ANTENATAL CARE

AIMS
‡ Assessment and management of maternal risk and symptoms. ‡ Assessment and management of fetal risk. ‡ Prenatal diagnosis and management of fetal abnormality. ‡ Diagnosis and management of perinatal complications. ‡ Decision regarding timing and mode of delivery. ‡ Parental education regarding pregnancy and childbirth. ‡ Parental education regarding child-bearing.

ANTENATAL VISITS

General practitioner Health advocates Midwives Counselors Antenatal care Obstetricians Health visitors Clinical genetics Neonatologists .

Schedule of visit during pregnancy .

Preconception clinic visit 8-14 weeks visit 20-24 weeks visit 36-38 weeks visit 41-42 weeks visit .

Suggested antenatal visit(Health Ministry) and follow-up : ‡ below 28 weeks .once a month ‡ 28-35 weeks .every week ‡ More visits may be necessary depending on your condition and needs .every 2 weeks ‡ 36 weeks and above .

Preconception clinic visit ‡ The ideal first antenatal visit is where health education and risk assessment can be directed towards the planned pregnancy. . ‡ Folic acid supplementation ‡ Food hygiene. including how to reduce the risk of a food-acquired infection ‡ Lifestyle advicesmoking cessation recreational drug use alcohol consumption in pregnancy ‡ Antenatal screeningscreening for haemoglobinopathies. the anomaly scan and screening for Down s syndrome ‡ As well as risks and benefits of the screening tests.

. genetic problems is referred to a feto-maternal specialist. For example. ‡ Investigations Blood test Urine test Vaginal speculum examination Ultrasound-as for early scan ‡ Management is based on the risk assessment.8-14 weeks (booking) visit ‡ Main purpose Comprehensive history Establish the gestational age Identify the maternal and fetal risk factors Discussion of mental health issue-association between maternal psychological factors and low birth weight and pre term labour.

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.To identify women at high risk of subsequent pre eclampsia and intrauterine growth restriction.20-24 weeks visit ‡ Result of the tests perform at the previous visits are reviewed ‡ Mother can do the Doppler ultrasound screening the uterine ateries.

5. 3. 6. The promotion of good health habits Allaying anxiety Increasing the mother s feeling of control and satisfaction with the pregnancy and delivery Preparation for postnatal period Infant feeding Subsequent contraception Discuss topics.breastfeeding.Antenatal classes and the familiarization hospital visit ‡ Objectives1. pain management during delivery & etc . 4. 2.

Antenatal visit in the second half of pregnancy ‡Important in ensuring the education .the rest of the pregnancy .the delivary ‡Assessment of maternal health and fetal growth .

Antenatal classes and the familiarization hospital visits ‡Informal education to support through pregnancy ‡Formal parenting classes -promotion of good habit -allaying anxiety -infant feeding .

ceasarean -fetal malpresentation -malposition ‡Good time to finalize on planned contraception .Antenatal visit with hospital team (36-38 weeks) ‡ the objective is to anticipate any prob regarding the prospective delivery ‡Several factor considered -prev.

Postdates visit ‡To decide either induction of labour is appropriate ‡To prevent still birth due to lack of accurate and reliable test ‡Usually perform at 42 weeks ‡Main methods are -amniotomy or surgical induction -medical methods (prostaglandin or oxytocin) Factor that are unfavourable for for vaginal delivary .

‡ High head : occipito posterior position Deflexed head Placenta priaevia ‡ Suspicious CTG reduced variability less than 10 BPM variable deceleration ‡ Reduced amniotic fluid ‡ Low bishop score of cervix .

HISTORY TAKING & PHYSICAL EXAMINATION .

depends on EDD calculated according to Naegele s rule and its correlation with gestational age as estimated by ultrasound measurements of the crown-rump length. biparietal diameter. fetal abdominal circumference and femur length d) Previous obstetric and gynaecological history e) Past surgical and medical history f) Parity and gravidity of the patient .Obstetric History ‡ Invaluable for the initial and on-going assessment of mother and fetus during antenatal care ‡ History include: a) Maternal age.oldest screening tests in the history of antenatal care b) Accurate menstrual history c) Asssess gestational age.

Physical Examination ‡ Woman s height and weight are recorded at the first visit ‡ Respiratory and cardiovascular examination performed. thorough physical examination remains an essential part of booking visit .exclude any complications in these systems ‡ Much of the physical examination carries little weight in predicting adverse events later in pregnancy ‡ In areas where morbidity is high.

Check for edema at a) Finger b) Pretibial area 3.Fetal heart auscultation . Lie 6. Symphysis-fundal height 4. Engagement 7.A typical examination at each antenatal visit 1. Presentation 5. Check for blood pressure 2.

COMMON SYMPTOMS .

NAUSEA & VOMITING ‡ also known as morning sickness ‡ Usually starts between the first and second missed menstrual period and continue until about 14 to 16 weeks ‡ due to the effects of large amounts of circulating steroids. they may continue throughout the day . especially oestrogens or HCG ‡ Although it tends to be worse in the morning.1.

‡ reduced by having women squat rather than bend over when reaching down. and avoiding high-heeled shoes. BACKACHE ‡ Due to excessive strain. providing back support with a pillow when sitting down.2. ‡ Prior low back pain and obesity were risk factors. ‡ increased with duration of gestation. bending. . lifting. or walking.

PELVIC JOINT PAIN ‡ Caused by steroid hormones and increased vascularity in all the soft tissues. . ‡ ligaments of the pelvic joints are softened and relaxed ‡ treatment is support. bed rest and analgesics.3.

HEARTBURN ‡ results from the upward displacement and compression of the stomach by the uterus ‡ avoidance of bending over or lying flat. ‡ Antacid preparations may provide considerable relief .4.

. VARICOSITIES ‡ Veins become large and tortuous ‡ Caused by enlarged uterus obstructing the venous return ‡ become more prominent as pregnancy advances ‡ Usually occurs in legs and vulva ‡ If it happens in the rectum. it will cause hemorrhoids.5.

nonfoods such as ice (pagophagia). starch (amylophagia). or clay (geophagia).6. PICA ‡ cravings of pregnant women for strange foods and. . not all pregnant women with pica are necessarily iron deficient. ‡ although the craving usually is improved after correction of iron deficiency. ‡ considered by some to be triggered by severe iron deficiency. at times.

CONSTIPATION ‡ due to the relaxing effect of progesterone on smooth muscle ‡ Laxatives may be required for tratment .7.

INCREASED VAGINAL DISCHARGE ‡ Due to increased secretion of cervical mucus and the vascularity of the vagina ‡ May cause bacterial vaginosis.8. . and candidiasis. trichomoniasis.

OTHER SYMPTOMS ‡ FATIGUE ‡ HEADACHE ‡ PTYALISM .9.

RISKS IN PREGNANCY ‡Infections in pregnancy ‡Diabetes in pregnancy ‡Antepartum haemorrhage ‡Hypertension in pregnancy ‡Pre-eclampsia .

thus if there is any sign of HS. antibiotics can be given in birth. Chlamydia . The commonest cause of severe sepsis in babies. Rubella .maternal infection in early pregnancy causes fetal abnormalities.chickenpox in pregnancy can be fatal to the mother. With screening.As well as causing PID and infertility. but infection before childbirth can cause mortality. .Can cause neonatal hepatitis. Non STI -haemolytic streptococcus . Hepatitis B. Treatment prevents fetal damage. such as deafness.Infections In Pregnancy STI Herpes simplex . is linked to prematurity and neonatal conjunctivitis. Syphilis .Vertical transmission to the fetus happens but retroviral treatment can dramatically reduce this. preventing most deaths. Transfer to the fetus is rare.MOT: genital tract.caused by Treponema pallidum. After 16 weeks. cardiac disease and mental retardation. but can be prevented with administration of immunoglobulin. the risk is very low. or stillbirth. HIV. the mum gets a c-section. Herpes zoster .Transmission occurs through vaginal delivery. this can lead to congenital disease. Vaccine is contraindicated in pregnancy. but doesn't reverse it.

Higher rate of congenital abnormalities in the child.Fetal distress. Early babies . are more common. Ill babies . Mum: Increased insulin use.Fetal lung maturity is less advanced.Diabetes in pregnancy Baby: Big babies . UTI is more common. Suffocating babies . especially if the glucose level is poorly controlled. making RDS more common. Higher chances of getting ketoacidosis.more likely to be a big baby. which can cause problems. and other diabetes side effects. Weird babies . such as retinopathy. .Preterm labor is more common. and the related sudden fetal death.

Management of acute bleeding As always. group and save. vasa praevia (bleeding from the foetal blood vessels) and inherited bleeding problems. Essentially.this is the cause in 20% of cases and occurs in 1 in 200 pregnancies.Antepartum Haemorrhage Definition Bleeding from birth canal after 24 weeks. cross-match Fetal monitoring .well. This is graded I-IV depending on how far down it is. the placenta separates from the uterus and the blood collects between uterus and placenta. firstly do ABC and resuscitate if shocked. regardless of the gestation. other causes such as : infection.the placenta is in the lower segment of the uterus. Foetal distress or severe bleeding require urgent delivery. Placental abruption . possibly covering the cervical os. Causes Placenta praevia . Uterine rupture . This is only mentioned because it's incredibly serious. the uterus ruptures. Bloods: FBC.

pheochromocytoma. or renal artery stenosis Preexisting diabetes (type 1 or type 2).Pre.eclampsia Maternal personal risk factors for preeclampsia: First pregnancy New partner/paternity Age younger than 18 years or older than 35 years History of preeclampsia Family history of preeclampsia in a first-degree relative Black race Obesity (BMI 30) Interpregnancy interval less than 2 years or more than 10 years Maternal medical risk factors for preeclampsia: Chronic hypertension. especially with microvascular disease Renal disease Systemic lupus erythematosus Obesity History of migraine . especially when secondary to such disorders as hypercortisolism. hyperaldosteronism.

rapidly increasing or nondependent edema may be a signal of developing preeclampsia. . Pain may be of sudden onset.Mild lower extremity edema is common in normal pregnancy. throbbing. is typically constant.Visual disturbances typical of preeclampsia are scintillations and scotomata. .Placental/fetal risk factors for preeclampsia Multiple gestations Hydrops fetalis Symptoms of preeclampsia: . or similar to a migraine headache.Headache is of new onset and may be described as frontal. with stretch of the liver capsule. These disturbances are presumed to be due to cerebral vasospasm. and may be moderate to severe in intensity. . .Rapid weight gain is a result of edema due to capillary leak as well as renal sodium and fluid retention.Epigastric pain is due to hepatic swelling and inflammation. .

 Cost.  Provide health care education.  Adequate assessment of maternal and fetal conditions. .  Must look out for possible complications and risk factors that occur during pregnancy.FACTORS AFFECTING THE SUCCESS OF ANTENATAL CARE  Definite plan.

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