Antenatal care involves systematic supervision of a pregnant woman from conception until delivery. It aims to ensure a healthy pregnancy and delivery of a healthy baby by screening for risks, preventing/treating complications, educating the mother, and providing ongoing medical supervision. Key aspects of antenatal care include regular checkups, history taking, physical examinations, investigations, health advice, and monitoring the health of the mother and fetus throughout pregnancy. Preconceptional care aims to optimize a woman's health before pregnancy to ensure a safe pregnancy.
2. DEFINITION OF ANTENATAL
CARE
Systemic supervision (examination and
advice ) of a woman during pregnancy is called
Antenatal care / prenatal care.
D.C.DUTTA
Antenatal care refers to the care given to an
expectant mother from the time of conception
until the beginning of labour.
3. AIMS
⢠To screen the high risk cases
⢠To prevent or detect or treat at the any earliest
complication
⢠To ensure continued medical surveillance and
prophylaxis
⢠To educate the mother about the physiology of
pregnancy and labour by demonstrations, charts and
diagrams so that fear is removed and psychology is
improved.
4. AIMS (CONTâD)
⢠To discuss with the couple about the place, time and
mode of the delivery, provisionally and care of the
newborn
⢠To motivate the couple about the need of family
planning
⢠To advice the mother about breast-feeding, post-
natal care and immunization
5. OBJECTIVES
To ensure a normal pregnancy with
delivery of a healthy baby from a
healthy mother
7. THE FIRST VISIT
Objectives :
⢠To assess the health status of the
mother and fetus to screen out the
risk pregnancy and formulate the plan
subsequent management.
â˘To obtain baseline information.
9. 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. Personal history
8. Socio-economic history
10. PARTICULARS OF THE PATIENT
1.Name
2.Age
3.Gravida and parity
4.Address
5.Date of first Examination
11. CHIEF COMPLAINTS WITH
DURATION
1. Period of amenorrhea
2. Nausea & vomiting, vertigo
3. Increased frequency of micturition
4. Constipation
5. Heaviness of breast
6. Rise of temperature
7. Edema
8. Pain in the abdomen
9. Backache
10. Vaginal bleeding
13. OBSTETRICAL HISTORY
⢠Duration of marriage
⢠Gravida
⢠Para
⢠No. of living children
⢠Health status of the babies
⢠Previous obstetrical history-antenatal and
intra-natal
20. GENERAL EXAMINATION
⢠Appearance
⢠Vital signs
⢠Height of patient
⢠Weight of patient
⢠Anemia
⢠Jaundice
⢠Edema
⢠Neck
⢠Tongue ,teeth , gums
⢠Breast
⢠Abdomen
21. INVESTIGATION
⢠CBC
⢠Blood grouping & Rh typing
⢠Urine R/E
⢠RBS
⢠VDRL
⢠HBS Ag
⢠Maternal serum alpha protein
⢠Serological for rubella and hepatitis
⢠Ultrasound
22. SUBSEQUENT VISIT
SCHEDULE
Generally-
â˘At interval of 4 weeks up to 28 weeks
â˘At interval of 2 weeks up to 36 weeks
â˘At weekly interval up to EDD
As per WHO recommendation at least 4 visit-
â˘1st
visit around 16 weeks
â˘2nd
visit between 24-28 weeks
â˘3rd
visit at 32 weeks
â˘4th
visit at 36 weeks
23. OBJECTIVES OF
SUBSEQUENT VISIT
⢠To assess fetal well being
⢠To assess lie , presentation , position
⢠To assess anaemia , pre eclampsia ,amniotic fluid
volume ,fetal growth .
⢠To organise specialist antenatal clinics with
cardia disease and diabetes .
⢠To select time for ultra sound for
amniocentesis ,chronic villus sampling when
indicated.
24. IN SUBSEQUENT VISIT
⢠General examination-
⢠weight, BP ,Pallor ,edemas.
⢠Patient complaints
⢠Fetal movements and date of quickening
⢠Gestational age to be calculated
⢠Health education
⢠Prophylaxis & treatment of anemia
⢠Developing individualized birth plan
⢠Abdominal examination
29. ANTENATAL ADVICE-
PRINCIPLES
Principles:
1.To impress the patient about the importance of
regular check up
2.To maintain or improve the health status of the
woman to the optimum till delivery by judicious
advice regarding diet, drugs and hygiene
3.To improve and tone up the psychology and to
remove the fear of pregnancy by talking
sympathetically to the patient and explaining the
principle changes and events likely to occur during
pregnancy
30. ANTENATAL ADVICE
⢠Diet
⢠Rest & sleep
⢠Bowel
⢠Personal cleanliness
⢠Clothing, shoes & belt
⢠Dental care
⢠Care of breast
⢠Coitus
⢠Travelling
⢠Smoking and alcohol
⢠Immunization
⢠Drug
32. DDA OF A WOMAN DURING
PREGNANCY (2ND
HALF)
Food element pregnancy
Kilocalories 2500
Protein 60 gm.
Iron 40 mg
Folic acid 400 Âľg
Calcium 1000 mg
Vitamin A 6000 I.U.
33. 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
34. BOWEL
⢠Regular bowel movement may be facilitated by
regulation of diet, taking plenty fluid, vegetable and
milk
Coitus
Should be avoided in
â˘1st
trimester
â˘last 6 weeks
35. BATHING
⢠The woman should take bath
daily but be careful against
slipping in bathroom due to
imbalance
36. CLOTHING ,SHOES, BELT
⢠Woman should wear loose
comfortable garments. High heel
shoes should better be avoided in
advanced pregnancy when the centre
of balance alters.
37. DENTAL CARE
⢠The dentist should be consulted at the
earliest if necessary this will facilitate
extraction or filling of the caries tooth ,if
required comfortably in 2 nd trimester the
best time for such procedure.
38. CARE OF BREAST
⢠If the nipples are anatomically normal
nothing is to be done beyond ordinary
cleanliness. If the nipples are retracted
,correction is to be done in the later
months by manipulation.
39. TRAVELLING
Should be avoided in
â˘1st
trimester
â˘last 6 weeks
Air travelling is contraindicated in
â˘Placenta praevia
â˘Preeclampsia
â˘Severe anemia
40. SMOKING AND
ALCOHOLISM
⢠Smoking and alcohol are injuries to health
during pregnancy.
⢠Heavy smokers have low birth weight
babies and abortion
⢠Alcohol during pregnancy leads to fetal
growth retardation
42. DRUGS
⢠Most of the drugs
cross the placenta to
reach the fetus while
prescribing the
physician should keep
in mind
43. PRECONCEPTIONAL CARE
ď§ Preconceptional care is the one
step ahead of antenatal care.
ď§ When a couple is seen and
counseled about pregnancy, its
course and outcome before the
time of actual conception, is
called Preconceptional care.
ď§ Objective: to ensure that, a
woman enters pregnancy with
an optimal state of health which
would be safe both to herself
and the fetus.
44. PRECONCEPTIONAL CARE
INCLUDES:
ď§ Identification of high risk factor
ď§ Basal level health status including BP recording
ď§ Rubella & Hepatitis immunization
ď§ Folic acid supplementation
ď§ Maternal health is optimized preconceptionally such as
overweight anemia
ď§ Patient with medical disease like hypertension,
diabetes are stabilized in an optimal state by
intervention
45. PRECONCEPTIONAL CARE INCLUDES:
(CONTâD)
ď§ Drugs used before pregnancy are verified and
changed if required to prevent any adverse effect of
the fetus; e.g., warfarin is replaced with heparin, oral
anti-diabetic drug with insulin
ď§ Advise to stop smoking, alcohol and drug abuse
ď§ Proper counseling to those with history of recurrent
fetal loss or family history of congenital
abnormalities
ď§ Counseling regarding health care cost
ď§ Find out supporting or helping people to help the
mother and care of the new born