Antenatal Care Definition of Antenatal care comprehensive

1
Antenatal Care
2
Definition of 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.

3
Goals

• To reduce maternal and perinatal mortality and
  morbidity rates
• To improve the physical and mental health of
  women and children

4
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

5
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 7th month.
• Once every 2 weeks till the 9th month
• Once every week during the 9th month, till labor.

6
(No Transcript)
7
History

• Personal history
• Family history
• Medical and surgical history
• Menstrual history
• Obstetrical history
• History of present pregnancy

8
Physical Examinations

• Height of over 150 cm indication of an
  average-sized pelvis
• The approximate weight gain during pregnancy is
  12 kg. 2kg in the first 20 weeks and 10 kg in
  the remaining 20 weeks (1.5 kg per week until
  term).

9

• Obesity (more than 20 kg above the weight-height
  formula) leads to an increased risk of
  gestational diabetes, pregnancy-induced
  hypertension and thrombo-embolic disorders

10
Local Examination

• The uterus may be higher than expected due to
  large fetus, multiple pregnancy, polyhydrammnios
  or mistaken date of last menstrual period.
• The uterus may be lower than expected due to
  small fetus, intrauterine growth retardation,
  oligohydramnios or mistaken date of last
  menstrual period.

11

• Fetal heart sound is heard by sonicaid as early
  as 10thweek 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

12
Investigations

• Urine should be tested for sugar, ketones and
  protein.
• Hemoglobin will be repeated
• At 36 weeks of gestation.
• Every 4 weeks if Hb is lt 9 g/dl.

13
Fetal kick count

• The pregnant woman reports at least 10 movements
  in 12 hours.
• Absence of fetal movements precedes intrauterine
  fetal death by 48 hours.

14
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

15

• Exercise should be simple, mild exercise avoid
  lifting heavy weights
• A tooth can be extracted during pregnancy, but
  local analgesia is recommended
• Catheter and enema should be avoided.
• Smoking may lead to ptyalism, nervousness and
  hyper emesis and make pregnant woman at increased
  risk of chest infections and thrombo-embolic
  disorders

16

• Pregnant woman should avoid contact with
  infectious diseases especially rubella or (German
  measles) because it has deleterious effects on
  the fetus
• Pregnant woman should avoid exposure to x-ray or
  irradiation because of possible teratogenic
  effects on the fetus such as birth defects or
  childhood leukemia

17
Common Discomforts of Pregnancy, Etiology, and
Relief Measures

• Urinary frequency
• RELIEF MEASURES
• Decrease fluid intake at night.
• Maintain fluid intake during day.
• Void when feel the urge.

18
Fatigue

• RELIEF MEASURES
• Rest frequency.
• Go to bed earlier.

19
Sleep difficulties

• RELIEF MEASURES
• Rest frequency
• Decrease fluid intake at night

20
Breast enlargement and sensitivity

• RELIEF MEASURES
• Wear a good supporting bra.
• Assess for other conditions.

21
Nasal stuffiness and epistaxis

• ETIOLGY Elevated estrogen levels
• RELIEF MEASURES
• Avoid decongestants.
• Use humidifiers, and normal saline drops.

22
Ptyalism (excessive salivation)

• ETIOLGY Unknown
• RELIEF MEASURES
• Perform frequent mouth care.
• Chew gum.
• Decrease fluid intake at night.
• Maintain fluid intake during day.

23
Nausea and vomiting

• RELIEF MEASURES
• Avoid food or smells that exacerbate condition.
• Eat dry crackers or toast before rising in
  morning.
• Eat small, frequent meals.
• Avoid sudden movements. Get out of bed slowly
• Breath fresh air to help relieve nausea.

24
Shortness of breath

• RELIEF MEASURES
• Use extra pillows at night to keep more upright.
• Limit activity during day

25
Heartburn

• RELIEF MEASURES
• Eat small, more frequent meals.
• Use antacids.
• Avoid overeating and spicy foods.

26
Dependent edema

• Avoid standing for long periods.
• Elevate legs when laying or sitting.
• Avoid tight stockings.

27
Varicosities

• Rest in sims' position.
• Elevate legs regularly.
• Avoid crossing legs.
• Avoid tight stockings.
• Avoid long periods of standing

28
Hemorrhoids

• RELIEF MEASURES
• Maintain regular bowel habits.
• Use prescribed stool softeners.
• Apply topical or anesthetic ointments to area.

29
Constipation

• RELIEF MEASURES
• Maintain regular bowel habits.
• Increase fiber in diet.
• Increase fluids.
• Find iron preparation that is least constipating

30
Leucorrhea

• RELIEF MEASURES
• Take a daily bath or shower.
• Wear cotton underwear.

31
Backache

• RELIEF MEASURES
• Wear shoes with low heels.
• Walk with pelvis tilted forward.
• Use firmer mattress.
• Perform pelvic rocking or tilting

32
Leg cramps

• RELIEF MEASURES
• Extend affected leg and dorsiflex the foot.
• Elevate lower legs frequently.
• Apply heat to muscles.
• Evaluate diet.

33
Faintness

• RELIEF MEASURES
• Rise slowly from sitting to standing.
• Evaluate hemoglobin and hematocrit.
• Avoid hot environments