Antenatal Care

Under supervision

Dr.Walaa Hassan abdelfatah Dr.Samar Mahmoud Fawzy

1 Mohamed Shahata abderahman

2 Mohamed Shaban abdelbaky

3 Mohamed Shaban Fathy

4 Mohamed Samir Mostafa

5 Mohamed Sayed Mohamed

GROUP A7
2023-2024
 Antenatal care

 Introduction

 Definition

 Important

 Schedule of visit

 Physiological change

 Minor discomfort

 MCH services for pregnant women

 Health education in each trimester

 Antenatal exercise

 Schedule of immunization
 Antenatal care

Introduction
Antenatal care (ANC): is the care provided by skilled healthcare
professionals to women throughout their pregnancy. It includes risk
identification and screening, prevention and management of
pregnancy-related or concurrent diseases, and health education and
promotion.

Definition of antenatal care:

Comprehensive health care provided during pregnancy.

Other definition:

Preventive obstetric program aiming to getting pregnancy, labor and

Puerperium as near to normal as possible.
Aims of ante-natal care

1. The main goal is the safety and welfare of the mother and her fetus.
2. Preparation of mother for labor, lactation and subsequent care of her
child.
3. Early detection and appropriate treatment of high risk conditions.
4. Reduction of maternal and infant mortality, still births and
premature.
5. Increase the number of breast-fed babies.
6. Integrated care delivery throughout pregnancy
Schedule of Antenatal visits

WHO showed that essential interventions can be provided over four

visits at specified intervals, at least for healthy women with no
underlying medical problems.
Contact:

Maternal Changes with Pregnancy

The whole uterus

Height : increase from 7.5 in non-pregnant states to 35 cm at term

Weight : increases from 50 gm in non-pregnant state to 1000 gm at
term
Shape : Pear shape in the non-pregnant state , becomes globular at 8th
week , then spherical by 12th week.
Position : with ascent from the pelvis , the uterus usually undergoes
rotation with tilting on itself to the right (dextrorotation) & deviated to
the right (dextroflexion) due to the presence of the rectosegmoid colon
on the left side which become loaded by fecal matter due to
constipation.
Consistency : becomes progressively softer due to :

i - Increased vascularity

ii - Presence of amniotic fluid

Capacity :

increases from 4 ml in non-pregnant state to 1000 ml at term

Contractility : Braxton Hicks contractions
Uterine blood vessels :
Uterine blood flow increases progressively reaching
500 ml / minute at term
Changes cervix : Become Soft, bluish and swollen in pregnancy
Changes in the vagina : soft , warm , moist with increased secretion and
violet in color due to increased vascularity
Changes in the vulva : It becomes soft, violet in color
Blood volume :
The total blood volume increases to reach a maximum of 40 % above
the non-pregnant level at 32 week .
Both RBCs and plasma volume increase. But, the increase in plasma
volume is more than the increase in RBCs mass (Hb mass) 15-20%
resulting in haemodilution (physiologic anemia)
Urinary system

1- Renal blood flow and glomerular filtration rate increases by 50-60 %

2- Mild renal glucosuria and proteinuria may occur increase GFR.
3- Increased liability to urinary tract infection especially on the right
side
4- Frequency of micturition
in early pregnancy due to :
i - Pressure on the bladder by the enlarged uterus .
ii - Congestion of the bladder mucosa .
In Late pregnancy due to: pressure by engaged head

Skin changes

Pigmentation
due to increased estrogen or melanocyte stimulating hormone
In the face = chloasma graviderom = mask of pregnancy
 a butterfly pigmentation on the cheeks and nose .
In abdomen:
Linea Nigra= pigmentation in midline below the umbilicus
Chloasma gravidarum

Linea nigra

Stria gravidarum
pigmentation in the lower abdomen ,
flanks , inner thighs , buttocks & breast and increase as pregnancy
advances
It starts bluish (stria rubra) , then becomes pale to become white (stria
albicans) after delivery , which persists

It may be due to mechanical stretching or increased glucocorticoids

which results in rupture of the elastic fibres in the dermis and exposure
of the vascular subcutaneous tissues
Breast signs
Diagnostic in primigravida and may persist after delivery .
In multigravida it may be due to the previous pregnancies .
i - First month :
increased size & vascularity (dilated veins) , mastodynia
ii - Second month :
increased pigmentation of the nipple & areola and prominence of
Montgomery tubercles (nonpigmented nodules around the primary
areola(12-20)
iii - Third month :
secretion of colostrum (thick yellowish fluid) which expressed from the
nipple
iv - Fourth month :
a pigmented area appears around the primary areola called the
secondary areola
GIT changes

- Appetite is usually increased

- Nausia and vomitting
- Relaxation of the smooth muscle wall and sphincters of the GIT leads
to
Decreased gastric emptying
Hurt burn

Contact: it implies an active connection between a pregnant woman and

a health care provider that is not implicit with the word „visit

Hematological changes:

A. Blood volume:

The total blood volume is increases markedly during pregnancy. It starts

to increase at 10th week reach a maximum of 40- 45% above the non-
pregnant level at 30-32 weeks, then remains constant to full term.
B. Plasma volume: increase parallels with blood volume and reached to

50% around 1.25 liters and increase is greater in multigravida, & large

fetuses

C. RBCs and hemoglobin:

RBCs volume increase to extent 20-30%. Total volume is 350 ml, the

mount to be regulated increased demand of oxygen transport during

pregnancy. A state of hemodilution (physiological anemia – hydramia)

during pregnancy produced due to disproportionate increase in plasma

and RBCs

D. leukocytosis (a type of White blood cells):

Increase extent to 10-15,000 mm3 during pregnancy and up to 20,000

/mm3 during labor.

F. Coagulation factors (Platelets and fibrinogen):

Platelets are slightly increased or no change. Fibrinogen is doubled

(from 200- 400 in non-pregnant to 300-600 mg %) These changes tend

to prevent excessive bleeding at delivery.

iii. Heart and Circulation:

a. Anatomical changes: The heart is displaced upward &outward

toward the left.

b. Cardiac output: Starts to increase from 10th week reaches its peak

40% at 24-30 weeks.

c. Blood pressure: Remains almost within normal values (systolic 110-

120mmhg. Diastolic 65-80 mm Hg) Due to diminished peripheral

vascular resistance affected by high level of progesterone.

d. Supine hypotension syndrome: During late pregnancy, the gravid

uterus produces a compression on the inferior vena cava when the

patient is on supine position. The normal B.P quickly restored by turning

the pt. to lateral position

iv. Respiratory system:

-Dyspnea is common as a result of

-Hyperventilation (progesterone effect).

-Elevation of the diaphragm (especially during the 8th month).

Metabolic Changes:

a- Weight gain:
The average total weight gain in pregnancy is 10-12 Kg. The increase

occurs mainly in the second and third trimester at a rate of 350-

400gm/week.

B-Water metabolism: There is tendency to water retention secondary to

sodium retention.

C-Mineral metabolism: There is increased demand for iron, phosphate,

magnesium and iodine.

viii. Endocrine system:

A-Placental hormones: HCG levels increase rapidly in early pregnancy

to maximum level at 8-10 weeks, and disappear of the placental

formation

B-Posterior pituitary:

Increase its oxytocin secretion near term to stimulate the onset of labor.

C-Thyroid gland:

-There is a slightly enlargement of the gland.

-Gland activity is increased and physiological goiter may occur.

ix. Skeletal Changes:

- Mechanical and hormonal changes results in modification of posture,

gait and joint mobility .

x. Cutaneous changes:

1. Face: (chloasma gravidarum or pregnancy mask)

It’s pigmentation around the cheek, forehead and eyes may be patch or

diffuse, disappearance spontaneously after delivery

Minor discomforts during pregnancy

1- Morning sickness:

Nausea and vomiting in early pregnancy affect about 50% of

pregnancies especially primigravida and disappears on the 12th week.

Causes: 1- Hormonal changes in the first 12 weeks of pregnancy 2-

Pregnant women may be more at risk of morning sickness in the

following conditions : a. Multiple pregnancy (twins or more) b. Previous

history of morning sickness. c. previous history of migraine headaches d.

History of sick when taking contraceptives containing estrogen e.

Primigravida. f. Experiencing stress

Treatment: Reassurance, Light diet, frequent small meals and vitamin

B6.

2- Backache:

More common at third trimester and worse at night

Etiology:

Relaxation of the back and pelvic joints (progesterone effect).

Muscle spasm& Lumbar lordosis.

In third trimester caused by the gravid uterus.

Management:

Frequent bed rest to minimize lordosis.

Avoid wearing high- heals &Sedatives.

Local heat (relaxation of muscles).

Use good body mechanics

Calcium as prescribed or from natural sources.

Reassurance by explanation the cause of discomfort.

Avoid long standing.

Use abed step of each leg alternately during standing

3- Constipation:

Etiology:

Reduced intestinal motility (progesterone effect).

Pressure by the gravid uterus on the intestine &colon.

Management:

Increase fluid intake.

Simple exercise as walking

Regulation of bowel habit.

Diet rich in fresh vegetables and milk.

Mild laxatives.

4- Dyspnea:

Etiology:

In the first half of pregnancy: progesterone induced hyperventilation. In

the second half of pregnancy: pressure on the diaphragm by the gravid

uterus.
Management:

Reassurance (anemia should be excluded).

Avoid full stomach and use extra bellows and ask women to take semi-

setting position

Leucorrhoea: excessive normal vaginal discharge .

Etiology: Increased vaginal discharge is common due to excess estrogen

production.

Management:

No treatment is needed except if there is associated infection as

trichomoniasis or moniliasis, maintain personal &feminine hygiene

&maintain cotton under wearing with frequently changing and maintain

dryness for genital area.

Palpitation and headache:

Etiology:

Increased blood volume leads to overload on the heart and C.N.S.

Errors of refraction.

Nasal congestion or chronic sinusitis.

Emotional tension.

If severe & persistent-headache occurs in the 3rd trimester,

preeclampsia should be excluded.

Management:

Reassurance

------------
Ptyalism (sialorrhoea):

Etiology:

Increased salivation occurs early in pregnancy in some women due to

estrogen secretion & subsides later on. It is due to failure of the patient

to swallow the saliva than increase in its amount.

Management:

Reassurance

Chew gums

Anticholinergic drugs as belladonna which induce dryness of the

mouth may be tried.

6- Hemorrhoids Piles: swollen veins inside the rectum or outside the

anus.
Etiology:

Laxity of the rectal veins by progesterone effect.

Congenial weakness of the wall of the veins.

Pressure by the gravid uterus.

Tendency to constipation and straining.

Management:

Avoid spicy food

Avoid constipation.

kegal exercise.

Local anesthetic ointment as lignocaine.

Acroparaesthesia: Numbness and tingling sensation of the fingers.

Etiology:

Edema of the carpal tunnel which may be relieved by diuretics.

Brachial plexus traction syndrome due to drooping of the shoulders

during pregnancy.

Management:

Minimize salt intake.

Vitamin B12-range of motion exercise.

Round ligament syndrome; a deep, sharp, stabbing or stretching

sensation that begins and worsen with movement

Etiology:

Sharp tearing pain either unilateral or bilateral in the lower abdominal

quadrant, more commonly on the left side due to dextro-rotation. It

usually starts about the 20th week of gestation.

Aggravated by sudden movement.

Management:

Local heat, rest, reassurance.

It usually resolves spontaneously as pregnancy progresses.

Leg cramps:

Sustained involuntary painful contractions, usually affecting the calf and

peroneal muscles, may occur in the second half pregnancy particularly at

night.

Etiology:

Unknown; it may be due to:

Deficiency of vitamin B1

Reduced serum calcium or elevated serum phosphorus.

 Local vascular insufficiency.

Management:

Elastic stocking.

Local heat ( gentle leg movements in a warm bath).

Calcium & vitamin b complex supplements.

Magnesium.

Aluminum hydroxide gel orally twice daily before meals adsorbs

phosphate and may increase Ca absorption.

Sleep with the foot end of the bed elevated.

Varicose veins: May occur in the vulva and or lower limbs.

Etiology:

Congenital weakness which is exaggerated by progesterone relaxing

effect

Pressure on the pelvic veins by the gravid uterus

Obesity

Vasodilatation caused by steroid hormones

Increased venous pressure

Management:
 Elevation of the legs in higher levels than the body during sitting, and

sleeping

Avoid long standing and sitting and tight clothes..

Control of weight gain and active muscle exercise.

Elastic cotton stockings are worn while the patient is lying down and

the veins are empty. N.B: Surgical and injection treatment should be

avoided during pregnancy.

Heart burn:

Etiology:

Relaxation of cardiac sphincter, caused by upward displacement and

compression of the stomach by the pregnant uterus. This leads to

regurgitation of acidic stomach contents and juice which in turn leads to

reflux esophagitis.

Management:

Frequent small meals.

Avoid spices, smoking and alcohol

Antacids containing aluminum hydroxide gel, as they buffer the

gastric contents, do not cause an acid rebound.

 Allowing 2 hours between meals and sleep.

Salt and water retention (estrogen effect).

**Pathological: refer to differential diagnosis of preeclampsia.

Management:

According to the cause:

Sitting with elevated foot, and avoid tight clothing and tight stockings.

Rest and reassurance.

Reduction of salt intake.

15-Urinary complaints:

Frequency, urgency and stress incontinence are quite common late

pregnancy.

Etiology:

Pressure of gravid uterus on the bladder.

Bladder congestion.

Pressure of fetal head on the bladder decreasing its capacity.

Increased intra-abdominal pressure.

Decreased intraurethral pressure.

Management: reassurance, after excluding urinary tract infection.Ankle

edema: (pitting, bilateral): common in late pregnancy

Etiology:

* Physiological: due to:

Decreased colloidal osmotic pressure.

Increased capillary permeability.

Increased tissue interstitial pressure (Na retention).

Increased venous pressure of lower limbs

(Pressure on the pelvic veins).

signs of labor (prodromal or pre-labor) stage:-

During the last few weeks of pregnancy, numbers of changes indicate

that the time of labor is approaching which are:-

1-Engagement of the fetal head: entrance of the presenting part into the

true pelvis which leads to pelvic pressure symptoms as:- Frequency of

micturition & difficulty in walking.

2- Lightening: it is the descent of the mother's abdomen due to the

engagement of the fetal presenting part which leads to the relief of the

upper abdominal pressure symptoms as dyspnea & palpitation.

3- Shelfing: It is falling forwards of the uterine fundus making the upper

abdomen to look like a shelf during standing position. This is due to

engagement of the head.

4- Increase vaginal discharge: due to pelvic congestion.

Show: as a result of the separation of operculum or cervical plug which

close the cervix during pregnancy and with the beginning of the cervical

dilatation some small blood vessels are ruptured which makes the

mucous stained with blood and begins to be pass through the vagina.

ANC: Antenatal Care

FANC: Focused Antenatal Care Model

MCH services for pregnant women:

A-Initial visit

1-History taking

II-Examination

1- General examination

Head: Ears, eyes, nose, mouth and throat.

Neck: palpation of the thyroid gland.
Observation of skin and hair.
Heart and lungs; are auscultated for irregularities in function.
Extremities; are examined for varicose veins and edema.
Vital signs; temp. Pulse, respiration and blood pressure.
Body weight and height: weight should be recorded in the first visit.
Then recording the weight in graph each return visit.

2- Local examination

1. Inspection of breast and nipples.

2. Abdominal examination:
a. Inspection of hair distribution, linea nigra, stria gravidarum and scare
of previous operations.

b. Palpation of the abdomen for:

 Height of the funds.
Fetal lie, attitude, position and presentation using the four grips.
c. Auscultation of fetal heart sound (120/160/min)
d. Pelvic measurements to evaluate fetopelvic accommodation.
e. Inspection of external genitalia.
f. Vaginal examination to rule out abnormalities of birth canal.
g. Cervix examination (position, size, mobility)
III- Investigations

Urine analysis: For glucose and albumen.

Blood tests include :

- Blood group is determined because of the risk of hemorrhage.

- Rhesus factor, if the mother is Rh-negative. Several follow up
determination for the presence of irregular antibodies should be done
throughout pregnancy (at 1st visit, 28 weeks, and 34 weeks and at
term). If the samples remain negative labor is allowed to proceed
without interference. The RH of
the infant should be determined and if positive, the mother should be
treated with Rh immune globulin.
- Hemoglobin, if HB is below 12.6 g. (85%), iron, folic acid, vitamins B
and C are prescribed. If HB below 10 g. (70%) blood investigations is
carried out.
- Wasserman test for screening of syphilis.
- Screening for AIDs, viral hepatitis B (VHB) and viral hepatitis C (VHC).
IV- Dental examination

V- Social services

B- Return visit

In every visit, the following should be done to pregnant women,

weight, measuring the blood pressure, general observation, urine
analysis for sugar and albumen, at the 30th week hemoglobin
estimation, abdominal examination, and size of the uterus. Should be
asked about general well-being, signs and symptoms of edema,
bleeding, constipation, headache, or any unusual symptoms.
Immunization: in Egypt, active immunization against tetanus is done
as a routine for all pregnant women attending MCH centers. Primary
immunization of pregnant women

consists of two doses of absorbed toxoid administered about one

month apart except if the woman was actively immunized, she can take
only one dose. For life long protection, the mother should receive 5
doses of tetanus toxoid, the 1st dose should be at first contact, or as
early as early as possible during pregnancy, 2nd dose after 4 weeks (give
80% protect ion). 6-l 2 months after the 2nd dose or during the
subsequent pregnancy, give the 3rd dose (give 95% protection).Another
2 doses given during the subsequent pregnancy or every 1-3 for the 4th
dose & 1-5 years for the 5th dose (give 99% lifelong protection).
Health education in Pregnancy
Health education in the first trimester:
1. Eat healthy foods.
Eating healthy foods is especially important for pregnant women. Your
baby needs nutrients to grow healthy and strong in the womb.
Eat plenty of colorful fruits such a guava,grape and banana
vegetables such a green pepper,eggplant and carrots whole grains
calcium-rich foods such a dairy milk products (milk,egg,yogurt and
cheese seafood (salmon and sardines)
foods low in saturated fat.
2. Take a daily prenatal vitamin.
Taking a daily prenatal multivitamin can help ensure you get the right
amount of the key nutrients you and your baby need during pregnancy.
These include folic acid, iron and calcium.
3. Stay hydrated.
A pregnant woman’s body needs more water than it did before
pregnancy. Aim for eight or more cups each day.
4. Go to your prenatal care checkups.
Women should get regular prenatal care from a health care provider.
Moms who don’t get regular prenatal care are much more likely to have
a baby with low birth weight or other complications. If available,
consider group prenatal care.
5. Avoid certain foods.
There are certain foods that women should avoid eating while
pregnant. Don’t eat:Raw or rare meats
Liver, sushi, raw eggs (also in mayonnaise)
Soft cheeses (feta, brie)
Unpasteurized milk
Raw and unpasteurized animal products can cause food poisoning.
Some fish, even when cooked, can be harmful to a growing baby
because they’re high in mercury.
6. Don’t drink alcohol.
Don’t drink alcohol before and during pregnancy and while
breastfeeding. Drinking alcohol increases the risk of having a baby with
fetal alcohol spectrum disorder (FASD). FASD can cause abnormal facial
features, severe learning disabilities and behavioral issues.
Alcohol can impact a baby’s health in the earliest stages of pregnancy,
before a woman may know she is pregnant. Therefore, women who
may become pregnant also should not drink alcohol.
7. Don’t smoke.
Smoking is unhealthy for you and your unborn child. It increases the risk
of sudden infant death syndrome (SIDS), premature birth, miscarriage
and other poor outcomes.
8. Get moving.
Daily exercise or staying active in other ways can help you stay healthy
during pregnancy. Check with your doctor to find out how much
physical activity is right for you.
9. Get a flu shot.
The flu can make a pregnant woman very sick and increase risks of
complications for your baby. The flu shot can protect you from serious
illness and help protect your baby after birth, too. Ask your doctor
about getting a flu shot.
10. Get plenty of sleep.
Ample sleep (7 to 9 hours) is important for you and your baby. Try to
sleep on your left side to improve blood flow.
11. Reduce stress.
Reducing stress is crucial for improving birth outcomes. Pregnant
women should avoid, as much as they can, stressful situations. Recruit
your loved ones to help you manage stress in your life.

Health education during the second trimester

1:Take a prenatal vitamin
take a prenatal vitamin every day during pregnancy. If you’re planning
to get pregnant, start taking prenatal vitamins before you get pregnant.
Your body uses vitamins, minerals and other nutrients in food to strong
and healthy. During pregnancy, your growing baby gets all necessary
nutrients from you. So you may need more during pregnancy than you
did before. If you’re pregnant with multiples (twins, triplets or more),
you may need more nutrients than if you’re pregnant with one baby.
Your prenatal vitamin contains the right amount of nutrients you need
during pregnancy.
If you’re a vegetarian, have food allergies or can’t eat certain foods,
your provider may want you to take a supplement to help you get more
of certain nutrients. A supplement is a product you take to make up for
certain nutrients that you don’t get enough of in foods you eat. For
example, your provider may recommend that you take a vitamin
supplement to help you get more vitamin D, iron or calcium.
2:excercise regularly
For most pregnant women, at least 30 minutes of moderate-intensity
exercise is recommended on most, if not all, days of the week.
Walking is a great exercise for beginners. It provides moderate aerobic
conditioning with minimal stress on your joints. Other good choices
include swimming, low-impact aerobics and cycling on a stationary bike.
Strength training is OK, too, as long as you stick to relatively low
weights.
Remember to warm up, stretch and cool down. Drink plenty of fluids to
stay hydrated, and be careful to avoid overheating.
3: drink lots of water
When you're pregnant, you need more water than the average person
in order to form amniotic fluid, produce extra blood, build new tissue,
carry nutrients, enhance digestion, and flush out wastes and toxins.
Benefits of Staying Hydrated
Especially during hot summer months, you’ll want to make sure you
stay adequately hydrated.
Here are just some of the benefits of staying hydrated during your
pregnancy:
Decreases constipation/hemorrhoids
Reduces swelling
Softens skin
Increases energy
Keeps you cooler
Decreases risk of urinary tract infections
Decreases risk of preterm labor and preterm birth
4: care of your teeth
During pregnancy, hormonal changes can make your gums more easily
irritated and inflamed. If you develop red, puffy or tender gums that
bleed when you brush, you may be experiencing an exaggerated
response to plaque that builds up on your teeth.
Looking after your teeth
Good dental hygiene is even more important during pregnancy. To avoid
plaque build-up, thoroughly clean your teeth and gums twice a day.
Brush in the morning after breakfast and last thing at night before going
to sleep, and floss once a day.
Some pregnant women find they gag while brushing their teeth. If
brushing makes you feel sick, try using a soft small-headed toothbrush
designed for children and brush later in the morning when you may not
gag as much. Concentrate on your breathing as you clean your back
teeth.
Brushing without toothpaste may help. Then smear fluoride toothpaste
over your teeth after brushing and don't rinse it off. Return to brushing
with fluoride toothpaste as soon as possible.
For healthy teeth and gums during pregnancy,
you should also:
Drink plenty of tap water.The fluoride in tap water strengthens the
teeth and helps to prevent decay — and neither fluoride in water nor in
toothpaste will harm a developing baby. Talk to your pharmacist or
doctor if you have any concerns.
Avoid sugary drinks.
Eat a wide variety of healthy foods.
Eat 2 1/2 serves of calcium-rich food,
5:Healthy diet
Eating healthy means following a healthy eating pattern that includes a
variety of nutritious foods and drinks.
Eat food high in calcium such a dairy products (milk,egg ,cheese and
yogurt)
seafood (salmons,sardines)
Eat a variety of vegetables, fruits, whole grains, fat-free or low-fat
Eat food rich in protein (fish,chicken, nuts and leafy greens)
Choose foods and drinks with less added sugars, saturated fats, and
sodium (salt).
Limit refined grains and starches, which are in foods like cookies, white
bread, and some snack foods.
If you are feeling sick, try eating a piece of whole-grain toast or whole-
grain crackers
Health education during third trimester
1: get plenty of rest and sleep
Early in your pregnancy, try to get into the habit of sleeping on your
side. Lying on your side with your knees bent is likely to be the most
comfortable position as your pregnancy progresses. It also makes your
heart's job easier because it keeps the baby's weight from applying
pressure to the large vein (called the inferior vena cava) that carries
blood back to the heart from your feet and legs.
But don't drive yourself crazy worrying that you might roll over onto
your back during the night. Shifting positions is a natural part of
sleeping that you can't control.
Try experimenting with pillows to find a comfortable sleeping position.
Some women place a pillow under their abdomen or between their
legs. Also, using a bunched-up pillow or rolled-up blanket at the small of
your back may help to relieve some pressure. In fact, you'll see many
"pregnancy pillows" on the market. If you're thinking about buying one,
talk with your doctor first about which might work for you.
Over-the-counter sleep aids, including herbal remedies, are not
recommended for pregnant women.
Instead, these tips may safely improve your chances of getting a good
night's sleep:
Cut out caffeinated drinks like soda, coffee, and tea from your diet as
much as possible. Restrict any intake of them to the morning or early
afternoon.

Avoid drinking a lot of fluids or eating a full meal within a few hours of
going to bed. (But make sure that you also get plenty of nutrients and
liquids throughout the day.) Some women find it helpful to eat more at
breakfast and lunch and then have a smaller dinner. If nausea keeps you
up, try eating a few crackers before you go to bed.
Get into a routine of going to bed and waking up at the same time each
day.
2:Healthy diet
Your baby gains weight quickly during the third trimester, and parts of
their body continue to form. Eyes open, nails form, and hair grows, to
name just a few of the things that go on.
With all this stuff happening, the food choices you make are very
important for the health of your baby.
Where to Get the Nutrients You Need
The building blocks of your meals and snacks should be:
Fruits
Vegetables
Protein
Whole grains
Healthy fats and oils
Low-fat or fat-free pasteurized dairy
Within those things are vitamins, minerals, and nutrients you need
daily.
Vitamin A helps your baby’s bones grow. It also supports
their skin and vision. Your baby’s eyes open and start to detect light in
the third trimester.
You can find vitamin A in:
Fish
Dairy products
Carrots
Cantaloupe
Spinach
Sweet potatoes
Fortified cereals
Vitamin C helps your body take in iron. It also helps make your
baby's teeth, gums, and bones healthy. Your immune system needs it,
too.Good options for vitamin C include:
Citrus fruits like oranges, tangerines, and grapefruit
Kiwi
Strawberries
Tomatoes
Red and green peppers
Broccoli
Eat food rich in iron such a red meat, legumes and lentils
 Continue to take prenatal vitamins.
 Stay active unless you’re experiencing swelling or pain.
 Work out your pelvic floor by doing Kegel exercises.
 Eat a diet high in fruits, vegetables, low-fat forms of protein, and
fiber.
 Drink lots of water.
 Eat enough calories (about 300 more calories than normal per day).
 Stay active with walking.
 Keep your teeth and gums healthy. Poor dental hygiene is linked to
premature labor.
 Get plenty of rest and sleep.
 Eat food rich in iron
 Good sources of iron
 Good sources of iron include:
-Liver (but avoid this during pregnancy)
-Red meat
-Beans, such as red kidney beans, edamame beans and chickpeas
-Nuts
 -Dried fruit – such as dried apricots
-Fortified breakfast cereals
-Soy bean flour
3: keep your gums and teeth healthy
It's very important to keep your teeth and gums clean and healthy
while you're pregnant. The best way to prevent or deal with gum
problems is to practise good oral hygiene.
Go to the dentist so they can give your teeth a thorough clean and
show you how to keep your teeth clean at home.
Here's how you can look after your teeth and gums:
Clean your teeth carefully twice a day for 2 minutes with a fluoride
toothpaste – ask your dentist to show you a good brushing method
to remove plaque.
Floss once a day to remove small bits of food from between your
teeth, which will help to prevent the build-up of plaque.
Brushing is best with a small-headed toothbrush with soft
filaments – make sure it's comfortable to hold.
Avoid having sugary drinks (such as fizzy drinks or sweet tea) and
sugary foods too often – try to keep them to meal times.
4: avoid:
strenuous exercise or strength training that could cause an injury to
your stomach
alcohol
caffeine (no more than one cup of coffee or tea per day)
smoking
illegal drugs
raw fish or smoked seafood
shark, swordfish, mackerel, or white snapper fish (they have high levels
of mercury)
raw sprouts
cat litter, which can carry a parasite that causes toxoplasmosis
unpasteurized milk or other dairy products

Exercise during pregnancy:

Why exercise during pregnancy?
During pregnancy, exercise can:
Reduce backaches, constipation, bloating and swelling
Boost your mood and energy levels
Help you sleep better
Prevent excess weight gain
Promote muscle tone, strength and endurance
Other possible benefits of following a regular exercise program during
pregnancy may include:
A lower risk of gestational diabetes
Shortened labor
A reduced risk of having a C-section
Suitable activities during pregnancy include:
 brisk walking
 swimming
 indoor stationary cycling
 prenatal yoga
 low impact aerobics under the guidance of a certified aerobics
instructor
 special exercises to prepare for labor and delivery
These activities carry little risk of injury, benefit the entire body, and are
usually safe to do until delivery.
1. Brisk walking
If prepregnancy exercise levels were low, a quick stroll around the
neighborhood is a good way to start.
This activity has several advantages:
It provides a cardiovascular workout with relatively little impact on the
knees and ankles.
If women start from home, it is free.
It is possible to walk almost anywhere and at any time during
pregnancy.
Friends and other family members can join for company.
Safety tip: Stay safe by choosing smooth surfaces, wearing supportive
footwear to prevent falls, and avoiding potholes, rocks, and other
obstacles.
2. Swimming
Swimming, walking in water, and aqua aerobics allow for motion
without putting pressure on the joints. Buoyancy may offer some relief
from the extra body weight as the pregnancy progresses.
It is important to choose a stroke that feels comfortable and does not
strain or hurt the neck, shoulders, or back muscles. Breaststroke may be
a good choice for this. Using a kickboard can help strengthen the leg
and buttock muscles.
Safety tips:
Use the railing for balance when entering the water to avoid slipping.
Refrain from diving or jumping, which could impact the abdomen.
Avoid warm pools, steam rooms, hot tubs, and saunas to minimize the
risk of overheating.
3. Stationary cycling
Cycling on a stationary bike, also called spinning, is safeTrusted
Source for most women during pregnancy, including first-time
exercisers.
Advantages include:
Cycling helps raise the heart rate while minimizing stress on the joints
and pelvis.
The bike helps support body weight.
As the bike is stationary, the risk of falling is low.
Later in pregnancy, a higher handlebar may be more comfortable.
4. Yoga
Prenatal yoga classes can help women keep their joints limber and
maintain flexibility. Yoga may also help with pain and stress
management, according to one studyTrusted Source.
The benefits of yoga include:
strengthening the muscles
stimulating blood circulation
helping maintain a healthy blood pressure
increasing flexibility
enhancing relaxation
teaching techniques to help women stay calm during labor and delivery
Safety tips: As pregnancy progresses, consider skipping poses that:
may lead to overbalancing
involve lying on the abdomen
involve spending time lying flat on the back
When lying flat on the back, the weight of the bump can put pressure
on major veins and arteries and decrease blood flow to the heart. This
reduced blood flow can lead to faintness.
Women should also take care to avoid overstretching, as this could lead
to injury.
5. Low impact aerobics
In low impact aerobic exercise, at least one foot stays on the ground at
all times.
This type of exercise can:
strengthen the heart and lungs
help maintain muscle tone and balance
limit stress on the joints
Some classes are designed especially for pregnant women. They can be
a good way to meet other people and train with an instructor who is
qualified to meet the specific needs of pregnant women.
Women who already attend a regular aerobics class should let the
instructor know that they are pregnant. The instructor can then modify
exercises where necessary and advise about suitable movements.
6. Preparing for labor: Squatting and pelvic tilts
Some exercises are particularly useful during pregnancy, as they
prepare the body for labor and delivery.
Squatting: As squatting may help open the pelvis during labor, it may be
a good idea to practice during pregnancy.
Stand with the feet shoulder-width apart and flat on the floor, keeping
the back straight.
Lower the buttocks down slowly, keeping the feet flat and the knees no
further forward than the feet.
Hold for 10 to 30 seconds at the lowest point, then slowly push up.
Pelvic tilts: These can strengthen the abdominal muscles and help
reduce back pain.
Start on the hands and knees.
Tilt the hips forward and pull the abdomen in, rounding the back.
Hold for a few seconds.
Release and let the back drop.
Repeat this up to 10 times.
Kegel exercises: These tone the muscles in the pelvic floor. Strong pelvic
muscles will help the woman push during delivery and reduce the risk
of urine leakage afterward.
Kegel exercises focus on tightening and holding the muscles that control
urine flow.
To perform this exercise, a person should:
Sit in a comfortable position, close the eyes, and visualize the muscles
that can stop urine flow.
Tighten these muscles as much as possible.
Hold this position for 3–5 seconds. It should feel as though the muscles
are lifting up as a result of the squeezing.
Release the muscles and rest for several seconds.
Repeat this up to 10 times.
People can vary this exercise by doing it while standing, lying down, or
crouching on all fours
Benefits
During pregnancy, exercise can help by:
increasing the heart rate steadily and improving circulation
reducing the risk of obesity and related complications, such as
gestational diabetes and hypertension
helping prevent constipation, varicose veins, backache, and other
pregnancy complications
keeping the body flexible and strong
supporting and controlling healthy weight gain
preparing the muscles for labor and birth
helping prevent deep vein thrombosis
improving sleep and emotional health
It may also:
shorten laborTrusted Source and decrease the need for medication and
pain relief
reduce the riskTrusted Source of a preterm or cesarean delivery
speed up recovery after delivery
give the infant a healthier start
Research suggestsTrusted Source that there may also be benefits for the
baby, such as:
a lower fetal heart rate
a healthier birth weight
a lower fat mass
improved stress tolerance
enhanced nervous system development

Places of delivery:

1. In MCH centers

There is an internal section with a limited number of beds for delivery

of:

a. Registered mothers who preferred to deliver at the center.

b. Mothers living under poor inconvenient housing.

c. Mothers with mild difficulties.

Warning signs & Symptoms during pregnancy

Warning signs & symptoms during pregnancy

Time of return visit: tell the mother about time of the next visit and if

she complains any of previous warning signs (as mentioned above)

instruct the mother to contact with her health care provider or any health

care center .

Vaccination (immunization) during pregnancy: