RUKHSANA.M.

HAROON
LECTURER
ION,DUHS

1
comprehensive health supervision of a
pregnant woman before delivery

Or it is planned examination, observation and

guidance given to the pregnant woman from
conception till the time of labor.

2
 To reduce maternal and perinatal mortality
and morbidity rates

 To improve the physical and mental health of

women and children

3
 To ensure that the pregnant woman and her
fetus are in the best possible health.

 To detect early and treat properly

complications

 Offering education for parenthood

 To prepare the woman for labor, lactation
and care of her infant

4
The first visit or initial visit should be made as
early is pregnancy as possible.
Return Visits:
 Once every month till 28 w.
 Once every 2 weeks till the 36 w
 Once every week, till labor.

5
 Assessment

History Examination Investigation

6
 Personal history
 Family history
 Medical and surgical history
 Menstrual history
 Obstetrical history
 History of present pregnancy

7
◦ The pregnant woman reports at
least 10 movements in 12 hours.

◦ Absence of fetal movements

precedes intrauterine fetal death
by 48 hours.

8
 Height of over 150 cm indication of an
average-sized pelvis
 The approximate weight gain during

pregnancy is 12 kg.; 2kg in the first 20 weeks

and 10 kg in the remaining 20 weeks (1.5 kg
per week until term).

9
 Symphysis–fundal height should be measured
and recorded at each antenatal appointment
from 24 weeks.
 Fetal presentation should be assessed by

abdominal palpation at 36 weeks.

10
 Fetal heart sound is heard by sonicaid as
early as 10thweek of pregnancy.

 Fetal heart sound is heard by Pinard' s fetal

stethoscope after the 20thweek of pregnancy.

11
◦ Urine should be tested for ketones and protein.

12
 Physiological changes  Smoking :
during pregnancy  Medications
 Weight gain  Infection
 Fresh air and sunshine  Irradiation
 Rest and sleep  Occupational and
 Diet environmental hazards
 Daily activities  Travel
 Exercises and relaxation  Follow up
 Hygiene  Minor discomforts
 Teeth
 Bladder and bowel
 Signs of Potential
Complications
 Sexual counseling

13
Urinary frequency
RELIEF MEASURES:
 Decrease fluid intake at night.
 Maintain fluid intake during day.
 Void when feel the urge.

14
RELIEF MEASURES:

 Rest frequency.

 Go to bed earlier.

15
ETIOLGY: Elevated estrogen levels
◦ RELIEF MEASURES :
 Avoid decongestants.
 Use humidifiers, and normal saline
drops.

16
ETIOLGY: Unknown
RELIEF MEASURES:
 Perform frequent mouth care.
 Chew gum.
 Decrease fluid intake at night.
 Maintain fluid intake during day.

17
•most cases of nausea and vomiting in
pregnancy will resolve spontaneously within 16
to 20 weeks.
•that nausea and vomiting are not usually
associated with a poor pregnancy outcome.

•non-pharmacological:
•ginger
•P6 (wrist) acupressure
•pharmacological:
•antihistamines.

18
◦ RELIEF MEASURES:
 Avoid food or smells that exacerbate condition.
 Eat dry crackers or toast before rising in morning.
 Eat small, frequent meals.
 Avoid sudden movements. Get out of bed slowly
 Breath fresh air to help relieve nausea.

19
RELIEF MEASURES:
 Eat small, more frequent meals.
 Use antacids.
 Avoid overeating and spicy foods.

20
 Avoid standing for long periods.
 Elevate legs when laying or sitting.
 Avoid tight stockings.

21
 Rest in sims' position.
 Elevate legs regularly.
 Avoid crossing legs.
 Avoid long periods of standing

22
RELIEF MEASURES:
 Maintain regular bowel habits.
 Use prescribed stool softeners.
 Apply topical or anesthetic
ointments to area.

23
RELIEF MEASURES:
 Maintain regular bowel habits.
 Increase fiber in diet.
 Increase fluids.
 Find iron preparation that is
least constipating

24
RELIEF MEASURES:
 Wear shoes with low heels.
 Walk with pelvis tilted forward.
 Use firmer mattress.
 Perform pelvic rocking or tilting

25
◦ RELIEF MEASURES:
 Extend affected leg and dorsiflex the foot.
 Elevate lower legs frequently.
 Apply heat to muscles.

26
:RELIEF MEASURES
•Rise slowly from sitting to standing.
•Evaluate hemoglobin and
hematocrit.
•Avoid hot environments

27
 Women’s bodies undergo substantial, which are
brought about by both hormonal and mechanical
effects.
 These changes lead to a variety of common
symptoms – including nausea and vomiting, low
back and pelvic pain, heartburn, varicose veins,
constipation and leg cramps – that in some
women cause severe discomfort and negatively
affects their pregnancy experience.
 In general, symptoms associated with mechanical
effects, e.g. pelvic pain, heartburn and varicose
veins, often worsen as pregnancy progresses.

28
 Symptoms of nausea and vomiting are
experienced by approximately 70% of
pregnant women and usually occur in the first
trimester of pregnancy (156); however,
approximately 20% of women may experience
nausea and vomiting beyond 20 weeks of
gestation (157). Low back and pelvic pain is
estimated to occur in half of pregnant
women, 8% of whom experience severe
disability (158).

29
 Symptoms of heartburn occur in two thirds of
pregnant women, and may be worse after
eating and lying down (159). Varicose veins
usually occur in the legs, but can also occur
in the vulva and rectum, and may be
associated

30
Screening

31
Nutritional Supplements

32
THANK YOU

33
 Zile, I., Rezeberga, D., Lazdane, G., & Gavare, I. (2019). Comparison of
antenatal care factors and pregnancy outcome in rural and urban context.
In SHS Web of Conferences (Vol. 68, p. 02007). EDP Sciences.
 World Health Organization. (2016).  WHO recommendations on antenatal care
for a positive pregnancy experience . World Health Organization.
 de Jersey, S., Guthrie, T., Tyler, J., Ling, W. Y., Powlesland, H., Byrne, C., &
New, K. (2019). A mixed method study evaluating the integration of
pregnancy weight gain charts into antenatal care.  Maternal & child
nutrition, 15(3), e12750.
 Lattof, S. R., Tunçalp, Ö., Moran, A. C., Bucagu, M., Chou, D., Diaz, T., &
Gülmezoglu, A. M. (2020). Developing measures for WHO recommendations
on antenatal care for a positive pregnancy experience: a conceptual
framework and scoping review.  BMJ open, 9(4), e024130.
 Tunçalp, Ӧ., Pena-Rosas, J. P., Lawrie, T., Bucagu, M., Oladapo, O. T., Portela,
A., & Gülmezoglu, A. M. (2017). WHO recommendations on antenatal care for
a positive pregnancy experience-going beyond survival.  BJOG, 124(6), 860-
862.
 World Health Organization. (2018).  WHO recommendations on antenatal care
for a positive pregnancy experience: summary: highlights and key messages
from the World Health Organization's 2016 global recommendations for
routine antenatal care (No. WHO/RHR/18.02). World Health Organization.

34