Download - Childbearing Antenal Assessment

The Childbearing FamilyThe Childbearing Family

Antenatal AssessmentAntenatal Assessment


• What is Antenatal Assessment?What is Antenatal Assessment?

• Why do an Antenatal Assessment?Why do an Antenatal Assessment?

• What is Maternal Mortality? What is Maternal Mortality?

• What is Maternal Morbidity?What is Maternal Morbidity?

• What is Perinatal Mortality?What is Perinatal Mortality?

• What is Neonatal Mortality?What is Neonatal Mortality?

• What is Infant Mortality?What is Infant Mortality?


To achieve the goals of antenatal care, the following To achieve the goals of antenatal care, the following is necessary;is necessary;

• Early, accurate estimation of gestational age Early, accurate estimation of gestational age

• Identification of the patient at risk for Identification of the patient at risk for complications complications

• Ongoing evaluation of the health status of both Ongoing evaluation of the health status of both mother and fetus mother and fetus

• Anticipation of problems and intervention, if Anticipation of problems and intervention, if possible, to prevent or minimize morbidity possible, to prevent or minimize morbidity

• Patient education and communicationPatient education and communication


• Maternal MortalityMaternal Mortality

• DEFINITION: DEFINITION: The quotient between the The quotient between the number of maternal deaths in a given number of maternal deaths in a given year and the number of live births in year and the number of live births in that same year, expressed per 100,000 that same year, expressed per 100,000 live births, for a given country, territory, live births, for a given country, territory, or geographic area, as reported by the or geographic area, as reported by the national health authority. national health authority.


• Maternal death is defined as the death of a Maternal death is defined as the death of a woman while pregnant or within the 42 woman while pregnant or within the 42 days after termination of that pregnancy, days after termination of that pregnancy, regardless of the length and site of the regardless of the length and site of the pregnancy, due to any cause related to or pregnancy, due to any cause related to or aggravated by the pregnancy itself or its aggravated by the pregnancy itself or its care, but not due to accidental or incidental care, but not due to accidental or incidental causes.causes.

• Rate in T&T 70.4per 100,000 per yearRate in T&T 70.4per 100,000 per year


• The Major causes of death during The Major causes of death during pregnancy are;pregnancy are;

• Ectopic pregnancyEctopic pregnancy

• Hypertension Hypertension

• Haemorrhage Haemorrhage

• EmbolismEmbolism

• Anaesthesia -related complicationsAnaesthesia -related complications


• Infant Mortality Infant Mortality

• The # of infant deaths in the first The # of infant deaths in the first year of life after live birth per 1000, year of life after live birth per 1000, compared with the number of live compared with the number of live births in one year from a specific births in one year from a specific geographic area. geographic area.

• In Trinidad and Tobago -28.9 per In Trinidad and Tobago -28.9 per 10001000


• Neonatal MortalityNeonatal Mortality

• The # of deaths during the first 28 days of life per The # of deaths during the first 28 days of life per 1000, live births per year.1000, live births per year.

• Neonatal deaths were caused by respiratory distress Neonatal deaths were caused by respiratory distress syndrome (57.8%), birth asphyxia (22.2%) and sepsis syndrome (57.8%), birth asphyxia (22.2%) and sepsis (13.5%) . Another study of early onset Group B (13.5%) . Another study of early onset Group B streptococcal (GBS) infection in neonates at the Mount streptococcal (GBS) infection in neonates at the Mount Hope Women's Hospital over the period 1996–97 found Hope Women's Hospital over the period 1996–97 found that the incidence of early onset neonatal GBS sepsis that the incidence of early onset neonatal GBS sepsis was five to six times higher than that reported in the was five to six times higher than that reported in the USA and UK USA and UK

• In Trinidad and Tobago -23/1000 (2000)In Trinidad and Tobago -23/1000 (2000)


• Peri-Natal MortalityPeri-Natal Mortality

• The # of stillbirths and deaths (from a viable The # of stillbirths and deaths (from a viable birth)in the firs week of life per 1000, live birth)in the firs week of life per 1000, live births and foetal deaths(after 28 weeks)births and foetal deaths(after 28 weeks)

• Stillbirths resulted from the hypertensive Stillbirths resulted from the hypertensive disorders of pregnancy, abruptio placentae, disorders of pregnancy, abruptio placentae, diabetes mellitus, intrapartum foetal distress diabetes mellitus, intrapartum foetal distress and lethal congenital anomalies and lethal congenital anomalies

• In Trinidad and Tobago 27.7 per 1000 per yearIn Trinidad and Tobago 27.7 per 1000 per year


• 4MILLION babies die in the 14MILLION babies die in the 1stst. Four . Four weeks of life. 3Million in early weeks of life. 3Million in early neonatal period. 3.3Million are neonatal period. 3.3Million are stillborn. 1.3 preventable. 90% in the stillborn. 1.3 preventable. 90% in the developing worlddeveloping world


• In Trinidad ad Tobago;In Trinidad ad Tobago;

• Over 50% of pregnant women attend free Over 50% of pregnant women attend free prenatal clinics that are provided in the health prenatal clinics that are provided in the health centers in Trinidad and Tobagocenters in Trinidad and Tobago

• At each visit a midwife conducts an examination. At each visit a midwife conducts an examination. At least twice during the pregnancy, a medical At least twice during the pregnancy, a medical officer conducts an examination.officer conducts an examination.

• This system facilitates the referral of women with This system facilitates the referral of women with complications (about 19% of clients) to specialist complications (about 19% of clients) to specialist clinics at six hospitals. clinics at six hospitals.


• The established protocol for prenatal The established protocol for prenatal care at the health centers includes care at the health centers includes testing for anaemia and VDRL , testing for anaemia and VDRL , screening for diabetes, and tetanus screening for diabetes, and tetanus immunization. immunization.

• Iron and folic acid supplements are Iron and folic acid supplements are recommended to pregnant women but recommended to pregnant women but are not generally available free at the are not generally available free at the health centers health centers


• Tetanus is a life-threatening bacterial disease that is Tetanus is a life-threatening bacterial disease that is caused by the toxin of a bacterium called caused by the toxin of a bacterium called Clostridium Clostridium tetanitetani. .

• Tetanus bacteria enter the body through an open Tetanus bacteria enter the body through an open wound. It could well be a tiny prick or scratch on the wound. It could well be a tiny prick or scratch on the skin, although Tetanus infection is more common when skin, although Tetanus infection is more common when there is a deep puncture wound such as a bite, cut, there is a deep puncture wound such as a bite, cut, burn or an ulcer. burn or an ulcer.

• Tetanus affects a person’s nervous system and can be Tetanus affects a person’s nervous system and can be fatal if left untreated. It is preventable through fatal if left untreated. It is preventable through immunization. immunization.


• The Tetanus Toxoid (TT) vaccine is given The Tetanus Toxoid (TT) vaccine is given during pregnancy to prevent tetanus to during pregnancy to prevent tetanus to the mother as well as baby. the mother as well as baby.

• Antibodies formed in the mother’s body, Antibodies formed in the mother’s body, after the vaccination, are passed on to after the vaccination, are passed on to the baby and protects for a few months the baby and protects for a few months after birth. It also helps prevent after birth. It also helps prevent premature delivery. premature delivery.


• In the first pregnancy, the recommendation is at least two In the first pregnancy, the recommendation is at least two doses of the TT vaccine. The first vaccination is given in the doses of the TT vaccine. The first vaccination is given in the first trimester soon after a pregnancy test is confirmed and first trimester soon after a pregnancy test is confirmed and after the after the first antenatal appointment..

• The second dose of the TT vaccine is given at least four to The second dose of the TT vaccine is given at least four to eight weeks after the first. Some experts recommend that eight weeks after the first. Some experts recommend that the second dose of the vaccine should be given four weeks the second dose of the vaccine should be given four weeks prior to the expected date of delivery.prior to the expected date of delivery.

• The WHO also recommends that a third vaccine be given The WHO also recommends that a third vaccine be given six months after the second one to provide protection for at six months after the second one to provide protection for at least five years. least five years.

http://www.babycenter.in/pregnancy/antenatalhealth/testsandcare/bookingappointment/


• If this is a second pregnancy and it If this is a second pregnancy and it has been less than two years since has been less than two years since the last pregnancy and the patient the last pregnancy and the patient had received both TT vaccines, then had received both TT vaccines, then only a booster dose is recommended.only a booster dose is recommended.

• In many countries such as the US, the In many countries such as the US, the Td or tetanus-diphtheria vaccine is Td or tetanus-diphtheria vaccine is recommended for pregnant women. recommended for pregnant women.


• About 90% of all deliveries take place in government About 90% of all deliveries take place in government institutions, which have facilities for cesarean sections, institutions, which have facilities for cesarean sections, blood transfusions, and acute neonatal care. The other blood transfusions, and acute neonatal care. The other 10 % take place in private hospitals and nursing 10 % take place in private hospitals and nursing homes (most of which have facilities for cesarean homes (most of which have facilities for cesarean sections), with minimal numbers taking place in homes sections), with minimal numbers taking place in homes and "other places." and "other places."

• Almost 90% of all deliveries are supervised by Almost 90% of all deliveries are supervised by midwives, the other 10% by doctors or "other midwives, the other 10% by doctors or "other persons." persons."

• Only about 10% of mothers use postnatal services at Only about 10% of mothers use postnatal services at health centers. health centers.


• The infant mortality rate is estimated at The infant mortality rate is estimated at 29 29 infant deaths per thousand live birthsinfant deaths per thousand live births, while , while the probability of dying before one’s fifth the probability of dying before one’s fifth birthday,birthday,

• the under-5 mortality rate (U5MR) is estimated the under-5 mortality rate (U5MR) is estimated to be around to be around 35 per one thousand live births35 per one thousand live births. . These estimates have been calculated byThese estimates have been calculated by

• averaging mortality estimates obtained from averaging mortality estimates obtained from women 25-29 years and 30-34 years, and refer women 25-29 years and 30-34 years, and refer to mid 2004.to mid 2004.


• Low Birth WeightLow Birth Weight

• Weight at birth is a good indicator, not only of Weight at birth is a good indicator, not only of a mother’s health and nutritional status but a mother’s health and nutritional status but also the newborn’s chances for survival, also the newborn’s chances for survival, growth , long-term health and psychosocial growth , long-term health and psychosocial development.development.

• Low birth weight (less than 2,500 grams) Low birth weight (less than 2,500 grams) carries a range of grave health risks for carries a range of grave health risks for children.children.


• Babies who were undernourished in the Babies who were undernourished in the womb face a greatly increased risk of womb face a greatly increased risk of dying during their early months and years. dying during their early months and years.

• Those who survive have impaired immune Those who survive have impaired immune function and increased risk of disease function and increased risk of disease They are likely to remain undernourished, They are likely to remain undernourished, with reduced muscle strength, throughout with reduced muscle strength, throughout their lives, and suffer a higher incidence of their lives, and suffer a higher incidence of diabetes and heart disease in later life. diabetes and heart disease in later life.


Children born underweight also tend Children born underweight also tend to have;to have;

- A lower IQ - A lower IQ

- Cognitive disabilities, affecting their - Cognitive disabilities, affecting their performance in school and their job performance in school and their job opportunities as adults.opportunities as adults.


• Early screening therefore is a major Early screening therefore is a major contributor to better outcomes of contributor to better outcomes of pregnancy.pregnancy.

• Screening and a thorough history Screening and a thorough history are usually the most important are usually the most important activities of the first Ante-natal visit. activities of the first Ante-natal visit.

• Pre-conceptive screening would be Pre-conceptive screening would be the option of choice if possiblethe option of choice if possible


• Think about the setting for the first Think about the setting for the first interview. interview.

• QuietQuiet

• FocusedFocused

• PrivacyPrivacy

• Health historyHealth history


• First TrimesterFirst Trimester

• Early confirmation gives most reliable assessment of Early confirmation gives most reliable assessment of gestational age.gestational age.

• Confirm Estimated Date of Delivery(E.D.D)Confirm Estimated Date of Delivery(E.D.D)

• Ask for the first day of the last menstrual period!Ask for the first day of the last menstrual period!

• Naegele’s rule Naegele’s rule

• Add sevenAdd seven days days

• Subtract three months ,- Subtract three months ,-

• Adjust the year Adjust the year if needed .if needed .

• There is a 2wk margin of error either side of this dateThere is a 2wk margin of error either side of this date


• What can affect the estimation of this date?What can affect the estimation of this date?

• Does not remember L.M.PDoes not remember L.M.P

• Has irregular periodsHas irregular periods

• Was taking the contraceptive pill Was taking the contraceptive pill

• Had a lighter than normal period Had a lighter than normal period

• Just had a baby and has not had a period as Just had a baby and has not had a period as yet.yet.

• Is still having periodsIs still having periods

Antenatal assessmentAntenatal assessment

• Take a complete health history; Take a complete health history;

• Social – family-partner-housing-work-financesSocial – family-partner-housing-work-finances

• Psychosocial –feelings-coping skills-self esteem-Psychosocial –feelings-coping skills-self esteem-body imagebody image

Medical- history of any illness or disease, Medical- history of any illness or disease, present or pastpresent or past

• Surgical- surgeries or procedures that may have Surgical- surgeries or procedures that may have impactimpact

• Obstetrical –previous pregnancies-results, Parity, Obstetrical –previous pregnancies-results, Parity, GravidaGravida


• Menstrual history –first day of last Menstrual history –first day of last menstrual periodmenstrual period

• Family history -diseases-heredity-Family history -diseases-heredity-geneticgenetic

• This gives a baseline to work with This gives a baseline to work with and a basis for referral if necessaryand a basis for referral if necessary


• Physical ExaminationPhysical Examination

• Head to toe exam including , breasts for signs of Head to toe exam including , breasts for signs of activity . Will give a general assessment of well activity . Will give a general assessment of well being and signs and symptoms of pregnancy being and signs and symptoms of pregnancy

• Weight /heightWeight /height

• Vital signs –baselineVital signs –baseline

• Heart, lungs.Heart, lungs.

• Urinalysis –abnormalities, albumin, blood, sugar, Urinalysis –abnormalities, albumin, blood, sugar, leucocytesleucocytes

• Blood testsBlood tests


• Abdominal PalpationAbdominal Palpation

• The abdominal examination consists of:The abdominal examination consists of:

• 1 -Preparation for this 1 -Preparation for this

• 2 -Inspection2 -Inspection

• 3 –Fundal palpation,3 –Fundal palpation,

• 4 -Lateral palpation4 -Lateral palpation

• 5 -Pelvic palpation5 -Pelvic palpation

• 6 -Auscultation6 -Auscultation

• 7 -Documentation and decision making7 -Documentation and decision making

• Look first –size, shape, signs of pregnancyLook first –size, shape, signs of pregnancy

• Any scars Any scars

• Measure size of uterus, from symphysis pubis to top of fundus, with tape Measure size of uterus, from symphysis pubis to top of fundus, with tape measuremeasure

• # of centimetres = # of weeks gestation# of centimetres = # of weeks gestation


• Laboratory TestsLaboratory Tests—Hb - Group- Rh factor-—Hb - Group- Rh factor-Platelets- HIV-VDRL(Venereal Disease Platelets- HIV-VDRL(Venereal Disease Research Laboratory) –Sickle- WBC –Rubella Research Laboratory) –Sickle- WBC –Rubella

• Ultrasound may be done –this helps to date Ultrasound may be done –this helps to date the pregnancy if needed.the pregnancy if needed.

• Heart rate/movement depending on stage of Heart rate/movement depending on stage of pregnancy pregnancy

• Advice can be given on nutrition – minor Advice can be given on nutrition – minor problems-exercise-rest-social referral-follow problems-exercise-rest-social referral-follow up appointments and supplementsup appointments and supplements


• PreparationPreparation

• It is important to carry out the usual It is important to carry out the usual essential care skills such as:essential care skills such as:

• Introduce yourself to the womanIntroduce yourself to the woman

• Consult the antenatal notesConsult the antenatal notes

• Determine the level of risk and the Determine the level of risk and the maternity care needs of the womanmaternity care needs of the woman

• Respect hygiene measures and the privacy Respect hygiene measures and the privacy of the womanof the woman


• The woman’s abdomen is inspected The woman’s abdomen is inspected for it’s shape. This can indicate size for it’s shape. This can indicate size and lie of the fetus, the amount of and lie of the fetus, the amount of amniotic fluid and sometimes fetal amniotic fluid and sometimes fetal movement may be noticed. movement may be noticed.

• Obvious scars will be seen and this Obvious scars will be seen and this information may be significant.information may be significant.


• Fundal HeightFundal Height

• The fundal height is measured to estimate The fundal height is measured to estimate whether this is in keeping with the expected whether this is in keeping with the expected date of birth. date of birth.

• This can be done using landmarks i.e. This can be done using landmarks i.e. xiphisternum, the symphysis pubis ,the xiphisternum, the symphysis pubis ,the umbilicus where the fundal height can be umbilicus where the fundal height can be measured in relation to these, and the period measured in relation to these, and the period of gestation is calculated. of gestation is calculated.


• Using the flat interior of the tips of Using the flat interior of the tips of the middle fingers of both hands the the middle fingers of both hands the fundus is palpated to identify the fundus is palpated to identify the fetal pole (cephalic or breech).fetal pole (cephalic or breech).

• If no pole is located the lie is not If no pole is located the lie is not longitudinal.longitudinal.


• Fundal palpationFundal palpation is carried out to find out the lie and is carried out to find out the lie and presentation of the fetus. Things which influence the presentation of the fetus. Things which influence the fundal height are: maternal parity, size, full bladder, fundal height are: maternal parity, size, full bladder, the lie and the number of fetuses.the lie and the number of fetuses.

• To determine what is found in the fundus a hand is To determine what is found in the fundus a hand is placed on the abdomen below the xiphisternum and placed on the abdomen below the xiphisternum and gently moved downwards until the fundus is felt.gently moved downwards until the fundus is felt.

•

• Alternatively a measuring tape is used keeping the Alternatively a measuring tape is used keeping the graduated side downwards so as not to influence the graduated side downwards so as not to influence the reader.reader.


• Alternatively a measuring tape is Alternatively a measuring tape is used to estimate the # of used to estimate the # of centimetres, which will approximate centimetres, which will approximate the # of weeks gestation.the # of weeks gestation.

• If the estimate is larger or smaller If the estimate is larger or smaller then the expected date, one must then the expected date, one must look for a cause.look for a cause.


• Lateral palpationLateral palpation assesses the main body of assesses the main body of the uterus to confirm the lie and identify the the uterus to confirm the lie and identify the fetal position. fetal position.

• The fetal back is usually firmer and more The fetal back is usually firmer and more regular in form than the other side of the fetus regular in form than the other side of the fetus i.e. the abdomen and the limbs.i.e. the abdomen and the limbs.

• One hand is placed on one side of the uterus to One hand is placed on one side of the uterus to apply pressure, whilst the other attempts, using apply pressure, whilst the other attempts, using the flats of the fingertips, to identify what is the flats of the fingertips, to identify what is found in the opposite found in the opposite side. side.


• The same manoeuvres are then carried out The same manoeuvres are then carried out on the other side of the uterus, that is the on the other side of the uterus, that is the right hand held firmly on the mothers left right hand held firmly on the mothers left side of the uterus and the flats of the insides side of the uterus and the flats of the insides of the fingertips identify the shape and form of the fingertips identify the shape and form of the right side of the uterus. of the right side of the uterus.

• Lateral palpation also provides insight into Lateral palpation also provides insight into the size of the fetus, the tone of the uterus, the size of the fetus, the tone of the uterus, amniotic fluid volume and also whether fetal amniotic fluid volume and also whether fetal movements are present.movements are present.


• Pelvic palpation is used to identify the Pelvic palpation is used to identify the presentation, that is the part of the fetus presentation, that is the part of the fetus lying in the lower pole of the uterus, over lying in the lower pole of the uterus, over the pelvic brim. It can be determined the pelvic brim. It can be determined whether:whether:

• ••the fetus is flexed or extendedthe fetus is flexed or extended

• ••the presenting part is engaged or notthe presenting part is engaged or not

• ••the presenting part is mobile (ballotable), the presenting part is mobile (ballotable), or engagingor engaging


• To carry out pelvic palpation both hands are To carry out pelvic palpation both hands are used. One hand is placed on either side of the used. One hand is placed on either side of the presentation and pressure is applied. presentation and pressure is applied.

• The presentation can be felt. The presentation can be felt.

• It may help if the woman takes a deep breath It may help if the woman takes a deep breath and blows out. and blows out.

• Engagement of the presentation is assessed Engagement of the presentation is assessed according to the passage of the widest according to the passage of the widest diameter of the presenting part through the diameter of the presenting part through the pelvic brim.pelvic brim.


• AuscultationAuscultation

Locating the fetal presentation and lie Locating the fetal presentation and lie will be helpful to show where to place will be helpful to show where to place the stethoscope to listen to the fetal the stethoscope to listen to the fetal heart. The approximate points of heart. The approximate points of fetal heart sounds are shown on the fetal heart sounds are shown on the image below. right occipito- posterior image below. right occipito- posterior right right


• The fetal heart is assessed for its presence, its rate The fetal heart is assessed for its presence, its rate and its regularity. and its regularity.

• The normal heart rate is between 120 & 160 beats The normal heart rate is between 120 & 160 beats per minute.per minute.

• This is easy to distinguish from the maternal heart This is easy to distinguish from the maternal heart rate, which must also be assessed to determine rate, which must also be assessed to determine that the fetal heart is actually being listened to.that the fetal heart is actually being listened to.

• Following the procedure the findings are discussed Following the procedure the findings are discussed with the mother and documentation and follow up with the mother and documentation and follow up carried out as appropriatecarried out as appropriate


• Records Records

• Records of the abdominal examination should Records of the abdominal examination should include the following features: include the following features:

• The fundal height, The fundal height,

• The lie,The lie,

• Presentation and degree of engagement, Presentation and degree of engagement,

• The position (if identified), The position (if identified),

• The fetal heart rate and whether fetal movements The fetal heart rate and whether fetal movements are felt.are felt.

•


• Abdominal examination during pregnancyAbdominal examination during pregnancy

• Abdominal examination provides the woman Abdominal examination provides the woman with information that pregnancy is progressing with information that pregnancy is progressing well. well.

• She can be reassured regarding fetal growth She can be reassured regarding fetal growth and fetal well being.and fetal well being.

• Other examinations and tests are used in Other examinations and tests are used in conjunction with the abdominal examination, conjunction with the abdominal examination, for example ultrasonic scan. for example ultrasonic scan.

Antenatal Assessment Antenatal Assessment

• The Pelvic Examination;The Pelvic Examination;

• Reveals important information regarding both internal Reveals important information regarding both internal and external health of the reproductive systemand external health of the reproductive system

ExternalExternal

Look for any abnormalities ;e.g. varicosities and Look for any abnormalities ;e.g. varicosities and oedema, previous episiotomyoedema, previous episiotomy

• InternalInternal

• Goodell’s sign (softening of the cervix) Goodell’s sign (softening of the cervix)

• Hegar’s sign (softening of the lower uterine segment )Hegar’s sign (softening of the lower uterine segment )

• Chadwick’s sign (bluish tinge of the vaginal and cervical Chadwick’s sign (bluish tinge of the vaginal and cervical mucosa)mucosa)


• Speculum examSpeculum exam

• Inspect the cervix and shape of os Inspect the cervix and shape of os

• Look for signs of discharge , ulceration or Look for signs of discharge , ulceration or inflammation.inflammation.

• Bi- manual exam Bi- manual exam (two-handed) (two-handed)

• Assess uterine size Assess uterine size

• Assess other pelvic organs Assess other pelvic organs

• Recto-vaginal examRecto-vaginal exam

• Some doctors will do this exam to assess the Some doctors will do this exam to assess the strength of the posterior vaginal wallstrength of the posterior vaginal wall


• An explanation is given to the patient An explanation is given to the patient

• Equipment set up. Equipment set up.

• Private setting Private setting

• Positioned – lithotomy (not in stirrups)Positioned – lithotomy (not in stirrups)

• Speculum exam Speculum exam

• Bi-manual examBi-manual exam

• Recto-vaginal examRecto-vaginal exam

• Assessment of pelvic size (usually done approx. 36Assessment of pelvic size (usually done approx. 36thth week.week.


• Second Trimester Second Trimester • Visits are usually scheduled as;Visits are usually scheduled as; Monthly until the 28Monthly until the 28thth wk. wk. • Then 2wkly till 36Then 2wkly till 36thth wk. and weekly thereafter until delivery wk. and weekly thereafter until delivery • Every visit the following checks are done-Every visit the following checks are done-• WeightWeight• Vital signs Vital signs • UrinalysisUrinalysis• Foetal assessment , fundal height ,foetal heart rate,Foetal assessment , fundal height ,foetal heart rate,• Oedema-varicosities ,vaginal infection, foetal movement , Oedema-varicosities ,vaginal infection, foetal movement ,

possible blood testspossible blood tests


• Discussion of other topics: Discussion of other topics: • Any problems Any problems • NutritionNutrition• Childbirth classes –different ways of Childbirth classes –different ways of

preparingpreparing• Type of delivery-what type of Type of delivery-what type of

delivery, birthing choicesdelivery, birthing choices• Method of feedingMethod of feeding


• Third Trimester Third Trimester

• Routine checks again Routine checks again

• Cephalo-pelvic assessment(clinical)- if any Cephalo-pelvic assessment(clinical)- if any doubt x-ray pelvimetry.doubt x-ray pelvimetry.

• Advice on labour and delivery- choicesAdvice on labour and delivery- choices

• Nutrition and feeding Nutrition and feeding

• Foetal Assessment –clinical assessment of Foetal Assessment –clinical assessment of growth-uterine size – foetal heart –growth-uterine size – foetal heart –movement- ultrasoundmovement- ultrasound


• Cephalo-pelvic AssessmentCephalo-pelvic Assessment

• Cephalo-pelvic disproportion exists Cephalo-pelvic disproportion exists when the capacity of the pelvis is when the capacity of the pelvis is inadequate to allow the fetus to inadequate to allow the fetus to negotiate the birth canal. negotiate the birth canal.

• Foetus – size, position ,abnormalityFoetus – size, position ,abnormality

• Mother – pelvic shape, Mother – pelvic shape, size ,measurement, inlet and outlet.size ,measurement, inlet and outlet.


• Foetal assessment of wellness Foetal assessment of wellness

• Kick counting Kick counting

• Non Stress Test (NST) Non Stress Test (NST)

• Biophysical Assessment Biophysical Assessment

• Ultrasound/MRIUltrasound/MRI

• Foetoscopy Foetoscopy

• OthersOthers