Antenatal Care PDF

ANTENATAL CARE AND HEALTH EDUCATION Ye b o a Ky e r e m a a N a o m i Dept. Maternal and Child Health School of Nursing and Midwifery University of Cape Coast Outline Definition of antenatal care Aims of antenatal care Objectives of antenatal care Antenatal care activities Health education...

ANTENATAL CARE AND HEALTH EDUCATION Ye b o a Ky e r e m a a N a o m i Dept. Maternal and Child Health School of Nursing and Midwifery University of Cape Coast Outline Definition of antenatal care Aims of antenatal care Objectives of antenatal care Antenatal care activities Health education 2 Objectives By the end of the session students would be able to; Discuss aims and benefit of antenatal care Perform antenatal care Analyse normal findings during antenatal care Perform health education 3 Introduction Antenatal care is an essential component during pregnancy which aids to detect deviations. Antenatal is a systemic supervision of a woman during pregnancy and this include examination and education. It is the care given to the woman from conception till child birth. 4  Aims of Antenatal The establishment of open communication and a relationship of partnership between the woman and the professionals involved in her care. A source of information about all aspects of care and empowerment. To screen for high risk cases. Provision of appropriate support for the woman. 5 Aims of Antenatal To prevent, detect and treat To discuss birth preparedness for complication timely. and complication readiness plan. To provide ongoing care and to continue risk assessment. To improve physical and mental health of the woman To give essential health education to the mother. 6 Objective of Antenatal The overall objective is to reduce maternal and neonatal morbidity and mortality. Is to have a normal pregnancy with a safe delivery of a healthy baby to a healthy mother. 7 Trends in Antenatal Care Traditional model (1900s). Focused antenatal model (2002). New Antenatal model (2016). 8 Activities at Antenatal Registration of pregnancy History Investigation Antenatal examination Health education 9 First Antenatal Visit History Examination Investigations Health education 10 History Particulars/Personal details/social history Present obstetric history Past obstetric history Medical history Surgical history 11 History: Particulars/Personal details/Social History Full name Date of birth Marital status Religion Address Occupation and that of the Telephone numbers partner Age Race 12 History: Present obstetric history Date of the first day of the last menstrual period (LMP). Estimated date of delivery is calculated ( 9 months forward and 7 days to LMP OR 3 months back and 7 days). The expected date of delivery can be two weeks before and two weeks after. 13 History: Present obstetric history The method of calculating the estimated date of delivery is known as Naegele’s rule. The pregnancy wheel or gestation calculators can also assist in estimating date of delivery 14  History: Previous obstetric history Previous pregnancies including miscarriages or terminations, death of the child. Details of all pregnancies, labour and puerperia are essential. 15 History: Medical and surgical history History about any illness; psychiatric disorders ( postpartum depression and puerperal psychosis), previous immunizations. Operations on the uterus or pelvis or pelvic floor are very important. 16 Discussion Analyse the significance of history taking during antenatal care and its implication on care delivery, maternal and foetal health. 17 History: medical and Surgical History Relevant accidents (spine and pelvic fractures) Congenital deformities Details of blood transfusion 18 History: Drugs And Medication History Drug allergies Long and short term medication Illicit drugs Herbal medication 19 Examination Objective of examination: To detect previously undiagnosed physical condition that might affect the pregnancy. To establish baseline that will guide the management of the mother and fetus. 20  Examination Main activities: Vital signs and anthropometry Physical examination Abdominal examination Pelvic examination 21 Investigations Investigation can take two forms: Screening which determines the risk or likelihood of a condition. Diagnostic test that will give a definite answer. 22 Investigations Common laboratory investigations : Full blood count Blood grouping Rhesus typing Sickling VDRL(Veneral Disease Reference Laboratory/Syphilis 23 Investigation Common laboratory investigations HIV BF for Malaria G6PD (Glucose 6 Phosphate dehydrogenase) Ultrasound San 24 Subsequent Visit Vital signs and weight Urinalysis Abdominal examination Health Education Routine medications 25  Vital signs Blood pressure Pulse Temperature 26 Urinalysis Protein Glucose 27 Abdominal examination Fundal height Presentation Liquor volume Position Fetal weight Engagement Lies Fetal movement Attitude State of the uterine wall 28 Abdominal examination Three ways to obtain information during abdominal examination: ▪ Observation ▪Palpation and measurement ▪Auscultation 29 Abdominal examination Observation or inspection: The most important features to be noticed are the size and shape. Striae gravidarium and linear nigra Abdominal scars 30  Abdominal examination Observation or inspection: Normal findings in late pregnancy Uterus is longitudinal and ovoid in shape Uterus is consistent with supposed length of gestation 31 Abdominal examination Possible indications for large uterus when dating is correct: Large fetus Uterine fibroids Multiple pregnancy Polyhydramnios Hydatidiform mole 32 Abdominal examination Indications for small uterus when dating is correct: Small fetus probably due to placenta insufficiency Fetal death oligohydramnios 33 Abdominal examination Palpation and Measurements: Three distinct manoeuvres employed in palpation are Fundal palpation Deep pelvic palpation Lateral palpation 34  Abdominal examination Fundal palpation- to determine which part of the fetus is lying in the fundus. Deep palpation- determine presentation, the lie and engagement. Lateral palpation- to locate the fetal back. 35 36 Auscultation Auscultation is done to ascertain the foetal heart beat. This is done using fetal stethoscope; Pinard monaural stethoscope or binaural or the electronic fetal heart monitor. In cases where the foetal heart rate can not be heard ultrasound can aid visualization. 37  Abdominal findings Week 12; fundus palpable above symphysis pubis Week 16; fundus half way to the umbilicus, fetal movement felt. Week 20; fundus reaches the lower boarder of the umbilicus and fetal heart sounds maybe audible. Week 24; fundus reaches the upper border of the umbilicus, heart sounds are present and fetus may just be palpable 38 Abdominal findings Week 28; fundus is one-third of the distance from the umbilicus to the xiphisternum, fetus easily palpable, presentation maybe found. Week 32; fundus is two-third of the distance from the umbilicus to the xiphisternum, lie and presentation palpable. 39 Abdominal findings Week 34; the uterus extends nearly as far as the xiphisternum, lie and presentation palpable. Week 36; fundus reaches xiphisternum. Week 37-40; all findings are similar except the fetus become more stable 40 Discussion What foetal risk factors will require transfer of women to higher levels of care during the antenatal period? 41 Health Education Birth preparedness is advance planning and preparation for delivery. Complication readiness is anticipating the actions needed in case of an emergency. This improve maternal health outcomes. 42 Health Education Key elements of birth preparedness and complication readiness Attending regular antenatal care during pregnancy. Identifying a skilled provider and making a plan for reaching the facility during labour. Setting aside personal funds to cover the cost pf travelling, delivery and other required supplies. 43 Health education Key elements of birth preparedness and complication readiness Recognising signs and symptoms of complications. Having a plan for emergencies; -knowing what transport can be used to get to the hospital, - identifying person(s) to accompany to the hospital and/or to stay at home with family, - identifying a blood donor. 44  Health education Benefits of birth preparedness and complication readiness Birth preparedness helps ensure that women can reach professional delivery care when labour begins. Birth preparedness can help reduce the delays that occur when women experience obstetric complications, such as; -recognising complications and deciding to seek care, -reaching a facility where skilled care is available, -receiving care from qualified providers at the facility. 45 Health education Benefits of birth preparedness and complication readiness Birth preparedness can help reduce the delays that occur when women experience obstetric complications, such as; -recognising complications and deciding to seek care, -reaching a facility where skilled care is available, -receiving care from qualified providers at the facility. 46 Health education Nutrition during pregnancy Helps a woman resist illness during her pregnancy and after the birth. Keeps a woman’s teeth and bones strong. Gives a woman strength to work. 47 Health education Nutrition during pregnancy Helps the baby grow well in the mother’s uterus. Helps a mother recover her strength quickly after the birth. Supports the production of plenty of good quality breast milk to nourish the baby. 48  Health Education Hygiene during pregnancy Pregnant women sweat more and have more vaginal discharge and they may be more vulnerable to infection by germs in the environment hence proper hygiene helps prevent infections. Regular mouth care reduces the incidences of tooth sensitivity and gum swelling during pregnancy. 49  Health Education Living a healthy lifestyle Sleep and rest every day helps the pregnant woman to stay strong and gives the fetus a better chance of being born healthy. Exercise Avoid lifting heavy loads. Drugs such as cigarette smoke, alcohol and illegal drugs such as opium, heroin, cocaine and barbiturates are harmful to the developing fetus. 50 Health Education Immunization Tetanus Diphtheria 51 Health Education Benefits of early and exclusive breastfeeding Provides the best nutrition for the newborn and offer protection against allergies. Is easily digested and efficiently used by the baby’s body Protects against infection and other illnesses Is cost-effective and affordable Promotes mother-baby bonding 52 Essential Topics for Health Education Importance of continuity of Malaria prevention care. Purpose of antenatal visit. Pregnancy induced hypertension Anaemia and iron, folic acid supplementation Sexual activity and safe sex 53 Essential Topics for Health Education Neonatal care and danger signs Drugs and substance abuse in newborn Importance of postnatal care Immunization schedule in Labour signs and progress of newborn delivery Mother to child transmission of HIV 54 Summary Antenatal care is a vital component that allows supervision of the pregnant woman till child birth. It is essential for the midwife to recognize deviation from normal to implement timely interventions. Health education is a key element in antenatal care that allows pregnant women to receive comprehensive information on their pregnancy and how to prepare for child birth. 55 References Fraser, D., M., & Copper, M., A. (2003). Myles Textbook for Midwives (14th ed ) Churchill Livingstone. London Hanretty, K., P. (2010) Obstetrics Illustrated (7th ed) Churchill Livingstone New York Macdonald, S,. & Magill-Cuerden, J. (2010). Mayes’ Midwifery (14th ed ). Bailliere Tindall. London 56 Thank You 57