ANTENATAL CARE

BY DR Rushabh Mehta

ANTENATAL CARE

BY DR Rushabh Mehta

DEFINATIONSystemic supervision of

womman during pregnancy is called antenatal care

Starts with begining of pregnancy

Ends at time of delivery

INCLUDES

1 . History General Examination Obstetrical

2 . Advice

AIMS1 . To screen high risk pregnancy2 . Prevant & treat complication3 . To continue medical survellence4 . To educate mother about physiology

of pregnancy & labour by demonstration charts & diagrams

5 . To discuss with couple about place,time & mode of delivery

6 . Need of family planning

OBJECTIVE

Healthy mother in possesion of healthy child

CRITERIA OF NORMAL PREGNANCY1. Retrospective term2. Delivery of a single baby between

38-42 weeks by date, weight 2.5 kg with no maternal complication

PROCEDURE AT 1ST VISIT

It shoud be be before she missed second period

OBJECTIVES

1.Asses health status of mother & foetus & screen out at risk pregnancy

2.Base line information above subsequent changes are assessed to determine gestational age

HISTIRY TAKING VITAL STATISTICS

NameAgeGravida/ParaReligionOccupationOccupation of husbandPeriod of gestationComplaintsIf no complaints then inquire about

sleep,appetite,bowel habit,urinary problems

HISTORY OF PRESENT PREGNANCY

HyperemesisThretand abortionPyelitisPre eclempsiaAPHMedicationRadiationMedical Surgical event

OBSTETRICAL HISTORYNumber of living child-boy-girlHealth status of BabyImmunisationLast issue MENSTRUAL HISTORY

1. LMP2. Regular cycle E.D.DNaegele’s formula

PAST MEDICAL HISTORY PAST SURGICAL HISTORY FAMILY HISTORYHigh BPDiabetesThyroid disorderBlood Dyscrasia PERSONAL HISTORYSmokingAlcoholContraception

EXAMINATIONGENERALBuiltObese/Average/ThinNutritionGood/Average/PoorHeightWeightPulseJaundiceTongue/Teeth/Gum/TonsilNeckOedema over leg

Causes of oedemaphysiologicalpre eclampsiaanaemiahypo proteinemiaheart failurenrphrotic syndrome

Pulse/BP/Heart/Lung/LiverBreast examination mandatoryPregnancy changes of nipple & areola

OBSTETRICAL EXAMINATION

1. Abdominal2. Vaginal-stages of vaginal examinationpass urine1.Inspection2.P/S-Vaginal or cervical swab to be taken3.Bimanual-Cervix-consistancy

-direction-Uterus-size

-shape -position -consistancy

ROUTINE EXAMINATION

Blood group Rh VDRL HBsAg HIV

URINE EXAMINATION

PROTEIN SUGAR PUS CELLS

CERVICAL CYTOLOGY

ULTRASOUND EXAMINATIONDetection of early pregnancyAccurate dateAbnormalityNumber of foetusUterus or Adenexal abnormalityPlacental localization

REPEAT INVESTIGATION Hb28 wks

36 wks UrineAlbumin

Sugar Every month

Procedure at subsequent visitCheck up4 weeks upto 28 weeks

2 weeks upto 36 weeksweekly till delivery

OBJECTIVEFoetal well beingLie , presantation , position &

number of foetusGrowth restriction , pre eclampsia

anaemia , polyhydroamniosSpecial antenatal clinic for

cardiac diseases & diabetesChorion villous sampling or

amniocentesis when indicated

HISTORY-New complaints-Date of quickening

GENERAL-Weight-Pallor-Oedema-BP

ABDOMAN EXAMINATIONFundal heightSecond trimester external ballotmentThird trimesterabdominal palpation-presantation-position-Volume of liquorAbdominal girth increases by 1 inch per

week beyond 30 weeks

VAGINAL EXAMINATIONAt 37 wksBefore inductionWith onset of labour

ANTENATAL ADVICE

PRICIPLESTo impress the patient about regular

check up

Maintain & improve health status

improve psychology & remove fear of unknown

DIETAdequate1 . Maternal health2 . Need for growing foetus3 . Strength of vitality required

during labour4 . Successful lactation Normal 1800 to 2000 + 300

calory

PREGNANCY DIET SHOUD BE

Rich in –Carbohydrates -Proteine -Vitamins -Mineral

It shoud be –Light -Nutritious -Easily digestible

DIET ADVICE

DEPENDS ON

-Socio economical status-Habits-Taste-Reasonable & Realistic

SUPPLEMENTORY NUTRITIONAL THERAPY IRON TBLETS VITAMINS CALCIUM-1GM FOLIC ACID-1MG RIBOFLAVIN-2MG NICOTINIC ACID-15MG

REST & SLEEP

Normal work

8-10 hour sleep

Avoid streneious work

BOWEL

Fluids

Green vegetables

Mild laxatives

BATH

CLOTHES/SHOES/BELT

DENTAL CARE-Extraction-Filling carries tooth

CARE OF BREAST Retracted nipple – correction done by

manipulation or by using shields

COITUSAvoid-1st trimester

-last 6 wks

TRAVEL-Avoid-railway preferred-air preferred

SMOKING & ALCOHOLInjourious to health

IMMUNISATIONTetanus toxoid

GENERAL ADVICECome to hospital if1.Painful uterine contraction

2.Sudden gush of watery fluid per vaginum

3.Any vaginal bleeding

MATERNAL EXERCISE , DANCE , YOGA THERAPY

COCHRANE REVIEWPregnant woman engaged in vigorous

exercise of atleast 2-3 times a week1 . Pregnancy of same length2 . Improves physical fitness3 . No late pregnancy complication

BENEFITS OF EXERCISE

Strengthens the muscleImprove postureGive enegy & improve moodDecreased discomfort of

pregnancyIncreased sleep,stamina,strength

BENEFITS TO INFANT

LESS BODY FATLESS CRANKY & LESS

INFANTILE COLICGREATER

NEURODEVELOPMENTAL SCORE AT 5 YEAR

RISK OF SEDENTARY LIFE

Decreased muscular tone Decreased cardio vascular fitness Excessive maternal weight gain Development of varicose vein PIH DVT Dyspnoea Low back pain Poor psychological adjustment

CONDITIONS REQUIRING MEDICAL SUPERVISION Cardiac disease Lung disease PIH Pre term labour/IUGR Placenta previa Multiple gestation thyroid

1.ANTENATAL CARE AT PRIMARY HEALTH CENTRE TETANUS TOXOID immunisation Iodide & folate supplementation Breast feeding counselling Identification of major risk of

obstructed labour

2.CHRMOSOMAL ABNORMALITY1 . FIRST TRIMESTER

-beta HCG-PAPP(pregnancy associated plasma proteine)

2 . SECOND TRIMESTERtriple marker

It includes-AFP -HCG -unconjugated oestrogen

QUADRUPLE TESTFourth biochemical markerINHIBIN-A it is increased in down’s

syndrome

FACTORS AFFECTING MARKERSFACTORS AFFECTING MARKERS-maternal weight-no of foetus-smoking-ethinicity-gravidity & parity-assisted reproduction-diabetes

OSCAR CLINIC

ONE STOP CLINIC FOR ASSESMENT OF RISK FOR FOETAL ANOMALY

Beta HCG + PAPP & USG for nuchal translucency + crown rump length + anomaly scan carried out between 11 to 14th weeks