ANTENATAL CARE
Case Scenario
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Farah 22 years old lady came to MCH center,
accompanied with her mother in law, complains from
nausea, fatigue, and missed period. LMP
15/7/2021
Antenatal period:
Time of physical and psychological preparation for
birth and parenthood. (time between conception
and the onset of labour ).
Antenatal care:
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Care provided to improve the health of the
pregnant woman and her baby by monitoring the
progress of the pregnancy and detecting and
managing any problems.
Pregnancy span 9 month ,but health care
provider use concept of lunar month, which
last 280 days, or 40weeks .
 First trimester last from 1 to 13 weeks .
 Second trimester last from 14 to 26 weeks.
 Third trimester from week 27 through 40.
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The purpose of antenatal care are to:
Establish baseline of present health.
 determine the gestational age of fetus.
 Monitor fetal development.
 Identify women at risk for complication.
 Minimize the risk of possible complication by
anticipating and preventing problem before
they occur.
 Provide time for education about pregnancy,
lactation and newborn care

Diagnosis of Pregnancy
Pregnancy may be assumed based on the
presence of certain signs and symptoms:
Presumptive signs are subjective and
recorded under the history of present
illness
Probable and positive signs of pregnancy are
objective and recorded as physical
assessment findings
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Urine pregnancy test: Reacts with human chorionic
gonadotropin (hCG), Performed on first voided urine
sample of the day; positive approximately 4 weeks
following the first day of the last menstrual period
Serum pregnancy test: Useful in monitoring expected
pattern of progression of hCG; detects hCG as early
as 9 days post-conception
Ultrasound: Confirms presence of gestational sac,
and fetal, cardiac activity, Validates location of
pregnancy (intrauterine versus ectopic)
Estimate Date of Delivery
Establishing an accurate date of delivery is
important to:
 Determine timing of antenatal screening
 Monitor growth of the fetus
 Scrutinize timing of delivery
■ Common abbreviations denoting delivery date are:
 EDD. ………estimated date of delivery
 EDC. ……… estimated date of confinement
 EDB. ……… estimated date of birth
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Naegele’s Rule
Formula used to estimate date of delivery
 Count back 3 months and add 7 days to the last
menstrual period (LMP) reported by the patient
 Example: The patient states that her LMP was April
20th.
20+7/4-3
27/1
 The baby is estimated to be due on January 27th
of the following year

Trimesters of Pregnancy
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Normally, pregnancy continues for 40 weeks or 280
days
1st trimester: conception until 12 weeks’ gestation
2nd trimester: 13 weeks until 27 weeks’ gestation
3rd trimester: 28 weeks until 40 weeks’ gestation
Schedule of Prenatal Visits (low-risk
pregnancy)
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Monthly until 28 weeks’ gestation
Biweekly from 28 weeks until 36 weeks
Weekly from 36 weeks until delivery
Nursing Care with First Prenatal
Visit
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Determine EDD based on LMP.
Document current gestational ‫ عمر الجنين‬age.
Document baseline vital signs
Document height, weight, and body mass index
(BMI)
Obtain urine specimen and test for presence of:
Glucose Negative/Trace
Protein Negative/Trace
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Auscultate fetal heart tones.
Fundal height is an indication of uterine size;
periodic measurements of the fundal height should
correlate strongly with fetal growth.
Uterine size increases in pregnancy in a
predictable pattern and is measured to gauge fetal
growth.
Fundal height that is lagging or greater than
expected should be further investigated
The relationship of the fundus (top part) of
the uterus to specific maternal abdominal
landmarks is used throughout pregnancy as a
gauge to assess fetal growth.
 The fundal height measurement correlates to
the weeks of gestation from approximately
22 to 34 weeks of gestation
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McDonald’s method
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Most often, the fundal height is measured with a tape
measure.
This method is usually initiated at around 22 weeks of
gestation.
The end of the measuring tape with the zero mark is
held on the superior border of the symphysis pubis.
Using the abdominal midline as guide, the tape is
stretched over the contour of the abdomen to the top
of the fundus
The measurement (in centimeters) is recorded and
equals the weeks of gestation ±2 wks
Physical examination:
General examination:
 It should be started at the moment of the pregnant
woman walked into the examination room.
 Perform vital Signs as a baseline.
 Report any signs of illness health.
* Examine the height
* Examine the weight
* The approximate weight gain during pregnancy is (
16% - 25% ) from the pre-pregnancy weight.

Diagnostic test
Blood test :
We must detecting the presence of human chorionic gonadotropin (
HCG).
It appear in serum as early as 24 to 48 after implantation.
 Complete blood count.
We must check for hemoglobin concentration ,WBC,RBC.
 Blood typing (include Rh typing).
 Maternal serum for alpha-fetoprotien this level will be elevated
if a neural tube or abdominal defect is present in fetus, low
level may be associated with down syndrome and other
chromosomal abnormalities. (done in 16-18 week).

An indirect coombs test (determination if Rh antibody
are present in Rh negative women)
 Antibody titer for rubella. TORCH.
 Urinanalysis:
 Is performed to test for proteinuria, glycosuria and
offer screening for asymptomatic bacteriuria (ASB).
 Glucose challenges is usually done between 24-28
weeks of gestation.
 Other test :
Aminocentesis procedure used to obtain amniotic fluid for
analysis may be needed to evaluate the fetus for
genetic disorder.
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Ultrasound
It can be used for the following purposes:
 To diagnose pregnancy as early as 6 weeks
gestation.
 To confirm the presence, size, and location of the
placenta and amniotic fluid .
 To detect any abnormality in the fetus, placenta,
amniotic fluid .
 To establish the presentation and position of the
fetus .
 To predict maturity by measuring of the biparital
diameter.

Assessment of fetal growth and
development:
Assess fundal height is used as indicator of fetal
growth.
From approximately gestational weeks 18-32 ,the
height in the fundus in centimeters is approximately
the same as the # of week of gestation (± 2GW).

Fetal movement ( quickening start 16-20 weeks)
To assess the movement ask the mother to lie in a
left recumbent position after a meal and record how
many movement it should be 4 fetal movement/hr),
nurse should instruct the mother to immediately
report any change in fetal movement.
 Fetal heart rate
FHR range from 120 to 160b/m .
 Ultrasound also provide information about wellbeing of the fetus.
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Abdominal exam
(Leopold maneuver)
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Leopold maneuvers: a four-part clinical assessment
method, to determine the lie, presentation, and
position of the fetus
It is necessary to place a small pillow or wedge
under her right or left hip to displace the weight of
the fetus off the major abdominal blood vessels.
A sustained supine position can interfere with gas
exchange between the woman and fetus.
An empty bladder is a prerequisite for abdominal
assessment.
First Maneuver
Determine the height the uterine fundus.
 Determine what fetal part is in the uterine
fundus.
 Will usually indicate the fetal part situated in
the fundus; usually a fetal head; infrequently a
fetal breech.
 Nurse faces woman's head
 Place hands on either side of the fundal area
so that the fingers of both hands almost touch
each other.
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 Can
be palpated above the symphysis pubis
between 12 weeks gestation.
 Reach the level of the umbilicus at about 20
to 22 weeks and reach the xiphoid process at
36 weeks.
 When the baby engages into the pelvis
between 38 and 40 weeks of gestation, the
fundal height drops slightly.
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Press gently and firmly with finger pads.
A somewhat hard and roundish shape, which when
moved back and forth between the finger pads,
also moves the entire fetus usually indicates a fetal
breech, A very hard round well defined shape
which can be moved back and forth (balloted)
usually indicates a fetal head.
First Maneuver: Palpation of the Uterine Fundus
Second Maneuver(latral palpation)
Determines back of fetus along the sides of
maternal abdomen)
 Palpate fetus between two hands
 Assess on which side is the fetal back or spine
and which side has small parts or extremities.
 Hands should alternately apply pressure
against the opposite hand.
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Third Maneuver
pelvic palpation of the uterus - assess the
presenting part).
 Provides information about the presenting part:
breech or head(cephalic ).
 Examiner faces woman's feet
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Place hands on either side of the lower
abdomen with finger pads at the lower uterine
pole and thumbs directed toward the umbilicus.
Carefully move fingers of each hand towards
each other in a downward and inward manner
using gentle pressure.
Fourth Maneuver (pawlik manouver)
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Face the woman's head and spread your hand widely
apart
Grasp the uterine contents just above the symphysis
pubis (firmly but gently)
Hold presenting part between index finger and thumb
Assess for cephalic versus Breech Presentation
This maneuver determine if the presenting part is
engaged or not
Nutrition
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Inquire about dietary practices
Gather 24-hour diet recall
Suggest an addition of 300 healthy calories per
day
Encourage daily prenatal vitamin with 400 micg
folic acid
Suggest 6–8 glasses of water daily
Encourage to follow food pyramid in daily choices
Exercise
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Physical activity in pregnancy is recommended
unless contraindicated by medical complications
Avoid sports with potential for abdominal trauma or
falls
Avoid overheating and supine positioning
■ STOP exercise if experiencing
 Vaginal bleeding
 Cramping
 Leaking of amniotic fluid
 Decreased fetal movement
 Dizziness
 Headache
 Chest pain
 Calf pain
 Dyspnea
Sexuality in Pregnancy
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Sex not restricted in pregnancy unless risk factors
exist for bleeding or preterm labor
Discuss expected changes in sexuality
Change in libido
Body image changes
Braxton-Hicks contractions with orgasm.
Education in the Second and Third
Trimester
■ Teach patient to count fetal movement and report
change in fetal movement pattern.
■ Discuss fetal growth and development.
■ Discuss symptoms of preterm labor.
■ Encourage childbirth preparation class
■ Discuss options for pain control in labor
■ Cesarean preparation class, if indicated
■ Epidural anesthesia class, if indicated
■ Explore preparing for the newborn
Danger signs during pregnancy