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Antenatal care(sreelakshmi)

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Antenatal care(sreelakshmi)

  2. 2. What is it? The care of the pregnant woman with the aim of achieving a healthy pregnancy and delivery of a normal baby Good antenatal care helps a woman to face labour in good health and in optimum condition
  3. 3. Why•Promote, protect & maintain the health ofmother•Detect high-risk cases•Proactive approach to complications•Remove the anxiety and dread associatedwith pregnancy•Reduce maternal and infant mortality andmorbidity rate•Teach mother the elements of child care,nutrition, personal hygiene &environmental sanitation•To attend to the under-fives
  4. 4. Schedule For Antenatal Visits in India  Monthly up to 28 weeks  Two weekly between 28 and 36 weeks  Weekly 36 weeks onwards. (This equals about 15 visits)  High-risk cases more frequent visits
  5. 5. Booking Visit ??First visit that the woman makes to the health care facility.Should be as early possible and preferably in the first trimester : To detect high-risk cases To offer MTP if required
  6. 6. Aims of Booking VisitoGet detailed history & assess if high riskoEstablish correct gestational age and date pregnancyoProvide information about what is to expected, the dangersignals etc. which she should know ofoPerform baseline investigations likeHB, blood group, Rh typing & urineanalysis
  7. 7. Routine InvestigationsName First done Repeated Interpretation1. Hb, PCV Booking Once every <10 g/dL or < 11 g/dL trimester (WHO) consider as anemia2. Blood group & Booking --- If Rh –ve, husband’sRh typing group & ICT3. HbsAg, HIV, Booking --- If +ve, refer for counsellingVDRL & PPTCT4. Urine routine Booking Every visit Pus cells> 5, do a cultureexamination Alb+ or >, consider pre- eclampsia5. GCT 24-48 weeks --- 130 mg/dL or more, do a GTT
  8. 8. History & Examinatioin History taking Systemic & obstetric examination Palpation: symphyseofundal height on every visit• Pelvic examination in 1st trimester
  9. 9. Continued..Sometimes other tests in individual cases like:• Testing for hemoglobinopathies• Glycosylated Hb• Maternal serum for screening Down’s syndrome
  10. 10. Immunizations in Pregnancy Tetanus toxoid – safe& mandatory  1st dose- at booking visit & then 6 weeks later  If already takes within last 3 years, booster at 36 weeks Usually others not given Safe Only in C.I epidemicsTetanus Typhoid RubellaHepatits Cholera MMRRabies Varicella BCG Yellow fever
  11. 11. Medications1. Folic acid – 5mg during 1st trimester ( if not begun preconceptionally)2. Fe & Ca started at 13 wks continued for 3 months after pregnancy Fe- 100mg Ca- 1mg/day
  12. 12. Health Education for the Pregnantwoman Diet  need extra 300kcal/day from 2nd trimester onwards  Protein  Salt  Iron  Calcium : 1.5 g daily  Vit. C, folic acid, Vit. B12  + tablets
  13. 13. Continued.. Weight gain: total of 11 kg. 500 g/wk during 2nd trimester Rest: Activity & Exercise: Clothes : Coitus Smoking & alcohol : abortion, growthrestriction, fetal alcohol syndrome restricted Drugs : Care of breasts: Travel :
  14. 14. Warning signals !!! Bleeding p/v at any time in pregnancy Head ache, blurring vision, epigastric pain & oliguria Pedal oedema, severe, not subsiding with rest, or on face & hands Decrease/ loss of fetal movements Abdominal pain Urinary infection with vulvovaginitis Clear fluid p/v PROM
  15. 15. Common Symptomatology in pregnancy Nausea & vomiting Backache Varicose veins Hemorrhoids Vaginal discharge Acidity & heart burn Constipation
  16. 16. Antenatal care up to 28 weeks Woman should seek care every month Weight, bp & urine checked at each visit Quickening, anemia, oedema (!!) Symphyseofundal height Others: Targeted ultrasound scan for anomalies (18-20 wks)…….
  17. 17. Antenatal care after 28 weeks Crucial period: pre-eclampsia, GDM, growth disorders bp, weight, urine routine, Hb Symphyseofundal height: detect IUGR & macrosomia She should be made aware….. Vaginal examination
  18. 18. Ultrasound in Pregnancy.. If only single scan, ideally in 2nd trimester to look for anomalies & dating. Booking scan : 10-14 wks confirm gestational age assess nuchal translucency• 1st trimester scan :• 3rd trimester scan:
  19. 19. Preconceptional / Prepregnancy Councelling1. General advice for all women: • Preconceptional folate • Rubella & Hep B vaccine • Weight reduction in obesity • Cessation of smoking / alcohol • Advice regarding drug intake • Rule out STDs, & HIV counseling • Avoid teratogens
  20. 20. Continued..2. Medical disorders • Preconceptional glycemic control in diabetes • Remission in chronic diseases like SLE & chronic renal disease • Cardiac surgery prior to pregnancy • Avoiding pregnancy in certain cardiac diseases • Changing teratogenic drugs as in epilepsy
  21. 21. Continued..3. Recurrent pregnancy loss • Checking for antiphospholipid antibody syndrome • Correction of uterine septum by hysteroscopic septal resection 4. Genetic problems • Parental karyotyping • Carrier screening based on ethnicity or family history • Dietary advice in PKU
  22. 22. Thank You…..