EINC LECTURE NOTES MODULE 2
8/20/21
ANTENATAL CARE
- Comprehensive health supervision before
delivery
- GOAL: reduce maternal and perinatal mortality
and morbidity rate/ improve physical and
mental health of women and child – because its
a normal process but takes a lot of changes in
the woman’s mental, physical, and physiological
state.
- IMPORTANCE: to detect complications
Hypertension, diabetes,
Offering education to parenthood – to know
how to care for children and family. Coz this is a
significant change
Prepare for labor, lactation, and care of child
Ex: how to breastfeed baby? How to know that
my baby is normal? Why the stool of baby is
watery?
SCHEDULE FOR ANTENATAL VISIT
1. Once every month till 28 weeks (7 months)
2. Once every 2 weeks till 36 weeks (8 month)
3. Once every week, till labor/nine months
 38-40 weeks = normal duration of pregnancy
 Beyond 40 weeks that would be a problem
 Before 37 weeks that is also a problem
FREQUENCY OF ANTENATAL APPOINTMENT
1. Nulliparous – with an uncomplicated pregnancy,
schedule 10 appointment
2. Parous or parity – with uncomplicated
pregnancy, a schedule of 7 appointment
ASSESSMENT IS IMPORTANT
- History, examinations, Investigation
- Collect data that will help you discover who is
this mother
SIGNIFICANT DATA
- Demographic (age (minor- bones not mature, if
35 yrs old. Mom can develop hypertension,
diabetes, tuberculosis), occupation, status,
income, weigh and height – below 5ft mahirap
manganak, pelvic are maliit sukat, cesarean,
kailangan magpatest, ultrasound, x-ray- putting
the life of baby at risk) what is mom is exposed
to environment not suitable for pregnancy
- Personal History
- Family history ( diabetes, cesarean delivery)
- Medical/ surgical history (previous respiratory
problems)
- Mens (REGULAR, IRREGULAR, MENTAL CRAMPS)
- Obstetrical history (how many time you gave
birth/abortion with intention or unintentional/
- History of present pregnancy (what are the
changes that moms consider/change in skin/GI
tract/ skeletal muscles)
PHYSICAL EXAMINATION
- The entire weight of mom should be 12 kg but
2kg in first 20 weeks or 5 months
- Or 10 kilograms in 20 weeks
- Every week must increase 1.5 kg weight
- Symphysis pubis – fundic height measure in
centimeter and measure every appointment or
contacts to healthcare provider in 6 months.
- Locate symphysis pubis of mother and fundic
height
- Fetal presentation = might be vertex. Transverse
or oblique
- Fetal heart sound= as early as 10 weeks of
pregnancy
- Heart tone in 20 weeks pinals fetal stethoscope
- Height over 150 cm indication of average sized
pelvis (pag maliit pelvis fetus will not pass
through)
FETAL KICK COUNTS
- Report at least 10 movements in 12 hours
- Must have 200 kicks in 24 hours
- Absence of movement precedes intrauterine
fetal death by 48 hours
BREECH PRESENTATION AT TERM
- If you have breech pregnancy you will be
schedule for 37-38 weeks of preggy
- If after 41 weeks, if there’s no labor within that
week, if patient is in normal size and cephalic
EINC LECTURE NOTES MODULE 2
8/20/21
doctor will do formal induction of labor= let - 7-9 months = 3rd trimester
uterus of mom contracts then cervix is
stimulated to open. But before that, offer If irregular period how makakaaffect kay mam?
vaginal examination, do examination for
- Wala siyang fertility period = hindi siya
membrane sweeping
mabubuntis /
- If uterus contact there’s a possibility that mom
- delay maturation ng ova maybe the problem is
will deliver
lack or immaturity of hypothalamus to release
- If 42 weeks check for meconium statin = fluid in
fsh to mature the ova
uterus of mom might be infected with fecal
- if you have PCOS, mabubuntis ka pero delayed
discharges of fetus/check VS of fetus = fetal
kasi d nagmamature si ovum
heart rate = if it decrease magkakaroon ng fetal
dimiss What is the benefit of follic acid to mother?
- Investigate for urine testing/ketones= diabetes,
acidic breathe/proteins = indication of - To prevent abnormalities like congenital defects
hypertension in pregnancy spinabefida
- Compplete blood count - Best time is 3 months before pregnancy
- Normal presentation = cephalic
 Nulliparous – first time mothers
EARLY ULTRASOUND  Parous= parity = fetus na naka daan na ng 20-24
weeks, can survive extrauterine life, kahit
- ESTIMATE GESTATIONAL AGE = no. of weeks of
outside uterus
pregnancy (37 weeks) AOG
 First schedule of pIlliteri, pag nagboard si pelliteri
- DETECT ANOMALIES/MULTIPLE PREGNANCY
ang kukunan ng sagot
(bingot/twins)
 Pilliteri = First schedule = 8 visit
- Best time for it acc to WHO is before 24 weeks
 DOH = 4 VIsit
gestation
 In 5 years’ time magkakaroon uli ng research about
- Late ultrasound = 24 weeks after
the number of contacts to know if ipagpapatuloy or
HEALTH TEACHING DURING FIRST TRIMESTER irerevised
 Kaya iniiwasan na sobra ng 40 weeks?
- IF 7 MONTHS NA ( still teach mom about this  Amniotic fluid is a clear, pag greenish infected na
through assessment you’ll discover the needs of  If nagkahernia ung mom, possible bang makaaffect
mother/ iclude what to prepare before delivery) un sa pregnancy? (No problem)

ANTENATAL CARE MODELS ==========================================

- must have minimum of 8 contacts to reduce Oxytocin given to contractions of uterus and normal pre-
mortality rate and improve experience of pregnancy size & to induce labor.
mother
- New heroes are mothers because they produce CONTACT VS. VISIT
baby
- Connection b/w healthcare provider and the
- Increase perinatal deaths in 4 visit ANC model
mom
- Increase frequency of maternal and fetal
- Take place in facility or community level
assessment to detect complications
- If mom has tuberculosis, stop medications so to
- No significant change if mom will have 8 to 11 or
avoid effects to fetus
15 contacts.
- No medications allowed to take unless
- 1-3 months = 1st trimester
prescribed.
- 4-6 months = 2nd trimester
EINC LECTURE NOTES MODULE 2
8/20/21
- Normal medications po ba is also not allowed or
will it have an effect po sa mom?
EFFECTIVE IMPLEMENTATION OF ANC REQUIRES
- Continuity of care
- Integrated service delivery (if service is not
available then they have to refer the mom in a
bigger facility)
- Improve communication
- Available supplies/commodities
- Empowered healthcare providers
LEOPOLD’S MANEUVER
- Done by practitioner only
- Abdominal palpation for fetal position and
presentation (vertex, face)
- Systematic method of observation and palpation
PURPOSE
- To determine where to listen in fetal heart rate
- Systematically observe for fetal size,
presentation and position
- To observe Single or multiple gestation
1. Is the fundal height consistent with fetal
maturity?
- Fetus should be in 20 weeks
2. Is the transverse, lie longitudinal or oblique
LONGITUDINAL
- Long axis of fetus aligned to mom
- Normal postion = head nasa baba,
I -
I pelvic brim
I -
TRANSVERSE
PRESENTATION IS EITHER
1. Vertex
2. Brow = extended/tilted/hyperflexion or
hyperextended (50-50)
3. Facial = 0
4. Breech = nakahyper flex, head is up in fundus
5. Shoulder = transverse (-----) head nasa right
DENOMINATOR
- Fetal part presenting itself
- O: occiput head down, very good presentation
- S: sacrum poor cesarean head up
- M: mentum, cesarean din
- F: frontal, face, d lalabas si baby
- AC : acromion or SC: scapula
ROA, LOA – THE BEST POSITION OF FETUS/ NORMAL
SPONTANEOUS DELIVERY
ROP, LOP, OP, OA – MEDIUM DELIVERY
ATTITUDE
- Flexed: head nakayuko paharap - when you do
your folix nakaflat (good attitude)
- Pag brow or face
- Pag deflexed
- Pag extended (poor attitude) not delivered
normally
ENGAGEMENT
- Dividing head into fifths
Head cannot be move, 4 or 5 done through
But if you palpate the head and it is bouncing,
not engaged meaning nag flofloat pa ung baby
sa tummy ng mom

- Long axis of fetus PERPENDICULAR to mom PREPARATION

- ------
1. Empty bladder = for the muscle to be relaxed
OBLIQUE during palpation
2. Place mom in dorsal recumbent position, supine
- 0-90 degrees to that of mom with knees flexed to relax abdominal muscle
3. Place pillow under head (ideally 7 months
above)
EINC LECTURE NOTES MODULE 2
8/20/21
4. Drape properly
5. Explain procedure (what youre gonna do)
6. Warm hand ( cold hands can stimulate uterine
contractions, if its contracting it will not be
accurate
7. Use palm for palpation not fingers. = but now
you can use finger pads depending on faculty
4. Pelvic = good and poor attitude PERFORM PAG MAY
GRIPS BREECH

1. Fundal grip: locate fundus PUPOSE: determine degree of flexion aand attitude or
habitus.
PURPOSE: determine fetal part lying in fundus and
determine presentation PROCEDURE: use both hands

PROCEDURE: use both hands feel fetal part lying in the Good attitude pag brow corresponds sa side flat occipital
fundus. Done deep but gentle plain walang contour if may obstruction at contour ay
poor attitude

2. Umbilical grip: push one side and feel if its flat soft
=back, then push other side from up to down = o my
PERFOMANCE INDICATOR:
nodules, kamay, irregular shape,
1. Rapport
PURPOSE: identify location and determine position of
2. Explain procedure
fetal back.
3. Secure informed consent (streygaviradum, pag d
PROCEDURE: one hand to steady uterus in one side of nagconscent how will you convince client to
abdomen. FACING THE PATIENT FOR FIRST AND SECOND conscent? Explain
AND THIRDMANEUVER 4. Perform organized systematic and timely
procedure
5. Assessment
 Obtain obstetrical to know if mom is in 28
week
 OB score
 Age of gestation
- No of weeks of pregnancy
- March has 31 days
3. Pawlick = determine engagement of fetus, if engage  Last men’s period (LMP)
ipeperform ung pelvic grip – Ex: March 10- 15, 2021 (Ask if this is first
day or last day)
Purpose: determine engagement of presenting part – March 15 nagkaroon ng huling regla
– March 10 first flow of menstruation on
PROCEDURE: using thumb and finger
the last menstrual period
EINC LECTURE NOTES MODULE 2
8/20/21
 AOG – LMP =
 Day of check up:
 AOG = 23 WEEKS AND 2/7 DAYS
 EDD = ONE WAY IS -3 + 7 (STANDARD
FORMULA) or add ka 9 months plus 7 days
LMP = 12/17/21
 MOM CAN DELIVER 1 WEEK BEFORE OR
AFTER EDD
o always remember that when obtaining fetal heart
rate kung san flat dun ung fetal tone
o wag kunin ang fetal heart tone sa lugar kung san
sumisipa si baby
o know whether it is cephalic right or left (lower
quadrant)
o breech (wag sa baba but sa upper surface, taas ng
umbilicus dahil nandun likod ng fetus) or
o transverse (take fetal heart tone sa umbilical area)
kasi iba-iba location for fetal heart rate
o obtain vitals
o empty bladder prevents stimulation of uterus, not
valid kasi bulging abdomen tas d accurate palpation.
it had to be relaxed
o position in supine w/ knees slightly flexed
o place pillow/towel under left side
o wash hands = wag na sabihin
o drapes client
o observe the clients abdomen = is it tranverse, check
diameter, or if fetus is having kicks or if it moves, or
if it has wave
o measure abdomenal girth/ fundic height
measurement. (tape measure place 0 end on
symohysis pubic and fundus)
o warm hands by rubbing = to prevent cold hands,
para d magcontract abdomen ni mother
o use palm in palpation
o maneuver 1-4 (1st three grips face mom and last
maneuver face foot of mom) if not engage don’t
perform number 4
o check clients response to procedure
o health teaching / prenatal visits
o ano po nararamdaman niyo?
o kapag may cramps, fatigue health teaching
o aftercare
o documentation = adpie and 1 ncp