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-
- Careful history taking and examination
- The advice given to pregnant mother
Objectives of antenatal care: The objectives are to ensure a normal pregnancy with delivery of a healthy mother.
- To screen the ‘high risk’ cases and detect high-risk factors.
- To prevent or to detect and treat any complications earlier.
- To ensure continued medical surveillance and prophylaxis.
- To educate the mother about the physiology of pregnancy and labor by demonstrations, charts, and diagrams so that fear is removed.
- To discuss the couple about the place, time, mode of delivery and care of the newborn.
- 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).
1st visit ( by 16 weeks):
- Anemia, syphilis, medical and obstetric risk factors.
- Individualized birth plan and health education.
2nd visit (between 24 -28 weeks):
- Symphysis-fundal height ( multiple pregnancies)
3rd visit ( at 32 weeks):
- Symphysis-fundal height ( multiple pregnancies, IUGR)
- Further, develop an individualized birth plan.
4th visit ( at 36th week):
- Identify fetal lie/ presentation
- Update individualized birth plan.
The procedure of antenatal visit:
History taking: History taking includes –
- Particulars of the patient
- Gravida and para
- Duration of marriage
- 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
- Age of the last child
4. Menstrual history
- Amount of blood flow
- EDD: This is done according to Naegele’s formula: LMP+9 calendar months+7 days.
- General examination: Body build, nutritional status, height, weight, pulse, BP, temperature, anemia, jaundice, edema, dehydration, examination of the breast.
- Per-abdominal examination
- Inspection: Shape of abdomen, stria and scar mark.
- The height of the uterus
- Fetal movement
- 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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- Blood: Hb%, ABO grouping, and Rh typing, VDRL
- Random blood glucose
- Urine R/M/E: Protein, sugar and pus cell
- Serological test for rubella
- Maternal serum alpha-fetoprotein
- Ultrasound examination
Antenatal advice :
- 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.
- Rest and sleep: 8 hours sleep per day and at least 2 hours rest after mid-day meal must be recommended.
- Bathing: The patient should be taken a daily bath but be careful against slipping in the bathroom.
- Bowel and bladder: Regular bowel movement may be facilitated by regulation of diet taking plenty of fluids, vegetables, and milk.
- Coitus: Coitus may be restricted during 1st and last trimester with the increased risk of miscarriage or preterm labor.
- Smoking and alcohol: Smoking and alcohol must be restricted in pregnancy.
- Traveling: Long journey must be avoided in pregnancy.
- Immunization: TT immunization- it does not only protect the mother but also neonates.
- 1st dose: At 5th
- 2nd dose: At 7th
Advice regarding family planning and baby care.
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- 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.