Chapter: Obstetric and Gynecological Nursing : Normal Pregnancy

Antenatal Care

Antenatal Care
Definition: - Antenatal care is the care given to a woman during her pregnancy.

Antenatal Care


Definition: - Antenatal care is the care given to a womanduring her pregnancy.




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

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

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

·                 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 hasbeen confirmed (after one or two missed periods)




Gravidity: Pregnancy


Primigravida = a woman pregnant for the first time


Multigravida = a woman who   has had      two or    more pregnancice


Parity- refers to delivery,


Nullipara = a woman who has not given birth to a child birth)


Multipara a woman who has given birth to more than onechild


Grandmultipara woman who has given birth to or morechildren



Lie: is the relationship of the long axis (spine) of the fetus tothe long axis of the mother’s uterus, and the normal lie is longitudinal Abnormal are transverse, oblique and variable.


Attitude: is the relationship of the fetal parts to one another,and the normal attitude is flexion, abnormals are extension and deflection


Presenting part: is the part of the fetus felt at the lower poleof the uterus and felt on abdominal examination and on vaginal examintion.


Presentation: is the part of the fetus in the lower pole of theuterus and the normal presentation is vertex, abnormal are breech, face, brow and shoulder.


Position: is the relationship of the denominator to thesix areas of the mother’s pelvis, normal position is anterior or lateral abnormal is Malposition is Occipital posterior position.


Crowned: When the Bi-parietals pass the ischial spinesand the head no longer recedes between contractions.


Denominator: The part of the fetus which determines theposition. (Vertex- occipute, breach -sacrum.Face- mentum).


Engaged: when the Bi-parietal diameters of the fetal headpasses thruogh the pelvic brim.



1. History Taking


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


1. Social Histiory


Name, age, address, occupation; Age less than 18 years or greater than 35 years are considerd 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

The Obstetric History 


1. 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?


2. 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.


2. Examination of the Pregnant Woman at First Visit




·           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?

Clinical Observation

 Height; - 150 cm or less needs special care.



Weight:-The average weight gain during pregnancy is about12-14 kg in the first trimester a woman should gain o.4 kg per month and in the second and third trimester she should gain 0.4 kg per week. It is Concedred as excessive if it is more than 3 kg a month during the second and third trimester; it is lessthan normal if it is less than 1 kg per month during the second and third trimester. Women who are under weigth coming in to pregnancy should gain more weigth than the average (0.5 kg per month or week rather than 0.4 kg). And may gains lessthan average (0.3 kg). Sudden increase in weight that suggests fliud retention or a loss of weight tht 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 andglossy, her eyes bright and clear,

Face: - Oedema, sign of anaemia


Neck - Swollen glands


Breast Examination


Asses the size, any Lumps in the breast


Nipples are they inverted or flat?


Teach the mother self - examination of the Breast



Heart and lungs are examined as usual to exclude diseases.


Abdominal Examination




·              To observe signs of pregnancy


·              To assess fetal size and growth


·              To assess fetal health


·              To diagnose the location of fetal parts.


·              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?


·                 Longtudinal, ovoid in primigravida


·                 Rround in multipara.


·                 Broad in transuerse lie.


b) Size:- Should correspond with the supposed period ofgestation


c) Skin: - The dark line of pigmentation which is lineanigra isseen any rash?


d) Strae gravidarum


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


On Palpation:


1. Fundal height and fundal palpation (1st Leopoled Maneuver)


1.1 Fundal Height


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


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


1.2 Fundal Palpation


Purpose- To know lie and presentation.


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

Figure:12 Fundal palpation

2. Lateral Palpation: (2nd Leopled maneuver)

Purpose-To know lie and position


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

Figure ; 13 Lateral palpation


3. Deep pelvic Palpation: (3rd Leopoled Maneuver)

Purpose -To Know Presentation & Attitude


Method: - Feel presenting part, is it hard or soft whilepalpatingfor the presenting part feel for eminences on back side.


Figure 14: Deep pelvic palpation


4. Pawlick's Grip: (4th  Leopard Maneuver)

 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.

Figure 15. Pwlick’s grip 


Auscultation: Check Fetal heart, rate and rhythm, count forone 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 1: Head fitting, sitting patient, Method

 Let her lie on a couch, place hand on the Symphysis pubes and get the woman to sit up by her own effort. The effort should force the head in to the pelvis.


METHOD 2 : Left hand grip method Grasp the fetal head withleft hand and push it down wards and backwards if a sense of give is felt the head has entered and there is no over and no cephalo pelvic disproportion.


Genito-Urinary System


·                 Frequency of micturation


·                 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 tibial bone.


3. Laboratory test


Urine:-For Protein and glucose


Blood Tests:-V.D.R.L.


·                 Rhesus and blood grouping.


·                 Hemoglobin



4. 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 10 hrs at night and 2 in the afternoon, clothing shuold be confortable


·                 Breast care


·                 Diet - Rich in Iron and protein


Report the following



·        Vaginal bleeding


·        Reduced fetal movements


·        Frontal or reccuring headaches


·        Sudden swelling


·        Rupture of the membranes


·        Premature onset of contractions etc.


Booking for Confinement

 Women should attend: - Monthly upto 28 weeks


·     Every 2 weeks up to 36 weeks


·     Weekly 36 weeks there after.


N.B. High risk mothers eg. 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 weeks of


·           gestation Health Education


·           Listening and managing any complaint


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