Antenatal care

1. DR.N.MONISHA

2. What is it?
 The care of the pregnant woman with the aim of
achieving a healthy pregnancy and delivery of a
normal,healthy baby
 Good antenatal care helps a woman to face labour in
good health and in optimum condition

3. AIMS OF
ANTENATAL CARE
•Promote, protect & maintain the health of
mother
•Detect high-risk cases
•Proactive approach to complications
•Remove the anxiety and dread associated
with pregnancy
•Reduce maternal and infant mortality and
morbidity rate
•Teach mother the elements of child care,
nutrition, personal hygiene &
environmental sanitation

4. Schedule For Antenatal Visits
 Monthly up to 28 weeks
 Two weekly between 28
and 34 weeks
 Weekly 34 weeks onwards.
High-risk cases more
frequent
visits

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 counselling if unplanned pregnancy

6. Aims of Booking Visit
oGet detailed history & assess if high risk
oEstablish correct gestational age and date pregnancy
oProvide information about what is to expected, the danger
signals etc. which she should know of
oPerform baseline investigations like
HB, blood group, Rh typing & urine
Analysis, Serology

7. Routine Investigations
Name First done Repeated Interpretation
1. Hb, PCV Booking Once every
trimester
<10 g/dL or < 11 g/dL
(WHO) FOGSI<10g/dl
consider as anemia
2. Blood group &
Rh typing
Booking --- If Rh –ve, husband’s
group & ICT
3. HbsAg, HIV,
VDRL
Booking --- If +ve, refer for counselling
& PPTCT
4. Urine routine
examination
Booking Every visit Pus cells> 5, do a culture
Alb+ or >, consider pre-
eclampsia
5. GCT
6.DIPSI
24-28 weeks
24-28 weeks
--- 130 mg/dL or more, do a
GTT
<140mg/dl

8. History & Examinatioin
 History taking
 Systemic & obstetric examination
Palpation: symphyseofundal height on
every visit
GRIPS: FUNDAL GRIP
SECOND GRIP/UMBLICAL GRIP
FIRST PELVIC/PAWLIK’S GRIP
SECOND PELVIC GRIP

9. 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
epidemics
C.I
Tetanus Typhoid Rubella
Hepatits Cholera MMR
Rabies Varicella
BCG
Yellow fever

10. Medications
1. 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- 1g/day

11. Health Education for the
Pregnant woman
 Diet
 need extra 300kcal/day from 2nd trimester onwards
 Protein
 Salt
 Iron
 Calcium : 1.5 g daily
 Vit. C, folic acid, Vit. B12
 + tablets

12. Continued..
 Weight gain: total of 11 kg.
 500 g/wk during 2nd trimester
 Rest and sleep
 Activity & Exercise
 Clothes : loose clothing is preferred
 Coitus
 Smoking & alcohol and drugs
 Care of breasts
 Travel

13. 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

14. Common Symptomatology in pregnancy
 Nausea & vomiting
 Backache
 Varicose veins
 Hemorrhoids
 Vaginal discharge
 Acidity & heart burn
 Constipation

15. 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)…….

16. Antenatal care after 28 weeks
 Crucial period: pre-eclampsia, GDM, growth
disorders
 bp, weight, urine routine, Hb
 Symphyseofundal height: detect IUGR & macrosomia
 Vaginal examination

17. Ultrasound in Pregnancy..
 First trimester scan- helps to detect early
pregnancy,accurate dating,number of foetus….
 Booking scan : 10-14 wks confirm gestational age
assess nuchal translucency
• 2nd trimester :anomaly scan
• 3rd trimester : growth scan

18. Preconceptional / Prepregnancy Councelling
1. 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

19. 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

20. 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

21. Thank You…..