Antenatal Care

1. Antenatal Care

2. Definition of Antenatal care comprehensive health supervision of a pregnant woman before delivery Orit is planned examination, observation and guidance given to the pregnant woman from conception till the time of labor.

3. Goals • To reduce maternal and perinatal mortality and morbidity rates • To improve the physical and mental health of women and children

4. Importance of Antenatal Care • To ensure that the pregnant woman and her fetus are in the best possible health. • To detect early and treat properly complications • Offering education for parenthood • To prepare the woman for labor, lactation and care of her infant

5. Schedule 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 month • Once every week during the 9th month, till labor.

7. History • Personal history • Family history • Medical and surgical history • Menstrual history • Obstetrical history • History of present pregnancy

8. Physical Examinations • Height of over 150 cm indication of an average-sized pelvis • The 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).

9. Obesity (more than 20 kg above the weight-height formula) leads to an increased risk of gestational diabetes, pregnancy-induced hypertension and thrombo-embolic disorders

10. Local Examination • The 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.

11. Fetal 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 120-160 beats/min

12. Investigations: • 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.

13. Fetal kick count • The pregnant woman reports at least 10 movements in 12 hours. • Absence of fetal movements precedes intrauterine fetal death by 48 hours.

14. Physiological changes during pregnancy Weight gain Fresh air and sunshine Rest and sleep Diet Daily activities Exercises and relaxation Hygiene Teeth Bladder and bowel Sexual counseling Smoking : Medications Infection Irradiation Occupational and environmental hazards Travel Follow up Minor discomforts Signs of Potential Complications Health Teaching during the First Trimester

15. Exercise should be simple, mild exercise avoid lifting heavy weights • A tooth can be extracted during pregnancy, but local analgesia is recommended • Catheter 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

16. Pregnant woman should avoid contact with infectious diseases especially rubella or (German measles) because it has deleterious effects on the fetus • Pregnant woman should avoid exposure to x-ray or irradiation because of possible teratogenic effects on the fetus such as birth defects or childhood leukemia

17. Common Discomforts of Pregnancy, Etiology, and Relief Measures : Urinary frequency RELIEF MEASURES: • Decrease fluid intake at night. • Maintain fluid intake during day. • Void when feel the urge.

18. Fatigue RELIEF MEASURES: • Rest frequency. • Go to bed earlier.

19. Sleep difficulties RELIEF MEASURES: • Rest frequency • Decrease fluid intake at night

20. Breast enlargement and sensitivity RELIEF MEASURES: • Wear a good supporting bra. • Assess for other conditions.

21. Nasal stuffiness and epistaxis ETIOLGY: Elevated estrogen levels • RELIEF MEASURES : • Avoid decongestants. • Use humidifiers, and normal saline drops.

22. Ptyalism (excessive salivation) ETIOLGY: Unknown RELIEF MEASURES: • Perform frequent mouth care. • Chew gum. • Decrease fluid intake at night. • Maintain fluid intake during day.

23. Nausea 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 slowly • Breath fresh air to help relieve nausea.

24. Shortness of breath • RELIEF MEASURES: • Use extra pillows at night to keep more upright. • Limit activity during day

25. Heartburn RELIEF MEASURES: • Eat small, more frequent meals. • Use antacids. • Avoid overeating and spicy foods.

26. Dependent edema • Avoid standing for long periods. • Elevate legs when laying or sitting. • Avoid tight stockings.

27. Varicosities • Rest in sims' position. • Elevate legs regularly. • Avoid crossing legs. • Avoid tight stockings. • Avoid long periods of standing

28. Hemorrhoids RELIEF MEASURES: • Maintain regular bowel habits. • Use prescribed stool softeners. • Apply topical or anesthetic ointments to area.

29. Constipation RELIEF MEASURES: • Maintain regular bowel habits. • Increase fiber in diet. • Increase fluids. • Find iron preparation that is least constipating

30. Leucorrhea RELIEF MEASURES: • Take a daily bath or shower. • Wear cotton underwear.

31. Backache RELIEF MEASURES: • Wear shoes with low heels. • Walk with pelvis tilted forward. • Use firmer mattress. • Perform pelvic rocking or tilting

32. Leg cramps • RELIEF MEASURES: • Extend affected leg and dorsiflex the foot. • Elevate lower legs frequently. • Apply heat to muscles. • Evaluate diet.

33. Faintness • RELIEF MEASURES: • Rise slowly from sitting to standing. • Evaluate hemoglobin and hematocrit. • Avoid hot environments