ANTENATAL CARE

AKSHITHA G R
 OBJECTIVES OF ANTENATAL CARE
• Reduce maternal and perinatal mortality and
morbidity
• Detect high risk cases
• Maintain health of the mother
• Proactive approach to complications
• provide necessary health education to mother
regarding
• danger signs, nutrition,personal hygiene
 PRENATAL VISITS
• BOOKED CASE- at least total3 antenatal visit with
two in the last trimester
• Booking visit- first visit woman makes to the health
care facility
AIMS
Risk assessment
Dating of pregnancy
Baseline investigation
Health education
 Subsequent visit
• The pregnant woman should be seen monthly up to
28 weeks , two weekly between 28 and 36 weeks
and thereafter weekly.
• In high risk more frequent visits needed
• Each visit
• -weight
- B.P
-symphysiofundal height in an empty bladder
•
 First trimester
• Basic investigations like CBC, blood
grouping,RH, antibody screening,urine
routine, thyroid,screen, GTT
• General examination
• Height ,weight, bmi
• Examine the breast
• Dating ultrasound
• Start on folic acid (prophylactic dose .5mg
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• Categorise high risk , low risk
HIGH RISK according to WHO
• elderly primi
• short statured primi
• threatened abortion and APH
• Malpresentation

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• pre eclampsia , eclampsia
• anemia
• elderly grand multipara
• twins, hydramnios
• previous still birth , iud, manual placental removal
• previous cs section, instrumental delivery
• pregnancy associated with medical disease

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• Start on ecospirin, lmwh if recommended
• Make adequate changes in medication already
being taken if not already made before
conception
• First trimester screen USS to measure NT and
aneuploidy screening at 11-14 weeks

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 SECOND TRIMESTER
• Start on prophylactic iron and calcium
• As per govt of india, prophylactic dose of iron
is 100mg of elemental iron
• In population with low calcium intake daily
elemental calcium of 1.5 to 2gm is
recommended to reduce risk of severe
preeclampsia
• Vitamin D3 Combination cn be used

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• Quadruple screen at 16-18 wks if double
marker not done
• Anomaly scan at 18 -20wks
• Complete blood count, antibody testing, urine
albumin at 24 weeks
• Symphysiofundal height to measured and
plotted from 24 weeks
• GTT repeated at 24 -28 wks

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• Fetal echo at 22- 24 weeks if warranted
• ANC once in 4 wks
• If RH negative anti-D may be given at 28 weeks

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 THIRD TRIMESTER
• Continue iron , calcium , folic acid
• ANC every 2 weeks till 36 weeks and then weekly till
delivery
• SFH to be measured, a discrepancy of more than 3cm
should need prompt USS examination
• Pregnant woman should be made aware of fetal movement
count abd to report in case of decreased fetal movements
• Routine doppler is not recommended- reserved for high risk
pregnancies and FGR
• Customised fetal growth chart to be plotted

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• Lmwh and aspirin to be continued till term
• GTT, CBC and urine albumin at 35-37 weeks
• Counselling regarding exercise, working,
alcohol, smoking, caffeine, nutrition, air travel,
sex , antenatal care , postnatal care and
contraception

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 VACCINATION
• Injection td first dose preferably at first visit,
second dose with a gap of atleast one month
preferably one month before EDD
• If previous pregnancy was within one year and
two dose already given, then one dose Is
enough as early as possible in upper arm

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 NUTRITION
• Pregnant woman needs an extra 300 kcal per
day especially from second trimester
• 60 g of extra protein to be provided daily
• Average wt gain should be 11 to 15 kg
• Rate of wt gain in second trimester about
500g per week

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 INVESTIGATIONS
FIRST DONE REPEATED INTERPRETATION
HB,PCV BOOKING EACH TRIMESTER <11G/DL ANEMIA
BLOOD GROUP BOOKING - IF RH
NEG,HUSBANG BG
AND ICT
HBS AG,HIV, VDRL BOOKING -

URE BOOKING EACH VISIT IF PUS CELL >5,

CULTURE, IF
ALBUMIN +
CONSIDER
PREECLMAPSIA
GDM 12-14 WKS EACH TRIMESTER

HBA1C FOR OVERT DM IN

FIRST TRIMSTER

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THANK YOU

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