‫بسم هللا الرحمن الرحيم‬

University of Alfasher

Faculty of Medicine

Genitourinary course (B)

Batch (26)

Antenatal Care
Dr. Gaafar Abdulrahman
Prof. Assistant in obstetrics and gynecology
MBBS. Alfashir University ,MD.SMSB
FMAS & DMAS (Laparoscopy ) India
Master in health professionals education
Alnelain University
Objectives of the lecture:

 Definition of ANC ?

 What are the aims of ANC?

 How dose it offered ?

 What are the advices and instructions?

 Frequencies of ANC visits.

Definition and Purpose
 Care given to a pregnant woman from the time
she realizes she is pregnant until the birth of
the baby.
 Focused ante-natal care aims to reduce
number of visits for women who have no prior
or current medical or obstetrical problems.
 To ensure that the mother and fetus are in
good health and that any problems during
pregnancy are recognized and treated and/or
referred appropriately.
 The aims of antenatal care are to bring the mother
and child to labour in the best possible condition.
They are:
1- A screening process applied to the entire
pregnant population to detect subgroups at higher
risk for complications of pregnancy.
2 -Suitable diagnostic procedures to determine
who are really at risk.
3 -The management of high-risk pregnancies.
4 -The educational preparation of the couple for
childbirth and the rearing of the infant.
Key Elements
 Listen to the clients concerns
and give appropriate advise.
 Respect client’s rights of

dignity, privacy and

confidentiality.
Antenatal visits :
 The current method of antenatal care was
established 80 years ago but is now subject
to change. In particular, the visits in mid-
pregnancy (12–34 weeks) may be reduced.
 Traditionally, the woman is seen monthly

from the booking visit until 28 weeks,

fortnightly until 36 weeks and then weekly
until delivery.
 A reduction in the number of visits does not
affect the outcome of pregnancy and is very
popular with women.
 The aim of the visits is to screen the low-risk

population by means of history, examination

and investigation; then antenatal care for
high-risk women may be carried out on a
more frequent basis.
 The following scheme applies to all women
and is an attempt to identify risk factors.
The spacing of antenatal visits by traditional and
by modern care:

Traditional Modern care

6 - 12 gestation in weeks 8 - 12 gestation in weeks
16 -
20 20
24 -
28 26
30 32
32 -
34 -
36 36
37 -
38 38
1st visit :
 Ideally the booking visit should be at 8–12
weeks 'gestation(booking visit).Perform the
followings:
 History
 Physical Examination
 Investigations
 Advise (verbal + written)
 Interventions
Investigations at booking visit:
 Urine:
Proteinuria—renal disease.
Glucose—diabetes.
White blood cells—response to infection.
Nitrite—bacteria
 Blood tests :
- full blood count
- ABO and Rhesus group.
- Viral hepatitis Antigens.
- Atypical antigens
- Rubella test
- VDRL test
- HIV screening
2nd Visit – Around 26wks (20min)
 History
 Physical examination
 Advise
 Interventions

Review, reinforce and focus on danger

points
 • Check the hemoglobin.
 • If the woman is Rh-negative also check for

the presence of Rh antibodies. Give anti-D.

 • Many now screen for gestational diabetes

by doing random blood sugar at 28 weeks’

gestation.
 • Check the lie and presentation of the fetus.
3rd Visit – Around 32wks (20min)
 History
 Physical examination
 Advise
 Interventions

Review, reinforce and focus on danger

points
 Check hemoglobin level.
 If the patient is Rh-negative,

check for the presence of

antibodies. Give anti-D.
 If the presentation is

cephalic, is the head engaged?

4th Visit – Around 36-38wks (20min)

 History
 Physical examination
 Advise
 Interventions

Review, reinforce and focus on danger

points
 Examine the cervix to assess the
chances of success of induction if
this is needed and do a
membrane(41wk)sweep if the
cervical os is open; 70% of women
will go into spontaneous labour
within 48 hours.(>40wk).
General advice for healthy pregnancy:
 Advise a visit to the dentist
reasonably soon, as there is an
increased prevalence of tooth
decay and gingivitis in pregnancy.
 Give dietary advice.
 Advise the woman to stop

smoking since it increases the risk

of intrauterine growth retardation
and delayed fetal maturation.
Advise the woman to stop drinking alcohol or
cut down on her intake.
 Advise the woman to avoid unpasteurized

products, soft cheese as these have been

associated with intrauterine death secondary
to listeriosis.
 Advise the woman to be careful when dealing
with cats’ litter by avoiding emptying the tray
and using rubber gloves because of the risk
of acquiring toxoplasmosis which may lead to
mental retardation in the fetus.
 Consider providing iron supplementation.
 Vitamin supplements. These are not usually
required by women receiving an adequate diet.
An exception is folic acid as it is often only
barely sufficient in many diets. The
requirements in pregnancy rise from 50ug a
day to 300ug a day. Many women are therefore
given prophylactic iron tablets that also contain
folic acid (500ug a day.) Folic acid supplements
have been shown to reduce the incidence of
neural tube defects (NTDs) when taken
preconceptually and up to 14 weeks’ gestation.
Intercourse during pregnancy:

 There is no restriction to intercourse during

pregnancy unless the woman bleeds from the
vagina or has placenta praevia. Mechanical
problems may occur in late pregnancy so that
alterations in the position of intercourse may
become necessary, for example the woman
may be more comfortable on top.
Rest and exercise:

 Even in normal pregnancy, the extra

weight carried by the woman may
increase her sense of tiredness and
lethargy. Sensible exercise such as
walking and swimming or organized
exercise to which the woman is
accustomed (e.g. aerobics) should be
allowed in pregnancy.
Bathing & clothes:

 The woman should bathe as she wishes. Avoid

vaginal douching in pregnancy. Use wide
clothes.
 Bowels:

Pregnancy tends to make women constipated

because of the progestogenic effect of relaxing
smooth muscles. This is best overcome by
increasing fluid intake, fresh fruit and by the
use of foods rich in fibre. Laxatives should not
be used unless the constipation becomes
symptomatic.
Thanks…..