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Dr. Priyanka Mahawar
Maternity cycle –
1. Fertilization;
2. Antenatal or prenatal period
3. Intra-natal period;
4. Postnatal period;
5. Inter-c...
Care of women during pregnancy
Objectives
To ensure a normal pregnancy with
delivery of a healthy baby from a
healthy mother
Antenatal care comprises
of-
1.Registration of pregnancy
2. History taking
3. Antenatal examinations
[general and obstetri...
Detect “high risk”
cases
Promote, Protect &
maintain the health of
mother
Complications
Reduce maternal
morbidity &
mortal...
THE FIRST VISIT
History taking
Examination
Investigation
History taking
1. Particulars of the patient
2. Chief complaints with duration
3. Past history
4. Obstetric history
5. Men...
Ideally – 13 ANC visits
First 7 months – once a month
Next month – twice a month
Last month – once a week
 Minimum – 4 A...
Physical
examination
Pallor
Pulse Respiratory rate
Weight
edema
Blood pressure
Breast examination
Pallor – Examine palpebral conjunctiva, nails,
tongue, oral mucosa, palms
Pulse – 60-90 / min.
R.R. – 18-20 breaths / min....
CONT.D
B.P. – Two consecutive readings – systolic >
140 mmHg and / or diastolic > 90 mmHg
Check urine for the presence of ...
Regular weight monitoring at each visit
9-11 kg. wt. gain entire pregnancy
After first trimester, wt. gain 2 Kg. / month
...
Measurement of fundal height
Fetal heart sounds
Fetal movements
Fetal parts
Multiple pregnancy
Fetal lie and presentation
...
Lab. Investigations
- Pregnancy test kit
Hb estimation
Blood & Rh grouping
Rapid malaria test
Urine testing for albumin & ...
Elderly primi (30 yr. and above)
Short statured primi (140 cm and
below)
Mal presentations
APH, threatened abortion
Pre – ...
Anaemia
Twins, hydramnios
IUFD, Still birth
Elderly grand multiparas
Prolonged pregnancy
H/o past caesarean or instrumenta...
In subsequent visit
• Patient complains
• General examination
• Gestational age to be calculated
• Identification of probl...
Second visit (24-28
weeks)
SFH measurement
To detect Multiple pregnancy
Third visit (32 weeks)
Screen for-
1. Preeclampsia
2. Multiple pregnancy
3. anemia
4. IUGR
Fourth visit (36 weeks)
• Identification of foetal
1. Lie
2. Presentation
3. Position
• Update birth plan
Antenatal advice
Entire pregnancy – 300
Kcal/day (extra)
Lactation (0-6 mth.) – 600
Kcal/day
Lactation (6-12 mth.) – 520
K...
Diet:
Supplementary iron therapy is needed
for all pregnant mothers from 20 weeks
onwards. (30 mg of ferrous / day)
(60-10...
Hygiene:
Daily bath is recommended, as it
stimulation refreshing and relaxing.
Avoid hot water bath.
Bowel care:
As there ...
Breast Care
Wash the breast with clean tap
water.
Exercise
Walk in moderation.
Avoid lifting heavy things.
Avoid long time...
Dressing:
Tight clothes and belts are avoided
The patient should wear
loose but comfortable dresses.
High heel shoes are b...
Rest and sleep
8 hour sleep at night
At least 2 hour sleep after mid-day meal
Hard strenuous work should be avoided in fir...
Warning sign
1. Headache
2. Blurring of vision
3. Convulsion
4. Vaginal bleeding
5. Fever
Thank you
Antenatal care
Antenatal care
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Antenatal care

  1. 1. Dr. Priyanka Mahawar
  2. 2. Maternity cycle – 1. Fertilization; 2. Antenatal or prenatal period 3. Intra-natal period; 4. Postnatal period; 5. Inter-conceptional period
  3. 3. Care of women during pregnancy
  4. 4. Objectives To ensure a normal pregnancy with delivery of a healthy baby from a healthy mother
  5. 5. Antenatal care comprises of- 1.Registration of pregnancy 2. History taking 3. Antenatal examinations [general and obstetrical] 4. Laboratory investigations 5. Health education
  6. 6. Detect “high risk” cases Promote, Protect & maintain the health of mother Complications Reduce maternal morbidity & mortality Remove anxiety & dread about pregnancy Teach the mother elements of child care, nutrition, personal hygiene & environmental sanitation Sensitization of mother to the need of family planning including advice to cases seeking MTP Objective s
  7. 7. THE FIRST VISIT History taking Examination Investigation
  8. 8. History taking 1. Particulars of the patient 2. Chief complaints with duration 3. Past history 4. Obstetric history 5. Menstrual history 6. Family history 7. Drug History 8. History of immunization 9. Socio-economic history 10. Contraceptive history 11. History of allergy
  9. 9. Ideally – 13 ANC visits First 7 months – once a month Next month – twice a month Last month – once a week  Minimum – 4 ANC visits 1st visit – within 12 weeks or as soon as pregnancy is confirmed 2nd visit – between 13 and 26 weeks 3rd visit – between 27 and 34 weeks 4th visit –between 36 weeks and term
  10. 10. Physical examination Pallor Pulse Respiratory rate Weight edema Blood pressure Breast examination
  11. 11. Pallor – Examine palpebral conjunctiva, nails, tongue, oral mucosa, palms Pulse – 60-90 / min. R.R. – 18-20 breaths / min. Edema
  12. 12. CONT.D B.P. – Two consecutive readings – systolic > 140 mmHg and / or diastolic > 90 mmHg Check urine for the presence of albumin Pre eclampsia – Hypertension + albuminuria Imminent eclampsia – D.B.P. > 110 mmHg. Eclampsia – Hypertension+ albuminuria + Convulsions
  13. 13. Regular weight monitoring at each visit 9-11 kg. wt. gain entire pregnancy After first trimester, wt. gain 2 Kg. / month Breast examination – Size and shape of nipples
  14. 14. Measurement of fundal height Fetal heart sounds Fetal movements Fetal parts Multiple pregnancy Fetal lie and presentation Inspection of abdominal scar or any other relevant findings
  15. 15. Lab. Investigations - Pregnancy test kit Hb estimation Blood & Rh grouping Rapid malaria test Urine testing for albumin & sugar VDRL / RPR testing HIV testing Blood sugar testing HBs Ag test
  16. 16. Elderly primi (30 yr. and above) Short statured primi (140 cm and below) Mal presentations APH, threatened abortion Pre – eclampsia, eclampsia
  17. 17. Anaemia Twins, hydramnios IUFD, Still birth Elderly grand multiparas Prolonged pregnancy H/o past caesarean or instrumental delivery Treatment for infertility Risk Approach
  18. 18. In subsequent visit • Patient complains • General examination • Gestational age to be calculated • Identification of problem • Foetal movement • SFH measurement • Health education • Prophylaxis & treatment of anemia • Developing individualized birth plan
  19. 19. Second visit (24-28 weeks) SFH measurement To detect Multiple pregnancy
  20. 20. Third visit (32 weeks) Screen for- 1. Preeclampsia 2. Multiple pregnancy 3. anemia 4. IUGR
  21. 21. Fourth visit (36 weeks) • Identification of foetal 1. Lie 2. Presentation 3. Position • Update birth plan
  22. 22. Antenatal advice Entire pregnancy – 300 Kcal/day (extra) Lactation (0-6 mth.) – 600 Kcal/day Lactation (6-12 mth.) – 520 Kcal/day
  23. 23. Diet: Supplementary iron therapy is needed for all pregnant mothers from 20 weeks onwards. (30 mg of ferrous / day) (60-100 mg/day) is given for large women, twin, and those women who book for ANC late in pregnancy • Anemic woman should take (200 mg/day
  24. 24. Hygiene: Daily bath is recommended, as it stimulation refreshing and relaxing. Avoid hot water bath. Bowel care: As there is increase chance of constipation, regular bowel movement may be facilitated by regulation of diet taking plenty of fluids, vegetables and milk.
  25. 25. Breast Care Wash the breast with clean tap water. Exercise Walk in moderation. Avoid lifting heavy things. Avoid long time standing. Avoid sitting with crossed legs as this may impede circulation.
  26. 26. Dressing: Tight clothes and belts are avoided The patient should wear loose but comfortable dresses. High heel shoes are better avoided. Alcohol, smoking and drugs should be avoided as the may affect the fetal wellbeing
  27. 27. 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 Coitus Should be avoided in • 1st trimester • last 6 weeks
  28. 28. Warning sign 1. Headache 2. Blurring of vision 3. Convulsion 4. Vaginal bleeding 5. Fever
  29. 29. Thank you
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