Antenatal care is  Systemic supervision (examination and advice) of a woman during pregnancy which should be of a regular and periodic nature in accordance with the principles laid down or more frequently according to the need of the individual is called antenatal care.

Antenatal care comprises of-

1. Careful history taking and examination
2. The advice given to pregnant mother

Objectives of antenatal care: The objectives are to ensure a normal pregnancy with delivery of a healthy mother.

1. To screen the ‘high risk’ cases and detect high-risk factors.
2. To prevent or to detect and treat any complications earlier.
3. To ensure continued medical surveillance and prophylaxis.
4. To educate the mother about the physiology of pregnancy and labor by demonstrations, charts, and diagrams so that fear is removed.
5. To discuss the couple about the place, time, mode of delivery and care of the newborn.
6. To motivate the couple about the needs of the family planning and also provide advice to the couple seeking medical examination of pregnancy.

WHO recommended the antenatal visit: In the developing countries, as per WHO the antenatal visit is curtailed to at least four (4).

1^st visit ( by 16 weeks): 

• Anemia, syphilis, medical and obstetric risk factors.
• Individualized birth plan and health education.

2^nd visit (between 24 -28 weeks): 

• Symphysis-fundal height ( multiple pregnancies)

3^rd visit ( at 32 weeks): 

• Symphysis-fundal height ( multiple pregnancies, IUGR)
• Pre-eclampsia
• Further, develop an individualized birth plan.

4^th visit ( at 36^th week): 

• Identify fetal lie/ presentation
• Update individualized birth plan.

The procedure of antenatal visit: 

History taking:  History taking includes –

1. Particulars of the patient

• Name
• Address
• Age
• Gravida and para
• Duration of marriage
• Religion
• Occupation
• Occupation of the husband
• Period of gestation

2. Medical and surgical history

• History of past medical problem
• History of past surgical problem

3. Obstetric history

• Number of children
• Health status of the baby
• Immunization
• Age of the last child

4. Menstrual history

• Cycle
• Duration
• Amount of blood flow
• LMP
• EDD: This is done according to Naegele’s formula: LMP+9 calendar months+7 days.

Physical Examination: 

1. General examination: Body build, nutritional status, height, weight, pulse, BP, temperature, anemia, jaundice, edema, dehydration, examination of the breast.
2. Per-abdominal examination

• Inspection: Shape of abdomen, stria and scar mark.
• Palpation

1. The height of the uterus
2. Fetal movement
3. Four grips: Fundal grip, two lateral grips, and pelvic grip.

• Auscultation: Fetal heart rate.

Per-vaginal examination: unless contraindicated.

Other system examination

• Cardiovascular system examination
• Respiratory system examination

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Investigation

Routine investigation

• Blood: Hb%, ABO grouping, and Rh typing, VDRL
• Random blood glucose
• Urine R/M/E: Protein, sugar and pus cell

Special investigation

• Serological test for rubella
• Maternal serum alpha-fetoprotein
• Ultrasound examination

Antenatal advice : 

1. Diet: The pregnancy diet ideally should be light, nutritious, easily digestible and rich in protein, minerals, and vitamins. Extra 300 kcalorie diet should be recommended.
2. Rest and sleep: 8 hours sleep per day and at least 2 hours rest after mid-day meal must be recommended.
3. Bathing: The patient should be taken a daily bath but be careful against slipping in the bathroom.
4. Bowel and bladder: Regular bowel movement may be facilitated by regulation of diet taking plenty of fluids, vegetables, and milk.
5. Coitus: Coitus may be restricted during 1^st and last trimester with the increased risk of miscarriage or preterm labor.
6. Smoking and alcohol: Smoking and alcohol must be restricted in pregnancy.
7. Traveling: Long journey must be avoided in pregnancy.
8. Immunization: TT immunization- it does not only protect the mother but also neonates.

• 1^st dose: At 5^th
• 2^nd dose: At 7^th

Advice regarding family planning and baby care.

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1. General advice

• Advice to attend antenatal checkup on the scheduled date of visit.
• She is advised to come to the hospital if any complication arises such as- intense headache, P/V bleeding, less fetal movement, disturbed sleep, vomiting, scanty micturation etc.
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