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Antenatal care

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Antenatal care

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Antenatal care

  1. 1. Antenatal Care Dr Sunil Kumar Samal
  2. 2. Learning Objectives- At the end of the lecture you will be able to know- 1. Antenatal history taking and examination 2. Know minor ailments during pregnancy and give proper advice 3. Know about proper nutrition, hygiene and immunization during pregnancy 4. Preconceptional care
  3. 3. Pretest-1 An expectant mother feels quickening at: A.12-18 weeks B. 16-20 weeks C. 26 weeks D. 24-28 weeks
  4. 4. Pretest 2 Minimum no of antenatal visit recommended by WHO A. 3 B. 4 C. 5 D. 6
  5. 5. What is Antenatal care • Periodic and regular supervision including history taking, 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.
  6. 6. 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
  7. 7. 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
  8. 8. Objectives To ensure a normal pregnancy with delivery of a healthy baby from a healthy mother
  9. 9. The criteria of a normal pregnancy are- Delivery of a single baby in good condition at term(between 37-42 weeks), with fetal weight of 2.5 kg or more and with no maternal complication
  10. 10. 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
  11. 11. 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
  12. 12. Antenatal care comprises of- • Careful history taking, examination and routine investigation • Advice given to the pregnant woman
  13. 13. THE FIRST VISIT • History taking • Examination • Investigation
  14. 14. History taking 1. Particulars of the patient 2. Chief complaints with duration 3. H/O present pregnancy/present illness 4. Past history 5. Obstetric history 6. Menstrual history 7. Family history 8. Drug History 9. History of immunization 10. Contraceptive history 11. History of allergy
  15. 15. Chief complaints with duration 1. Period of amenorrhea 2. Nausea & vomiting, vertigo 3. Increased frequency of micturition 4. Constipation 5. Heaviness of breast 6. Rise of temperature 7. Edema 8. Pain in the abdomen 9. Backache 10. Vaginal bleeding
  16. 16. H/O present pregnancy/Present illness •First trimester •Second trimester •Third trimester
  17. 17. Past history 1.HTN 2.DM 3.BA 4.Renal Disease 5.Psychiatric illness 6.IHD 7.Any previous operation
  18. 18. Past Obstetric History • Duration of marriage • Gravida • Para • Abortion • Alive
  19. 19. Menstrual History Age of menarche Menstrual period Menstrual cycle LMP EDD
  20. 20. Family history • HTN • DM • Multiple pregnancy
  21. 21. Drug History Antihypertensive Hypoglycemic Antidepressant Corticosteroid Anticoagulant
  22. 22. Physical examination General examination Abdominal examination
  23. 23. General examination • Appearance • Height, weight and BMI of patient • Pallor • Icterus • Edema • breast • thyroid
  24. 24. General examination (cont’d) • Temperature • Pulse • BP • RR
  25. 25. Abdominal examination Inspection Palpation percussion Auscultation
  26. 26. Inspection Shape of the uterus Striae scar mark
  27. 27. Palpation • Assessment of fundal height • Symhysio-fundal height • Abdominal girth • Fundal grip • Lateral grip • First pelvic grip • Second pelvic grip
  28. 28. Auscultation Normal FHR is 110-160 b/m foetal tachycardia (>160 b/m) foetal bradycardia (<110 b/m)
  29. 29. Routine Investigation • Haemoglobin & haematocrit • Blood grouping & Rh typing • Urine R/E • RBS • Serology-VDRL, HIV and Hbs Ag • Serum thyroid function test • Ultrasound
  30. 30. Ultrasound Early pregnancy scan(preferably at 6-9 weeks) to: •Intra or extrauterine •Viability •Determine gestational age •Detect multiple pregnancies •Molar pregnancy
  31. 31. 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 growth and maturity
  32. 32. Antenatal advice Principles: 2.To make aware the mother about the importance of regular check up 3.To maintain or improve the health status of the woman to the optimum till delivery by judicious advice regarding diet, drugs and hygiene 4.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
  33. 33. 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:
  34. 34. Diet Diet should be: nutritious, balanced,light • easily digestible • rich in protein, mineral and vitamin • with woman’s choice
  35. 35. 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.
  36. 36. 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
  37. 37. Bowel • Regular bowel movement may be facilitated by regulation of diet, taking plenty fluid, vegetable and milk • Stool softner Coitus Should be avoided in •1st trimester •last 6 weeks
  38. 38. Travelling Should be avoided in •1st trimester •last 6 weeks Air travelling is contraindicated in •Placenta praevia •Preeclampsia •Severe anemia
  39. 39. •Clothing •Shoes •Belt •Care of breast •Dental care •Bathing •Smoking and alcohol
  40. 40. Labour analgesia/anaesthesia • Epidural • Entonox
  41. 41. Immunization Indicated- •TT •HAV •HBV •Rabies Contraindicated- •Live virus vaccine (rubella measles, mums, varicella)
  42. 42. Warning sign 1. Headache 2. Blurring of vision 3. Convulsion 4. Vaginal bleeding 5. Fever
  43. 43. 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.
  44. 44. Preconceptional care includes:  Identification of high risk factor  Basal level health status including BP recording  Rubella & Hepatitis immunization  Folic acid supplementation  Correction of anemia  Patient with medical disease like hypertension, diabetes are stabilized in an optimal state by intervention
  45. 45. 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
  46. 46. To Summarize… • Careful history taking • Through clinical examination • Investigation(routine and special) • Advice: Diet(nutrition), hygiene, specific to any problem • Subsequent visits- maternal and fetal health • Couple education, counselling and advice • Preparation for child birth: Couple is informed about labour course, delivery, the need of operation, labour analgesia and anesthesia and the complication
  47. 47. Post test 1 Periconceptional use of the following agent leads to reduced incidence of neural tube defects A. Folic acid B. Iron C. Calcium D. Vitamin A
  48. 48. Post test 2- Daily caloric needs in pregnancy is about…..… kilocal: A. 1000 B. 1500 C. 2500 D. 3500
  49. 49. Post test 3 Term delivery defined as delivery of fetus- A. 37-42 weeks B. <37 weeks C. >42 weeks D. 28-37 weeks
  50. 50. Post test 4 Use of one of the following vaccinations is absolutely contraindicated in pregnancy: A. Hepatitis-B B. Cholera C. Rabies D. Yellow fever
  51. 51. Post test 5 Earliest detection of pregnancy by ultrasound is by: A. Gestation sac B. Fetal node C. FSH D. Fetal skeleton
  52. 52. Feedback This lecture”Antenatal Care”- A. Very Good B. Good C. Average D.poor
  53. 53. Thank you
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Antenatal care

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