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

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

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

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

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

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

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

Secific health protection : Anemia -50-60 % 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 34-36 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.

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

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