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ANTENATAL CARE
BY
DR Rushabh Mehta
ANTENATAL CARE
BY
DR Rushabh Mehta
DEFINATION
Systemic supervision of
womman during pregnancy is
called antenatal care
Starts  with begining of
pregnancy
Ends  at time of delivery
INCLUDES
1 . History General
Examination Obstetrical
2 . Advice
AIMS
1 . To screen high risk pregnancy
2 . Prevant & treat complication
3 . To continue medical survellence
4 . To educate mother about physiology
of pregnancy & labour by
demonstration charts & diagrams
5 . To discuss with couple about
place,time & mode of delivery
6 . Need of family planning
OBJECTIVE
Healthy mother in possesion of
healthy child
CRITERIA OF NORMAL
PREGNANCY
1. Retrospective term
2. Delivery of a single baby between
38-42 weeks by date, weight 2.5
kg with no maternal complication
PROCEDURE AT 1ST
VISIT
It shoud be be before she missed
second period
OBJECTIVES
1.Asses health status of mother &
foetus & screen out at risk
pregnancy
2.Base line information above
subsequent changes are
assessed to determine
gestational age
HISTIRY TAKING
 VITAL STATISTICS
Name
Age
Gravida/Para
Religion
Occupation
Occupation of husband
Period of gestation
Complaints
If no complaints then inquire about
sleep,appetite,bowel habit,urinary problems
HISTORY OF PRESENT
PREGNANCY
Hyperemesis
Thretand abortion
Pyelitis
Pre eclempsia
APH
Medication
Radiation
Medical Surgical event
 OBSTETRICAL HISTORY
Number of living child
-boy
-girl
Health status of Baby
Immunisation
Last issue
 MENSTRUAL HISTORY
1. LMP
2. Regular cycle
 E.D.D
Naegele’s formula
 PAST MEDICAL HISTORY
 PAST SURGICAL HISTORY
 FAMILY HISTORY
High BP
Diabetes
Thyroid disorder
Blood Dyscrasia
 PERSONAL HISTORY
Smoking
Alcohol
Contraception
EXAMINATION
GENERAL
BuiltObese/Average/Thin
NutritionGood/Average/Poor
Height
Weight
Pulse
Jaundice
Tongue/Teeth/Gum/Tonsil
Neck
Oedema over leg
Causes of oedema
physiological
pre eclampsia
anaemia
hypo proteinemia
heart failure
nrphrotic syndrome
Pulse/BP/Heart/Lung/Liver
Breast examination mandatory
Pregnancy changes of nipple & areola
OBSTETRICAL
EXAMINATION
1. Abdominal
2. Vaginal
-stages of vaginal examination
pass urine
1.Inspection
2.P/S-Vaginal or cervical swab to be taken
3.Bimanual
-Cervix-consistancy
-direction
-Uterus-size
-shape
-position
-consistancy
ROUTINE EXAMINATION
 Blood group Rh
 VDRL
 HBsAg
 HIV
URINE EXAMINATION
 PROTEIN
 SUGAR
 PUS CELLS
CERVICAL CYTOLOGY
ULTRASOUND
EXAMINATION
Detection of early pregnancy
Accurate date
Abnormality
Number of foetus
Uterus or Adenexal abnormality
Placental localization
REPEAT INVESTIGATION
 Hb28 wks
36 wks
 UrineAlbumin
Sugar Every month
Procedure at subsequent visit
Check up4 weeks upto 28 weeks
2 weeks upto 36 weeks
weekly till delivery
OBJECTIVE
Foetal well being
Lie , presantation , position &
number of foetus
Growth restriction , pre
eclampsia anaemia ,
polyhydroamnios
Special antenatal clinic for
cardiac diseases & diabetes
Chorion villous sampling or
amniocentesis when indicated
HISTORY
-New complaints
-Date of quickening
GENERAL
-Weight
-Pallor
-Oedema
-BP
ABDOMAN EXAMINATION
Fundal height
Second trimester external ballotment
Third trimester
abdominal palpation
-presantation
-position
-Volume of liquor
Abdominal girth increases by 1 inch per
week beyond 30 weeks
VAGINAL EXAMINATION
At 37 wks
Before induction
With onset of labour
ANTENATAL ADVICE
PRICIPLES
To impress the patient about regular
check up
Maintain & improve health status
improve psychology & remove fear of
unknown
DIET
Adequate
1 . Maternal health
2 . Need for growing foetus
3 . Strength of vitality required
during labour
4 . Successful lactation
Normal 1800 to 2000 + 300
calory
PREGNANCY DIET
SHOUD BE
Rich in –Carbohydrates
-Proteine
-Vitamins
-Mineral
It shoud be –Light
-Nutritious
-Easily digestible
DIET ADVICE
DEPENDS ON
-Socio economical status
-Habits
-Taste
-Reasonable & Realistic
SUPPLEMENTORY
NUTRITIONAL THERAPY
 IRON TBLETS
 VITAMINS
 CALCIUM-1GM
 FOLIC ACID-1MG
 RIBOFLAVIN-2MG
 NICOTINIC ACID-15MG
REST & SLEEP
Normal work
8-10 hour sleep
Avoid streneious work
BOWEL
Fluids
Green vegetables
Mild laxatives
 BATH
 CLOTHES/SHOES/BELT
 DENTAL CARE
-Extraction
-Filling carries tooth
 CARE OF BREAST
Retracted nipple – correction done by
manipulation or by using shields
 COITUS
Avoid-1st
trimester
-last 6 wks
 TRAVEL-Avoid
-railway preferred
-air preferred
 SMOKING & ALCOHOL
Injourious to health
 IMMUNISATION
Tetanus toxoid
GENERAL ADVICE
Come to hospital if
1.Painful uterine contraction
2.Sudden gush of watery fluid per
vaginum
3.Any vaginal bleeding
MATERNAL EXERCISE , DANCE ,
YOGA THERAPY
COCHRANE REVIEW
Pregnant woman engaged in vigorous
exercise of atleast 2-3 times a week
1 . Pregnancy of same length
2 . Improves physical fitness
3 . No late pregnancy complication
BENEFITS OF EXERCISE
Strengthens the muscle
Improve posture
Give enegy & improve mood
Decreased discomfort of
pregnancy
Increased sleep,stamina,strength
BENEFITS TO INFANT
LESS BODY FAT
LESS CRANKY & LESS
INFANTILE COLIC
GREATER
NEURODEVELOPMENTAL
SCORE AT 5 YEAR
ANTENATAL CARE by Dr Rushabh Mehta
RISK OF SEDENTARY LIFE
 Decreased muscular tone
 Decreased cardio vascular fitness
 Excessive maternal weight gain
 Development of varicose vein
 PIH
 DVT
 Dyspnoea
 Low back pain
 Poor psychological adjustment
CONDITIONS REQUIRING
MEDICAL SUPERVISION
 Cardiac disease
 Lung disease
 PIH
 Pre term labour/IUGR
 Placenta previa
 Multiple gestation
 thyroid
1.ANTENATAL CARE AT
PRIMARY HEALTH CENTRE
 TETANUS TOXOID immunisation
 Iodide & folate supplementation
 Breast feeding counselling
 Identification of major risk of
obstructed labour
2.CHRMOSOMAL
ABNORMALITY
1 . FIRST TRIMESTER
-beta HCG
-PAPP(pregnancy associated plasma
proteine)
2 . SECOND TRIMESTER
triple marker
It includes-AFP
-HCG
-unconjugated oestrogen
 QUADRUPLE TEST
Fourth biochemical marker
INHIBIN-A it is increased in down’s
syndrome
FACTORS AFFECTING MARKERSFACTORS AFFECTING MARKERS
-maternal weight
-no of foetus
-smoking
-ethinicity
-gravidity & parity
-assisted reproduction
-diabetes
OSCAR CLINIC
 ONE STOP CLINIC FOR ASSESMENT
OF RISK FOR FOETAL ANOMALY
 Beta HCG + PAPP & USG for nuchal
translucency + crown rump length +
anomaly scan carried out between 11 to
14th
weeks
ANTENATAL CARE by Dr Rushabh Mehta

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ANTENATAL CARE by Dr Rushabh Mehta