dr. areefa al bahri ch. 5 antenatal care comprehensive health supervision of a pregnant woman before...

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.

• Personal history

• Family history

• Medical and surgical history

• Menstrual history

• Obstetrical history

• History of present pregnancy

History

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