Ante natal care **

How many women die of child birth

world wide VS deaths due to corona ? 38
per 100000 pregnant women / 286000
• Minimum 4 visits … first trimester, second
trimester, third trimester 2 visits.
AIMS of ANC -- (reduce Maternal & Perinatal mortality)
• Protection and improvement of mother’s health
• Protection of the Baby…… deliver a healthy new-
born
• Early identification of complications and treatment
• Reducing costs by early diagnosis
• Early referrals
• Statistics … outcome

Help to give a Positive experience,

 Key Areas of Concern
– Providing ante-natal information on potential risks.
– Lifestyle considerations, smoking, drinking, work-life
balance, psychological preparation for the new
mother and vitamins with iron, Vit.D & Folic acid.
– Screening for haematological conditions, viz.
Thalassemia, Anaemia
– Screening for fetal anomalies
– Screening for clinical conditions, viz. hypertension,
gestational diabetes
 When does it start ?
• Pre-conception counselling … smoking,
alcohol, illicit drugs, diet,
• folic acid – reduces the chances of getting
neural tube defects – dose 4000 micro
gms/day (0.4 mgm)
 Common discomforts
• Pelvic pains – ligamental stretch
• Urinary frequency - ?
• Ankle swelling – ivc compression, fluid retention,
ccf, pre eclampsia.
• Varicosities – support stockings
• Heartburn – posture, antacids ( not to be taken with Iron )
• Constipation – fluids, fibre, fybogel
• Haemorrhoids
 Common discomforts

• Low back pain – posture and relaxing

• Dental decay, hypertrophic gums – see dentist
• Skin changes – chloasma
• Itch – iron def, cholestasis --- antihistamines
• Stretch marks - moisturisers
 Schedule of visits
• First trimester once ( Booking )
• Second trimester  once in 4 weeks
• Third trimester  once in 7 days
• Increased weight gain >
1kgm per month
• Hypertension >130/90,
Early visits if family history of htn
any • Age >30years
complications • Family history of diabetes,
are detected abnormal glucose tolerance
test
 Must grading to high risk
• First Visit
– Detailed history with special reference to family
history, personal history --- smoking, alcohol, illicit
drugs.
– Weight, height, BP
– Menstural history, LMP / EDD
– Obstetrical history … include puerperium, child’s
present health, breast feeding
– Blood Tests for grouping ABO & Rh, VDRL, HBsAg, HIV,
Hb
– Urine routine and culture
 Each subsequent visit
• All observations to be recorded and correlated with
the previous findngs.
• Confirmation of the findings. ( wt, Hb., Urine, BP, oedema,
uterine height, presentation, lie, breast care)
• Discuss the patient’s problems, (adv on clothing, footwear).
• Talk about what to expect / what are the danger signs.
• Prepare the couple for the process of labor.
• Blood tests Hb & urine routine to be done once a
month
 Role of Ultrasound
• First ultrasound on first visit … baseline record
of foetal growth parameters (Dating Scan)
– Head circumference, BPD
– CRL < 10 weeks
– Congenital annomalies
– Placenta
– Liqour amnii

• Repeat in second trimester at 16 to 20 weeks

– Nuchal Translucency (NT scan / Nuchal scan) for Trisomy
– Growth parameters BPD, head circumference, Femur L, chest
circumference, abd circumference
– Placenta
– Congenital malformations
 Some Questions
• What are kegel exercises ? How are they done ?
• Role of Folic acid, Iron, Calcium (read Pre eclampsia)
• Date of Quickening
• Determination of the period of gestation
» .LMP and CRL at 6 -8 weeks.
» ..Except for patients taking oral contraceptives.
» …Serial records of ANC if available.

• Lightening … sense of relief as the head engages.

• USG --- foetal sac at 5weeks, Foetal heart at 8 week
» With TVS foetal heart can be picked up at 5 to 6 weeks
• Earliest confirmation of pregnancy is CRL on USG at 6 weeks.
 Postnatal care
• Maternal
– Lochia xs bleeding = pph admit
– Early mobilisation
• Breasts – engorgement lasts 2-3 days mild
temp increase.
– Nipple pain- creams / daktarin if candida
– Mastitis – keep breasts empty / flucloxacillin
• Follow up for htn / gdm.
 Postnatal care

• Blood pressure / gdm

• Fundal height …. For involution
• Perineum … perineal laceratios / episiotomy
• Symptoms of depression
• Contraceptive advice
 Postnatal care
• Fetal • Fetal exam
– Method of delivery – Genitalia .. Descent of testis
– Length of gestation – Hips
– Weight
– Femoral pulses
– Feeding
– Spine
– Concerns of the mother
– Birth marks
 Postnatal care
• Fetal examination
– Fontanelles
– Eyes- cataract
– Sclera – jaundice
– Hb
– Lungs
– Abd. - masses
 6 week exam
• Maternal
– Feeding
– Depression
– Lochia
– Contracption
– BP
– Abd. exam
– Smear if due