Antenatal Care

Antenatal Care

Systematic supervision of a woman during pregnancy is called antenatal care. The supervision should be of a regular and periodic nature in accordance with the principles laid down or more frequently according to the need of the individual. 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. The objective of Antenatal care is to ensure a normal pregnancy with delivery of a healthy baby from a healthy mother.

Aims of antenatal care:

1. to monitor the progress of pregnancy in order to ensure maternal health and normal fetal development.
2. to recognise the deviation from the normal and provide management or treatment as required.
3. to ensure that the woman reaches the end of her pregnancy physically and emotionally prepared for her delivery.
4. to identify high risk pregnancy and for their proper management.
5. to reduce or prevent maternal and perinatal mortality and morbidity
6. to help and support the mother in breast feeding and parenting.
7. to offer family welfare advices on parenthood.

Antenatal care comprises of:

1. Registration of pregnancy
2. History taking
3. Antenatal examinations [general and obstetrical]
4. Health education

A.  Registration of pregnancy:

The registration of pregnancy must be done in an antenatal clinic within 12 weeks.

B.  History taking:

A complete history of the woman including the following is collected in the first visit.

1. Demographic data (Name, age, address, marital status, religion, education, occupation etc)
2. Menstrual history.
3. Personal history.
4. Past medical and surgical history.
5. Family history.
6. History of present pregnancy (last menstrual period LMP, Expected date of delivery EDD, etc.
7. Obstetrical history (number of pregnancy, any abnormality in previous pregnancies and deliveries).
8. Calculation of expected date of delivery (EDD): EDD is calculated by adding nine calendar months and seven days to the date of first day of the woman’ s last menstrual period, provided the woman has a regular 28-day menstrual cycle.

C.  Antenatal examination:

A complete general examinations of the body is conducted, including

1. Height: The height is carefully recorded, as patients measuring 5 feet or less is more likely to have a small pelvis that may cause difficulty during delivery.
2. Weight: Weight should be regularly taken using an accurate weighing machine. Periodic and regular weight checking helps in detecting abnormalities.
3. Pallor: Colour of conjuctiva, soft palate, tongue, and nail beds are to be noted. (Paleness indicates anemia)
4. Jaundice: Eyes and mouth are to be observed for yellow discolouration. (yellow discolouration indicates of jaundice)
5. Tongue, teeth, gums: Observe for signs of infection and malnutrition.
6. Legs: Legs are to be examined for oedema.
7. Breasts: Examination of the breasts is mandatory, to note the presence of pregnancy charges and condition of the nipples (cracked / depressed / inverted).
8. Abdominal and vaginal examinations: Position of the uterus is noted in abdominal examination. Unless necessary, vaginal examinations is not routinely done except for the first time when the woman attends the clinic to confirm pregnancy.

Laboratory investigations:

1. Complete blood count including haemoglobin level,

2. Blood grouping and Rh typing.

3. Blood for VDRL

4. Urine examinations:

5. Urine should be tested for albumin, sugar, pus cells,

One to two doses of tetanus toxoid is given to immunize against tetanus infection iron and folic acid supplements is given

Subsequent visits:

• Up to 28 week -- the antenatal check up should be done at an interval of 4 weeks from the first visit.
• Beyond 28 weeks, the antenatal check up should be done at interval of 2 weeks upto 36 week and
• thereafter weekly, till the expected date of delivery.

At each visit, the findings are to be recorded in the same card for better evaluation.

D. Health education:

The antenatal education should include.

Diet

The diet during pregnancy should be adequate to provide for

a. the maintenance of maternal health.

b. the needs of the growing fetus.

c. the strength and vitality required during labour and

d. the successful lactation.

The pregnancy diet should be light, nutritious and easily digestible. It should be rich in protein, minerals vitamins and fibres and of the required calories. Dietary advice should be given with due consideration to the socio-economic condition, food habits and taste of the individual. Supplementary iron therapy is needed for all pregnant mothers from 20 weeks onwards.

Personal hygiene

1. Rest and sleep: The woman may continue her usual activities throughout pregnancy. Hard and strenuous work should be avoided. On an average, a patient should have 10 hours of sleep (8 hours at night and 2 hours at noon)

2. Bowel: As there is a tendency of constipation during pregnancy, regular bowel movement may be facilitated by regulation of diet taking plenty of fluids, vegetables and

milk.

3. Bathing: Daily baths and preferably twice a day are advised.

4. Clothing: The patient should wear loose but comfortable dresses. High heel shoes are better avoided.

5. Dental hygiene: The dentist should be consulted at the earliest, if necessary.

6. Care of the breasts: Cleanliness of the breasts is maintained. If anatomical defects are present advise to seek medical help.

7. Coitus: Contact with the husband to be avoided during the first trimester and last 6 weeks.

8. Travel: Long distance travel better to be avoided. Rail route is preferable.

9. Smoking and alcohol: Smoking and alcohol are to be avoided totally during pregnancy as both cause variable injuries to the fetus.

10. Drugs: The pregnant women should avoid over-the counter drugs (drugs without medical prescription). The drugs may have teratogenic effects on the growing fetus especially during the first trimester (The first three months is the period of organogenesis. Teratogens will cause gross malformation or defects to the fetus. The common teratogens are drugs caffeine, exposure to x-rays, alcohol, nicotine, etc).

General advice

The patient should be persuaded to attend for antenatal checkup positively on the scheduled date of visit. She is instructed to report to the doctor even at an early date and if the following untoward (warning signs and symptoms) symptoms arise:

• · intense persistent headache
• · severe oedema
• · disturbed sleep with restlessness
• · low urine output (less than 500 ml per day)
• · epigastric pain
• · persistent vomiting
• · painful uterine contractions
• · sudden gush of watery fluid per vaginum
• · active vaginal bleeding, etc.