ANTENATAL CARE

ANTENATAL CARE/ PRENATAL CARE

Antenatal care is the care given to a woman during her pregnancy.

Objectives:

1. To promote and maintain good health of the mother and fetus during pregnancy

2. To ensure that the pregnancy result in healthy infant and healthy mother.

3. To detect early and treat appropriately 'high risk' conditions (Medical or Obstetrical).

4. To prepare the woman for Labour, Lactation and the subsequent care of the baby.

Early antenatal care is important as soon as possible after pregnancy has been confirmed (after one or two missed periods).

FIRST VISIT EXAMINATION OF PREGNANT WOMAN

Objectives:

·        To diagnose pregnancy.

·        To identify high risk pregnancy.

·        To give advice for pregnant mother.

GENERAL APPEARANCE:

As she walks in, observe any deformity, stunted growth, limp etc. Does she look well or pale and tired?

History Taking

 Is a means of assessing the health of the woman to find out any condition which may affect child bearing.

1.     Social History: Name, age, address, occupation; Age less than 18 years or greater than 35 years are considered as high risk mothers.

2.     Family History: To know the genetic predisposition to certain diseases

3.     Medical History: Former illnesses may have damage certain structures or organs which could give rise to complications during pregnancy and labour.

4.     Surgical History: Operations on the genital tract. Any abdominal operations

5.     The Obstetric History: Past Obstetrical History. Record of previous pregnancies and labour. Was labour premature or postmature, spontaneous or induced? History of instrumental deliveries, previous obstetric complications and previous babies?

6.     History of the Present Pregnancy: Ask the last normal menstrual period and then calculate the gestational age of the pregnancy and expected date of delivery.

CLINICAL OBSERVATION

·        Height: 150 cm or less needs special care.

·        Weight: The average weight gain during pregnancy is about 12-14 kg.

Ø     In the first trimester: A woman should gain o.4 kg per month and

Ø     In the second and third trimesters she should gain 0.4 kg per week.

Ø     It is excessive if it is more than 3 kg a month during the 2nd and 3rd trimesters.

Ø     1kg per month during the 2nd and 3rd trimesters is less than normal.

NOTE: Sudden increase in weight that suggests fluid retention or a loss of weight that suggests illness should be carefully evaluated at prenatal visits.

·        Blood pressure: - Checked and recorded at each visit.

PHYSICAL EXAMINATION:

Appearance: The hair of a healthy woman is shining and glossy, her eyes bright and clear or otherwise

·        Face: Oedema, sign of anaemia

·        Legs:  Oedema, size of the foot.

·        Neck  Swollen glands

BREAST EXAMINATION:

Ø Assess the size, any Lumps in the breast?

Ø Nipples are they inverted or flat?

Ø Teach the mother self - examination of the Breast.

Heart and lungs are examined as usual to exclude diseases.

ABDOMINAL EXAMINATION

Ø AIMS:

Ø To observe signs of pregnancy

Ø To assess fetal size and growth

Ø To assess fetal health

Ø To diagnose the location of fetal parts.

Ø To detect any deviation from normal.

Steps for Abdominal Examination.

                 1. Inspection

                 2. Palpation

                 3. Auscultation

INSPECTION (5S)

a) Shape: Note contour -is it round, oval, irregular or pendulous?

Ø Longitudinal, ovoid in primigravida

Ø Round in multipara.  

b) Size: Should correspond with the supposed period of gestation

c) Skin: The dark line of pigmentation which is linea nigra is seen or any rash?

d) Strae gravidarum

e) Scar - Any operation scar (c/s)?

ON PALPATION:

1. Fundal height: Fundal Height at about 12 to 14 wks of pregnancy, the uterus is palpated above the symphysis pubis as a firm globular sphere; it reaches the umbilicus at 20 to 22 wks, the xyphoid process at 36 wks, and then often returns to about 4 cm below the xyphiod due to lightening at 40 wks.

Method: Measure distance of fundus with points on abdomen and assessing the fundal height in finger breadth below the xiphisternum or measure by centimeter.

2. Fundal Palpation: The Purpose is to know lie and presentation.

 Method: Use 2 hands using palms of hands palpate on either side of the fundus. Fingers held close together, palpate the upper pole of the uterus and feel that it is hard or soft or irregular.

3. Lateral Palpation: The Purpose is to know lie and position.

Method: Always facing the mother, fix the hand on the center of the abdomen with the right hand and palpate with left hand and vise versa. Note the regularity; the regular side is the back.

4. Deep pelvic Palpation: The Purpose is to Know Presentation & Attitude

  Method: Feel presenting part, is it hard or soft ? While palpating for the presenting part feel for eminences on back side.

5. Pawlick's Grip: The lower pole of the uterus is grasped with the right hand the     midwife facing the women's head, feel the occiput and sinciput, note which is lower.

   AUSCULTATION:

   Check fetal heart, rate and rhythm, count for one minute if regular.

     Method: Use Pinards stethoscope

·        Hand should not touch it while listening,

·        Ear must be in close from contact with stethoscope.

  PELIVIC ASSESSEMENT

·        By x-ray of the pelvis

·        Clinical (assessing sign of contracted pelvis)

·        Head fitting

   Head Fitting: The head is the best pelvimeter.

   Method: Head fitting sitting patient Method- Let her lie on a couch, place hand on the     Symphysis pubis and get the woman to sit up by her own effort. The effort should     force  the head into the pelvis.   

   GENITO-URINARY SYSTEM

·        Frequency of micturition.

·        Check for abnormal discharge.

  CIRCULATORY SYSTEM

  Varicosities: Varicose veins may occur in the legs, anus (hemorrhoids) and vulva.

  Vulval varicosities are rare and very painful.

  The Vulva

·        Vulval warts

·        Purulent irritating discharge

   The Lower Limbs

·        Examine for bones alignment and deformities.

·        Check pitting oedema in the lower limbs by applying fingertip pressure for 10 seconds over the tibia bone.

  LABORATORY TEST

·        Urine: For Protein and glucose

·        Blood Tests: V.D.R.L.

·        Rhesus and blood grouping.

·        Hemoglobin

  Points to Be Advised On

·        The advantages of antenatal check up

·        The use of tetanus toxoid vaccine.

·        The danger of lifting heavy loads (exercise).

·        Rest at least 10hrs at night and 2 in the afternoon, clothing should be confortable

·        Breast care

·        Diet - Rich in Iron and protein.

   Report the Following

·        Vaginal bleeding

·        Reduced fetal movements

·        Frontal or reoccurring headaches

·        Sudden swelling

·        Rupture of the membranes

·        Premature onset of contractions etc.

      BOOKING FOR CONFINEMENT

   Women should attend: - Monthly up to 28 weeks.

·        Every 2 wks up to 36 wks.

·        Weekly 36 wks thereafter.

   NOTE: High risk mothers e.g. Multiple pregnancy, suspected disproportion etc. should    attend weekly.

   AT SUBSEQUENT VISITS:

·        Blood pressure, weight (edema).

·        Abdominal examination (all steps of abdominal examination).

·        Hematocrit test should be repeated at 28 and 36 wks of gestation .

·        Health Education.

·        Listening and managing any complaint.

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