ANTENATAL CARE DR. MADHAVI KARKI

ANC Care of the woman during pregnancy to achieve healthy mother and healthy baby at the end of pregnancy.

IMPORTANCE OF ANC:- 1.Promote, protect & maintain health during pregnancy. 2.Detect high risk cases during ANC examination and take proper action during delivery. 3.Many maternal diseases diagnosed and treated, which prevent transmission to infant. e.g. syphilis, hepatitis. 4.Tetanus immunization to mother can prevent tetanus neonatorum in infant.

ANC VISIT Standard:- Total 14 visits Intermediate:- Total 5 visits Every 4 week up to 32 weeks. Every 2 week from 32-36 weeks. Every week from 36 weeks till delivery. Intermediate:- Total 5 visits 1st: before 12 week 2nd: 20-22week 3rd: 28-32 week 4th: 34-36week 5th: 38- till delivery Minimum:- Total 3 visits 1st visit: 4-12 weeks 2nd visit: 24-26 weeks 3rd visit: 36-38 weeks

ACTIVITIES DURING ANTENATAL VISIT Advice Essential investigation Antenatal examination History taking Registration of the pregnant women.

HISTORY 1 General information 2 Chief complaint Name, age , gravidity, parity, LMP, EDD 2 Chief complaint 3 History of present illness 4 History of current pregnancy Details of the 1st ,2nd & 3rd trimester Lab tests & USG

5 Menstrual & gynecological history Contd... 5 Menstrual & gynecological history LMP Menstrual cycles, flow, dysmenorrhoea, menorrhagia OCP Surgical procedures History of infertility Sexually transmitted diseases Uterine anomalies

6 Past obstetric history Contd... 6 Past obstetric history Outcome of previous pregnancies in details including the abortions Any significant antenatal, intrapartum or postpartum events Previous maternal complications Mode of delivery Birth Weight Life & health of the baby

7 Past medical/ surgical History Contd... 7 Past medical/ surgical History Some medical conditions may have impact on the course of the pregnancy or the pregnancy may have an impact on the medical condition examples: Heart disease Kidney disease UTI Autoimmune disease Psychiatric disorders Hepatitis Venereal diseases Blood transfusion Hypertension DM Epilepsy Thyroid disease Bronchial asthma Any previous surgery.

8. Drug History 9. Family History 10. Social History Contd... 8. Drug History 9. Family History Hereditary illness → DM., HTN, thalassemias, sickle cell disease, hemophilia Congenital defects e.g.. neural tube defects, Down syndrome Twins 10. Social History Cigarette smoking, illegal drug use, domestic violence

ANTENATAL EXAMINATION GENERAL EXAMINATION:- Height Weight BP Pulse Head, eyes, ears, nose & throat  no changes Thyroid to rule out thyroid disease.

SKIN - pigmentation of the face (chloasma), abdomen (linea nigra) and vulva Stretch marks on the abdomen, thighs & breasts BREAST -  nodularity CVS - HR  Soft systolic murmur S2 - loud LUNGS - Elevation of the diaphragm -  total lung capacity OPHTHALMOSCOPY - hypertensive /diabetic women

ABDOMINAL EXAMINATION 1 Inspection Shape & size Asymmetry Fetal movement Surgical scars Cutaneous signs of pregnancy Linea nigra, striae gravidarum, striae albicans, umbilicus flat or everted, superficial veins

2 PALPATION 3 AUSCULTATION 4 PERCUSSION Fundal height Obstetrical Grips:- Fundal grip Two Lateral grip Pelvic grip-1st and 2nd 3 AUSCULTATION Fetal heart at 13-14 wks 4 PERCUSSION No importance

OBSTETRICAL GRIPS :

VULVAL &VAGINAL EXAM not routinely performed until some complaints. done only in 1st visit and during labour. Hyper pigmentation Look for abnormalities - Varicose veins/ hemorrhoids, Warts or herpes  vaginal secretions Cx - Softer, pigmented with thick , yellowish mucous Uterus enlarged

PRENATAL LABORATORY TESTING 8.Hepatitis B 7.VDRL for both partners 6.HIV test. 5.Stool R/E-to rule out parasitic infestation 4.Urine R/E-to see pus, glucose, protein, albumin 3.Blood glucose Random 2.Blood grouping and RH typing 1.Hb FIRST TRIMESTER LABORATORY TESTS Repeat of the investigations -Hb is repeated at 28th and 36th week

SECOND TRIMESTER LABORATORY TESTS 1.MATERNAL SERUM ALPHA FETO PROTEIN (MSAFP):- AFP is protein produced by yolk sac and fetal liver and is present in the mothers blood. When MSAFP is elevated, one must suspect of:- a. open neural tube defects b. multiple pregnancy c. anterior abdominal wall defects d. renal anomalies. Low levels are found in Downs syndrome. Test is done between 15-20 weeks.

3. ACETYL CHOLINESTERASE It is a combined biochemical test which includes maternal serum alpha fetoprotein, hCG and UE (unconjugated oestradiol). It is done for detection of Downs syndrome. In the affected pregnancy level of MSAFP and UE tend to be low whereas hCG tends to be high. It is also performed at 15-18weeks. Confirmation to be done by amniocentesis. 2.TRIPLE TEST Amniotic fluid Acetyl cholinesterase is elevated in open neural tube defects. 3. ACETYL CHOLINESTERASE

ANTENATAL ADVICE 1. The mother should have nutritious diet rich in protein, vitamins and minerals. The diet should contain milk, egg, plenty of green vegetables and fruits and majority of animal fat containing vitamin A and D. 2.The women is advised not to have strenuous work in the first trimester and last 6 weeks. 3. The patient is advised to have sleep for 10 hrs i.e. 8 hrs at night and 2 hrs at noon.

Contd... 4.Coitus should be avoided during first trimester and also during last 6 weeks for fear of premature labour and introduction of infection. 5. Smoking and alcohol should be stopped because this may induce abortion or congenital anomalies of fetus. 6.Travel by jerky vehicles is avoided during 1st trimester and last 6 weeks .The long journey is limited during the second trimester.

Contd... 7. Advice for regular ANC check-up. 8. She is advised to come to hospital, when there is intense headache, disturb sleep with restlessness ,urinary troubles, epigastric pain, vomiting and scanty urination. 9. She is advised to come to the hospital for admission- Painful uterine contraction lasting for more than 10 min or earlier and continued for at least 1 hr suggestive of labour. Sudden gush of watery per vagina. Vaginal bleeding