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Antenatal Care
Objectives
I want you to be able to:
• Understand the value of Antenatal care.
• Perform a booking visit.
• Know the booking investigations.
• Act on the results of the investigations.
• Pick up abnormalities during the ANC.
Amis of Pre-pregnancy Care
• To bring the woman to pregnancy in the best possible health.
• To provide the means of ensuring that preventable factors are attended to before pregnancy starts, e.g., Rubella
• To discuss relevant issues.• To give advice about the effect of: Preexisting disease and its treatment on the pregnancy—Diabetes
, Hypertension the effect of pregnancy on preexisting disease and its treatment
• To consider the likelihood and effects of any recurrence of events from previous pregnancies and deliveries.
Aims of Antenatal Care
1. Management of maternal symptomatic problems.
2. Management of fetal symptomatic problems.
3. Screening and prevention of fetal problems.
4. Preparation of the mother for childbirth.5. Preparation of the couple for
childbearing.
Booking appointment
• Ideally by 10 weeks of gestation
• Identify women who may need additional care and plan the pattern of care.
• Measure the weight (Wt) and height (Ht)
• Measure blood pressure (BP) and check urine for proteinuria.
• Determine risk for gestational Diabetes and Pre-eclampsia
Booking Visit
History Age Parity Menstrual history Medical history Surgical history Socio-background
Obstetric history
Booking Visit
Examination Face; complexion, eyes, teeth Thyroid gland Chest, lungs, Heart and breasts Abdomen, changes of pregnancy, any scars
Uterine size
Fetal heart Pelvic ???/ vagina
Booking Investigation
• Offer blood tests: • Blood group and Rhesus status• Screen for anaemia and haemoglobinopathies• Hepatitis B Virus• Rubella susceptibility• Syphilis• Toxoplasmosis• Mid stream urine• Offer early ultrasound, for gestational age, structural
anomalies• Offer screening for Down syndrome???
Supportive Information
• Give information supported by written information.
• Give an opportunity to discuss issues and ask questions.
• Be alert to any factors, social that may affect the health of both mother and fetus/baby.
• Offer ante-natal classes
Specific Information
• How the baby develops during pregnancy
• Nutrition and diet, including Iron supplement.
• The pregnancy care pattern
• Planning the place of birth
• breastfeeding
Ultrasound Scan (USS)
USS to determine gestational age using:• Gestational sac• Crown-rump measurement, 10-13 weeks• Bipareital diameter (BPD) 14 18 weeks• Fetal Biometry: BPD, Head Circumference (HC),
Femur length (FL), Abdominal Circumference (AC) 18-24 weeks
USS to determine fetal growth:• using fetal biometry variablesUSS to determine fetal wellbeing Using:
USS to determine anomalies
• 10-12 weeks
• 20 weeks
Down’s syndrome screening
• Combined test, 11-14 weeks of gestation
• Serum screening (Triple or quadruple test) 15-20 weeks.
Main purpose of visits
• History and examination, clarification of uncertain gestation, identification of risk factors for the pregnancy.
• Booking blood tests
Subsequent Visits14-16 weeks
• Review history, discuss and record screening tests,
• Measure BP and test urine,
• Check Hb level if < 11gm/dl consider Iron supplement.
• Examine the fundal height and listen to the fetal heart.
18-20 weeks
• Measure BP and test urine,
• Examine the fundal height and listen to the fetal heart.
• Discuss the structural anomaly scan
• If placenta extends across the internal cervical os, offer another scan at ??????
24 weeks
• Measure BP and test urine for?????
• Measure the plot symphysis-fundal height for nulliparous
28 weeks
• Measure BP and test urine
• Offer another screening for anaemia and atypical red-cell alloantibodies
• Investigate a Hb <10gm/dl
• Offer anti-D prohylaxis to a women who are Rhesus D-negative
• Offer screening for gestational Diabetes
• Measure symphysis fundal height
32 weeks of gestation
• Check the dates from LMP.
• Review, discuss and record the results undertaken at 28 weeks.
• Measure BP and test urine
• Measure S-F height
34-36 weeks
• Check the dates from LMP.• Review, discuss and raised issue.• Measure BP and test urine• Measure S-F height• Offer a second does of anti-D prophylaxis• Arrange an USS if low-lying placenta at 20
weeks• Give specific information on preparation for
labour
36-37 weeks
• Check the dates from LMP.• Review, discuss and record the results
undertaken at 28 weeks.• Measure BP and test urine• Measure S-F height• Check the presentation, if breech offer external
cephalic version(ECV)• Give specific information on preparation for
labour• Information on breastfeeding
38 weeks
• Check the dates from LMP.
• Measure BP and test urine
• Measure S-F height
• Check the presentation, if breech offer external cephalic version (ECV)
• Give specific information on preparation for labour
• Information on breastfeeding
40 weeks
• Check the dates from LMP.• Measure BP and test urine• Measure S-F height• Check the presentation, if breech offer
external cephalic version(ECV), can be difficult
• Give specific information on preparation for labour
• Information on breastfeeding
41 weeks
• Check the dates from LMP.• Measure BP and test urine• Measure S-F height• Give specific information on preparation
for labour• Information on breastfeeding• Offer membrane sweep• Offer induction of laour
Clinical assessment of bony pelvis
• It is not important. However if done should include checking the:
• Anteroposterior diameter, from the symphysis pubis to the sacral promontory.
• Curve of the sacrum.• Promimance of the ischial spines.• The angle of the greater sciatic notch• Subpubic angle
Further Reading
• www.nice.org.uk
