Antenatal Check Up: History taking SBA - Presentation 2 (b) Antenatal Check Up: History taking Maternal Health Division Ministry of Health & Family Welfare Government of India

Antenatal Check Up: History taking What is the importance of history taking? Diagnose pregnancy (first visit only) Identify medical or obstetric complications in present pregnancy Identify complications during previous pregnancies Antenatal Check Up: History taking

Antenatal Check Up: History taking Points to be taken care of : Ensure privacy Ensure calm and quiet atmosphere Make the woman comfortable and relaxed Maintain confidentiality Establish rapport Record all facts on Mother & Child Protection (MCP) card Highlight abnormal findings Antenatal Check Up: History taking

Antenatal Check Up: History taking Start with Age of woman Order of pregnancy Birth interval Record LMP (1st day of woman’s last Menstrual period) and calculate Expected Date of Delivery EDD = LMP + 9 months +7 days Antenatal Check Up: History taking

Antenatal Check Up: History taking Ask for symptoms What are normal symptoms during pregnancy? Nausea & vomiting Heart burn Constipation Increased frequency of urination These symptoms may cause discomfort to the woman Antenatal Check Up: History taking

Antenatal Check Up: History taking What are the symptoms of complications? Fever Persistent vomiting with dehydration Palpitations, tiredness Breathlessness at rest / on mild exertion Generalized swelling of body / facial puffiness Severe headache and/ or blurring of vision Passing smaller amount of urine or burning micturition Leaking or bleeding per vaginum Abnormal vaginal discharge / itching Decreased or absent fetal movements Antenatal Check Up: History taking

Antenatal Check Up: History taking Obstetric history No. of previous pregnancies Date (month / year) Mode (vaginal / caesarian) Outcome (live birth, still birth, preterm, abortion, ectopic, vesicular mole) Antenatal Check Up: History taking

Antenatal Check Up: History taking Obstetric history Any past obstetric complications Recurrent pregnancy loss, Post abortal complications, APH, Hypertensive disorders of pregnancy, Malpresentation, Obstructed labor, PPH, Third degree tears, Puerperal sepsis, Thrombo-embolism etc Any past obstetric procedures Cesarean section, Instrumental delivery, Manual removal of placenta Antenatal Check Up: History taking

Antenatal Check Up: History taking Any current / past systemic illnesses High BP Diabetes Heart disease : Breathlessness on exertion, palpitation Tuberculosis : Cough> 2 wks , blood in sputum, prolonged fever Renal disease Epilepsy : Convulsions Asthma : Attacks of breathlessness Jaundice Malaria Any other history suggestive of RTI / STI ; HIV / AIDS Antenatal Check Up: History taking

Antenatal Check Up: History taking Family history of systemic illness Hypertension Diabetes Tuberculosis Thalassemia or repeated blood transfusions Multiple pregnancies Intake of alcohol or tobacco or smoking Drug intake or allergies Domestic violence Antenatal Check Up: History taking

Indications for referral to 24 x 7 PHC Previous history of : Stillbirth or neonatal loss Three or more spontaneous consecutive abortions Obstructed labor Premature births, twins or multiple pregnancy Weight of baby < 2.5 Kg or > 4.5 Kg Hypertension, pre-eclampsia, or eclampsia Surgery of reproductive tract (LSCS) Congenital anomaly of the baby Treatment for infertility Rh negative pregnancy Antenatal Check Up: History taking

Indications for referral to 24 x 7 PHC High fever with or without abdominal pain, too weak to get out of bed Fast or difficult breathing Haemoglobin 7–11 g% even after consuming IFA tablets for 30 days Excessive vomiting, unable to take anything orally Breathlessness at rest Reduced urinary output with high BP High BP (>140/90 mmHg) with or without proteins in the urine Antenatal Check Up: History taking

Indications for referral to FRUs Malpresentation Multiple pregnancy Any bleeding P/V during pregnancy and after delivery (a pad is soaked < 5 minutes) Severe headache with blurred vision Haemoglobin <7 g% Convulsions or loss of consciousness Decreased or absent foetal movements Active labour lasting longer than 12 hours in a primipara and more than 8 hours in a multipara Continuous severe abdominal pain Antenatal Check Up: History taking

Indications for referral to FRUs Premature rupture of membranes (PROM) before 37 weeks High BP (>140/90 mmHg) with proteins in the urine, and severe headache with blurred vision or epigastric pain Temperature more than 38°C Foul smelling discharge before or after delivery/abortion Ruptured membranes for more than 18 hours FHR >160/minute or <120/minute Perineal tear ( 2nd, 3rd and 4th degree) Antenatal Check Up: History taking

Antenatal Check Up: History taking To summarize History taking of an ante-natal woman includes Recording LMP Asking for symptoms Obstetric history Any current / past systemic illnesses or allergies Family history of systemic illness History of Intake of drugs, alcohol, tobacco etc. History of domestic violence Antenatal Check Up: History taking

Antenatal Check Up: History taking Thank you Antenatal Check Up: History taking