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Sreelakshmi. M




 ANTENATAL
CARE
             SREELAKSHMI. M
What is it?
 The care of the pregnant woman with the aim of
 achieving a healthy pregnancy and delivery of a
 normal baby

 Good antenatal care helps a woman to face labour in
 good health and in optimum condition
Why

•Promote, protect & maintain the health of
mother
•Detect high-risk cases
•Proactive approach to complications
•Remove the anxiety and dread associated
with pregnancy
•Reduce maternal and infant mortality and
morbidity rate
•Teach mother the elements of child care,
nutrition, personal hygiene &
environmental sanitation
•To attend to the under-fives
Schedule For Antenatal Visits in India
  Monthly up to 28 weeks
  Two weekly between 28
   and 36 weeks
  Weekly 36 weeks onwards.
 (This equals about 15 visits)

  High-risk cases   more
                      frequent
                       visits
Booking Visit ??
First visit that the woman makes to the health care
  facility.

Should be as early possible and preferably in the first
  trimester :
 To detect high-risk cases
 To offer MTP if required
Aims of Booking Visit
oGet detailed history & assess if high risk

oEstablish correct gestational age and date pregnancy

oProvide information about what is to expected, the danger
signals etc. which she should know of

oPerform baseline investigations like
HB, blood group, Rh typing & urine
analysis
Routine Investigations
Name               First done      Repeated        Interpretation
1. Hb, PCV            Booking        Once every    <10 g/dL or < 11 g/dL
                                     trimester     (WHO) consider as
                                                   anemia
2. Blood group &      Booking            ---       If Rh –ve, husband’s
Rh typing                                          group & ICT
3. HbsAg, HIV,        Booking            ---       If +ve, refer for counselling
VDRL                                               & PPTCT
4. Urine routine      Booking        Every visit   Pus cells> 5, do a culture
examination                                        Alb+ or >, consider pre-
                                                   eclampsia
5. GCT               24-48 weeks         ---       130 mg/dL or more, do a
                                                   GTT
History & Examinatioin
 History taking
 Systemic & obstetric examination
    Palpation: symphyseofundal height on
              every visit


• Pelvic examination in 1st trimester
Continued..
Sometimes other tests in individual cases like:
• Testing for hemoglobinopathies
• Glycosylated Hb
• Maternal serum for screening Down’s syndrome
Immunizations in Pregnancy
 Tetanus toxoid – safe& mandatory
     1st dose- at booking visit & then 6 weeks later
     If already takes within last 3 years, booster at 36 weeks
    Usually others not given


   Safe       Only in             C.I
             epidemics
Tetanus    Typhoid          Rubella
Hepatits   Cholera          MMR
Rabies                      Varicella
                            BCG
                            Yellow fever
Medications
1.   Folic acid – 5mg during 1st trimester ( if not begun
     preconceptionally)


2. Fe & Ca started at 13 wks
       continued for 3 months after
                          pregnancy
       Fe- 100mg Ca- 1mg/day
Health Education for the Pregnant
woman
 Diet
   need extra 300kcal/day from 2nd trimester onwards
   Protein
   Salt
   Iron
   Calcium : 1.5 g daily
   Vit. C, folic acid, Vit. B12
   + tablets
Continued..
 Weight gain: total of 11 kg.
                 500 g/wk during 2nd trimester
 Rest:
 Activity & Exercise:
 Clothes :
 Coitus
 Smoking & alcohol : abortion, growth
restriction, fetal alcohol syndrome   restricted
 Drugs :
 Care of breasts:
 Travel :
Warning signals !!!
 Bleeding p/v at any time in pregnancy
 Head ache, blurring vision, epigastric pain & oliguria
 Pedal oedema, severe, not subsiding with rest, or on face &
    hands
   Decrease/ loss of fetal movements
   Abdominal pain
   Urinary infection with vulvovaginitis
   Clear fluid p/v     PROM
Common Symptomatology in pregnancy
 Nausea & vomiting
 Backache
 Varicose veins
 Hemorrhoids
 Vaginal discharge
 Acidity & heart burn
 Constipation
Antenatal care up to 28 weeks
 Woman should seek care every month
 Weight, bp & urine checked at each visit

 Quickening, anemia, oedema (!!)

 Symphyseofundal height

 Others:
     Targeted ultrasound scan for
     anomalies (18-20 wks)…….
Antenatal care after 28 weeks
 Crucial period: pre-eclampsia, GDM, growth
 disorders

 bp, weight, urine routine, Hb


 Symphyseofundal height: detect IUGR & macrosomia


 She should be made aware…..


 Vaginal examination
Ultrasound in Pregnancy..
 If only single scan, ideally in 2nd trimester to look for
  anomalies & dating.
 Booking scan : 10-14 wks      confirm gestational age
                                assess nuchal translucency

• 1st trimester scan :
• 3rd trimester scan:
Preconceptional / Prepregnancy Councelling
1. General advice for all women:
   • Preconceptional folate
   • Rubella & Hep B vaccine
   • Weight reduction in obesity
   • Cessation of smoking / alcohol
   • Advice regarding drug intake
   • Rule out STDs, & HIV
     counseling
   • Avoid teratogens
Continued..
2. Medical disorders
  •   Preconceptional glycemic control in diabetes
  •   Remission in chronic diseases like SLE & chronic renal
      disease
  •   Cardiac surgery prior to pregnancy
  •   Avoiding pregnancy in certain cardiac diseases
  •   Changing teratogenic drugs as in epilepsy
Continued..
3. Recurrent pregnancy loss
  •   Checking for antiphospholipid antibody syndrome
  •   Correction of uterine septum by hysteroscopic septal
      resection

   4. Genetic problems
  •    Parental karyotyping
  •    Carrier screening based on ethnicity or family history
  •    Dietary advice in PKU
Thank You…..

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Antenatal care(sreelakshmi)

  • 2. What is it?  The care of the pregnant woman with the aim of achieving a healthy pregnancy and delivery of a normal baby  Good antenatal care helps a woman to face labour in good health and in optimum condition
  • 3. Why •Promote, protect & maintain the health of mother •Detect high-risk cases •Proactive approach to complications •Remove the anxiety and dread associated with pregnancy •Reduce maternal and infant mortality and morbidity rate •Teach mother the elements of child care, nutrition, personal hygiene & environmental sanitation •To attend to the under-fives
  • 4. Schedule For Antenatal Visits in India  Monthly up to 28 weeks  Two weekly between 28 and 36 weeks  Weekly 36 weeks onwards. (This equals about 15 visits)  High-risk cases more frequent visits
  • 5. Booking Visit ?? First visit that the woman makes to the health care facility. Should be as early possible and preferably in the first trimester :  To detect high-risk cases  To offer MTP if required
  • 6. Aims of Booking Visit oGet detailed history & assess if high risk oEstablish correct gestational age and date pregnancy oProvide information about what is to expected, the danger signals etc. which she should know of oPerform baseline investigations like HB, blood group, Rh typing & urine analysis
  • 7. Routine Investigations Name First done Repeated Interpretation 1. Hb, PCV Booking Once every <10 g/dL or < 11 g/dL trimester (WHO) consider as anemia 2. Blood group & Booking --- If Rh –ve, husband’s Rh typing group & ICT 3. HbsAg, HIV, Booking --- If +ve, refer for counselling VDRL & PPTCT 4. Urine routine Booking Every visit Pus cells> 5, do a culture examination Alb+ or >, consider pre- eclampsia 5. GCT 24-48 weeks --- 130 mg/dL or more, do a GTT
  • 8. History & Examinatioin  History taking  Systemic & obstetric examination Palpation: symphyseofundal height on every visit • Pelvic examination in 1st trimester
  • 9. Continued.. Sometimes other tests in individual cases like: • Testing for hemoglobinopathies • Glycosylated Hb • Maternal serum for screening Down’s syndrome
  • 10. Immunizations in Pregnancy  Tetanus toxoid – safe& mandatory  1st dose- at booking visit & then 6 weeks later  If already takes within last 3 years, booster at 36 weeks Usually others not given Safe Only in C.I epidemics Tetanus Typhoid Rubella Hepatits Cholera MMR Rabies Varicella BCG Yellow fever
  • 11. Medications 1. Folic acid – 5mg during 1st trimester ( if not begun preconceptionally) 2. Fe & Ca started at 13 wks continued for 3 months after pregnancy Fe- 100mg Ca- 1mg/day
  • 12. Health Education for the Pregnant woman  Diet  need extra 300kcal/day from 2nd trimester onwards  Protein  Salt  Iron  Calcium : 1.5 g daily  Vit. C, folic acid, Vit. B12  + tablets
  • 13. Continued..  Weight gain: total of 11 kg.  500 g/wk during 2nd trimester  Rest:  Activity & Exercise:  Clothes :  Coitus  Smoking & alcohol : abortion, growth restriction, fetal alcohol syndrome restricted  Drugs :  Care of breasts:  Travel :
  • 14. Warning signals !!!  Bleeding p/v at any time in pregnancy  Head ache, blurring vision, epigastric pain & oliguria  Pedal oedema, severe, not subsiding with rest, or on face & hands  Decrease/ loss of fetal movements  Abdominal pain  Urinary infection with vulvovaginitis  Clear fluid p/v PROM
  • 15. Common Symptomatology in pregnancy  Nausea & vomiting  Backache  Varicose veins  Hemorrhoids  Vaginal discharge  Acidity & heart burn  Constipation
  • 16. Antenatal care up to 28 weeks  Woman should seek care every month  Weight, bp & urine checked at each visit  Quickening, anemia, oedema (!!)  Symphyseofundal height  Others: Targeted ultrasound scan for anomalies (18-20 wks)…….
  • 17. Antenatal care after 28 weeks  Crucial period: pre-eclampsia, GDM, growth disorders  bp, weight, urine routine, Hb  Symphyseofundal height: detect IUGR & macrosomia  She should be made aware…..  Vaginal examination
  • 18. Ultrasound in Pregnancy..  If only single scan, ideally in 2nd trimester to look for anomalies & dating.  Booking scan : 10-14 wks confirm gestational age assess nuchal translucency • 1st trimester scan : • 3rd trimester scan:
  • 19. Preconceptional / Prepregnancy Councelling 1. General advice for all women: • Preconceptional folate • Rubella & Hep B vaccine • Weight reduction in obesity • Cessation of smoking / alcohol • Advice regarding drug intake • Rule out STDs, & HIV counseling • Avoid teratogens
  • 20. Continued.. 2. Medical disorders • Preconceptional glycemic control in diabetes • Remission in chronic diseases like SLE & chronic renal disease • Cardiac surgery prior to pregnancy • Avoiding pregnancy in certain cardiac diseases • Changing teratogenic drugs as in epilepsy
  • 21. Continued.. 3. Recurrent pregnancy loss • Checking for antiphospholipid antibody syndrome • Correction of uterine septum by hysteroscopic septal resection 4. Genetic problems • Parental karyotyping • Carrier screening based on ethnicity or family history • Dietary advice in PKU