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Antenatal Care
Definition of Antenatal care
comprehensive health supervision of a
pregnant woman before delivery
Or it is planned examination, observation
and guidance given to the pregnant
woman from conception till the time of
labor.
Goals
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To reduce maternal and perinatal
mortality and morbidity rates
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To improve the physical and mental
health of women and children
Importance of Antenatal Care
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To ensure that the pregnant woman and her
fetus are in the best possible health.
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To detect early and treat properly
complications
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Offering education for parenthood
To prepare the woman for labor, lactation and
care of her infant
Schedule for Antenatal Visits:
The first visit or initial visit should be made
as early is pregnancy as possible.
Return Visits:
 Once every month till 7th month.
 Once every 2 weeks till the 9th month
 Once every week during the 9th month,
till labor.
Assessment
History
Examination
Investigation
History
 Personal
history
 Family history
 Medical and surgical history
 Menstrual history
 Obstetrical history
 History of present pregnancy
Physical Examinations
Height of over 150 cm indication of an
average-sized pelvis
 The approximate weight gain during
pregnancy is 12 kg.; 2kg in the first 20
weeks and 10 kg in the remaining 20
weeks (1.5 kg per week until term).
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Obesity (more than 20 kg above the
weight-height formula) leads to an
increased risk of gestational diabetes,
pregnancy-induced hypertension and
thrombo-embolic disorders
Local Examination
The uterus may be higher than expected
due to large fetus, multiple pregnancy,
polyhydrammnios or mistaken date of last
menstrual period.
 The uterus may be lower than expected due
to small fetus, intrauterine growth
retardation, oligohydramnios or mistaken
date of last menstrual period.
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Fetal heart sound is heard by sonicaid as
early as 10thweek of pregnancy.
 Fetal heart sound is heard by Pinard' s
fetal stethoscope after the 20thweek of
pregnancy.
 The normal fetal heart rate is 120-160
beats/min
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Investigations:
 Urine
should be tested for sugar,
ketones and protein.
 Hemoglobin
will be repeated:
 At 36 weeks of gestation.
 Every 4 weeks if Hb is < 9 g/dl.
Fetal kick count
 The
pregnant woman reports at
least 10 movements in 12 hours.
 Absence
of fetal movements
precedes intrauterine fetal death
by 48 hours.
Health Teaching during the First
Trimester
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Physiological changes
during pregnancy
Weight gain
Fresh air and sunshine
Rest and sleep
Diet
Daily activities
Exercises and relaxation
Hygiene
Teeth
Bladder and bowel
Sexual counseling
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Smoking :
Medications
Infection
Irradiation
Occupational and
environmental hazards
Travel
Follow up
Minor discomforts
Signs of Potential
Complications
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Exercise should be simple, mild exercise avoid
lifting heavy weights
 A tooth can be extracted during pregnancy,
but local analgesia is recommended
 Catheter and enema should be avoided.
 Smoking may lead to ptyalism, nervousness
and hyper emesis and make pregnant woman
at increased risk of chest infections and
thrombo-embolic disorders
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Pregnant woman should avoid contact with
infectious diseases especially rubella or
(German measles) because it has deleterious
effects on the fetus
 Pregnant woman should avoid exposure to x-
ray or irradiation because of possible
teratogenic effects on the fetus such as birth
defects or childhood leukemia
Common Discomforts of Pregnancy,
Etiology, and Relief Measures :
Urinary frequency
RELIEF MEASURES:
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Decrease fluid intake at night.
Maintain fluid intake during day.
Void when feel the urge.
Fatigue
RELIEF MEASURES:
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Rest frequency.
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Go to bed earlier.
Sleep difficulties
RELIEF MEASURES:
 Rest frequency
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Decrease fluid intake at night
Breast enlargement and
sensitivity
RELIEF MEASURES:
Wear a good supporting bra.
 Assess for other conditions.
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Nasal stuffiness and epistaxis
ETIOLGY: Elevated estrogen levels
 RELIEF MEASURES :
 Avoid
decongestants.
 Use humidifiers, and normal saline drops .
Ptyalism (excessive salivation)
ETIOLGY: Unknown
RELIEF MEASURES:
Perform
frequent mouth care.
Chew gum.
Decrease fluid intake at night.
Maintain fluid intake during day.
Nausea and vomiting
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RELIEF MEASURES:
 Avoid food or smells that exacerbate condition.
 Eat dry crackers or toast before rising in morning.
 Eat small, frequent meals.
 Avoid sudden movements. Get out of bed slowly
 Breath fresh air to help relieve nausea.
Shortness of breath
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RELIEF MEASURES:
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Use extra pillows at night to keep more upright.
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Limit activity during day
Heartburn
RELIEF MEASURES:
Eat small, more frequent meals.
 Use antacids.
 Avoid overeating and spicy foods.
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Dependent edema
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Avoid standing for long periods.
Elevate legs when laying or sitting.
Avoid tight stockings.
Varicosities
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Rest in sims' position.
Elevate legs regularly.
Avoid crossing legs.
Avoid tight stockings.
Avoid long periods of standing
Hemorrhoids
RELIEF MEASURES:
Maintain regular bowel habits.
Use prescribed stool softeners.
Apply topical or anesthetic
ointments to area.
Constipation
RELIEF MEASURES:
Maintain regular bowel habits.
Increase fiber in diet.
Increase fluids.
Find iron preparation that is
least constipating
Leucorrhea
RELIEF MEASURES:
Take
a daily bath or shower.
Wear cotton underwear.
Backache
RELIEF MEASURES:
Wear shoes with low heels.
Walk with pelvis tilted forward.
Use firmer mattress.
Perform pelvic rocking or tilting
Leg cramps
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RELIEF MEASURES:
Extend affected leg and dorsiflex the foot.
 Elevate lower legs frequently.
 Apply heat to muscles.
 Evaluate diet.
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Faintness
RELIEF MEASURES:
•Rise slowly from sitting to standing.
•Evaluate hemoglobin and
hematocrit.
•Avoid hot environments