Antenatal care involves regular supervision and examination of a pregnant woman by a health care provider. The goals are to monitor the health of the mother and baby, screen and treat any complications, educate the mother on healthy pregnancy practices, and ensure a normal delivery of a healthy baby. Key aspects of antenatal care include medical history taking, physical examinations to monitor fetal growth and position, laboratory tests, health advice on nutrition, rest, hygiene and immunizations. Regular checkups are recommended with increasing frequency in the third trimester to closely monitor the pregnancy.

1. Antenatal care
Presented by:
Captain Donna W.M. Khyriem
166 MH

2. What is Antenatal care?
• Periodic and regular supervision including
examination and advice of a woman during
pregnancy is called Antenatal care.

3. AIMS
Theaimsare-
• Toscreenthehighriskcases
• Toprevent ordetectortreatattheearliest any
complications
• Toensurecontinuedmedicalsurveillanceand
prophylaxis
• Toeducatethemotheraboutthephysiologyof
pregnancyandlabourbydemonstrations, chartsand
diagramssothatfearisremovedandpsychologyis
improved.

4. AIMS (cont’d)
• To discusswiththecoupleabouttheplace,timeand
modeofthedelivery,provisionallyandcareofthe
newborn
• To motivatethecoupleabouttheneedoffamily
planning
• To advicethemotheraboutbreast-feeding,post-natal
careandimmunization

5. OBJECTIVES
To ensure a normal pregnancy with
delivery of a healthy baby from a
healthy mother

6. CRITERIA OF NORMAL PREGNANCY
Delivery of a single
baby in good condition
at term (38 -42), with
fetal weight of 2.5kg
or more and with no
maternal complication

7. SERVICES
As per WHO recommendation at least 4 visit-
• 1st visit around 16 weeks
• 2nd visit between 24-28 weeks
• 3rd visit at 32 weeks
• 4th visit at 36 weeks

8. Services (cont’d)
Generally-
• At interval of 4 weeks up to 28 weeks
• At interval of 2 weeks up to 36 weeks
• At weekly interval up to EDD
15
visits

9. Antenatal care
comprises of-
• Careful history
takingand
examinationand
investigation
• Advicegivento
the pregnant
woman

10. THE FIRST VISIT
• History taking
• Examination
• Investigation

11. History taking
1. Particulars of the patient
2. Chief complaints with duration
3. Past medical surgical history
4. Obstetric history
5. Menstrual history
6. Family history
7. Drug History
8. History of immunization
9. Socio-economic history
10.Contraceptive history
11.History of allergy

12. Particulars of the patient
1. Name
2. Date of first Examination
3. Address
4. Age
5. Duration of marriage
6. Religion
7. Occupation

13. 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

14. Past history
1. HTN
2. DM
3. Renal Disease
4. Psychiatric illness
5. IHD
6. Any previous operation

15. Obstetrical History
• Duration of marriage
• Gravida
• Para
• Abortions

16. Menstrual History
Age of menarche
Menstrual period
Menstrual cycle
LMP
EDD

17. Family history
a) HTN
b) DM
c) Multiple pregnancy
d) Tuberculosis
e) Known hereditary diseases

18. Drug History
Antihypertensive
Hypoglycemic
Antidepressant
Corticosteroid
Anticoagulant

19. General examination
Abdominal examination

20. General examination
• Appearance
• Height of patient
• Weight of patient
• Anemia
• Jaundice
• Edema
• Cyanosis

26. General examination (cont’d)
• Temperature
• Pulse
• BP
• RR
• Breast
• Heart sound
• Lungs

27. Abdominal examination
A thorough and systemic
abdominal examination
beyond 28weeks of
pregnancy

28. Patient Preparation
• Patient is asked to evacuate the bladder
• Lie in dorsal position with thighs slightly flexed
• Abdomen is fully exposed
• Examiner stands on the right side of the patient

29. Abdominal Examination
Inspection
Palpation
Percussion
Auscultation

30. • Shape of the uterus-
Longitunidal /transverse/
oblique
Inspection

31. Inspection
Striae
scar mark

32. Inspection
Contour of the uterus- fundal
notching, convex or flattened
anterior wall, cylindrical or spherical
shape
Undue enlargement of the uterus

33. PALPATION
• Assessment of fundal height
• Abdominal girth
• Fundal grip
• Lateral grip
• First pelvic grip
• Second pelvic grip

35. SYMPHYSIS FUNDAL HEIGHT (SFH)

39. Leopold maneuvers

40. FETAL POSITIONS

41. Auscultation
Normal FHR is 120-160 b/m
Causes of foetal tachycardia (>160 b/m)
Causes of foetal bradycardia (<120 b/m)

43. Causes of foetal tachycardia
(>160 b/m)
1. Maternal high fever
2. Foetal distress
3. Maternal tachycardia

44. Causes of foetal bradycardia
(<120 b/m)
1. Foetal distress
2. Foetal cardiac conduction defect

45. FETAL HEART SOUND

46. Per Vaginal Examination

47. Normal Labour

49. Station of the head

50. Investigation
• CBC
• Blood grouping & Rh typing
• Urine R/E
• RBS
• VDRL
• HBS Ag
• Ultrasound

51. In Subsequent Visit
• Patient complains
• General examination
• Gestational age to be calculated
• Identification of problem
• Fetal movement
• SFH measurement
• Health education
• Prophylaxis & treatment of anemia
• Developing individualized birth plan

52. Second visit (24-28 weeks)
SFH measurement
To detect Multiple pregnancy

53. Third visit (32 weeks)
Screen for-
1. Preeclampsia
2. Multiple pregnancy
3. Anemia
4. IUGR

54. Fourth visit (36 weeks)
• Identification of fetal
1. Lie
2. Presentation
3. Position
• Update birth plan

55. Antenatal advice
Principles:
1. To impressthepatientabouttheimportanceofregular checkup
2. Tomaintainorimprovethehealthstatusofthewomantothe
optimumtill deliverybyjudiciousadviceregardingdiet,drugs
andhygiene
3. To improveandtoneupthepsychologyandtoremovethefear of
pregnancybytalkingsympatheticallytothepatient and
explainingtheprinciple changesandeventslikelytooccurduring
pregnancy

56. Antenatal advice (cont’d)
• Diet
• Rest & sleep
• Bowel
• Personal cleanliness
• Clothing, shoes & belt
• Dental care
• Care of breast
• Coitus
• Travelling
• Smoking & alcohol
• Immunization
• Drug
• Mental
preparation
• Exercise
• Child care
• Birth plan
• Family planning
Following advices are to be given:

57. DIET
Diet should be:
1. nutritious
2. balanced
3. light
4. easily digestible
5.rich in protein,
mineral and vitamin

58. 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

59. Bowel
• Regular bowel movement may be facilitated
by regulation of diet, taking plenty fluid,
vegetable and milk
Coitus
Should be avoided in
• 1st trimester
• last 6 weeks

60. Travelling
Should be avoided in
• 1st trimester
• last 6 weeks
Air travelling is contraindicated in
• Placenta praevia
• Preeclampsia
• Severe anemia

61. Immunization
Indicated-
• TT
• HAV
• HBV
•Rabies
Contraindicated-
• Live virus vaccine (rubella measles, mumps,
varicella)

62. Warning sign
1. Headache
2. Blurring of vision
3. Convulsion
4. Vaginal bleeding
5. Fever