Antenatal Care

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Antenatal Care


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Definition of Antenatal care

comprehensive health supervision of a

pregnant woman before delivery

Orit is planned examination, observation

and guidance given to the pregnant

woman from conception till the time of

labor.


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Goals

To reduce maternal and perinatal

mortality and morbidity rates

To improve the physical and mental

health of women and children


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Importance of Antenatal Care

To ensure that the pregnant woman and herfetus are in the best possible health.

To detect early and treat properlycomplications

Offering education for parenthood

To prepare the woman for labor, lactation andcare of her infant


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Schedule for Antenatal Visits:

The first visit or initial visit should be made

as early is pregnancy as possible.

Return Visits:

Once every month till 7th month.

Once every 2 weeks till the 9th month

Once every week during the 9th month,till labor.


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Assessment

History Examination Investigation


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History

Personal history

Family history

Medical and surgical historyMenstrual history

Obstetrical history

History of present pregnancy


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Physical Examinations

Height of over 150 cm indication of an

average-sized pelvis

The approximate weight gain during

pregnancy is 12 kg.; 2kg in the first 20

weeks and 10 kg in the remaining 20

weeks (1.5 kg per week until term).


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Obesity (more than 20 kg above the

weight-height formula) leads to an

increased risk of gestational diabetes,

pregnancy-induced hypertension andthrombo-embolic disorders


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Local Examination

The uterus may be higher than expected

due to large fetus, multiple pregnancy,

polyhydrammnios or mistaken date of last

menstrual period. The uterus may be lower than expected due

to small fetus, intrauterine growth

retardation, oligohydramnios or mistaken

date of last menstrual period.


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Fetal heart sound is heard by sonicaid as

early as 10thweek of pregnancy.

Fetal heart sound is heard by Pinard' s

fetal stethoscope after the 20thweek of

pregnancy.

The normal fetal heart rate is 120-160

beats/min


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Investigations:

Urine should be tested for sugar,

ketones and protein.

Hemoglobin will be repeated:

At 36 weeks of gestation.

Every 4 weeks if Hb is < 9 g/dl.


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Fetal kick count

The pregnant woman reports at

least 10 movements in 12 hours.

Absence of fetal movements

precedes intrauterine fetal deathby 48 hours.


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Health Teaching during the First

Trimester

Physiological changesduring pregnancy

Weight gain

Fresh air and sunshine

Rest and sleep

Diet

Daily activities

Exercises and relaxation

Hygiene

Teeth Bladder and bowel

Sexual counseling

Smoking :

Medications

Infection

Irradiation

Occupational andenvironmental hazards

Travel

Follow up

Minor discomforts

Signs of PotentialComplications


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Exercise should be simple, mild exercise avoid

lifting heavy weights

A tooth can be extracted during pregnancy,

but local analgesia is recommended Catheter and enema should be avoided.

Smoking may lead to ptyalism, nervousness

and hyper emesis and make pregnant womanat increased risk of chest infections and

thrombo-embolic disorders


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Pregnant woman should avoid contact with

infectious diseases especially rubella or

(German measles) because it has deleterious

effects on the fetus Pregnant woman should avoid exposure to x-

ray or irradiation because of possible

teratogenic effects on the fetus such as birthdefects or childhood leukemia


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Common Discomforts of Pregnancy,

Etiology, and Relief Measures:

Urinary frequency

RELIEF MEASURES: Decrease fluid intake at night.

Maintain fluid intake during day.

Void when feel the urge.


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Fatigue

RELIEF MEASURES:

Rest frequency.

Go to bed earlier.


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Sleep difficulties

RELIEF MEASURES:

Rest frequency

Decrease fluid intake at night


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Breast enlargement and

sensitivity

RELIEF MEASURES:

Wear a good supporting bra.

Assess for other conditions.


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Nasal stuffiness and epistaxis

ETIOLGY: Elevated estrogen levels

RELIEF MEASURES:

Avoid decongestants.

Use humidifiers, and normal saline drops.


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Ptyalism (excessive salivation)

ETIOLGY: Unknown

RELIEF MEASURES:

Perform frequent mouth care.

Chew gum.

Decrease fluid intake at night.

Maintain fluid intake during day.


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Nausea and vomiting

RELIEF MEASURES:

Avoid food or smells that exacerbate condition.

Eat dry crackers or toast before rising in morning.

Eat small, frequent meals.Avoid sudden movements. Get out of bed slowly

Breath fresh air to help relieve nausea.


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Shortness of breath

RELIEF MEASURES:

Use extra pillows at night to keep more upright.

Limit activity during day


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Heartburn

RELIEF MEASURES:

Eat small, more frequent meals.

Use antacids.

Avoid overeating and spicy foods.


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Dependent edema

Avoid standing for long periods.

Elevate legs when laying or sitting.

Avoid tight stockings.


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Varicosities

Rest in sims' position.

Elevate legs regularly.

Avoid crossing legs. Avoid tight stockings.

Avoid long periods of standing


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Hemorrhoids

RELIEF MEASURES:

Maintain regular bowel habits.

Use prescribed stool softeners.Apply topical or anesthetic

ointments to area.


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Constipation

RELIEF MEASURES:

Maintain regular bowel habits.

Increase fiber in diet.Increase fluids.

Find iron preparation that is

least constipating


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Leucorrhea

RELIEF MEASURES:

Take a daily bath or shower.

Wear cotton underwear.


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Backache

RELIEF MEASURES:

Wear shoes with low heels.

Walk with pelvis tilted forward.Use firmer mattress.

Perform pelvic rocking or tilting


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Leg cramps

RELIEF MEASURES:

Extend affected leg and dorsiflex the foot.

Elevate lower legs frequently.

Apply heat to muscles. Evaluate diet.


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Faintness

RELIEF MEASURES:Rise slowly from sitting to standing.

Evaluate hemoglobin and

hematocrit.Avoid hot environments

Antenatal Care

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