1. Dr. Fouzia Shaikh Associate professor LUMHS
Antenatal Care
Dr. Fouzia Shaikh
Associate professor
LUMHS

2. Definition of 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.

3. Goals To reduce maternal and perinatal mortality and morbidity rates
To improve the physical and mental health of women and children

4. 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

5. 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 7th month.
Once every 2 weeks till the 9th month
Once every week during the 9th month, till labor.

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

8. Physical Examinations
Height of over 150 cm indication of an average- sized pelvis
The approximate weight gain during pregnancy is 12 kg.; 2kg in the first 20 weeks and 10 kg in the remaining 20 weeks (1.5 kg per week until term).

9. Obesity (more than 20 kg above the weight- height formula) leads to an increased risk of gestational diabetes, pregnancy-induced hypertension and thrombo-embolic disorders

10. Local Examination
The uterus may be higher than expected due to large fetus, multiple pregnancy, polyhydrammnios or mistaken date of last menstrual period.
The uterus may be lower than expected due to small fetus, intrauterine growth retardation, oligohydramnios or mistaken date of last menstrual period.

11. Fetal heart sound is heard by sonicaid as early as 10thweek of pregnancy.
Fetal heart sound is heard by Pinard' s fetal stethoscope after the 20thweek of pregnancy.
The normal fetal heart rate is beats/min

12. Investigations: Urine should be tested for sugar, ketones and protein.
Hemoglobin will be repeated:
At 36 weeks of gestation.
Every 4 weeks if Hb is < 9 g/dl.

13. Fetal kick count
The pregnant woman reports at least 10 movements in 12 hours.
Absence of fetal movements precedes intrauterine fetal death by 48 hours.

14. 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

15. Exercise should be simple, mild exercise avoid lifting heavy weights
A tooth can be extracted during pregnancy, but local analgesia is recommended
Catheter and enema should be avoided.
Smoking may lead to ptyalism, nervousness and hyper emesis and make pregnant woman at increased risk of chest infections and thrombo-embolic disorders

16. Pregnant woman should avoid contact with infectious diseases especially rubella or (German measles) because it has deleterious effects on the fetus
Pregnant woman should avoid exposure to x-ray or irradiation because of possible teratogenic effects on the fetus such as birth defects or childhood leukemia

17. FOCUSED ANTENATAL CARE
The high risk approach intended to classify pregnant women as “low risk” or “high risk” based on predetermined criteria and involved many ANC visits. This approach was hard to implement effectively since many women had at least one risk factor, Focused or goal oriented ANC services provide specific evidence-based interventions for all women, carried out at certain critical times in the pregnancy.

18. The essential elements of a focused approach to antenatal care • Identification and surveillance of the pregnant woman and her expected child • Recognition and management of pregnancy-related complications, particularly pre-eclampsia • Recognition and treatment of underlying or concurrent illness • Screening for conditions and diseases such as anaemia, STIs (particularly syphilis), HIV infection, mental health problems, and/or symptoms of stress or domestic violence

19. Preventive measures, including tetanus toxoid immunisation, de-worming, iron and folic acid, Intermittent preventive treatment of malaria • Advice and support to the woman and her family for developing healthy home behaviours and a birth and emergency preparedness plan to: o Increase awareness of maternal and newborn health needs and self care during pregnancy and the postnatal period, including the need for social support during and after pregnancy

20. recognition of danger signs for the woman and the newborn as well as transport and funding plans in case of emergencies o Help the pregnant woman and her partner prepare emotionally and physically for birth and care of their baby, particularly preparing for early and exclusive breastfeeding and essential newborn care Promote postnatal family planning/birth spacing

21. How many visits
A recent multi-country randomized control trial led by the WHO17 and a systematic review showed that essential interventions can be provided over four visits at specified intervals, at least for healthy women with no underlying medical problems. • First visit: On confirmation of pregnancy • Second visit: weeks • Third visit: weeks • Fourth visit: before expected date of delivery or when the pregnant woman feels she needs to consult health workerLeading causes of maternal mortal

22. Common Discomforts of Pregnancy, Etiology, and Relief Measures :
Urinary frequency
RELIEF MEASURES:
Decrease fluid intake at night.
Maintain fluid intake during day.
Void when feel the urge.

23. Fatigue
RELIEF MEASURES:
Rest frequency.
Go to bed earlier.

24. Sleep difficulties Rest frequency RELIEF MEASURES:
Decrease fluid intake at night

25. Breast enlargement and sensitivity
RELIEF MEASURES:
Wear a good supporting bra.
Assess for other conditions.

26. Nasal stuffiness and epistaxis
ETIOLGY: Elevated estrogen levels
RELIEF MEASURES :
Avoid decongestants.
Use humidifiers, and normal saline drops.

27. Ptyalism (excessive salivation)
ETIOLGY: Unknown
RELIEF MEASURES:
Perform frequent mouth care.
Chew gum.
Decrease fluid intake at night.
Maintain fluid intake during day.

28. Nausea and vomiting RELIEF MEASURES:
Avoid food or smells that exacerbate condition.
Eat dry crackers or toast before rising in morning.
Eat small, frequent meals.
Avoid sudden movements. Get out of bed slowly
Breath fresh air to help relieve nausea.

29. Shortness of breath RELIEF MEASURES:
Use extra pillows at night to keep more upright.
Limit activity during day

30. Heartburn RELIEF MEASURES: Eat small, more frequent meals.
Use antacids.
Avoid overeating and spicy foods.

31. Dependent edema Avoid standing for long periods.
Elevate legs when laying or sitting.
Avoid tight stockings.

32. Varicosities Rest in sims' position. Elevate legs regularly.
Avoid crossing legs.
Avoid tight stockings.
Avoid long periods of standing

33. Hemorrhoids RELIEF MEASURES: Maintain regular bowel habits.
Use prescribed stool softeners.
Apply topical or anesthetic ointments to area.

34. Constipation RELIEF MEASURES: Maintain regular bowel habits.
Increase fiber in diet.
Increase fluids.
Find iron preparation that is least constipating

35. Leucorrhea RELIEF MEASURES: Take a daily bath or shower.
Wear cotton underwear.

36. Backache RELIEF MEASURES: Wear shoes with low heels.
Walk with pelvis tilted forward.
Use firmer mattress.
Perform pelvic rocking or tilting

37. Leg cramps RELIEF MEASURES:
Extend affected leg and dorsiflex the foot.
Elevate lower legs frequently.
Apply heat to muscles.
Evaluate diet.

38. Faintness RELIEF MEASURES: Rise slowly from sitting to standing.
Evaluate hemoglobin and hematocrit.
Avoid hot environments