ANTENATAL CARE

Definition  Systematic supervision or care of a woman during pregnancy.  Also called prenatal care.

 Primary aim of antenatal care is to achieve at the end of pregnancy a healthy mother and a healthy baby.  Ideally this care should begin soon after conception ( or even preconceptionally ) and continue throughout pregnancy.  Includes a) Careful history taking and examination & examination & b) Advice to the pregnant b) Advice to the pregnant woman woman

Objectives 1.To promote, protect & maintain the health of the mother during pregnancy. 2.To detect “high risk” cases and give them special attention. 3.To foresee complications and prevent them. 4.To remove anxiety and dread associated with delivery. 5.To reduce maternal and infant mortality and morbidity.

Objectives (cont) 6. To teach the mother elements of child care, nutrition & personal hygiene. 7. To sensitize the mother to the need for family planning, including advice to cases seeking medical termination of pregnancy.

Components of first visit  Detailed history  Physical examination  Investigations Hemoglobin Blood group & Rh typing Blood group & Rh typing Serological tests for HIV, Hepatitis B, Serological tests for HIV, Hepatitis B, Rubella & Syphilis Rubella & Syphilis Urine analysis Urine analysis Pap smear ( If facilities are available) Pap smear ( If facilities are available) Ultrasound Ultrasound  Folic acid / Iron and calcium supplementation

Subsequent visits  At interval of 4 weeks up to 28 weeks; at interval of 2 weeks up to 36 weeks; and thereafter weekly up to the expected date of delivery.  In developing countries, WHO recommends at least 4 visits in the antenatal period – 1 st at 16 weeks, 2 nd between 24 – 28 weeks, 3 rd at 32 weeks and 4 th at 36 weeks.  Further visits are advised depending on the condition of the mother.  Once in 1 – 2 weeks in high risk cases

Subsequent visits  History  Physical examination ( weight gain, B.P)  Investigations Hemoglobin Hemoglobin Urine analysis Urine analysis Ultrasound Ultrasound  Iron and calcium supplementation  Immunization against tetanus  Advice on nutrition, self care, family planning, delivery.  Referral services where necessary

Identification of high risk cases  Elderly primi  Short statured primi  Malpresentations  Antepartum hemorrhage, threatened abortion  Pre-eclampsia and eclampsia  Anaemia  Twins, hydramnios  Previous stillbirth, Intrauterine Death, Manual Removal Of Placenta  Grandmultiparas  Previous Caesarean  Medical complications  HIV

Maintenance of records  Antenatal card prepared at the first examination which contains the patients registration number, identifying data, past history and pregnancy events.  Subsequent examination findings and history and investigations reports entered in the card.

Antenatal advice Antenatal advice 1.Diet  Increased calorie requirement (2500 kcal in pregnancy and 2600 kcal during lactation )  Light, nutritious, easily digestible  A balanced and adequate diet  Atleast half litre of milk, plenty of green leafy vegetables and fruits  Supplementary nutritional therapy - Iron, calcium, folic acid

Recommended weight gain in pregnancy  11 – 12 kg  1 – 2 kg in 1 st trimester  5 kg in 2 nd and 3 rd trimesters

Recommended weight gain Prepregnancy BMI Recommended weight gain in kilograms Recommended weight gain in kilograms Low ( BMI < 19.8 ) Normal ( BMI 19.8 – 26 ) High ( BMI 26 – 29 ) 7.0 – – 11.5 Obese ( BMI > 29 ) < 7.0 < 7.0

2. Antenatal hygiene  Rest and sleep – 10 hrs per day  Personal cleanliness  Avoid constipation  Exercise  Avoid smoking and alchohol  Oral hygiene  Coitus  Care of breasts  Travel

3. Drugs Use of drugs that are not absolutely essential should be discouraged, especially between 4 – 8 weeks of pregnancy. Use of drugs that are not absolutely essential should be discouraged, especially between 4 – 8 weeks of pregnancy.

4. Immunization  Routine – Tetanus  Others given during epidemic or while traveling to an endemic zone.  Live viral vaccines are contraindicated  Rabies, Hepatitis A & B vaccines can be given

5. Warning signs  Headache  Blurring of vision  Epigastric pain and vomiting  Bleeding per vagina  Leaking per vagina  Painful uterine contractions  An other unsusual symptoms

Management of high risk cases Mental preparation Family planning advice

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