Process of Antenatal care
Women are encouraged to start antenatal visit as soon as pregnancy is suspected or they miss their menses for two months. This is necessary to confirm pregnancy and plan for appropriate care. To ascertain baseline data recording of vital signs – B/P, blood values, urinalysis and fetal development. This will serve as a standard to assess as the pregnancy progress. It also helps to assess the level of health of the women. Patient could attend antennal clinic in either at health centre, hospital or maternity homes. During this period a comprehensive history is taken. These provide important information about the woman’s general and reproductive health, both past and present. This starts by history taking.
The aim of history taking is not just for record keeping but it is a means of assessing the health of the woman. To know what to guide against in her management and method of delivery. Decision can be made if she will require hospital confinement.
Great patience is needed when taking history of a new patient especially primigravida.
Patient must be prepared to give accurate details of herself:
· Gain her co-operation
· Provide privacy
· Ensure friendliness and kindness.
· Ask direct questions.
· Do not help her to answer question
· Use simple non-technical language.
History is taken in the following areas.
Social History: should include the woman’s name, address, age,occupation, religion, marital status and race (if need be). Social status, income, any social or financial problems should be recorded. Home condition is enquired.
Family History: This is to detect if there is any disease that runs inthe family or hereditary conditions e.g. Diabetes which may show for the first time in pregnancy, sickle cell disease, Hypertension, mental disorders that can lead to psychosis in pregnancy or puerperium twining in family. Tuberculosis, venereal diseases, etc. Personal History should include:
Medical History: Ask if she has certain diseases e.g. Cardiacdisease, Diabetes, hypertension, Rubella, kidney disease, venereal disease etc.
Any previous operations in the Abdomen, uterus or other areas including D & C which will be complicated by perforation leading to rupture uterus in labour. Caesarean section leaves scar tissue which may not stretch well in labour. Others are hysterectomy, myometomy or accident injury to the legs or joints or any blood transfusion.
Menstrual history: Regularity of cycle, volume, duration and dysmenorrhoea.
Previous Pregnancies: What ever the out come, abortion; miscarriage - if yet at what age of pregnancy cause, where, in the hospital or at home, complete or incomplete, any D & C, blood transfusion. Bleeding after 28 weeks, if pregnancy was normal or complicated by e.g. vomiting etc.If she carries the pregnancy till term.
Labour: if normal pre or post mature delivery. Type of delivery forceps or vacuum delivery. Spontaneous on set or induced, was it prolonged ,date, hemorrhage etc where she delivered, was the baby alive or dead, if dead, why? Any perineal tear or episiotomy.
Puerperium: Was the puerperium uneventful? Was she wellthroughout, any haemorrhage, lochia discharge. Did she breast feed her baby and was she delayed for any reason. Others complications like sepsis, psychosis, venous thrombosis, Pyrexia etc.
Baby’s History: Method of birth, Pre, Post or at term. Weight atbirth, alive, still birth, perinatal death or neonatal death.Method of feeding, breastfed, how long, weaning method.Illness after delivery, congenital malformation, Birth injuries etc.Alive or dead –If dead at what age and the cause.Place of delivery Home or Hospital.
Last menstrual period (LMP) –to calculate expected Date of Delivery (EDD). Any morning sickness, bleeding, exposure to rubella, etc. Feeding pattern, social habit e.g. smoking or takes alcohol, parity – grande multiparous is prone to co mplication.