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Dr. Areefa Al Bahri
Ch. 5
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.
Importance of Antenatal
• To ensure that the pregnant woman and her fetus
are in the best possible health.
• To detect early and treat properly complications
• Offering education for parenthood
• To prepare the woman for labor, lactation and care
of her infant
Schedule for Antenatal
The first visit or initial visit should be made as
early is pregnancy as possible.
Return Visits:
• Once every month till 30.
• Once every 2 weeks till the 37
• Once every week during the 38, till labor.
Signs of pregnancy
• Presumptive (subjective )signs of pregnancy:
These signs are least indicative of pregnancy; they could easily indicate
other conditions. signs lead a woman to believe that she is pregnant
 Amenorrhea.
 Breast changes and tangling sensation.
 Chlosma and linea nigra.
 Abdominal enlargement & striae gravidarum.
 Nausea & vomiting.
 Frequent urination.
 Fatigue
 quickening :sensations of fetal movement in the abdomen. Firstly
felt by the patient at approximately 16 to 20 weeks.
Probable signs( objective) of pregnancy:
 Hegar’s sign (softening of the lower uterine segment).
Goodell’s sign (softening of the cervix ,uterus, and vagina
during pregnancy.).
 Ballottement. (dropping and rebounding of the fetus in its
surrounding amniotic fluid in response to a sudden tap on
the uterus)
 Positive pregnancy test.
 Braxton hicks contractions. more frequently felt after 28
weeks. They usually disappear with walking or exercise.
Positive signs of pregnancy:
 Fetal heart tones :
 by Doppler technology
 Fetal movement felt by the
examiner. after about 20 weeks'
 Visualization of the fetus by the
Assessment and physical examination.
☺ history.
☺ Physical assessment.
☺ Nutritional assessment
☺ Psychological assessment
☺ Laboratory data.
☺ Ultrasound.
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 - 13 kg.; 2kg in the first 20
(1.5 kg per week until term).
• General exam ex. Vital sign , systemic,
 The size of the abdomen
is inspected for:
- the height of the fundus,
which determines the
period of the gestation.
- multiple pregnancy.
Laboratory data
Blood group
To determine blood type.
Hgb & Hct
To detect anemia.
To determine immunity
Urine analysis
To detect infection or renal disease.
protein, glucose, and ketones
Papanicolaou (pap) test
To screen for cervical cancer
To detect sexual transmitted disease.
To screen for gestational diabetes.
Stool analysis
for ova and parasites
Hepitits Bserface antigine To detect carrier status or
active disease
Hemoglobin will be repeated:
At 36 weeks of gestation.
Every 4 weeks if Hb is<9g/dl.
If there is any other clinical reason.
• Fetal heart sound is heard by sonicaid as
early as 12-16 thweek of pregnancy.
• Fetal heart sound is heard by Pinard' s fetal
stethoscope after the 20thweek of
• The normal fetal heart rate is 120-160
Health Teaching during the First
• Physiological changes during
• Weight gain
• Fresh air and sunshine
• Rest and sleep
• Diet
• Daily activities
• Exercises and relaxation
• Hygiene
• Teeth
• Bladder and bowel
• Sexual counseling
Smoking :
Occupational and
environmental hazards
Follow up
Minor discomforts
Signs of Potential