ANTENATAL CARE

DEFINITION

Systematic supervision(examination and advices )

of a women during pregnency is called antenatal
care.
DC DUTTA’S

ANTENATAL CARE CONSISIT OF

 Careful history taking and examinations.(General and obstetrical)
 Advice given to pregnant women.
 AIMS
(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,
 OBJECTIVES

 Toensure a normal pregnancy with delivery

of a healthy baby from a healthy mother.
 CRITERIA OF A NORMAL DELIVERY

 Delivery of single baby

 Good condition
 At term
 Fetal weight more than 2.5 kg
 No maternal complication
 ANTENATAL VISITS

WHO recommendation, the visit may be

curtailed to at least 4
 first in second trimester around 16
weeks, second between 24 and 28
weeks,
 the third visit at 32 weeks
 the fourth visit at 36 weeks.
High risk pregnancies are advised more
frequent visits, depending on the risk factors
 PROCDURE AT FIRST VISIT

OBJECTIVES
 Toassess the health status of mother and
fetus.
 To
assess the fetal gestational age and to
obtain baseline information.
 Toorganize and continued obstetric care and
risk assessment.
History collection
 General information of mother
 Period of gestation
 History of present pregnancy(LMP,EDC)
 Past obstetrical history
 Menstrual history
 Medical and surgical history
 Family history
 Personal history
Physical examination
 General examination
 Vital signs
 Head to foot assessment
 Obstretical examination
 Routine investigation(blood and urine)
 Special investigation(rubella ,hepatis b,hiv)
 Usg examination
PROCEDURE AT SUBSEQUENT VISITS

To assess
 Fetal wellbeing
 Lie, presentation, postion and number of fetus
 Anemia, pre-eclampsia, amniotic fluid volume and
fetal growth.
 To organise special antenatal clinic for patients with
problem like cardiac disease and diabetes.
 To select,time for usg ,aminocenthesis when
indicated.
HISTORY COLLECTION
 Appearance of new complaints, lightening , quickening.
 Examination include
1.Weight

2.Pallor

3.Edema of the legs

4.Bp monitoring
 Abdominal examination
 Abdominal enlargement
 Pregnancy mask
 Skin changes
 Antenatal advices

PRINCIPLES:
 To counsel the women about the optimum till the
importance of regular checkup.
 To maintain or improve the health status of the
woman delivery by judicious advice regarding diet,
drugs and hygiene.
 To improve the psychology and to remove the fear
of the unknown by counseling the woman
 ANTENATAL ADVICES
 Nutrition
 Personal hygiene
 Regular checkup
 rest and sleep
 Travel
 Coitus
 Smoking and alcohol
 immunization
 Exercise
 Common symptoms and management
 DIET
 The recommended intake is an increase in daily caloric intake by
300 kcal/day.
 in the second trimester 400 kcal/day.
 in the third trimester Women with normal BMI should eat adequately
so as to gain the optimum weight (11kg)
 Overweight women with BMI between 26 and 29 should limit weight
gain to 7kg and obese women (BMI more than 29) should gain less
weight.
 The pregnancy diet idealls should be light, nutritious, easily
digestible and rich in protein , minerals and vitamins.
 Pregnant women should be informed that dietary supplementation
with folic acid before conception and throughout the first 12 weeks
pregnancy reduces the risk of having a baby with a neural tube
defect.
 4mg of folic acid daily taken women with a
previous history of
• neural tube defect
• anticonvulsant therapy
• pregestational diabetes
Supplemental iron therapy is needed for all
pregnant mothers from I6 weeks onwards
 1 tablet containing at least 60 mg ofelemental
iron and 500 microgramoffolic acid should be
given 1-2 times daily
 The govemment ofindia (ministry ofhcaith)
recommends for all pregnantwomen.
 100 mg ofelemental iron and 500 microgram of
folic acid for-100 days from14 weeks gestation.
 PERSONEL HYGIENE

 Bathing
 Dental care
 Breast care
 Bowel
 Clothing , shoe
 TRAVEL

 Travel by vechicle having jerks is better to be avoided ,especially in 1

st trimester and the last 6 weeks•
 Travel by vehicles having jerks is better to be avoided,especially in first•
 The long journey is preferably to be limited to the second trimester.•
 Rail route is preferable to bus route•
 Travel in pressurized aircraft is safe upto 36 weeks.•
 Air travel is contraindicated in cases with
 Placenta previa
 Pre-eclampsia
 Severe anemia
 Sickle cell disease•
Prolonged sitting in a car or aeroplane should be avoided due to the risk of
venous stasis and thromboembolism•
 REST AND SLEEP

 The patient may continue her usual activities throughout pregnancy.

 Excessive and strenuous work should be avoided especially in the
first trimester and the last weeks.
 On an average patient should be in bed for 10 hours (8 hours at
night and 2hours at noon), especially in the last 6 weeks.
 In late pregnancy, lateral posture is more comfortable
 Smoking and alcholism

 Smoking is injurious to health; it is better to stop

smoking.
 • Heavy smokers have smaller babies and there is
also more chance of abortion.
 • Alcohol consumption to be drastically curtailed or
avoided so as to prevent fetal development or
growth retardation.
 COITUS

 Generally coitus is not restricted during pregnancy.

 Release of prostaglandins and oxytocin with coitus
may cause uterine contractions.
 Women with increased risk of miscarriage or
preterm labor should avoid coitus if they feel such
increased uterine activity.
 EXERCISE
 Exercise should be regular (30min/day), of low
impact, and as a part of daily activities.
 • Exercise should avoid any symptoms of
breathlessness, fatigue or dizziness.
 • Exercise should be done in a cool area without
becoming uncomfortable and warm
 • Prolonged supine position, any compression to the
uterus or risk of injury (fall) should be avoided.
 Pelvic floor exercise, back and abdominal exercise
etc.
 IMMUNIZATION

In the developing countries immunization in pregnancy is a

routine for tetanus.
• Live virus vaccines (rubella,measles, mumps,
varicella,yellow fever) are contraindicated.
• Rabies,hepatitis A and B vaccines,toxoids can be given as
in non pregnant state.
• Immunization against tetanus not only protects the mother
but also the neonates.
• In unprotected women,0.5 ml tetanus toxoid is given
intramuscularly at 6 weeks interval for 2 such,the first one to
be given between 16 and 24 weeks.
Women who are immunized in the past,a booster dose of 0.5
ml IM is given in the last trimester
 COMMON SYMPTOMS AND
THEIR MANAGEMENT IN
SYMPTOMS
PREGNANCY
MANAGEMENT
Nausea and Vomiting Small frequent meals
Low fat, bland food
Avoidance of triggers
Supportive therapy
Medications
Heart Burn Avoidance of large meals
Avoiding lying down for 2 hours after a
meal
Semi recumbent position when lying
down
Pica Correct iron deficiency
Ptyalism (excessive Reassurance
salivation)
Constipation High fibre diet
Mild laxatives
SYMPTOMS MANAGEMENT
Hemorrhoids Stool softeners
Sitz bath
Varicosities Rest, elevation of foot
Elastic stocking
Backache Proper posture
Exercises
Symptomatic therapy
Vaginal discharge (without Reassurance
itching) Personal hygiene