ANTENATAL CARESreelakshmi. M

ANTENATAL CARE

SREELAKSHMI. M

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

Why

•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•To attend to the under-fives

Schedule For Antenatal Visits in India

Monthly up to 28 weeksTwo weekly between 28 and 36 weeksWeekly 36 weeks onwards.(This equals about 15 visits)

High-risk cases more frequent

visits

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

Aims of Booking VisitoGet 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 likeHB, blood group, Rh typing & urine analysis

Routine Investigations Name First done Repeated Interpretation

1. Hb, PCV Booking Once every trimester

<10 g/dL or < 11 g/dL (WHO) 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 cultureAlb+ or >, consider pre-eclampsia

5. GCT 24-48 weeks --- 130 mg/dL or more, do a GTT

History & Examinatioin

History takingSystemic & obstetric examination

Palpation: symphyseofundal height on

every visit

• Pelvic examination in 1st trimester

Continued..Sometimes other tests in individual cases like:• Testing for hemoglobinopathies• Glycosylated Hb• Maternal serum for screening Down’s syndrome

Immunizations in PregnancyTetanus 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

Medications 1. Folic acid – 5mg during 1st trimester ( if not

begun preconceptionally)

2. Fe & Ca started at 13 wks continued for 3 months after

pregnancyFe- 100mg Ca- 1mg/day

Health Education for the Pregnant womanDiet

need extra 300kcal/day from 2nd trimester onwards Protein Salt Iron Calcium : 1.5 g daily Vit. C, folic acid, Vit. B12 + tablets

Continued.. Weight gain: total of 11 kg. 500 g/wk during 2nd trimester Rest: Activity & Exercise:Clothes :Coitus Smoking & alcohol : abortion, growth restriction, fetal alcohol syndrome restricted

Drugs :Care of breasts: Travel :

Warning signals !!!Bleeding p/v at any time in pregnancyHead ache, blurring vision, epigastric pain &

oliguriaPedal oedema, severe, not subsiding with rest, or

on face & handsDecrease/ loss of fetal movementsAbdominal painUrinary infection with vulvovaginitisClear fluid p/v PROM

Common Symptomatology in pregnancyNausea & vomitingBackache Varicose veinsHemorrhoidsVaginal dischargeAcidity & heart burnConstipation

Antenatal care up to 28 weeks

Woman should seek care every monthWeight, bp & urine checked at each visit

Quickening, anemia, oedema (!!)

Symphyseofundal height

Others: Targeted ultrasound scan for anomalies (18-20 wks)…….

Antenatal care after 28 weeksCrucial period: pre-eclampsia, GDM, growth

disorders

bp, weight, urine routine, Hb

Symphyseofundal height: detect IUGR & macrosomia

She should be made aware…..

Vaginal examination

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:

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

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

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

Thank You…..