1. Antenatal care Dr. Rekha Dutt Associate Professor Department of PSM ,
Dr D.Y. Patil Medical college , Navi Mumbai

2. It is care of woman during pregnancy
Primary aim : to achieve at end of pregnancy a healthy mother and healthy baby

3. ANTENATAL CARE objectives
To promote, protect and maintain the health of pregnant women
To detect high risk cases and give them special attention
To foresee complications and prevent them
To remove anxiety associated with pregnancy
To reduce maternal and infant mortality and morbidity
To teach elements of child care, nutrition, hygiene and sanitation
To sensitize her regarding family planning
To attend the under 5 children accompanying the mother

4. SERVICES Antenatal visit- a minimum of 3 visits 1st visit at 20 weeks
2nd visit at 32 week
3rd visit at 36 weeks

5. Prenatal services Health history Physical examination- wt gain, BP
Lab examination – urine analysis, CBC, blood grouping and Rh, serological examination
Fe and folic acid supplementation
TT immunization
Home visit by female health worker
Referral services

6. RISK APPROACH
It is managerial tool for improved MCH care. Purpose is to provide better services for all but special attention to those who need them most. It is for max utilization of resources.
High risk mothers are:
Elderly primi (30 yrs and above)
Short primi (140 cm and below)
Malpresentation
APH ,Threatened abortion
Preeclampsia, eclampsia
Anemia
Twins ;hydroamnios
Previous still birth, IUDeath, manual removal of placenta
Elderly grandmultipara
Prolonged pregnancy (14 days after EDD)
H/O previous Caesarean or instrumental delivery
Pregnancy associated with general diseases

7. Maintenance of records
Home visits –at least 1 by ANM or MPHWF
Prenatal Advice :
Diet – pregnant women requires 300 extra cal per day, additional Fe and folic acid, Ca and other nutrients are also required
Personal hygiene ,rest , bowels , exercise ,no smoking and alcohol , oral hygiene, sex
Drugs-caution is required
Radiation- malformation in fetus
Warning signs- swelling of feet, fits, headache, blurring of vision, bleeding or discharge per vagina
Child care- nut education, child rearing , FP

8. Secific health protection :
Anemia % of pregnant women are anemic (Hb < 11 gm %). The GOI initiated a prog in which 100 mg of elemental Fe and 500 mcg of F.A tab are given
Other nut deficiency- protein, vit A,D,iodine
Toxemia of pregnancy – increase in blood pressure and presence of albumin in urine. Check BP regularly.
Tetanus – two doses of TT vaccine
Syphilis – VDRL test at early and late pregnancy. Congenital syphilis is preventable.
Injections of 1 gram procaine penicillin for ten days are adequate.
German measles – congenital malformations
Prevention – rubella vaccine . Before vaccination it is advisable to rule out pregnancy and effective contraception be maintained for 8 weeks .
Rh status – if women is Rh –ve and husband Rh+ve she is kept under surveillance. The blood is examined again at 28 weeks and weeks for Abs. Rh anti D immunoglobulin should be given at 28 weeks of gestation to prevent sensitization in first pregnancy. If baby is Rh +ve the Rh anti D immunoglobulin is again given with in 72 hours of delivery . Same should be done after abortion.
HIV infection – prenatal screening . Infected women may choose abortions , informed decision on breast feeding .
Prenatal genetic screening – for chromosomal abnormalities , congenital anomalies, haemoglobinopathies.

9. Mental preparation - free and frank talk on all aspects of pregnancy and delivery. Mother craft classes are beneficial .
Family planning – more receptive
Pediatric component – care to under 5 accompanying the mother

10. THANK YOU