Normal Pregnancy

Normal Pregnancy:

Pregnancy is a state of carrying fetus inside uterus by a woman from conception to birth. Gestation is the term given to pregnancy.

Prenatal :

Prenatal is the period from conception to birth.

Intranatal:

Intranatal is the period from the initiation of labour pain till

birth.

Postnatal:

Postnatal is the period from birth to 42 days Otherwise called as puerperium.

Prenatal or 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:

Aims of antenatal care are

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).

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.     A complete general examinations of the body is conducted, including

2.     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.

3.     Weight: Weight should be regularly taken using an accurate weighing machine. Periodic and regular weight checking helps in detecting abnormalities.

4.     Pallor: Colour of conjuctiva, soft palate, tongue, and nail beds are to be noted. (Paleness indicates anemia)

5.     Jaundice: Eyes and mouth are to be observed for yellow discolouration. (yellow discolouration indicates of jaundice)

6.     Tongue, teeth, gums: Observe for signs of infection and malnutrition.

7.     Legs: Legs are to be examined for oedema.

8.     Breasts: Examination of the breasts is mandatory, to note the presence of pregnancy charges and condition of the nipples (cracked / depressed / inverted).

9.     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:

1.     Up to 28 week -- the antenatal check up should be done at an interval of 4 weeks from the first visit.

2.     Beyond 28 weeks, the antenatal check up should be done at interval of 2 weeks upto 36 week and

3.     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

the maintenance of maternal health. b. the needs of the growing fetus.

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.