2Definition of Antenatal care comprehensive health supervision of a pregnant woman before deliveryOr it is planned examination, observation and guidance given to the pregnant woman from conception till the time of labor.
3Goals To reduce maternal and perinatal mortality and morbidity rates To improve the physical and mental health of women and children
4Importance of Antenatal Care To ensure that the pregnant woman and her fetus are in the best possible health.To detect early and treat properly complicationsOffering education for parenthoodTo prepare the woman for labor, lactation and care of her infant
5Schedule for Antenatal Visits: The first visit or initial visit should be made as early is pregnancy as possible.Return Visits:Once every month till 7th month.Once every 2 weeks till the 9th monthOnce every week during the 9th month, till labor.
7History Personal history Family history Medical and surgical history Menstrual historyObstetrical historyHistory of present pregnancy
8Physical Examinations Height of over 150 cm indication of an average-sized pelvisThe approximate weight gain during pregnancy is 12 kg.; 2kg in the first 20 weeks and 10 kg in the remaining 20 weeks (1.5 kg per week until term).
9Obesity (more than 20 kg above the weight-height formula) leads to an increased risk of gestational diabetes, pregnancy-induced hypertension and thrombo-embolic disorders
10Local ExaminationThe uterus may be higher than expected due to large fetus, multiple pregnancy, polyhydrammnios or mistaken date of last menstrual period.The uterus may be lower than expected due to small fetus, intrauterine growth retardation, oligohydramnios or mistaken date of last menstrual period.
11Fetal heart sound is heard by sonicaid as early as 10thweek of pregnancy. Fetal heart sound is heard by Pinard' s fetal stethoscope after the 20thweek of pregnancy.The normal fetal heart rate is beats/min
12Investigations: Urine should be tested for sugar, ketones and protein. Hemoglobin will be repeated:At 36 weeks of gestation.Every 4 weeks if Hb is < 9 g/dl.
13Fetal kick countThe pregnant woman reports at least 10 movements in 12 hours.Absence of fetal movements precedes intrauterine fetal death by 48 hours.
14Health Teaching during the First Trimester Physiological changes during pregnancyWeight gainFresh air and sunshineRest and sleepDietDaily activitiesExercises and relaxationHygieneTeethBladder and bowelSexual counselingSmoking :MedicationsInfectionIrradiationOccupational and environmental hazardsTravelFollow upMinor discomfortsSigns of Potential Complications
15Exercise should be simple, mild exercise avoid lifting heavy weights A tooth can be extracted during pregnancy, but local analgesia is recommendedCatheter and enema should be avoided.Smoking may lead to ptyalism, nervousness and hyper emesis and make pregnant woman at increased risk of chest infections and thrombo-embolic disorders
16Pregnant woman should avoid contact with infectious diseases especially rubella or (German measles) because it has deleterious effects on the fetusPregnant woman should avoid exposure to x-ray or irradiation because of possible teratogenic effects on the fetus such as birth defects or childhood leukemia
17Common Discomforts of Pregnancy, Etiology, and Relief Measures : Urinary frequencyRELIEF MEASURES:Decrease fluid intake at night.Maintain fluid intake during day.Void when feel the urge.
18FatigueRELIEF MEASURES:Rest frequency.Go to bed earlier.
19Sleep difficulties RELIEF MEASURES: Rest frequency Decrease fluid intake at night
20Breast enlargement and sensitivity RELIEF MEASURES:Wear a good supporting bra.Assess for other conditions.
21Nasal stuffiness and epistaxis ETIOLGY: Elevated estrogen levelsRELIEF MEASURES :Avoid decongestants.Use humidifiers, and normal saline drops.
22Ptyalism (excessive salivation) ETIOLGY: UnknownRELIEF MEASURES:Perform frequent mouth care.Chew gum.Decrease fluid intake at night.Maintain fluid intake during day.
23Nausea and vomiting RELIEF MEASURES: Avoid food or smells that exacerbate condition.Eat dry crackers or toast before rising in morning.Eat small, frequent meals.Avoid sudden movements. Get out of bed slowlyBreath fresh air to help relieve nausea.
24Shortness of breath RELIEF MEASURES: Use extra pillows at night to keep more upright.Limit activity during day
25Heartburn RELIEF MEASURES: Eat small, more frequent meals. Use antacids.Avoid overeating and spicy foods.
26Dependent edema Avoid standing for long periods. Elevate legs when laying or sitting.Avoid tight stockings.
27Varicosities Rest in sims' position. Elevate legs regularly. Avoid crossing legs.Avoid tight stockings.Avoid long periods of standing
28Hemorrhoids RELIEF MEASURES: Maintain regular bowel habits. Use prescribed stool softeners.Apply topical or anesthetic ointments to area.
29Constipation RELIEF MEASURES: Maintain regular bowel habits. Increase fiber in diet.Increase fluids.Find iron preparation that is least constipating
30Leucorrhea RELIEF MEASURES: Take a daily bath or shower. Wear cotton underwear.
31Backache RELIEF MEASURES: Wear shoes with low heels. Walk with pelvis tilted forward.Use firmer mattress.Perform pelvic rocking or tilting
32Leg cramps RELIEF MEASURES: Extend affected leg and dorsiflex the foot.Elevate lower legs frequently.Apply heat to muscles.Evaluate diet.
33Faintness RELIEF MEASURES: Rise slowly from sitting to standing. Evaluate hemoglobin and hematocrit.Avoid hot environments