.To impress the patient about the importance of regular check up2.To maintain or improve the health status of the woman to the optimum till delivery by judicious advice regarding diet, drugs and hygiene3.To improve and tone up the psychology and ot remove the fear of pregnancy by talking sympathetically to the patient and explaining the principle changes and events likely to occur during pregnancy

Antenatal advice (cont’d)

• Diet• Rest & sleep• Bowel• Personal cleanliness• Clothing, shoes & belt• Dental care• Care of breast• Coitus• Travelling

• Smoking & alcohol• Immunization• Drug• Mental preparation• Exercise• Child care• Birth plan• Warning sign• Family planning

Following advices are to be given:

Diet

Diet should be: 1.nutritious 2.balanced3.light4.easily digestible5.rich in protein, mineral and vitamin 6.with woman’s choice

DDA of a woman during pregnancy (2nd half)

Food element pregnancy

Kilocalories 2500

Protein 60 gm.

Iron 40 mg

Folic acid 400 g

Calcium 1000 mg

Vitamin A 6000 I.U.

Diet for a pregnant woman (3000 Kcal)

Early morning:•Tea or coffee – 1 cup•Biscuit – 2 pcsBreakfast:•Chapatties – 2 pcs•Egg – 1 poached or boiled•Vegetable – 1 cupMidmorning:•Milk – 250 ml or 1 glass•Biscuit – 2 pcs•Apple or orange – 1 pc

Diet for a pregnant woman (3000 Kcal)

Lunch:1.Cooked rice – 4 cup2.Meat or fish – 3 pcs or 120 gm.3.Cooked Dal – 2 cups4.Vegetable – 1 cup5.Leafy vegetable – ½ cup6.Salad – tomato, carrot, cucumber

Evening:•Biscuits – 2 pcs•Fruits – on choiceDinner:•Cooked rice – 3 cup•Meat or fish – 3 pcs or 120 gm.•Cooked Dal – 2 cups•Vegetable – 1 cupBed time: one glass of milk

Diet for a pregnant woman (3000 Kcal)

Early morning:•Tea or coffee – 1 cup (without sugar)•Salted Biscuit – 2 pcsBreakfast:•Chapatties – 2 pcs / Atta – 60 gm.•Egg – 1 poached or boiled•Vegetable – ½ cup•Milk – 150 ml or 1 cupMidmorning: apple or sweet lime

Diet for a pregnant diabetic woman (2200 Kcal)

Lunch:1.Cooked rice – 1.5 cup / rice – 60 gm.2.Meat or fish – 1 pcs or 40 gm.3.Cooked Dal – 1 cup4.Leafy vegetable – ½ cup5.Salad – tomato, carrot, cucumberEvening: (4 pm)•Salted Biscuits – 2 pcs•Milk – 150 ml or 1 cup

Diet for a pregnant diabetic woman (2200 Kcal)

Dinner:•Chapatties – 3 pcs / Atta – 90 gm.•Meat or fish – 1 pcs or 40 gm.•Cooked Dal – 1 cup•Vegetable – ½ cupBed time: one cup of milk

Diet for a pregnant diabetic woman (2200 Kcal)

Restricted food:•sugar•Molasses•Honey•Jam / jelly•Sweet•Chocolate•Ice-cream•juice

Diet for a pregnant diabetic woman (2200 Kcal)

Rest and sleep

• 8 hour sleep at night• At least 2 hour sleep after mid-day

meal• Hard strenuous work should be

avoided in first trimester and last 4 weeks

Bowel

• Regular bowel movement may be facilitated by regulation of diet, taking plenty fluid, vegetable and milk

CoitusShould be avoided in •1st trimester•last 6 weeks

Travelling

Should be avoided in •1st trimester•last 6 weeksAir travelling is contraindicated in•Placenta praevia•Preeclampsia•Severe anemia

Immunization

Indicated-•TT•HAV•HBV•RabiesContraindicated-•Live virus vaccine (rubella measles, mums, varicella)

Warning sign

1. Headache2. Blurring of vision3. Convulsion4. Vaginal bleeding5. Fever

Preconceptional care Preconceptional care is the one step ahead of

antenatal care. When a couple is seen and counseled about

pregnancy, its course and outcome before the time of actual conception, is called Preconceptional care.

Objective: to ensure that, a woman enters pregnancy with an optimal state of health which would be safe both to herself and the fetus.

Preconceptional care includes:

Identification of high risk factor Basal level health status including BP recording Rubella & Hepatitis immunization Folic acid supplementation Maternal health is optimized preconceptionally

such as overweight anemia Patient with medical disease like hypertension,

diabetes are stabilized in an optimal state by intervention

Preconceptional care includes: (cont’d)

Drugs used before pregnancy are verified and changed if required to prevent any adverse effect of the fetus; e.g., warfarin is replaced with heparin, oral anti-diabetic drug with insulin

Advise to stop smoking, alcohol and drug abuse Proper counseling to those with history of recurrent

foetal loss or family history of congenital abnormalities

Counseling regarding health care cost Find out supporting or helping people to help the

mother and care of the new born