ANTE NATAL CARE

GOOD MORNING
Prenatal or antenatal care

Systematic supervision of a woman

during pregnancy is called antenatal
care.
 Antenatal care

It is the education, supervision and

treatment to a pregnant woman so that
her pregnancy and labour will
terminate with delivery of a mature
healthy living baby, without injury to
the mind or body of the mother.
OBJECTIVE OF
ANTENATAL CARE

To ensure a normal pregnancy with

delivery of a healthy baby from a
healthy mother.
AIMS OF ANTENATAL CARE
1. To monitor the progress of pregnancy
in order to ensure maternal health and
normal fetal development.
2. To recognise the deviation from the
normal and provide management or
treatment as required.
3. To ensure that the woman reaches the
end of her pregnancy physically and
emotionally prepared for her delivery.
CONTINUED…..
4.To identify high risk pregnancy and
for their proper management.
5.To reduce or prevent maternal and
perinatal mortality and morbidity.
6.To help and support the mother in
breast feeding and parenting.
7. To offer family welfare advices on
parenthood.
ANTENATAL CARE COMPRISES?
1. Registration of pregnancy
2. History taking
3. Antenatal examinations [general and
obstetrical]
4. Laboratory investigations
5. Health education
1. Registration of pregnancy:

The registration of pregnancy must be

done in an antenatal clinic within 12
weeks.
2. History taking
A complete history of the woman including
the following are collected in the first visit.
1.Demographic data (Name, age, address,
marital status, religion, education,
occupation etc)
2. Menstrual history.
3. Personal history.
4. Past medical and surgical history.
CONTINUED…..
5. Family history.
6. History of present pregnancy (last
menstrual period LMP, Expected date of
delivery EDD, etc.
7. Obstetrical history (number of pregnancy,
any abnormality in previous pregnancies
and deliveries).
3. Antenatal examination
A complete general examinations of the body is
conducted, including
1.Height: The height is carefully recorded, as
patients measuring 5 feet or less is more likely to
have a small pelvis that may cause difficulty during
delivery.

 2. Weight: Weight should be regularly taken using

an accurate weighing machine. Periodic and regular
weight checking helps in detecting abnormalities.
 
3. Pallor: Colour of conjuctiva, soft palate,
tongue, and nail beds are to be noted.
(Paleness indicates anemia)

4. Jaundice: Eyes and mouth are to be

observed for yellow discolouration. (yellow
discolouration indicates of jaundice)
 
5. Tongue, teeth, gums: Observe for signs of
infection and malnutrition.
 
6. Legs: Legs are to be examined for
oedema.
 
7. Breasts: Examination of the breasts is
mandatory, to note the presence of
pregnancy charges and condition of the
nipples (cracked / depressed / inverted).
8. Abdominal and vaginal examinations:
Position of the uterus is noted in abdominal
examination. Unless necessary, vaginal
examinations is not routinely done except
for the first time when the woman attends
the clinic to confirm pregnancy.
 
Preliminaries
Before performing obstetric examination
of mother she should evacuate the
bladder.
Make her lie down in dorsal position.
She is made to flex her knees while
doing pelvic palpation.
Examination is performed by fully
exposing the abdomen.
Examiner stands on right side of mother.
 Inspection
Size and shape of the uterus is assessed
An examiner can also observe fetal
movements.
Ovoid in primigravid woman
Multiparous woman – pendulous abdomen in
which uterus sags forward.
Skin condition and presence of any scar is
noted.
Linea nigra may be seen.
Palpation
Warm hands before palpation
Centralize uterus, place ulnar border of
left hand on upper most level of fundus
and measure till symphysis pubis with
help of an inch tape.
Fundal height:……cm
Abdominal girth: measure around
abdomen at the level of umbilicus
 Pelvic Grip or Leopold maneuver
Leopold's Maneuvers are a common and
systematic way to determine the position of
a fetus inside the woman's uterus; they are
named after the gynecologist Christian
Gerhard Leopold.
First Leopold maneuver.

FUNDAL
PALPATION:
The uterine fundus is
palpated to determine
which fetal part
occupies the fundus.
Second Leopold maneuver.

LATERAL PALPATION:
 Each side of the maternal
abdomen is palpated to
determine which side is the
fetal spine and which is the
extremities.
 Spine : smooth curved and
resistent feel
 Limbs : small knob like
irregular parts
Third Leopold/Pawlik’s maneuver.
One hand applies
pressure on the
fundus while the
index finger and
thumb of the other
hand palpate the
presenting part to
confirm presentation
and engagement.
Fourth Leopold maneuver.

 The area above the

symphysis pubis is palpated
to locate the fetal presenting
part and thus determine how
far the fetus has descended
and whether the fetus is
engaged. If hands are
converging indicates
unengagement ; diverging
indicates engagement of
head.
4. Laboratory investigations
1. Complete blood count including
a) haemoglobin level
b) Blood grouping and Rh typing.
c)Blood for VDRL
2.Urine examinations:
Urine should be tested for albumin, sugar, pus
cells,
One to two doses of tetanus toxoid is given to
immunize against tetanus infection.
Iron and folic acid supplements is given
SUBSEQUENT VISITS
Up to 28 week -- the antenatal check up
should be done at an interval of 4 weeks from
the first visit.
Beyond 28 weeks, the antenatal check up
should be done at
Interval of 2 weeks upto 36 week and
thereafter weekly, till the expected date of
delivery.
At each visit, the findings are to be recorded in
the same card for better evaluation.
5. Health education
1. Diet: The diet during pregnancy
should be adequate to provide for
a. the maintenance of maternal
health.
b. the needs of the growing fetus.
c. the strength and vitality required
during labour and
d. the successful lactation.
 
The pregnancy diet should be light, nutritious
and easily digestible.
It should be rich in protein, minerals vitamins
and fibres and of the required calories.
Dietary advice should be given with due
consideration to the socio-economic condition,
food habits and taste of the individual.
Supplementary iron therapy is needed for
all pregnant mothers from 20 weeks onwards.
2. Personal hygiene:
1. Rest and sleep: The woman may continue
her usual activities throughout pregnancy.
Hard and strenuous work should be avoided.
On an average, a patient should have 10 hours
of sleep (8 hours at night and 2 hours at noon)

2. Bowel: As there is a tendency of constipation

during pregnancy, regular bowel movement
may be facilitated by regulation of diet taking
plenty of fluids, vegetables and milk.
3. Bathing: Daily baths and preferably
twice a day are advised.
4. Clothing: The patient should wear loose
but comfortable dresses. High heel shoes
are better avoided.
5. Dental hygiene: The dentist should be
consulted at the earliest, if necessary.
6. Care of the breasts: Cleanliness of the
breasts is maintained. If anatomical
defects are present advise to seek medical
help.
7. Coitus: Contact with the husband to be
avoided during the first trimester and last
6 weeks.
8. Travel: Long distance travel better to
be avoided. Rail route is preferable.
9. Smoking and alcohol: Smoking and
alcohol are to beavoided totally during
pregnancy as both cause variable injuries
to the fetus.

10. The pregnant women should avoid

over-the counter drugs (drugs without
medical prescription). The drugs may
have teratogenic effects on the growing
fetus especially during the first trimester.
General advice
She is instructed to report to the doctor even at an
early date and if the following warning signs
and symptoms symptoms arise:
· intense persistent headache
· severe oedema
· disturbed sleep with restlessness
· low urine output (less than 500 ml per day)
· epigastric pain
. persistent vomiting
· painful uterine contractions
· sudden gush of watery fluid per vaginum
· active vaginal bleeding etc.