Antenatal Care

Dr. Esam Nureldin O.Elzain

Associate Professor
Obst.&Gyn. Dept.

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Objectives:

1- Prevention early detection and treatment of pregnancy

related complications as pre-eclampsia, eclampsia and hemorrhage.
2- Prevention ,early detection and treatment of medical
disorders. e.g.: anemia and diabetes.
3- Detection of malpresentations, malpositions and
disproportion that may influence the decision of labour.
4- Instruct the pregnant woman about hygiene, diet and
warning symptoms.
5·Do laboratory studies of parameters may affect the foetus as
blood group, Rh typing, toxoplasmosis and syphilis.

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Preventive Medicine
1- to maintain the mother’s body & mental health.

2- to anticipate difficulties & complications of pregnancy

& labour.

3- to ensure the birth of a healthy baby.

4- to help the mother to raise up (rear) the child.

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Pre-pregnancy counseling
Before pregnancy
-Those who had abortion or preterm labour or any obst.
Complications during the previous pregnancies.
-any disease that might harm the baby or will be
exacerbated by pregnancy (heart& renal failure,
epilepsy…)

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frequency of antenatal visits:

- Booking visit. (1st. Visit) ….. ?? Timing?

- Every month ---- during the first 6 months(30/40).
- Every 2 weeks --- during the 7th and 8th months (30-
36/40).
- Every week --- during the last month.
More frequent visits are indicated in high risk
pregnancy.

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The first visit (Booking visit):
1- Proper history:
- personal history: about diseases(D.M, ↑Bp., thyroid dis. Heart dis.,
Renal, Surgical operations, Bl. Transfusion, long term drugs)
- family history: previous diseases+ inherited dis.(muscle dystrophy,
Huntington's chorrea), twins..
- Past obst. History: previous pregnancies & mode of deliveries
(recurrent misscourages = ? Cervical incompetence, IUFD= ↑Bp., DM,
Rh. Incompatibility.)
. Difficult or instrumental delivery, C/S …)
- Current pregnancy: was on oral contraceptive pills?, LMP, G.Age.
Any problems….

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Cont. Booking visit
2- Examination:
. General:
vital signs: (P., Bp., RR.), G. observations: (Gait, deformities, Height, weight.)

- H&N, U.L., CVS., Chest….

. Abdominal :
(organomegally, FL, Lie, presentation,… surgical scars, hernial orifices, pigmentations of pregn. …)

. Local:
inspection: (Ext. genitalia: circumcision, mutilation, perineal, vulval & vaginal abnormalities…)
P.V: Position : AV. Or RV. - Size., UT. Fibroids, Ov. Cyst.

- pelvic assessment : at Term = < 36/40

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Cont. Booking visit
3- investigations:
Laboratory
- Blood grouping. -Rh typing.
- Hemoglobin. (Hb%)
- Screening for ( TORCH)
(Toxoplasma, Rubella, Cytomegalovirus & Herpes zoster.)
Hepatitis, HIV, VDRL , and Measles if needed. α -fetoprotein=
neural tubal defects (16-18/40).
- Urine analysis particularly for albumin and sugar.
Ultrasound (U/S):
(1) Booking visit (2) 16/40 (3) 3rd.trimester.
(more frequent if complicated pregnancy)

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Return visits:

A- History: ask the patient about any complaint .

B- Examination: -Bp., FL: (progress of pregnancy: 32/40=presentation.

>36/40= engagement)–Edema, V. veins….
Weight: total (accepted) gain +/- 12 Kg.
(16-28/40 average gain = 6 Kg.)
( Then 2 Kg. every 4/40.)

C- investigations:
Hb% (30/52 – 36/52 ) . urine : for albumin and sugar.
U/S: (IUGR, F. anomalies, Liquer amount)
+ ( other investigations according to the C/O.=Amniocentesis, chorionic
biopsy, Fetoscopy…)

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Amniocentesis & chorionic biopsy
Chorionic Villous
Sampling (CVS)

Amniocente sis

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Advices during pregnancy:

Including all her Living pattern:

eating , walking , cleaning , sexual life …….

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1- Diet:
The daily requirements are:
 a- Calories. b- Proteins.
 c- Carbohydrates.
 d- Lipids.
 e- Vitamins:- A. , B. (Thiamine), B2 (Riboflavine).
Nicotinic acid., C (Ascorbic acid , Vitamin D. Folic acid.
. f- Minerals : e.g.: Iron & Calcium.

( well balanced diet)

Coffee and tea: should be restricted.

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2) Smoking &Gat chewing:
should be avoided as it may cause intrauterine growth
retardation or premature labour.

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3) Rest and sleep:
at least 2 hours in the midday &8 hours at night.

4) Exercises:
- violent exercises as diving and water sports
should be avoided.
- Tough house work should be minimized·
- walking is encouraged.

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5) Clothing:

Lighter and loser clothes of non synthetic materials

are more comfortable due to increased BMR and
sweating.
Clothes which hang from the shoulders are more
comfortable than that requiring waste bands.
Breast support is required.
Avoid tight elastic hosiery or its bands.

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6) Shoes:
High - heeled shoes should be discouraged as they
increase lumbar lordosis, back strain and risk of
falling down.

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Hyagin
7) Bathing: Shower bathing is preferable than tube or
sea bathing for fear of ascending infection. Vaginal
douching should be avoided.

8) Teeth brushing: Regular cleaning. Consult the

dentist when needed.

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9) Breasts:
to reduce the incidence of retracted and/ or cracked
nipples postpartum, the patient is instructed to
massage them with a mixture of glycerin and alcohol
during the last 6 weeks of pregnancy.

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10) Bowels:
Constipation is avoided by increasing vegetables,
fluids and milk intake and mild exercise.

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11) Coitus:
Whenever abortion or pre term labour is a threat,
coitus should be avoided. Otherwise, it is allowed with
less frequency and violence. Some obstetricians advise
abstinence in the last 4 weeks of pregnancy for fear of
ascending infection.

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12) Traveling:
long and tiring journeys should be avoided
particularly if the woman is prone to abortion or
preterm labour.
Traveling is not contraindicated but not the long ones
specially near term.

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13) Medications:
not to be taken without obstetrician advice due to risk
of teratogenicity

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Exposure to infections& irradiation
14) Exposure to infections:
is to be avoided particularly those of documented
teratogenicity e.g. rubella ,cytomegalovirus, herpes
huminis and varicella zoster viruses (TORCH)
15) Exposure to irradiation:
is to be avoided whether diagnostic or therapeutic.
( Teratogenicity)

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16) The warning symptoms:
which indicate immediate contact to the obstetrician
are:
(i) Vaginal bleeding, (ii) excessive persisting vomiting.

(iii) Abdominal pain, (iv) persistent headache

(v) blurring of vision. (vi) oedema of upper limbs or face.

(vii) gush of fluid per vagina. (viii) diminished or absent fetal
movements.

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Applied Clinical
i)Vaginal bleeding =
1ST.&2ND.TRIMESTERS  misscarriage.
3rd.trimester APH.

(ii) gush of fluid per vagina= PROM (if before term)

(iii) Abdominal pain Premature labour

(iv) persistent headache )

(v) blurring of vision. )  PIH
(vi) oedema of lower limbs or face. )

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QUIZ-1
What is correct about antenatal care :
a) The program is useless if started before the 12th.week.
b) It is designed for detection of high risk patients.
c) It is a place for correcting malpresentations.
d) It has no role in reducing maternal mortality rate.
e) It’s success depends upon the level of the provider.

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