ANTENATAL CARE

Roll num: 26-30

 Introduction

● Systematic supervision (examination and advice) of a woman

during pregnancy is called antenatal care.
● Antenatal care comprises of:
● 1) Careful history taking and examinations (general and
obstetrical)
● 2)Advice given to the pregnant woman.
● The criteria of a normal pregnancy are delivery of a single baby
in good condition at term (between 38 and 42), with fetal weight
of 2.5 kg or more and with no maternal complication. As such, a
normal pregnancy is a retrospective term.
 Aims and objective
(1) to screen the “high risk” cases
(2) to prevent or to detect and treat at the earliest any complication.
(3) to ensure continued risk assessment and to provide ongoing primary preventive health care.
(4) to educate the mother about the physiology of pregnancy and labor by demonstrations,
charts and diagrams (mothercraft classes), so that fear is removed and psychology is improved.
(5) to discuss with the couple about the place, time and mode of delivery, provisionally and care
of the newborn.
(6) to motivate the couple about the need of family planning and also appropriate
advice to couple seeking medical termination of pregnancy.
 History taking
Vital statistics :

Name :

Date of first examination : Address :

Age :

Gravida and parity : PARITY INDEX

Duration of marriage :( FERTILITY OR FECUNDITY)

Religion :

Occupation :

Occupation of husband :

Period of gestation :
● CHIEF COMPLAINTS: Even if there is no complaints,enquiry is to be
made about sleep,appetite,bowel habit and urination.
● History of present illness : Onset,duration,severity,use of medications and
progress to be made.
● History of present pregnancy : Imp complications in different trimesters,
number of previous ANC visits, immunisation status, has to be noted
● Obstetric history :
● The obstetric history is to be summed up as :Status of gravida, parity, number of
deliveries (term,preterm), miscarriage, pregnancy termination (MTP) and living issue [e.g. Mrs
R.L, (P2+0+1+2) G4, P2,miscarriage 1, living 2 at 36 weeks of present pregnancy].
● Menstrual history :Cycle, duration, amount of blood flow and first day of the last normal
menstrual period (LNMP) are to be noted.
● Past medical history :Relevant history of past medical illnesses is to be elicited.
● Past surgical history :hypertension, diabetes, tuberculosis, blood dyscrasia, known
hereditary disease, if any, or twinning is to be enquired.
● Family history :Family history of hypertension, diabetes, tuberculosis, blood dyscrasia,
known hereditary disease, if any, or twinning is to be enquired.
● Personal history :Contraceptive practice prior to pregnancy, smoking or alcohol habits are
to be enquired.
 ANTENATAL ADVICE

The objective is:

1.To counsel the women about the

importance of regular checkup.

2. To maintain or improve the health

status of the woman.

3.To improve the psychology and to

remove the fear of the unknown by
counseling the woman.
DIET :
The diet during pregnancy should be adequate to provide: (a) good
maternal health (b) optimum fetal growth (c) the strength and vitality
required during labor and successful lactation.
During pregnancy 300kcal more than normal calorie intake is required for
the growth of maternal tissues, development of foetus and the placenta
and an extra 650 kcal is required during lactation.
A weight gain of 9-11 kg is considered as optimum weight gain.
The pregnancy diet should ideally be light, nutritious, easily digestible
and rich in protein,minerals and vitamins.
Excessive weight gain increases antepartum and
intrapartum complications including fetal macrosomia.
ANTENATAL HYGIENE :
IMMUNIZATION:
All pregnant women are given 2 doses of 0.5 mL tetanus toxoid intramuscularly at 6 weeks
interval, the first dose is given on first antenatal visit. Women who are immunized in the past, a
booster dose of 0.5 mL IM is given in the last trimester.

GENERAL ADVICE:
The patient should be persuaded to attend for antenatal checkup positively on the schedule date
of visit. Generally, checkup is done at interval of 4 weeks up to 28 weeks; at interval of 2 weeks up
to 36 weeks and thereafter weekly till delivery.Atleast 4 antenatal visits should be made. She is
instructed to report to the physician even at an early date if symptoms such as intense headache,
disturbed sleep with restlessness, urinary troubles, epigastric pain, vomiting and scanty urination
are experienced.
 MINOR AILMENTS

1. Nausea and vomiting: Nausea and vomiting especially in the morning, soon after
getting out of bed,are usually common in primigravidae. They usually appear
following the first or second missed period and subside by the end of first
trimester.
2. Backache Physiological changes that contribute to backache are: joint ligament
laxity (relaxin, estrogen), weight gain, hyperlordosis and anterior tilt of the pelvis.
Massaging the back muscles, analgesics and rest help relieve the pain.
3. Constipation: Constipation is a quite common ailment during pregnancy. Atonicity
of the gut due to the effect of progesterone, diminished physical activity and
pressure of the gravid uterus on the pelvic colon are the possible explanations.
4. Leg cramps: It may be due to
deficiency of diffusible serum calcium
or elevation of serum phosphorus.
5. Acidity and heartburn: Heartburn is
common in pregnancy due to
relaxation of the esophageal
sphincter. Patient is advised to avoid
over eating and not to go to bed
immediately after the meal.
6. Varicose veins: Varicose veins in
the legs and vulva (varicosities) or
rectum (hemorrhoids) may appear for
the first time or aggravate during
pregnancy, usually in the later
months. It is due to obstruction in the
venous return by the pregnant uterus.
They usually disappear after delivery.
7. Syncope: It is often seen in a woman following prolonged standing or standing
upright abruptly. This is due to pooling of blood in the veins of the lower
extremities. There is the effect of compression of the pelvic veins by the gravid
uterus also.
8. Round ligament pain: Stretching of the round ligaments during movements in
pregnancy may cause sharp pain in the groins. This pain may be unilateral or
bilateral. It is usually felt in second trimester onwards. This is more common in
right side as a result of dextrorotation of uterus.
9. Ankle edema maybe present physiological. It disappears on rest, on persistent
and increasing edema pre eclampsia is suspected and should be evaluated.
10. Excess vaginal discharge indicates the presence of any infection
(Trichomonas, Candida, Bacterial vaginosis) and should be treated with vaginal
application of metronidazole or miconazole.
 Introduction to Preconception Care
● Preconception care is medical attention given
before pregnancy.
● Aims to optimize maternal and fetal health.
● Identifies and modifies risk factors before
conception.
● Vital in ensuring a healthy pregnancy and
outcome.
 Importance of Preconception Care
● Reduces maternal and perinatal morbidity and
mortality.
● Enhances fertility and pregnancy outcomes.
● Addresses risk factors early.
● Educates women on reproductive health.
 Components of Preconception Care
● 1. Risk Assessment: Medical, surgical, and genetic
history.
● 2. Health Promotion: Nutrition, immunization,
lifestyle.
● 3. Interventions: Chronic disease control, medication
management.
● 4. Education and Counseling: Fertility awareness and
family planning.
 Detailed Risk Assessment
● Assess past obstetric history: abortions, stillbirths,
preterm labor.
● Identify chronic illnesses: diabetes, hypertension,
thyroid disorders.
● Evaluate genetic history and consanguinity.
● Review current medications and teratogen
exposure.
Lifestyle and Behavioral Modifications
● Cease tobacco, alcohol, and illicit drugs.
● Nutritional support: Balanced diet, folic acid,
iron.
● Weight optimization: Address
underweight/obesity.
● Address mental health: Screen for depression
and anxiety.
Immunization and Infection Screening
● Check immunity for Rubella, Varicella,
Hepatitis B.
● Screen for HIV, Syphilis, TB, and TORCH
infections.
● Update vaccines pre-pregnancy as needed.
● Prevent vertical transmission of infections.
 Chronic Disease Management
● Control diabetes: Target HbA1c <6.5% before
conception.
● Manage hypertension: Switch to pregnancy-safe
drugs.
● Stabilize thyroid conditions: Ensure euthyroid
state.
● Review antiepileptic drug safety and dosage.
 Folic Acid and Genetic Counseling
● Folic Acid: 400 mcg daily (low risk); 4 mg (high risk).
● Prevents neural tube defects when started early.
● Genetic Counseling: For advanced age, family history,
consanguinity.
● Use of karyotyping and carrier screening if indicated.
 Benefits and National Guidelines
● Benefits: Reduced anomalies, better maternal
outcomes.
● Improved health awareness and pregnancy
planning.
● WHO: Promotes global preconception health.
● India: RCH, RMNCH+A, Anemia Mukt Bharat
initiatives.
 Conclusion
● Preconception care is essential for maternal and
fetal health.
● Should be integrated into routine reproductive
health services.
● Empowers women to make informed choices.
● Improves overall outcomes for future pregnancies.