Antenatal
Care
DR. FOUZIA SHAIKH
ASSOCIATE PROFESSOR
LUMHS
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

To reduce maternal and perinatal mortality and
morbidity rates

To improve the physical and mental health of
women and children
Importance of Antenatal
Care

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
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
 Family
history
history
 Medical
and surgical history
 Menstrual history
 Obstetrical
 History
history
of present pregnancy
Physical Examinations

Height of over 150 cm indication of an averagesized 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).

Obesity (more than 20 kg above the weightheight 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.

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
Investigations:
Urine
should be tested for
sugar, ketones and protein.
Hemoglobin
At
will be repeated:
36 weeks of gestation.
Every
g/dl.
4 weeks if Hb is < 9
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











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
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



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
FOCUSED ANTENATAL
CARE
The high risk approach
intended to classify pregnant women as “low risk” or
“high risk” based on predetermined criteria and involved
many ANC visits. This approach was hard to implement
effectively since many women had at least one risk
factor,
Focused or goal oriented
ANC services provide specific evidence-based
interventions for all women, carried out at certain critical
times in the pregnancy.
The essential elements of a
focused approach to antenatal care
• Identification and surveillance of the pregnant woman
and her expected child
• Recognition and management of pregnancy-related
complications, particularly pre-eclampsia
• Recognition and treatment of underlying or concurrent
illness
• Screening for conditions and diseases such as anaemia,
STIs (particularly syphilis), HIV infection, mental health
problems, and/or symptoms of stress or domestic
violence
Preventive measures, including tetanus toxoid
immunisation, de-worming, iron and folic acid,
Intermittent preventive treatment of malaria
• Advice and support to the woman and her family for
developing healthy home behaviours and a birth and
emergency preparedness plan to:
o Increase awareness of maternal and newborn
health needs and self care during pregnancy and the
postnatal period, including the need for social support
during and after pregnancy
recognition of danger signs for the woman and the
newborn as well as transport and funding plans in
case of emergencies
o Help the pregnant woman and her partner
prepare
emotionally and physically for birth and care of their
baby, particularly preparing for early and exclusive
breastfeeding and essential newborn care
Promote postnatal family planning/birth spacing
How many visits
A recent multi-country randomized control trial led by
the WHO17 and a systematic review showed that
essential interventions can be provided over
four visits at specified intervals, at least for healthy
women with no underlying medical problems.
• First visit: On confirmation of pregnancy
• Second visit: 20-28 weeks
• Third visit: 34-36 weeks
• Fourth visit: before expected date of delivery
or when the pregnant woman feels she
needs to consult health workerLeading causes of
maternal mortal
Common Discomforts of Pregnancy,
Etiology, and Relief Measures :
Urinary frequency
RELIEF MEASURES:

Decrease fluid intake at night.

Maintain fluid intake during day.

Void when feel the urge.
Fatigue
RELIEF MEASURES:

Rest frequency.

Go to bed earlier.
Sleep difficulties
RELIEF MEASURES:
Rest

frequency
Decrease fluid intake at night
Breast enlargement and
sensitivity
RELIEF MEASURES:

Wear a good supporting bra.

Assess for other conditions.
Nasal stuffiness and
epistaxis
ETIOLGY: Elevated estrogen levels
 RELIEF
MEASURES :
Avoid
Use
decongestants.
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
 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

RELIEF MEASURES:

Use extra pillows at night to keep more upright.

Limit activity during day
Heartburn
RELIEF MEASURES:

Eat small, more frequent meals.

Use antacids.

Avoid overeating and spicy foods.
Dependent edema

Avoid standing for long periods.

Elevate legs when laying or sitting.

Avoid tight stockings.
Varicosities

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
tilting
pelvic rocking or
Leg cramps

RELIEF MEASURES:

Extend affected leg and dorsiflex the foot.

Elevate lower legs frequently.

Apply heat to muscles.

Evaluate diet.
Faintness
RELIEF MEASURES:
•Rise slowly from sitting to standing.
•Evaluate hemoglobin and
hematocrit.
•Avoid hot environments