Antenatal Care

ANTENATAL CARE

Every pregnancy needs special care. All pregnant women should be registered and encouraged for institutional delivery. Causes of maternal mortality are preventable by the good antenatal care

Definition of Antenatal Care

Antenatal care refers to the care that is given to an expected mother from time of conception is confirmed until the beginning of labor

Antenatal care is systemic supervision of a woman during pregnancy at regular intervals to monitor:

–  Maternal wellbeing

–  Fetal wellbeing

–  Progress of fetal growth

Goals of Antenatal Care

·           Ensure mother health

·           Ensure delivery of a healthy infant

·           Anticipate problem

·            Diagnose problem early

Objectives of Antenatal Care

·           Early detection and if possible, prevention of complications of pregnancy.

·           Educate women on danger and emergency signs & symptoms.

·           Prepare the woman and her family for childbirth.

·           Give education & counseling on family planning.

Schedule of Antenatal Care

·            Medical checkup every four weeks up to 28 weeks gestation

·            Every 2 weeks until 36 weeks of gestation.

·            Every week until delivery

·            An average 7-12 antenatal visits/pregnancy

·            More frequent visits may be required if complications arise

Importance of Abdominal Examination

•            Monitor progress of pregnancy and fetal growth

•            Check for fetal lie and presentation 

•            Auscultate fetal heart sounds

What does it include?

•            Measurement of fundal height

•            Assessment of fetal lie and presentation 

•            Assessment of fetal movement

•            Auscultation of fetal heart sounds 

•            Inspection for scars

Methods of Abdominal Examination

•            Inspection

•            Palpation

•            Auscultation

Preparation for Abdominal Examination

•            Ensure privacy

•            Examination room should be well lighted and airy

•            Woman is asked to empty her bladder

•            Explain the women about the procedure/ process

•            To make her comfortable, keep talking to her

•            She lies supine with legs partially flexed

•            Stand on her right side

First start with Inspection

•            Shape - Check whether the uterine shape is ovoid or longitudinal or transverse or oblique

•            Size - Appropriate to the weeks of pregnancy or not?

•            Skin Changes - look for

Striae Gravidarum - (The brown and silvery lines all over the abdomen and)

Linea Niagra - (the pigmented line from the symphysis pubis to umblicus)

•            Cullen's Sign - Bruishing discoloration around the umblicus

•            Scars - Any incision scars present or not

•            Contour of the abdomen- The general contour of the entire abdominal wall is observed. The contour should be checked carefully for distention and note must be made as to whether any distention is generalized or localized to a portion of the abdomen. Similarly, the flanks should be checked for any bulging

•            Check for visible foetal movements if not visible, confirm with the mother about the foetal movement

2. Palpation:

Palpate the Uterus with warm hands

Step 1: Measure the fundal height keep the ulnar border of curved left hand on woman’s abdomen parallel to symphysis pubis

Start  from  xiphisternum  and  gradually proceed towards symphysis pubis lifting the hand between each step till a bulge / resistance of uterine fundus is felt

Mark the level of fundus

Measure the fundal height by finger or inch tape it is measured by the inch tape each cm is week. If it is 35 cms then it is considered as 35 weeks up to umbilicus it is 24 weeks. Then each finger is 1 cm measure from the umbilicus till the fundus of the uterus.

Step 2: Leopold’s maneuvers -It includes four grips

•            Fundal grip

•            Lateral grip

•            Pelvic Grip I /Superficial pelvic grip and  Pelvic Grip II / Deep Pelvic Grip

1.  Fundal Palpation / Fundal Grip - Helps to determine lie and presentation of fetus

2.  Lateral Palpation / Lateral Grip (both Right and left lateral) - Helps to locate fetal back and limbs

3.  Pelvic Grip I / Superficial Pelvic Grip -Helps to determine whether head or breech is presenting at pelvic brim. Whether the presenting part is engaged / fixed / free.

4.  Pelvic Grip II / Deep Pelvic Grip - Helps to know the degree of flexion of head.

Check or ask for Foetal Movements

Fetal movement are reliable sign of foetal well - being.

 These are felt around 18-22 wks of pregnancy (felt earlier in multigravida than primigravida).

Normally 10-12 foetal movements should be felt by the pregnant woman in a day.

Decreased foetal movements may be an indication of foetal distress.

Pattern of foetal movement may change prior to labour due to reduced space.

If Foetal Movements are absent or not felt, consult ANM or doctor.

3. Auscultation

•            Use a fetoscope or stethoscope.

•            Best heard on the side of the back of the fetus.

•            In vertex presentation FHS is best heard midway between the line joining the umbilicus and the anterior superior iliac spine on the side of the back.

•            In breech presentation FHS is heard above the umbilicus (Fetal Heart Sound).

•            Count the FHS for one full minute FHR (Fetal Heart Rate).

•            FHS is heard over the abdomen by stethoscope / fetoscope after 24 weeks of pregnancy.

•            Normal FHR is 120 – 160 beats per min.

•            FHR < 120 beats per min or > 160 beats per minute, indicates fetal distress.

•            Confirm that you are listening to the FHS and not maternal pulse.

DIET in Pregnancy

•            Total caloric intake should be increased to 300 kcal /day due to 15% increase in BMR.

•            Diet should contain 20% Protein (better from animal source), 30% fat, and 50% carbohydrates.

•            Sufficient fluids should be taken. (10 glasses for a day).

•            Absorption of iron is interfered if taken with tea, coffee or foods rich in fluoride.

•            Enhanced if taken with lemon water or orange juice.

•            Encourage mother to take plenty of fruits and vegetables like mango, guava, orange, amla etc containing vitamin C.

•            Emphasize the importance of high protein diet like black gram, ground nuts, whole grains, milk, eggs etc.

Supplementation - Iron, folic acid and calcium as prescribed

WEIGHT gain in Pregnancy

•            Total weight gain approximately 12 Kgs.

•            Weight gain of 2 kgs in first trimester. 5 kgs in second and 5 kgs in third trimester.

•            Monitoring of weight gain should be done in conjunction with close monitoring of BP.

•            Overweight or sudden increase of weight is to be notified immediately.

Oral Care

•            It is easy to have an increase in dental decay cavities  due  to  pregnancy.  Heartburn,increased snacking, morning sickness can all increase chances of developing tooth decay or gum disease. Good oral care is an important during pregnancy as it is the most important time of life.

CARE OF BREAST

•            Breast engorgement may cause discomfort during late pregnancy. A well-fitting brassiere can give relief.

•            Travelling during pregnancy is not prohibited but some precautions must be taken.

•            Avoid long trips if possible. Always check with care provider before travelling. Wear seatbelt, the shoulder belt shouldd go between the breasts and the lap belt should go under the tummy. Plan for frequent stops. Get out and walk as much as possible. This will prevent swelling of the foot.

•            When travelling by air, need to drink extra fluids. Walk around whenever possible. Do isometric exercises of legs and foot to help prevent swelling and blood clots. Do not plan to travel after 34 weeks of pregnancy.