importance of antenatal care
DESCRIPTION
Importance of antenatal care: prepared by Abir Chowdhury, Chittagong, BangladeshTRANSCRIPT
Importance of Antenatal care
Presented by:
Captain Nishat Fatema Nipun
MBBS (AFMC)
MO, CMH, Chittagong, Bangladesh
What is Antenatal care
• Periodic and regular supervision including examination and advice of a woman during pregnancy is called Antenatal care.
• The supervision should be of a regular and periodic nature in accordance with the need of the individual.
Aims
The aims are-•To screen the high risk cases•To prevent or detect or treat at the any earliest complication•To ensure continued medical surveillance and prophylaxis•To educate the mother about the physiology of pregnancy and labour by demonstrations, charts and diagrams so that fear is removed and psychology is improved
Aims (cont’d)
• To discuss with the couple about the place, time and mode of the delivery, provisionally and care of the newborn
• To motivate the couple about the need of family planning
• To advice the mother about breast-feeding, post-natal care and immunization
Objectives
To ensure a normal pregnancy with delivery of a healthy baby from a
healthy mother
Criteria of normal pregnancy
Delivery of a single baby in good condition at term with no maternal
complication
Services
As per WHO recommendation at least 4 visit-•1st visit around 16 weeks•2nd visit between 24-28 weeks•3rd visit at 32 weeks•4th visit at 36 weeks
Services (cont’d)
Generally-•At interval of 4 weeks up to 28 weeks•At interval of 2 weeks up to 36 weeks•At weekly interval up to EDD
Antenatal care comprises of-
• Careful history taking and examination and investigation
• Advice given to the pregnant woman
THE FIRST VISIT
• History taking• Examination• Investigation
History taking1. Particulars of the patient2. Chief complaints with duration3. Past history4. Obstetric history5. Menstrual history6. Family history7. Drug History8. History of immunization9. Socio-economic history10.Contraceptive history11.History of allergy
Particulars of the patient
1.Name2.Age3.Address4.Marital status5.Date of Admission6.Date of Examination
Chief complaints with duration1. Period of amenorrhea2. Nausea & vomiting, vertigo3. Increased frequency of micturition4. Constipation5. Heaviness of breast6. Rise of temperature7. Edema8. Pain in the abdomen9. Backache10. Vaginal bleeding
Past history
1.HTN2.DM3.BA4.Renal Disease5.Psychiatric illness6.IHD7.Any previous operation
Obstetrical History
• Duration of marriage• Gravida• Para• ALC
Menstrual History
Age of menarcheMenstrual periodMenstrual cycleLMPEDD
Family history
a)HTNb)DMc)Multiple pregnancy
Drug History
AntihypertensiveHypoglycemicAntidepressantCorticosteroidAnticoagulant
Physical examination
General examinationAbdominal examination
General examination
• Appearance• Height of patient• Weight of patient• Anemia• Jaundice• Edema• Cyanosis• Clubbing• Koilonychia• Leuconychia
General examination (cont’d)
• Temperature• Pulse• BP• RR• Breast• Heart sound• Lungs
Abdominal examination
InspectionPalpationpercussionAuscultation
Inspection
Shape of the uterusStriaescar mark
Palpation
• Assessment of fundal height• Lie• Abdominal girth• Fundal grip• Lateral grip• First pelvic grip• Second pelvic grip
Auscultation
Normal FHR is 120-160 b/mCauses of foetal tachycardia (>160 b/m)Causes of foetal bradycardia (<120 b/m)
Causes of foetal tachycardia (>160 b/m)
1. Maternal high fever2. Foetal distress3. Maternal tachycardia
Causes of foetal bradycardia (<120 b/m)
1. Foetal distress2. Foetal cardiac conduction defect
Investigation• CBC• Blood grouping & Rh typing• Urine R/E• RBS• VDRL• HBS Ag• Ultrasound
Ultrasound
early pregnancy (preferably at 10-13 weeks) to:•Determine gestational age•Detect multiple pregnancies•Help with later screening for Down's syndrome
Ultrasound (cont’d)
At 11-14 weeks: offer nuchal translucency screening for Down's syndrome, with other tests if available.
At 18-20 weeks: offer screening with ultrasound for congenital anomalies.
At 36 weeks: for foetal maturity, placenta praevia.
In subsequent visit
• Patient complains• General examination• Gestational age to be calculated• Identification of problem• Foetal movement• SFH measurement• Health education• Prophylaxis & treatment of anemia• Developing individualized birth plan
Second visit (24-28 weeks)
SFH measurementTo detect Multiple pregnancy
Third visit (32 weeks)
Screen for-1.Preeclampsia2.Multiple pregnancy3.anemia4.IUGR
Fourth visit (36 weeks)
• Identification of foetal1.Lie2.Presentation3.Position
• Update birth plan
Antenatal advicePrinciples:1.To impress the patient about the importance of regular check up2.To maintain or improve the health status of the woman to the optimum till delivery by judicious advice regarding diet, drugs and hygiene3.To improve and tone up the psychology and ot remove the fear of pregnancy by talking sympathetically to the patient and explaining the principle changes and events likely to occur during pregnancy
Antenatal advice (cont’d)
• Diet• Rest & sleep• Bowel• Personal cleanliness• Clothing, shoes & belt• Dental care• Care of breast• Coitus• Travelling
• Smoking & alcohol• Immunization• Drug• Mental preparation• Exercise• Child care• Birth plan• Warning sign• Family planning
Following advices are to be given:
Diet
Diet should be: 1.nutritious 2.balanced3.light4.easily digestible5.rich in protein, mineral and vitamin 6.with woman’s choice
DDA of a woman during pregnancy (2nd half)
Food element pregnancy
Kilocalories 2500
Protein 60 gm.
Iron 40 mg
Folic acid 400 g
Calcium 1000 mg
Vitamin A 6000 I.U.
Diet for a pregnant woman (3000 Kcal)
Early morning:•Tea or coffee – 1 cup•Biscuit – 2 pcsBreakfast:•Chapatties – 2 pcs•Egg – 1 poached or boiled•Vegetable – 1 cupMidmorning:•Milk – 250 ml or 1 glass•Biscuit – 2 pcs•Apple or orange – 1 pc
Diet for a pregnant woman (3000 Kcal)
Lunch:1.Cooked rice – 4 cup2.Meat or fish – 3 pcs or 120 gm.3.Cooked Dal – 2 cups4.Vegetable – 1 cup5.Leafy vegetable – ½ cup6.Salad – tomato, carrot, cucumber
Evening:•Biscuits – 2 pcs•Fruits – on choiceDinner:•Cooked rice – 3 cup•Meat or fish – 3 pcs or 120 gm.•Cooked Dal – 2 cups•Vegetable – 1 cupBed time: one glass of milk
Diet for a pregnant woman (3000 Kcal)
Early morning:•Tea or coffee – 1 cup (without sugar)•Salted Biscuit – 2 pcsBreakfast:•Chapatties – 2 pcs / Atta – 60 gm.•Egg – 1 poached or boiled•Vegetable – ½ cup•Milk – 150 ml or 1 cupMidmorning: apple or sweet lime
Diet for a pregnant diabetic woman (2200 Kcal)
Lunch:1.Cooked rice – 1.5 cup / rice – 60 gm.2.Meat or fish – 1 pcs or 40 gm.3.Cooked Dal – 1 cup4.Leafy vegetable – ½ cup5.Salad – tomato, carrot, cucumberEvening: (4 pm)•Salted Biscuits – 2 pcs•Milk – 150 ml or 1 cup
Diet for a pregnant diabetic woman (2200 Kcal)
Dinner:•Chapatties – 3 pcs / Atta – 90 gm.•Meat or fish – 1 pcs or 40 gm.•Cooked Dal – 1 cup•Vegetable – ½ cupBed time: one cup of milk
Diet for a pregnant diabetic woman (2200 Kcal)
Restricted food:•sugar•Molasses•Honey•Jam / jelly•Sweet•Chocolate•Ice-cream•juice
Diet for a pregnant diabetic woman (2200 Kcal)
Rest and sleep
• 8 hour sleep at night• At least 2 hour sleep after mid-day
meal• Hard strenuous work should be
avoided in first trimester and last 4 weeks
Bowel
• Regular bowel movement may be facilitated by regulation of diet, taking plenty fluid, vegetable and milk
CoitusShould be avoided in •1st trimester•last 6 weeks
Travelling
Should be avoided in •1st trimester•last 6 weeksAir travelling is contraindicated in•Placenta praevia•Preeclampsia•Severe anemia
Immunization
Indicated-•TT•HAV•HBV•RabiesContraindicated-•Live virus vaccine (rubella measles, mums, varicella)
Warning sign
1. Headache2. Blurring of vision3. Convulsion4. Vaginal bleeding5. Fever
Preconceptional care Preconceptional care is the one step ahead of
antenatal care. When a couple is seen and counseled about
pregnancy, its course and outcome before the time of actual conception, is called Preconceptional care.
Objective: to ensure that, a woman enters pregnancy with an optimal state of health which would be safe both to herself and the fetus.
Preconceptional care includes:
Identification of high risk factor Basal level health status including BP recording Rubella & Hepatitis immunization Folic acid supplementation Maternal health is optimized preconceptionally
such as overweight anemia Patient with medical disease like hypertension,
diabetes are stabilized in an optimal state by intervention
Preconceptional care includes: (cont’d)
Drugs used before pregnancy are verified and changed if required to prevent any adverse effect of the fetus; e.g., warfarin is replaced with heparin, oral anti-diabetic drug with insulin
Advise to stop smoking, alcohol and drug abuse Proper counseling to those with history of recurrent
foetal loss or family history of congenital abnormalities
Counseling regarding health care cost Find out supporting or helping people to help the
mother and care of the new born