Dr. Areefa Al Bahri

1. Dr. Areefa Al Bahri Ch. 5 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.

2. 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

3. 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 30. • Once every 2 weeks till the 37 • Once every week during the 38, till labor.

4. Signs of pregnancy • Presumptive (subjective )signs of pregnancy: These signs are least indicative of pregnancy; they could easily indicate other conditions. signs lead a woman to believe that she is pregnant • Amenorrhea. • Breast changes and tangling sensation. • Chlosma and linea nigra. • Abdominal enlargement & striae gravidarum. • Nausea & vomiting. • Frequent urination. • Fatigue • quickening :sensations of fetal movement in the abdomen. Firstly felt by the patient at approximately 16 to 20 weeks. .

5. Probable signs( objective) of pregnancy: • Hegar’s sign (softening of the lower uterine segment). Goodell’s sign (softening of the cervix ,uterus, and vagina during pregnancy.). • Ballottement. (dropping and rebounding of the fetus in its surrounding amniotic fluid in response to a sudden tap on the uterus) • Positive pregnancy test. • Braxton hicks contractions. more frequently felt after 28 weeks. They usually disappear with walking or exercise.

6. Positive signs of pregnancy: • Fetal heart tones : • by Doppler technology • Fetal movement felt by the examiner. after about 20 weeks' gestation • Visualization of the fetus by the ultrasound.

7. Assessment and physical examination. ☺ history. ☺ Physical assessment. ☺ Nutritional assessment ☺ Psychological assessment ☺ Laboratory data. ☺ Ultrasound.

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

9. Physical Examinations • Height of over 150 cm indication of an average-sized pelvis • The approximate weight gain during pregnancy is 12 - 13 kg.; 2kg in the first 20 (1.5 kg per week until term). • General exam ex. Vital sign , systemic,

10. Abdomen: • The size of the abdomen is inspected for: - the height of the fundus, which determines the period of the gestation. - multiple pregnancy.

11. Laboratory data

13. * Hemoglobin will be repeated: • - At 36 weeks of gestation. • - Every 4 weeks if Hb is<9g/dl. • - If there is any other clinical reason.

14. Fetal heart sound is heard by sonicaid as early as 12-16 thweek 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

15. 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

16. THANKS A LOT