ANTENATAL CARE

PRESENTED BY
YASH JAJODIA
ZEBA KHAN
GUIDED BY
DR. Q.H KHAN SIR

 Our sincere gratitude to—
 Dr. Q.H. Khan Sir
 Dr. Teeku Sinha Sir
 Dr. K.P. Brahmapurkar Sir
 Dr. V.K. Brahmapurkar Mam
 Dr. Sameer Painkra Sir
 Dr. Akhilesh Badge Sir
 Dr. Dharamraj Nag Sir
 Dr. R.S. Bahrolia Sir
 Dr. N. Susheel Kumar Sir
 Dr. Ravindra Chaurasia Sir

 MCH problems
 ANC objective
 Antenatal visit
 Prenatal advice
 Specific health protection
 Mental preparation
 Family planning
 Paediatric component
 Programmes for Maternal health care

CONCERNS IN DEVELOPING COUNTERIES ARE-
•prevent of communicable disease
•Reduction of maternal and child mortality and morbidity rate
•Spacing between pregnancy
•Improvement of nutrition etc.
There is a triad of problem in India :
MALNURTRITION
INFECTION
UNCONTROLLED REPRODUCTION

MATERNAL MALNUTRTION CAN CAUSE :
 Low birth weight child
 Anemia
 Toxemias of pregnancy
 Post partum hemorrhage

Direct
1. Supplementary food
program
2. Distribution of iron and
folic acid tablet
3. Fortification
4. Nutrition education
Indirect
Ramification :
1. Immunization
2. Improvement of
environment sanitation
3. Clean drinking water
4. Family planning
5. Food hygiene

 Mother can get infected by:
HIV, Hep B, Cytomegalovirus , HSV , toxoplasma
 IT MAY CAUSE :
1. Fetal growth retardation
2. Low birth weight
3. Abortion
4. Puerperal sepsis
 PREVENT AND TREATED BY:
a) Immunization of child
b) Immunization of mother
c) Education of mother
d) Personal hygiene and appropriate sanitation

 PROBLEM :
1. Increase prevalence of LBW
2. Severe anemia
3. Abortion
4. Ante partum hemorrhage
5. High maternal and prenatal mortality
 PREVENTION AND CONTROL:
a) Introduction of IUD
b) Oral pills
c) Long acting medroxy-progesterone acetate
d) Training mid wives and community health worker for family
planning

 Reduction of maternal, perinatal, infant and
childhood mortality and morbidity
 Promotion of reproductive health
 Promotion of physical and psychological
development of the child and adolescent within
the family

To achieve a healthy mother and a
healthy baby at the end of pregnancy
When should It begin?
Ideally this should begin soon after conception and
continue throughout pregnancy
ANTENATAL CARE

To promote, protect and maintain the health of the
mother during pregnancy
*To detect high-risk cases and give them special
attention
* To early detect complications and prevent them
*To remove anxiety associated with delivery
*To reduce maternal mortality rate and infant mortality
rate
*To teach the mother elements of child care, nutrition,
personal hygiene and environmental Sanitation
*Sensitize the mother to the need for family planning

A minimum of 4 visits during the entire period of
pregnancy
 1st VISIT- within 12 weeks
 2nd VISIT- between 14-26 weeks
 3rd VISIT- between 28-34 weeks
 4th VISIT- between 36 weeks and term

 Facilitates proper planning and allow for adequate care to
be provided for both mother and the fetus
 Record the date of last menstrual period and calculate
expected date of delivery
 The health status of the mother can be assessed and any
illness that she is suffering from can be detected
 Timely detection of complication and help to manage them
appropriately
 Help to confirm if the pregnancy is wanted or not
 Early detection of pregnancy to facilitate a good
interpersonal relationship between the caregiver and
pregnant women

PREGNANCY TRACKING
in case registered woman does not turn up for
her regular ANC check-up ANM must follow her
and counsel her the regular ANC check-up

HISTORY TAKING
 confirm pregnancy
 identify complication during any previous pregnancy
 identify current medical complication
 record first date of last menstrual period
 record symptoms indicating complication
 history of systemic illness
 history of drugs

 PALLOR
 PULSE
 RESPIRATORY RATE
 OEDEMA:
 Normally appears in the evening and disappears in
morning after full night sleep.
 Edema in face, hand, abdominal wall is abnormal

 BP:
 Take two consecutive reading 4 Hrs. apart
 SBP>140 mmHg / DBP>90mmHg represent
HYPERTENSION which may be due to PIH or chronic
hypertension
 PIH- women with high BP should be checked for the
presence of albumin in her urine.
 DBP > 110 mmHg is a danger sign of imminent ecclampsia
 Woman with albunuria should be referred to FRU
immediately

• WEIGHT
 Normally - during pregnancy 9-11 kg weight is gained (
2kg/month)
 in case of inadequate dietary intake, only 5-6 kg is gained
during pregnancy
 LOW WEIGHT GAIN- intrauterine growth retardation &
low birth weight
 HIGH WEIGHT GAIN(>3kg/month) - suspicious for pre
eclampsia or diabetes or twins
•BREAST EXAMINATION :
Size and shape of nipple

 MEASUREMENT OF FUNDAL HEIGHT
 12 WEEKS- uterine fundus just palpable per abdomen
 20 WEEKS- fundus felt at lower border of umbilicus
 36 WEEKS- felt at the level of xiphisternum
 FETAL HEARTSOUND
 Heard after 6th month
 Rate 120-140 per min
 Best heard at midline
 FOETAL MOVEMENT
 felt after 18-22nd week

FOETAL PART
 felt at about 22nd week
 After 28th week - head back and limbs can be
distinguished
FOETAL LIE AND PRESENTATION
 relevant only after 32 weeks
INSPECTION OF ABDOMINAL SCAR
 Striae gravidarum
 Striae albicans

 previously the most widespread method used was based
on the date of last menstrual period
 the most accurate gold standard for assessment is
routine early ultrasound together with fetal movement
ideally in the first trimester
 in many countries combination approach is used i.e,
ultrasound and last menstrual period

 AT SUBCENTRE:
 pregnancy detection test
 Hb estimation
 Urine test for presence of albumin and sugar
 Rapid malaria test
 AT PHC/CHC/FRU:
 blood group, including Rh factor
 VDRL/RPR
 HIV testing
 Rapid malaria test
 Blood sugar testing
 HBsAg for hep-B infection

 Iron and folic acid supplementation and medications as
needed
 Immunization against tetanus
 Instructions on nutrition, family planning, self care,
delivery
 Home visiting by a female health worker/trained dai
 Referral services
 Inform the woman about Janani Suraksha Yojana and
other incentives offered by the government.

 Central purpose of antenatal care is to identify high risk
cases, arrange for them skilled care while continuing to
provide appropriate care for all mothers
 These cases comprises
 antepartum Hemorrhage
 malpresentation
 anemia
 twins
 Previous stillbirth
 prolong pregnancy

 history of previous cesarean
 pregnancy-associated with General diseases
 treatment for infertility
 three or more spontaneous consecutive abortion
 preeclampsia and eclampsia
 Elderly primi (>30yrs)
 Short statured primi (<140 cm)

o DIET:
 Pregnancy in total duration consumes about 60,000 kcal ,over
and above normal metabolic requirement.
 Lactating woman need 550 kcal/day.
 Iron and folic acid level should be maintained at sufficient
level.( IRON-pregnant 35mg/day , lactating 21mg/day , FOLIC
ACID- pregnant 500mcg/day ,lactating 300mcg/day)
o PERSONAL HYGIENE
a) Bath every day ,wear clean clothes and keep hair clean and
tidy
b) 8 hours sleep and 2 hours rest after mid day meals
c) Avoid constipation
d) Manual physical labour should be avoided
e) Smoking should be cut off
f) Alcohol drinking can cause pregnancy loss
g) Maintain oral hygiene
h) Sexual intercourse should be restricted especially during the

o RADIATION
 Positive danger to the developing foetus
 Can cause leukaemia and other neoplasm
o WANING SIGNS – should report immediately in following case
 Swelling of the feet
 Fits
 headache
 Blurring of the vision
 Bleeding or discharge per vagina
o CHILD CARE-
 Nutrition education
 Advice on hygiene and childrearing
 Cooking demonstration
 Family planning education
 Family budgeting

DRUG ADVERS EFFECT
Thalidomide (hypotonic drug) Deformed hand and feets of babies
born
LSD Chromosomal damage
streptomycin 8th nerve damage and deafness
Iodide containing preparation Congenital goiter
corticosteroid Impair foetal growth
Sex hormone Virilism
tetracycline Affect growth of bones & enamel
formation of teeth
Pethidine (anesthetic) During labour have depressant
effect on the baby and delay the
onset of effective respiration

 A) ANAEMIA
 B) OTHER NUTRITIONAL DEFICIENCY
 C)TOXIEMAS OF PREGNANCY
 D)TETANUS
 E)SYPHILIS
 F)GERMAN MEASLES
 G)Rh STATUS
 H)HIV INFECTION
 I)HEPATITIS B INFECTION
 J)PRENATAL GENETIC SCREENING

 Mental preparation is as important aspects of
antenatal care.
 Sufficient time and opportunity must be given to the
expectant mothers to have a free and frank talk on all
aspects of pregnancy and delivery .
 “Mother Craft” classes at MCH centres help a great
deal in achieving this objective.

 The mother is psychologically more receptive to advice
on family planning than at other times.
 If the mother has had 2 or more children, she should
be motivated for puerperal sterilization.
 “All India Postpartum Programme Services” are
available to all expectant mothers in india.

 It is suggested that a paediatrician should be in
attendance at all antenatal clinics to pay attention to
the under five accompanying mothers.

 Maternal mortality is a global tragedy.
WORLD INDIA
• 300,000Maternal deaths
annually
• 99% - Developing countries
• 1% - Developed countries
• 67,000Maternal deaths
annually

 Neonatal mortality :-
WORLD INDIA
• 40 Lakhs Neonatal deaths
annually
• 9 Lakhs Neonatal deaths
annually
• About 7 Lakhs die
within first week of
birth

Reducing the Maternal and infant mortality is the key goal of
Maternal and Child Health Care Programmes.
Evolution of MCH care Programmes :-
1. Family Welfare Programme(1979) :-
 Integration of family planning services
with those of MCH
 Effective IEC to improve awareness
 Easy and convenient access to FW
services free of cost

2. Child Survival and Safe Motherhood Programme(1992) :-
Early registration of pregnancy
Minimum three ANC check ups
Universal coverage with TT immunization
Detection of High risk pregnancies and
prompt referral
Promotion of institutional deliveries
Birth spacing
FOR PREGNANT WOMEN

FOR CHILDREN
CSSM(contd.) :-
 Proper new born care
 High coverage levels under UIP
 Diarrheal Disease Control Programme- Oral Rehydration
Therapy
 ARI Control Programme

3. Reproductive and Child Health Programme :-
 Phase-1, 1997
 Essential obstetric care
 24 hour delivery services at PHC/CHCs
 Essential newborn care
 Emergency obstetric care
 Medical termination of pregnancy
 Prevention of RTI and STDs

4. Reproductive and Child Health Programme- II :-
 Started from April, 2005
 Essential Obstetric Care :-
- Institutional deliveries
- Skilled Birth Attendants(SBA) at delivery
 Emergency Obstetric Care :-
- Operationalising FRU
- Operationalising PHC and CHCs for round the clock
delivery services
 Strengthening referral system

5. National Rural Health Mission :-
Launched on 5th April,2005
Main aim is to provide equitable, accessible and affordable
health care
Many initiatives were taken under NRHM to reduce the
maternal mortality including Janani Suraksha Yojana
JSY
• 12 April, 2005
• Centrally sponsored scheme
• Cash assistance with institutional care

Concerns of JSY
High out of pocket expenses
• OPD fees
• Diagnostic tests
• Admission fees
• Drugs and Consumables
Spending on Transport
Spending on Diet

 Voluntary scheme wherein any obsteric and gynaec
specialist ,maternity home ,nursing home,lady
doctor/MBBS doctor can voluunteer themselves for
providing safe motherhood services.
 The enrolled doctor will display a “Vanteemataram logo” at
their clinics.
 Iron and folic acid tablets , oral pills, TT injection etc will
be provided by the respective district medical officers to
the vandemataram doctors/clinics.
 The cases needing special care and treatment can be
referred to the government hospitals with their
vandemataram card.

Janani Shishu Suraksha Karyakram(JSSK) :-
Launched on June 1, 2011.
Invokes a new approach to healthcare, placing , for the first time,
utmost emphasis on entitlements and elimination of out- of-
pocket expenses for both pregnant women and sick neonates.
Entitles all pregnant women delivering in public health
institutions to absolutely free and no-expense delivery, including
caesarian delivery.

Entitlements would include free drugs and consumables, free
diagnostics, free blood, free diet for the duration of woman’s
stay in the facility, expected to be three days in case of normal
delivery and seven days in case of caesarian section.
Free transport from home to the facility, between facilities in case
of referral, and also drop-back home after the delivery.
This initiative is estimated to benefit more than 1 crore pregnant
women and newborns who access government health institutions
every year in both urban and rural area.

for all sick Similar entitlements
newborns (upto 1 year).
between the facilities, in case
 Free treatment
 Free transport to the facility and
of
referral and back to home from the
facility.

Eliminating the out-of-pocket expenses for the families of
pregnant women and sick newborns in government health
facilities.
To increase the access to health care for the pregnant
women who still deliver at home ( estimated to be 70 lakh per
year).
 Timely access to health care for sick newborns.
Supplementing the cash assistance given to a pregnant
woman under JSY.

 Free Drugs and consumables
 Free Essential Diagnostic tests (blood tests, urine tests, USG etc.)
 Free Diet during the stay in the health institution
 Free provision of Blood
 Free and zero expense Delivery and caesarian section
 Free Transport from home to Health institutions
 Free Transport between facilities, in case of referral
 Drop back to home from institutions after 48 hrs. of stay
 Exemption from all kind of user charges

 Free and zero expense treatment
 Free Drugs and consumables
 Free Essential Diagnostic tests
 Free provision of Blood
 Free Transport from home to Health institutions
 Free Transport between facilities, in case of
referral
 Drop back to home from institutions
 Exemption from all kinds of user charges

 Park’s textbook of preventive and social medicine,dr.K.Park,24th
edition,bhanot publication.
 www.who.int

HEALTHY MOTHER………
HEALTHY CHILD……

ANTENATAL CARE

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ANTENATAL CARE