Antenatal Care PDF

ANTENATAL CARE Dr.. Ahmed Reda Dr Definitions       Ante: means before. Natal: means delivery. Antenatal: means before delivery. Miscarriage: loss of a pregnancy before the age of viability Live birth: a fetus born alive after the age of viability Stillbirth : a fetus born dead after the age o...

ANTENATAL CARE Dr.. Ahmed Reda Dr Definitions       Ante: means before. Natal: means delivery. Antenatal: means before delivery. Miscarriage: loss of a pregnancy before the age of viability Live birth: a fetus born alive after the age of viability Stillbirth : a fetus born dead after the age of viability Antenatal care (ANC) Definition Health care program given to an expected mother from time of pregnancy confirmation until the beginning of labor Goal To ensure the safety of both the mother and the fetus Objectives 1) Try to get healthy mother and new born 2) Estimation of gestational age & expected date of delivery 3) Identify high risk pregnancy 4) Early detection & treatment of any diseases during pregnancy 5) Early detection of congenital fetal malformations 6) Patient education and instructions 7) Preparation of the couples for childbirth Elements        History taking. Physical examination. Investigations ( Routine and screening tests ). Plan schedule for return visits. Instructions & advice. Reassurance. Plan for delivery. Documentation An antenatal card should be filled for every woman on her initial visit. Aim  is to highlight any risk factor present.  Explain to the patient on her initial visit the long term plan for the current pregnancy and the expected delivery plan.  Instruct the patient to carry and preserve her antenatal card on each visit.  THE BOOKING VISIT THE 1ST ANTENATAL VISIT History taking  Menstrual: to identify last menstrual period (LMP), estimated date of delivery (EDD) and calculate gestational age (GA) EDD = 1st day of LMP + 7 days + 9 months Obstetric history: previous pregnancy  Medical history: hypertension, diabetes, heart disease…,  Surgical history: uterine surgery as myomectomy, previous CS…,  Family history e.g. twins, diabetes, familial disorder  Examination General: weight, hieght  BMI, blood pressure  Abdominal (abd. masses, enlarged liver or spleen, hernia ….)  Vaginal examinations (only if necessary) are performed.  Fundal level assessment in relation to pregnancy duration.  Investigations Ultrasound scan to confirm viability, dates and identify multiple pregnancy (ideally GA= 8-12 weeks)  Lab. Tests  – Full blood count. – Blood group and Rh-type (Anti-D antibodies if Rh-negative) – Complete urine analysis, urine culture to screen for bacteruria.  Other Investigations: if medically indicated – – – – Liver functions Kidney functions Clotting tests Echocardiogram Schedule Low risk patients High risk patients Every 4 weeks till 28 weeks.  Every 2 weeks between 28 and 36 weeks.  Every week after 36 weeks till delivery.   Are seen more frequently according to their condition and  Jointly with the corresponding specialist physician (cardiologist, endocrinologist, neurologist,………..) Instructions 1. Nutrition – Calories: requirements are the same (2500 Calorie/ day) as increased metabolism is compensated for by decreased activity. – Protein: (1-2 g/kg) (85 gm/day) (animal and plant sources) – Carbohydrates: restricted, to avoid unnecessary weight gain. – Fats: (accompanying animal proteins are enough) – Calcium: (1.5 – 2 gm day) (milk and milk products, better than supplementation formulae) – Iron: (30 mg/day) needs supplementation by third month. – Folic acid: (400 mcg/day) except for high risk patients for NTD(5mg/day). – Water: drinking water 2-3 liters/day. – Prohibit caffeine intake (coffee, cola) 2. Weight gain – 10-12 kg during pregnancy Instructions 3. Dental care: – 4. Breast care: – 5. allowed when comfortable, prophylaxis against thromboembolism for long flight travelers is required. Exercise: – 8. no restrictions except if there is vaginal bleeding or ruptured membranes. Traveling: – 7. Panthenol cream for cracked nipples and soft & light brassiere for breast heaviness. Marital life: – 6. encourage visiting dentist for routine check and all dental treatments are welcomed with proper antibiotic cover. moderation of physical activity is desirable and walking is preferable. Smoking: prohibited. Instructions 9. Rest and sleep : – 10. Drugs: – – 11. Avoid all unnecessary medications Minor disturbances expected during pregnancy and are managed without medications whenever possible Immunization : – 12. 8 hours by night and 1-2 hours in the afternoon Live attenuated vaccines are contraindicated (e.g. MMR) Bathing: – Tub baths are avoided for fear of ascending infection. SUBSEQUENT VISITS History taking Any new problems and worries  Check about satisfactory fetal movement  Examination Weight: Check proper weight gain  Blood pressure measurement  Abdominal palpation for uterine size and fetal growth (20-41 weeks)  Abdominal palpation for fetal lie and presentation (36/37 weeks)  Investigations  Routine follow up investigations  Lab. Tests – Full blood count repeated at 28-30 weeks (and at 36 if anemic) – Urine test for albumin and glucose by dipsticks – Complete urine analysis, urine culture if symptomatic  Other Investigations: if clinicaly indicated Ultrasound Late 1st trimester  Screening scan for Down $  18-24 weeks GA  Detailed Anomaly scan  28-30 weeks GA  Repeat scan for growth pattern and placental localization.  36-38 weeks GA  for growth pattern, placenta, lie & presentation.  WARNING SIGNS DURING PREGNANCY Refer to DOCTOR  Vaginal bleeding  A sudden gush of fluid (liquor amnii)  Severe persistent headache  Blurring of vision  Persistent vomiting  Abdominal pain  Swelling of lower limbs, face, or fingers. COMMON COMPLAINTS DURING PREGNANCY 1. Morning sickness: – – – 2. Heartburns: – 3. 5. 6. 8. 9. Ample amount of fluids and high fiber diet as fruits and vegetables Haemorrhoids (piles) Headache: paracetamol Breast tenderness: – 7. Management; frequent light diet, antacids, and allowing 2 hours between meals and sleeps Constipation: – 4. sensation of nausea with or without vomiting which may be more evident in the morning. Is common, especially in PG Management by reassurance, frequent small light meals, vitamin B6, and antiemetic drugs in severe cases Avoid tight clothes and warm compresses Urinary symptoms Excessive vaginal discharge Bachache – Avoid high heels and tight clothes. Rest and warm compresses and maybe topical analgesics ROLE OF WOMEN’S HEALTH PHYSIOTHERAPIST 1. 2. 3. 4. Early introduction to ergonomic back-care education Help understanding of stress and its control Advise about the importance of physical health Activities for the pelvic floor and abdominal muscles, legs and arms can usefully be included in ANC programs Thank You