1. 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.

2. 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

3. 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.

4. 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. .

5. 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.

6. 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.

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

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

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

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

11. 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.

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

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

14. 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 beats/min

15. 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

16. THANKS A LOT