Prepared by:Sajad Abdulredha Ali

Halwer Medical University- Iraq

Introduction

Every year there are an estimated 200 million pregnancies in the world, each of these pregnancies is at risk for an adverse out come for the woman and her infant.

While risk can not be totally eliminated, they can be reduced through effective and acceptable maternity care.

To be most effective, health care should begin early in pregnancy and continue at regular intervals.

Antenatal care

It is the education, supervision and treatment to a pregnant woman so that her pregnancy and labour will terminate with delivery of a mature healthy living baby, without injury to the mind or body of the mother.

Goals

1. Assessment and management of maternal risk and symptoms.2. Assessment and management of fetal risk3. Prenatal diagnoses and management of fetal

abnormality4. Diagnoses and management of perinatal complications5. Decision regarding timing and mode of delivery 6. Parental education regarding pregnancy and childbirth 7. Parental education regarding child-rearing

WHO recommends a minimum of four ANC visits

• First visit: On confirmation of pregnancy• Second visit: 20-28 weeks• Third visit: 34-36 weeks• Fourth visit: before expected date of deliveryor when the pregnant woman feels sheneeds to consult health worker

Every women should have a record file and every event should be written in it.

If pregnancy is passing uneventfully these visits are enough but if complications arise we need more visits

First Trimester Visit •confirm intrauterine pregnancy and assess the gestational age.•We have to deal with complications that present with vaginal bleeding and abdominal pain. •Women can be investigated using history,examination,biochemical testing & transvaginal U/S to exclude non-viable pregnanacy.ectopic pregnanacy or hydatiform mole,

 

Second Trimester Visit Assessment of maternal health & fetal growth & wellbeing. The results of tests performed at 1st trimester visit are reviewed with the motherThe results of the U/S scan for fetal abnormality are also reviewed. Any incidental maternal symptoms are dealt with ,this period is also important in insuring the education of the woman regarding the rest of pregnancy & her delivery,

 

Third Trimester Visit  The primary objective of this visit is to anticipate any problems regarding the prospective delivery.Uterine fundal height ,fetal lie, presentation & position are mandatory.Vaginal examination will help us to check for any abnormaity in the pelvis, cervical status ,fetal presenting part,station & position.Mode of delivery & planned contraception after delivery shoud be discussed at this time.

 

Post Dates Visit [ 41 – 42 weeks ]

 With accurate pregnancy dating, true post dates pregnancy are identified,At this visit , a joint decision is taken as to whether an induction of labour is appropriate, this is current practice because of the reported assossiation between post dates pregnancy & pregnancy outcome.Induction of labour usually performed by the 42nd week.

In summery at each visit the following procedure and examination should be

performed :

1- History:

Alarmin signs present complain, personal hx, past medical and surgical hx, Family hx, Obestetrical hx…

2- Examination: •Height: patients measuring 5 feet or less are more likely to have a small pelvis that may cause difficulty during delivery.

•Weight gain (11-16 kg)• Normal weight women should

gain 11.5-15 kg• Underweight women should

gain 12.5-18 kg• Obese women should gain no

more than 7 kg. Blood Pressure, Pallor, Jaudice,

Mouth, Legs, Breasts, and Abdominal and Vaginal examination.

3- Investigations:, PAP Smear, CBC, GUE, RBS, U/S.. And further investigations if required.

4- Health Education.

Diet:Calories (2500 cal/day)Protein (60gm/day)Calcium (1.2 gm /day)Folic acid (400 µg/day)Supplementary iron therapy is neededfor all pregnant mothers from 20 weeksonwards.

(30 mg of ferrous / day) (60-100 mg/day) is given for large women, twin, and those women who book for ANC late in pregnancy•Anemic woman should take (200 mg/day).

Hygiene:Daily bath is recommended, as it stimulation refreshing and relaxing.Avoid hot water bath.Vaginal Douches not favorable.

Bowel care:As there is increase chance of constipation,regular bowel movement may be facilitatedby regulation of diet taking plenty of fluids,vegetables and milk.

Breast CareWash the breast with clean tap water.

ExerciseWalk in moderation.Avoid lifting heavy things.Avoid long time standing.Avoid sitting with crossed legs as this may impede circulation.

SleepRegular sleep is advised, 8 hrs sleep per day and increasing toward term is recommended.Sleeping on the left side is preferable.

Travel:Travel is allowed when comfortableCar safety belts have to be adjusted to be comfortable for womanThose traveling more than four hours must take a break every 4 hours and walk for about of minutes to decrease the risk of DVT

Sexual ActivitySexual intercourse is allowed with moderation, it’s completely safe and normal unless the woman has vaginal bleeding or rupture memb.Sexual activity is avoided in early pregnancies in woman with previous history of Preterm labor

ImmunizationOne to two doses of tetanus toxoid is given to immunize against tetanus infection.

Dressing:Tight clothes and belts are avoidedThe patient should wearloose but comfortable dresses. High heel shoes are better avoided.

Alcohol, smoking and drugs should be avoided as the may affect the fetal wellbeing

Alarming Symptoms and signs

Vaginal Bleeding Severe edema Escape of fluid from the vagina Abnormal gain or loss of weight Decrease or cessation of fetal movement Sever headache Epigastric pain Blurred vision Fever Abdominal pain

Conclusion

Antenatal care is an essential aspect of health care delivery for improving pregnancy out come.By this service we can detect high risk pregnancies and we can direct them for proper management

References 1. Obstetrics by ten teachers, 19th edition, by Philip N

Baker and Louise C Kenny.2. Prevention and Recognition of Obstetric Fistula

Training Package: FACILITATOR’S MANUAL.3. National Institute for Health and Clinical Excellence,

Issue date: March 2008.4. http://

www.ahunterobstetrics.com/antenatalcare.html