This document provides information about antenatal care. It discusses what antenatal care is, its aims and objectives which include screening for high risk cases, preventing or treating complications, educating mothers, and motivating family planning. It outlines the criteria for a normal pregnancy and services including 4 recommended visits. The document details what occurs at the first visit including taking a thorough history and conducting an examination. It provides advice that should be given to mothers during antenatal care such as maintaining a nutritious diet, getting adequate rest, and being aware of warning signs during pregnancy.

1. Antenatal care
Presented by:
Captain Donna W.M. Khyriem
166 MH

2. What is Antenatal care?
• Periodic and regular supervision including
examination and advice of a woman during
pregnancy is called Antenatal care.

3. AIMS
The aims are-
• To screen the high risk cases
• To prevent or detect or treat at the earliest any
complications
• To ensure continued medical surveillance and
prophylaxis
• To educate the mother about the physiology of
pregnancy and labour by demonstrations, charts and
diagrams so that fear is removed and psychology is
improved.

4. AIMS (cont’d)
• To discuss with the couple about the place, time and
mode of the delivery, provisionally and care of the
newborn
• To motivate the couple about the need of family
planning
• To advice the mother about breast-feeding, post-natal
care and immunization

5. OBJECTIVES
To ensure a normal pregnancy with
delivery of a healthy baby from a
healthy mother

6. CRITERIA OF NORMAL PREGNANCY
Delivery of a single
baby in good condition
at term (38 -42), with
fetal weight of 2.5kg
or more and with no
maternal complication

7. SERVICES
As per WHO recommendation at least 4 visit-
• 1st visit around 16 weeks
• 2nd visit between 24-28 weeks
• 3rd visit at 32 weeks
• 4th visit at 36 weeks

8. Services (cont’d)
Generally-
• At interval of 4 weeks up to 28 weeks
• At interval of 2 weeks up to 36 weeks
• At weekly interval up to EDD
15
visits

9. Antenatal care
comprises of-
• Careful history
taking and
examination and
investigation
• Advice given to the
pregnant woman

10. THE FIRST VISIT
• History taking
• Examination
• Investigation

11. History taking
1. Particulars of the patient
2. Chief complaints with duration
3. Past medical surgical history
4. Obstetric history
5. Menstrual history
6. Family history
7. Drug History
8. History of immunization
9. Socio-economic history
10.Contraceptive history
11.History of allergy

12. Particulars of the patient
1. Name
2. Date of first Examination
3. Address
4. Age
5. Duration of marriage
6. Religion
7. Occupation

13. Chief complaints with duration
1. Period of amenorrhea
2. Nausea & vomiting, vertigo
3. Increased frequency of micturition
4. Constipation
5. Heaviness of breast
6. Rise of temperature
7. Edema
8. Pain in the abdomen
9. Backache
10. Vaginal bleeding

14. Past history
1. HTN
2. DM
3. Renal Disease
4. Psychiatric illness
5. IHD
6. Any previous operation

15. Obstetrical History
• Duration of marriage
• Gravida
• Para
• Abortions

16. Menstrual History
Age of menarche
Menstrual period
Menstrual cycle
LMP
EDD

17. Family history
a) HTN
b) DM
c) Multiple pregnancy
d) Tuberculosis
e) Known hereditary diseases

18. Drug History
Antihypertensive
Hypoglycemic
Antidepressant
Corticosteroid
Anticoagulant

19. General examination
Abdominal examination

20. General examination
• Appearance
• Height of patient
• Weight of patient
• Anemia
• Jaundice
• Edema
• Cyanosis

26. General examination (cont’d)
• Temperature
• Pulse
• BP
• RR
• Breast
• Heart sound
• Lungs

27. Abdominal examination
A thorough and systemic
abdominal examination
beyond 28weeks of
pregnancy

28. Patient Preparation
• Patient is asked to evacuate the bladder
• Lie in dorsal position with thighs slightly flexed
• Abdomen is fully exposed
• Examiner stands on the right side of the patient

29. Abdominal Examination
Inspection
Palpation
Percussion
Auscultation

30. • Shape of the uterus-
Longitunidal /transverse/
oblique
Inspection

31. Inspection
Striae
scar mark

32. Inspection
Contour of the uterus- fundal
notching, convex or flattened
anterior wall, cylindrical or spherical
shape
Undue enlargement of the uterus

33. PALPATION
• Assessment of fundal height
• Abdominal girth
• Fundal grip
• Lateral grip
• First pelvic grip
• Second pelvic grip

35. SYMPHYSIS FUNDAL HEIGHT (SFH)

39. Leopold maneuvers

40. FETAL POSITIONS

41. Auscultation
Normal FHR is 120-160 b/m
Causes of foetal tachycardia (>160 b/m)
Causes of foetal bradycardia (<120 b/m)

43. Causes of foetal tachycardia
(>160 b/m)
1. Maternal high fever
2. Foetal distress
3. Maternal tachycardia

44. Causes of foetal bradycardia
(<120 b/m)
1. Foetal distress
2. Foetal cardiac conduction defect

45. FETAL HEART SOUND

46. Per Vaginal Examination

47. Normal Labour

49. Station of the head

50. Investigation
• CBC
• Blood grouping & Rh typing
• Urine R/E
• RBS
• VDRL
• HBS Ag
• Ultrasound

51. In Subsequent Visit
• Patient complains
• General examination
• Gestational age to be calculated
• Identification of problem
• Fetal movement
• SFH measurement
• Health education
• Prophylaxis & treatment of anemia
• Developing individualized birth plan

52. Second visit (24-28 weeks)
SFH measurement
To detect Multiple pregnancy

53. Third visit (32 weeks)
Screen for-
1. Preeclampsia
2. Multiple pregnancy
3. Anemia
4. IUGR

54. Fourth visit (36 weeks)
• Identification of fetal
1. Lie
2. Presentation
3. Position
• Update birth plan

55. Antenatal advice
Principles:
1. To impress the patient about the importance of regular check up
2. To maintain or improve the health status of the woman to the
optimum till delivery by judicious advice regarding diet, drugs
and hygiene
3. To improve and tone up the psychology and to remove the fear of
pregnancy by talking sympathetically to the patient and
explaining the principle changes and events likely to occur during
pregnancy

56. Antenatal advice (cont’d)
• Diet
• Rest & sleep
• Bowel
• Personal cleanliness
• Clothing, shoes & belt
• Dental care
• Care of breast
• Coitus
• Travelling
• Smoking & alcohol
• Immunization
• Drug
• Mental
preparation
• Exercise
• Child care
• Birth plan
• Family planning
Following advices are to be given:

57. DIET
Diet should be:
1. nutritious
2. balanced
3. light
4. easily digestible
5. rich in protein,
mineral and vitamin

58. Rest and sleep
• 8 hour sleep at night
• At least 2 hour sleep after mid-day
meal
• Hard strenuous work should be
avoided in first trimester and last 4
weeks

59. Bowel
• Regular bowel movement may be facilitated
by regulation of diet, taking plenty fluid,
vegetable and milk
Coitus
Should be avoided in
• 1st trimester
• last 6 weeks

60. Travelling
Should be avoided in
• 1st trimester
• last 6 weeks
Air travelling is contraindicated in
• Placenta praevia
• Preeclampsia
• Severe anemia

61. Immunization
Indicated-
• TT
• HAV
• HBV
• Rabies
Contraindicated-
• Live virus vaccine (rubella measles, mumps,
varicella)

62. Warning sign
1. Headache
2. Blurring of vision
3. Convulsion
4. Vaginal bleeding
5. Fever