2. At the end of this session student will be able to:
• To demonstrate how to make an immediate
general assessment of the pregnant
woman
• To apply the process flow of providing
antenatal care services
• To discuss the importance Antenatal care

3. Antenatal Care/Prenatal Care
ANC is the care of the woman during
pregnancy to achieve a healthy mother and a
health baby.

4. Providers of Antenatal care
• Doctor
• Nurse
• Midwife/auxiliary midwife

5. Goals of antenatal care
1. The main goal is the safety and welfare of the mother
and her fetus.
2. The preparation of mother for labor, and lactation.
3. The early detection and appropriate treatment of highrisk conditions.
4. The reduction of maternal and infant mortality, and
prematurity.

6. Components of antenatal care
A) Registration
B) History taking
C) Obstetric Examination
D) Clinical service
E) Health Education
F) Immunization

7. 1- Registration of AN visits
• Booking visit: to be at 6th week of gestation
• 6th – 28th week : to be very 4 weeks
• 29th – 36th week: to be every 2 weeks
• 36th up to delivery: to be weekly

8. ANC4

The World Health Organization (WHO)
recommends a minimum of four antenatal
visits.
At least 4 routine antenatal visits
1st visit: before 4 months
2nd visit: 6 months
3rd visit: 8 months
4th visit: 9 months

9. Visits to Prenatal Care
Make the woman comfortable.
Greet her, make sure she is comfortable and ask
how she is feeling.
If first visit, register the woman and issue a
Mother and Child Book (antenatal record form)

10. 2- OBSTETRIC HISTORY



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1-General information
Name, age , gravidity, parity, LMP, EDD
Gravidity no. of pregnancies including current
pregnancy (regardless of the outcome N or abortion)
Parity no. of births beyond 24 wk gestation
2-Current problem/ complaint
3-History of current complaint
4-History of current pregnancy
 details of the 1st ,2nd & 3rd trimester
lab tests & U/S scanspattern

11. OBSTETRIC HISTORY
5-Menstrual & gynecological history
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LMP details ( was it conform to the usual in terms of
timing, volume, and appearance)
Regular or irregular cycles
Length of the cycle
Surgical procedures
Hx of infertility
Sexually transmitted diseases

12. OBSTETRIC HISTORY
6-Past obstetric history
 Outcome of previous pregnancies in details including
the abortions
 Any significant antenatal, intrapartum or postpartum
events
 Previous maternal complications
 Mode of delivery
 Baby Wt
 Life & health of the baby

13. OBSTETRIC HISTORY
7-Past medical/ surgical Hx
Some medical conditions may have impact on the course of the
pregnancy or the pregnancy may have an impact on the medical
condition examples:







Heart disease
Hypertension
DM
Epilepsy
Thyroid disease
Bronchial asthma
Any previous surgery.

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Kidney diseases
UTI
Autoimmune disease
Psychiatric disorders
Hepatitis
Venereal diseases
Blood transfusion

14. OBSTETRIC HISTORY
8. Drug Hx
9. Family Hx
- Hereditary illness → DM., thalassemia, sickle cell
disease, hemophilia
- Congenital defects eg. neural tube defects, Down
syndrome
- Twins
10. Social Hx → Cigarette smoking, illegal drug use, domestic
violence, housing condition.

15. 3- OBTETRIC PHYSICAL EXAMINATION

General exam
-Ht. Wt., BMI
-BP in 2nd trimester
-Pulse 
-Head, eyes, ears, nose & throat no changes
-Thyroid diffuse enlargement
-Skin pigmentation of the face (chloasma), abdomen (linea nigra)
Stretch marks on the abdomen, thighs & breasts

16. OB PHYSICAL EXAM

General exam
-Breast nodularity
-CVS HR 
 COP
-Lungs Elevation of the diaphragm  total lung
capacity

17. Abdominal exam
1-Inspection
shape & size
 asymmetry
 fetal movement
surgical scars
cutaneous signs of pregnancy linea nigra, striae
gravidarum, umbilicus flat or everted, superficial veins

18. Abdominal exam
2-Palpation

Fundal Height

Fundal Grip

19. Abdominal exam
2-Palpation:

Lateral Grip

Pelvis Grip

20. 2-Palpation:

Deep pelvic grip

21. 3-Ascultation fetal heart at 13-14 wks
4-Percussion polyhydramnious

22. Vulval &Vaginal exam
not routinely performed
-Hyper pigmentation
-Look for abnormalities  Varicose veins/
hemorrhoids,Warts or herpes
- vaginal secretions
-Cx Softer, pigmented
-Uterus enlarged

23. Provision of AN visits
ON ALL VISITS:
Check duration of pregnancy (AOG).
Ask for bleeding/danger signs during this
pregnancy
Check record for previous treatments
received during this pregnancy
Prepare birth and emergency plan
Ask patient if she has other concerns
Give education and counseling on family
planning and breastfeeding

24. 4- Clinical Services during ANC
Get baseline laboratory information of the
woman on the first or following the first visit.
Hemoglobin, blood group
Urinalysis
VDRL or RPR to screen for
syphilis

25. Check for pallor or anemia.
On 1st visit, check hemoglobin &
blood type. The normal
hemoglobin cut-off level for a
pregnant woman is 11g/dl.
On subsequent visits:



Look for conjunctival pallor.
Look for palmar pallor.
Count number of breaths in one
minute.

26. Check for hypertension/ pre-eclampsia.
Measure BP in sitting position.
If diastolic BP is 90 mm Hg or
higher repeat measurement
after 1 hour rest.
If diastolic BP is still 90 mm Hg
or higher ask the woman if she
has:
•
Severe headache
•
Blurred vison
•
Epigastric pain
Check urine for protein.

27. 5- Immunize against tetanus.
Tetanus Toxoid Immunization Schedule
Vaccine
TT1
Minimum Interval
at first contact with woman 15-49
yrs or at first ANC visit
Duration of Protection
NIL – no protection
TT2
at least 4 weeks after TT1
•Infants born to the mother will be protected from
neonatal tetanus
•3 years of protection for the mother
TT3
at least 6 months after TT2
•Infants born to the mother will be protected from
neonatal tetanus
•5 years of protection for the mother
TT4
at least 1 year after TT3
•Infants born to the mother will be protected from
neonatal tetanus
•10 years of protection for the mother
TT5
at least 1 year after TT4
•Infants born to the mother will be protected from
neonatal tetanus
•Lifetime protection for the mother

28. 6- Provide health information, advice
HEALTH INFORMATION:
1.Nutrition
2.Self-care during pregnancy
3.Effect of tobacco, alcohol &
drugs
4.Breastfeeding
5.Birth & Emergency situations
6.Schedule of appointment

29. Advise on Danger Signs
1. Vaginal bleeding
2. Convulsions
3. Severe headache
4. Severe abdominal pain
5. Fast or difficult breathing
6. Fever or burning urination