Antenatal Care & High Risk Pregnancy

Prepared by:

Dr. Gehanath Baral

MBBS,DGO,MD
Senior Consultant Gynecologist & Obstetrician: Government of Nepal
Visiting Professor: CTGU
20th March,2007
 Definition

Out patient care

of a
pregnant woman with a
systematic examination,
tests and
appropriate advice.
 Why ?

1. To prepare for childbirth and care of her

own and her newborn.

2. To manage obstetric risk factors.

3. To give apprprioate advice for

termination of pregnancy.

4. To ensure normal pregnancy and normal

delivery.
 Normal pregnancy
 Maternal age=20-30yrs
(optimal age=20-24yrs)

 Term= 37-42weeks

 No maternal complication

 Birth wt.=2.5+kg

 Healthy fetus
 Antenatal tests 1
 Urine  Pregnancy test (once),
Albumin, Sugar, Microscopy (each
visit)

 Blood  Hb, ABO/Rh Grouping,

VDRL/RPR/TPHA, RBS (once)
 Antenatal tests 2:USG:

1. 1st trimesterto confirm pregnancy, to

see viability ,to localize pregnancy

2. 2nd trimester18-28wks-Anomaly scan,

Placentation

3. 3rd trimesterLiquor, presentation,

maturity, placentation, Biophysical profile
 High Risk pregnancy
Definition

 Factor/s present in a pregnant

woman which adversely affect/s the
maternal and/or perinatal outcome.
 High Risk Factors 1
 Age=Teenage pregnancy or Elderly
woman(>35)
 H/O Infertility
 Ht<145cm
 Wt. BMI<20/>25
 High Risk Factors 2: Past
pregnancy
 >P4
 Recurrent abortion  PET/ET
 Ectopic pregnancy  CS, Hysterotomy,
 Molar pregnancy Uterine rupture,
 SB, NND, Anomaly Perforation,
 Preterm, SGA, LGA  ABO/Rh
incompatibility
 Birth wt.>4kg
 Retained
placenta/PPH
 High Risk Factors 3 : Medical
disorders
 Associated tumors
 HTN  Psychiatric
 DM  Epilepsy
 Renal  Infective
 Thyroid TB
 Bleeding HIV
 Connective tissue Other STDs
 Hepatitis Exanthematous
High Risk Factors 4 :Past surgery

 Myomectomy
 CS,Hysterotomy,Uterine
rupture,Perforation,
 VVF repair
 Complete perineal tear repair
 Bladder neck surgery
 High Risk Factors 5:Present
pregnancy
 Threatened abortion/ APH
 Multiple pregnancy
 Malpresentation
 PET/ET
 Acute febrile illness
 H/O trauma
 H/O drug use