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)
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.
History taking:- Is a means of assessing the health of the woman to find out any condition which may affect child bearing.
Name, age, address, occupation; Age less than 18 years or greater than 35 years are considerd as high risk mothers.
To know the genetic predisposition to certain diseases
Former illnesses may have damage certain structures or organs which could give rise to complications during pregnancy and labour.
• Any abdominal operations
Record of previous pregnancies and labour
Was labour premature or postmature, spontaneous or induced, history of instrumental deliveries, previous obstetric complications and previous babies?
· To diagnose pregnancy
· To identify high risk pregnancy
· To give advice for pregnant mother
As she walks in, observe any deformity, stunted growth, limp etc. does she look well or pale and tired?
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,
Face: - Oedema, sign of anaemia
Neck - Swollen glands
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.
· 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.
· 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)
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.
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
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
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
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,
· By x-ray of the pelvis
· Clinical (assessing sign of contracted pelvis)
· Head fitting
The head is the best pelvimeter
METHOD 1: Head fitting, sitting patient, Method
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.
· Frequency of micturation
· Check for abnormal discharge
Varicosities: - Varicose veins may occur in the legs, anus(hemorrhoids) and vulva. Vulval varicosities are rare and very painful.
· Vulval warts
· Purulent irritating discharge
Examine for bones alignment and deformities.
Check pitting oedema in the lower limbs by applying fingertip pressure for 10 seconds over the tibial bone.
Urine:-For Protein and glucose
· Rhesus and blood grouping.
· 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
· Vaginal bleeding
· Reduced fetal movements
· Frontal or reccuring headaches
· Sudden swelling
· Rupture of the membranes
· Premature onset of contractions etc.
· 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.
· 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