Antenatal care

1. Antenatal Care
Dr Sunil Kumar Samal

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. Pretest-1
An expectant mother feels quickening at:
A.12-18 weeks
B. 16-20 weeks
C. 26 weeks
D. 24-28 weeks

4. Pretest 2
Minimum no of antenatal visit recommended by
WHO
A. 3
B. 4
C. 5
D. 6

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. 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. 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. Objectives
To ensure a normal pregnancy
with delivery of a healthy baby
from a healthy mother

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. 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. 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. Antenatal care comprises of-
• Careful history taking, examination and
routine investigation
• Advice given to the pregnant woman

13. THE FIRST VISIT
• History
taking
• Examination
• Investigation

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. 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. H/O present pregnancy/Present illness
•First trimester
•Second trimester
•Third trimester

17. Past history
1.HTN
2.DM
3.BA
4.Renal Disease
5.Psychiatric illness
6.IHD
7.Any previous operation

18. Past Obstetric History
• Duration of
marriage
• Gravida
• Para
• Abortion
• Alive

19. Menstrual History
Age of menarche
Menstrual period
Menstrual cycle
LMP
EDD

20. Family history
• HTN
• DM
• Multiple pregnancy

21. Drug History
Antihypertensive
Hypoglycemic
Antidepressant
Corticosteroid
Anticoagulant

22. Physical examination
General examination
Abdominal
examination

23. General examination
• Appearance
• Height, weight and BMI of
patient
• Pallor
• Icterus
• Edema
• breast
• thyroid

24. General examination (cont’d)
• Temperature
• Pulse
• BP
• RR

25. Abdominal examination
Inspection
Palpation
percussion
Auscultation

26. Inspection
Shape of the
uterus
Striae
scar mark

27. Palpation
• Assessment of fundal
height
• Symhysio-fundal height
• Abdominal girth
• Fundal grip
• Lateral grip
• First pelvic grip
• Second pelvic grip

28. Auscultation
Normal FHR is 110-160 b/m
foetal tachycardia (>160 b/m)
foetal bradycardia (<110 b/m)

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. Ultrasound
Early pregnancy scan(preferably at 6-9 weeks) to:
•Intra or extrauterine
•Viability
•Determine gestational age
•Detect multiple pregnancies
•Molar pregnancy

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. 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. 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. Diet
Diet should be:
nutritious,
balanced,light
• easily digestible
• rich in protein, mineral and vitamin
• with woman’s choice

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. 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. 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. Travelling
Should be avoided in
•1st trimester
•last 6 weeks
Air travelling is contraindicated in
•Placenta praevia
•Preeclampsia
•Severe anemia

39. •Clothing
•Shoes
•Belt
•Care of breast
•Dental care
•Bathing
•Smoking and alcohol

40. Labour analgesia/anaesthesia
• Epidural
• Entonox

41. Immunization
Indicated-
•TT
•HAV
•HBV
•Rabies
Contraindicated-
•Live virus vaccine (rubella measles,
mums, varicella)

43. Warning sign
1. Headache
2. Blurring of vision
3. Convulsion
4. Vaginal bleeding
5. Fever

44. 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.

45. 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

46. 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

47. 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

48. 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

49. Post test 2-
Daily caloric needs in pregnancy is about…..… kilocal:
A. 1000
B. 1500
C. 2500
D. 3500

50. Post test 3
Term delivery defined as delivery of fetus-
A. 37-42 weeks
B. <37 weeks
C. >42 weeks
D. 28-37 weeks

51. 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

52. Post test 5
Earliest detection of pregnancy by ultrasound is by:
A. Gestation sac
B. Fetal node
C. FSH
D. Fetal skeleton

53. Feedback
This lecture”Antenatal Care”-
A. Very Good
B. Good
C. Average
D.poor

54. Thank you