Dr. Areefa Al Bahri Ch. 5 Antenatal Care 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.

Importance of Antenatal Care 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

Schedule for Antenatal Visits: The first visit or initial visit should be made as early is pregnancy as possible. Return Visits: Once every month till 30. Once every 2 weeks till the 37 Once every week during the 38, till labor.

Signs of pregnancy Presumptive (subjective )signs of pregnancy: These signs are least indicative of pregnancy; they could easily indicate other conditions. signs lead a woman to believe that she is pregnant Amenorrhea. Breast changes and tangling sensation. Chlosma and linea nigra. Abdominal enlargement & striae gravidarum. Nausea & vomiting. Frequent urination. Fatigue quickening :sensations of fetal movement in the abdomen. Firstly felt by the patient at approximately 16 to 20 weeks. .

Probable signs( objective) of pregnancy: Hegar’s sign (softening of the lower uterine segment). Goodell’s sign (softening of the cervix ,uterus, and vagina during pregnancy.). Ballottement. (dropping and rebounding of the fetus in its surrounding amniotic fluid in response to a sudden tap on the uterus) Positive pregnancy test. Braxton hicks contractions. more frequently felt after 28 weeks. They usually disappear with walking or exercise.

Positive signs of pregnancy: Fetal heart tones : by Doppler technology Fetal movement felt by the examiner. after about 20 weeks' gestation Visualization of the fetus by the ultrasound.

Assessment and physical examination. ☺ history. ☺ Physical assessment. ☺ Nutritional assessment ☺ Psychological assessment ☺ Laboratory data. ☺ Ultrasound.

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

Physical Examinations Height of over 150 cm indication of an average-sized pelvis The approximate weight gain during pregnancy is 12 - 13 kg.; 2kg in the first 20 (1.5 kg per week until term). General exam ex. Vital sign , systemic,

Abdomen: The size of the abdomen is inspected for: - the height of the fundus, which determines the period of the gestation. - multiple pregnancy.

Laboratory data Test Purpose Blood group To determine blood type. Hgb & Hct To detect anemia. Rubella To determine immunity Urine analysis To detect infection or renal disease. protein, glucose, and ketones Papanicolaou (pap) test To screen for cervical cancer Chlamydia To detect sexual transmitted disease. Glucose To screen for gestational diabetes.

Test purpose Stool analysis for ova and parasites Hepitits Bserface antigine To detect carrier status or active disease

* Hemoglobin will be repeated: - At 36 weeks of gestation. - Every 4 weeks if Hb is<9g/dl. - If there is any other clinical reason.

Fetal heart sound is heard by sonicaid as early as 12-16 thweek of pregnancy. Fetal heart sound is heard by Pinard' s fetal stethoscope after the 20thweek of pregnancy. The normal fetal heart rate is 120-160 beats/min

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

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