Antenatal Care

Antenatal Care

• Antenatal care (ANC) is a healthcare program for pregnant women from confirmation of pregnancy until the onset of labor.
• The goal of ANC is to ensure the safety of both the mother and the fetus.

Objectives of Antenatal Care

• Ensure a healthy mother and newborn
• Estimate gestational age and expected date of delivery
• Identify high-risk pregnancies
• Detect and treat diseases during pregnancy
• Detect congenital fetal malformations
• Educate patients and prepare them for childbirth

Elements of Antenatal Care

• History taking
• Physical examination
• Investigations (routine and screening tests)
• Plan schedule for return visits
• Instructions and advice
• Reassurance
• Plan for delivery
• Documentation

The Booking Visit (1st Antenatal Visit)

• History taking:
  • Menstrual history to identify last menstrual period (LMP) and estimate gestational age (GA)
  • Obstetric history
  • Medical history
  • Surgical history
  • Family history
• Physical examination:
  • General: weight, height, and BMI
  • Blood pressure
  • Abdominal examination
  • Vaginal examination (if necessary)
  • Fundal level assessment
• Investigations:
  • Ultrasound scan to confirm viability, dates, and identify multiple pregnancy (ideally at 8-12 weeks)
  • Laboratory tests:
    • Full blood count
    • Blood group and Rh-type (Anti-D antibodies if Rh-negative)
    • Complete urine analysis and urine culture

Schedule of Antenatal Visits

• Low-risk patients:
  • Every 4 weeks until 28 weeks
  • Every 2 weeks between 28 and 36 weeks
  • Every week after 36 weeks until delivery
• High-risk patients:
  • Seen more frequently according to their condition and jointly with the corresponding specialist physician

Instructions for Patients

• Nutrition:
  • Calories: same as non-pregnant women (2500 Calorie/day)
  • Protein: 1-2 g/kg/day (animal and plant sources)
  • Carbohydrates: restricted to avoid unnecessary weight gain
  • Fats: accompanying animal proteins are enough
  • Calcium: 1.5-2 g/day (milk and milk products)
  • Iron: 30 mg/day (needs supplementation by the third month)
  • Folic acid: 400 mcg/day (except for high-risk patients for NTD: 5mg/day)
• Weight gain: 10-12 kg during pregnancy
• Dental care: encouraged, with routine check-ups and antibiotic cover
• Breast care: panthenol cream for cracked nipples and soft, light brassiere for breast heaviness
• Exercise: no restrictions except for vaginal bleeding or ruptured membranes
• Traveling: allowed, but with precautions for thromboembolism for long flights
• Immunization: live attenuated vaccines are contraindicated

Subsequent Visits

• History taking: any new problems and worries, satisfactory fetal movement
• Examination:
  • Weight: checking proper weight gain
  • Blood pressure measurement
  • Abdominal palpation for uterine size and fetal growth
  • Abdominal palpation for fetal lie and presentation
• Investigations:
  • Routine follow-up investigations
  • Laboratory tests: full blood count repeated at 28-30 weeks (and at 36 weeks if anemic)

Warning Signs During Pregnancy

• Refer to a doctor if experiencing:
  • Vaginal bleeding
  • Sudden gush of fluid (liquor amnii)
  • Severe persistent headache
  • Blurring of vision
  • Persistent vomiting
  • Abdominal pain
  • Swelling of lower limbs, face, or fingers