Introduction:

Antenatal care refers to the care given to an expectant mother from the time the
conception is confirmed until the beginning of labour. It includes monitoring the progress of
pregnancy, providing appropriate support to the woman and her family and providing
information, which will assist them to make sensible choices.

Definition:

Systematic supervision (examination and advice) of a woman during pregnancy is called

antenatal (prenatal) care.

Antenatal care comprises of:

 Careful history taking and examinations (general and obstetrical)

 Advice given to the pregnant women
Aims of antenatal care:

The aim is to monitor the progress of pregnancy in order to support maternal health and
normal foetal development. It is essential that the midwife critically evaluates the physical,
psychological and sociological effects of pregnancy on the woman and her family.

 Developing a partnership with the woman.

 Providing a holistic approach to the woman’s care that meets her individual needs.
 Promoting an awareness of the public health issues for the woman and her family.
 Exchanging information with the women and her family and enabling them to make
informed choices about pregnancy and birth.
 Being an advocate for the woman and her family during her pregnancy, supporting her
right to choose care that is appropriate for her own needs and those of her family.
 Recognising complications of pregnancy and appropriately referring women within the
multidisciplinary team
 Facilitating the woman and her family in their preparations to meet the demands of birth
and making a birth plan.
 Facilitating the woman to make an informed choice about methods of infant feeding and
giving appropriate and sensitive advice to support her decision.
 Offering education for parenthood within a planned programme or on an individual basis.
 Working in partnership with other pertinent organisations.
Objective of antenatal care:
 Promote, protect and maintain the health of the mother during pregnancy.
 Detect “high risk” pregnancies and give the mothers special attention.
 Foresee complications and take preventive measures.
 Remove anxiety and fear associated with pregnancy.
  Reduce maternal and infant morbidity and mortality.
 Teach the mother elements of nutrition, personal hygiene and new born care.
 Sensitize the mother to the need of family planning.
Antenatal trimester:
 1st Trimester : Till 14 weeks
 2nd Trimester : 15 - 28 weeks
 3rd Trimester : 29 - 40 weeks
Timings of antenatal visit:

The first visit should not be deferred beyond the second missed period. Once a month
until 28 weeks. Twice a month until 36 weeks. Every week during the last 4 weeks of
pregnancy.

Articles required for antenatal examination:

Articles Rationale
Vital sign checking tray:
Two galipot- one with spirit cotton and one To clean thermometer before and after
with dry cotton
Thermometer use To check temperature
Sphygmomanometer To monitor blood pressure
Stethoscope To measure blood
Paper bag pressure To discard waste
General examination tray:
2 drape sheet To cover patient properly
Scale To check the height
Pencil, pen To record findings
Notebook To record findings
Torch To proper visualization
Inch tape To measure height
Others:
Weight machine To take height
Per-vaginal examination:
Small mackintosh To protect bed
Medium bowl with savlon water To clean perineum
Xylocain jelly To lubricant vagina during examination
One pair sterile gloves To prevent cross infection

Antenatal history taking:

 Identification data:
 Name-
 Age-
 Husband name-
 Husband age-
 Address-
 Religion-
 Hospital no-
 Date of booking-
 Date of last antenatal check-up-
 Date of admission-
 Ward no-
 Bed no-
 Under doctor-
 Diagnosis-
 Date of discharge from hospital-
 Reason for hospital admission:
 Chief complain-
 Onset-
 Duration-
 Severity-
 Relieving factor-
 Aggravating factor-
 Social history:
 Housing condition-
 Drainage facility-
 Type of family-
 Total family member-
 Total earning member of the family-
 Per capita income-
 Personal history:
 Education of wife
 Education of husband-
 Occupation of wife-
 Occupation of husband-
 Hobby-
 Habit-
 Addiction-
 Immunization-
 Medical history:
 Any medical illness-
 Any previous surgery-
 Any medication continues previously-
 How long-
 Why medication was stopped-
 Blood transfusion or allergic history-
 Family history:
 History of diabetes, hypertension, asthma, chronic disease-
 Psychiatric illness-
 History of congenital anomaly among family member-
 Multiple pregnancy-
 Family believe about pregnancy-
 Marital history:
 Duration of marriage-
 Consanguinity-
 Relationship with husband-
 Choice of contraception-
 Planned pregnancy-
 Menstrual history:
 Age of menarche-
 Cycle-
 Flow-
 Duration-
 Clots-
 Dysmenorrhoea-
 Relieve measure-
 LMP-
 EDD-
 Obstetrical history:
 Period of gestation
 Gravida-
 Pariety-
 Term pregnancy-
  Abortion-
 Multiple pregnancy-
 Present obstetrical history-

1st trimester 2nd trimester 3rd trimester

 Past obstetric history-

Sl Date of Place of Durat Cours Mode Condition Baby Remarks

no deliver delivery ion of e of of of mother Sex Weig
y pregn pregn delive in ht
ancy ancy ry puerperium

 Dietary history:
 Dietary pattern-
 Any problem in digestion-
 Appetite-
 24 hours’ diet recall-

Time Food Amount approximately

 Complication during pregnancy:

 Type of complication-
 Onset-
 Duration-
 Care advised to mother-
Antenatal physical examination:
 General head to foot examination:
 Height-
 Weight-
 Body build-
 Posture-
 Gait-
  Hygiene and grooming-
 Vital sign: Temperature- Pulse- Respiration- BP-
 Head:
1) Inspection-
2) Palpation-
 Forehead-
 Eyes-
 Ears-
 Nose-
 Face-
 Mouth-
 Neck-
 Lymph node-
 Chest:
1) Inspection- Bilaterally equal rise.
2) Auscultation- Air entry bilaterally equal, Breath sound, S1 and S2 audible.
 Genitourinary system-
 Central nervous system-
 Skeletal system-
 Obstetrical examination:

Obstetrical examination includes breast examination, abdominal palpation, perineal

assessment.

 Breast assessment:
1) Inspection-
 Development-
 Consistency-
 Symmetry-
 Veins-
 Areola- Primary- Secondary-
 Montgomery’s tubercles-
 Nipple protractility-
 Colostrum: Yes/No
2) Palpation-
 Lumps-
 Axillary lymph nodes-
 Abdominal examination:
 1) Inspection-
 Size-
 Shape-
 Contour of abdominal wall: Bladder- Flanks- Umbilicus-
 Skin changes-
 Operation scar-
 Visible foetal movement-
 Sign of infection-
2) Palpation-
 Height of the fundus-
 Period of gestation-
 Abdominal girth-
 Fundal palpation: (normal)

Fundal grip- (a) broad, soft and irregular mass suggestive of breech or (b) smooth, hard and
globular mass suggestive of head. In transverse lie, neither of the foetal poles is palpated in the
fundal area.

Lateral grip- In this grip we can find out the position of the back, limbs and the anterior
shoulder. The back is suggested by smooth curved and resistant feel. The limb side is
comparatively empty and there are small knobs like irregular parts.

Pelvic grip: Four fingers of both the hands are placed on either side of the midline in the lower
pole of the uterus and parallel to the inguinal ligament. The fingers are pressed downwards and
backwards in a manner of approximation of finger tips to palpate the part occupying the lower
pole of the uterus.

Pawlik’s grip- The overstretched thumb and four fingers of the right hand are placed over the
lower pole of the uterus keeping the ulnar border of the palm on the upper border of the
symphysis pubis. It can be denoted by- 1/5, 2/5, 3/5, 4/5, 5/5.

3) Auscultation-
 Foetal heart rate-
 Rhythm-
 Location-
 Perineal examination:
 Consistency: Firm/soft
 Show: Present/absent
 Dilatation-
 Effacement-
 Station-
 Position of head-
 Status of membrane-
 Colour of meconium-
 Odour-
 Vaginal bleeding-
Investigation during antenatal period:
 1st trimester:
 Haemoglobin
 HIV / HBsAg / VDRL
 Blood grouping and typing
 Urine analysis
 HbA1C
 Thyroid profile
 Dual test
 2nd trimester:
 At 24 – 28 weeks
 Haemoglobin
 Urine protein [Esp if BP is high]
 GCT [Glucose Challenge Test]
 GTT [Glucose Tolerance Test]
 At 18 – 22 weeks
 Anomaly scan
 3rd trimester:
 Hemoglobin
 Platelet count
 Tests for coagulation [PT / APTT]
 Ultrasound:
 GROWTH scan at 30 – 33 weeks to r/o IUGR
 At 37-38 weeks- for AFI / EFW or Doppler if necessary
Antenatal advice:
 Diet:
 During pregnancy, there is increased calorie requirement due to increased growth of the
maternal tissues, foetus, and placenta and increased basal metabolic rate.
 The increased caloric requirement is to the extent of 300 over the non-pregnancy state
during second half of pregnancy.
 The pregnancy diet ideally should be light, nutritious, easily digestible and rich in
protein, minerals and vitamins.
  The diet should consist in addition to the principal food at least half litre, if not 1 litre of
milk, plenty of green vegetables and fruits.
 Supplementary nutritional therapy:
 Supplementary iron therapy is needed for all pregnant mothers from 16 weeks onwards.
 For planned parenthood folic acid supplement before staring pregnancy.
 Antenatal hygiene:
 Rest and sleep: Recreational exercises are permitted as long as she feels comfortable. On
an average, the patient should be in bed for about 10 hours especially in last 6 weeks.
 Bowel: Constipation causes backache and abdominal discomfort. Regular bowel
movement facilitate by good diet, plenty of fluids, vegetables and milk or prescribing
stool softeners at bed times.
 Bathing: Daily taking bath is recommended.
 Clothing shoes and belt: Wear comfortable garments, high heel shoes and tight belt
should avoid.
 Care of breast: A well-fitting brassiere can give relief.
 Coitus: Generally it should not be restricted but should avoid in last trimester.
 Travel: Better to avoid jerking vehicles especially in 1st trimester and last 6 weeks.
 Immunization: 2 dose of TT protect foetus from tetanus. All most all the drug should
restrict in pregnancy.
 General advice: Regular antenatal visit should advice and notice and report warning
signs if reported.
Conclusion:

Antenatal care refers to the care that is given to a pregnant woman from the time that
conception is confirmed until the beginning of labour. The midwife will provide a woman-
cantered approach to the care of the woman and her family by sharing information with the
woman to facilitate her to make informed choices about her care.