Antenatal Care

Antenatal

​ ​Care​ ​(ANC) 

Definition

​: a preventive obstetric health care program that optimizes maternal-fetal

outcomes

​ ​through​ ​the​ ​routine​ ​monitoring​ ​of​ ​pregnancy. 

Reasons

​ ​to​ ​attend​ ​the​ ​Antenatal​ ​Clinic: 

● To

​ ​build​ ​trust​ ​between​ ​the​ ​client​ ​and​ ​the​ ​provider 

● To

​ ​achieve​ ​the​ ​best​ ​possible​ ​health​ ​status 

● To

​ ​obtain​ ​a​ ​baseline​ ​recording​ ​data 

● To

​ ​identify​ ​and​ ​manage​ ​high-risk​ ​pregnancy 

● To

​ ​provide​ ​basic​ ​health​ ​education 

● To

​ ​minimize​ ​maternal​ ​and​ ​fetal​ ​mortality​ ​and​ ​morbidity  

Schedule

​ ​of​ ​ANC​ ​Visits: 

● Every

​ ​4​ ​weeks​ ​until​ ​the​ ​28th​ ​week​ ​of​ ​pregnancy. 

● Every

​ ​2​ ​weeks​ ​between​ ​the​ ​28th​ ​and​ ​36th​ ​weeks​ ​of​ ​pregnancy. 

● Every

​ ​1​ ​week​ ​between​ ​the​ ​36th​ ​week​ ​and​ ​delivery.  

Booking

​ ​Procedures:​ ​(Registration) 

Client

​ ​history: 

● Personal history: Name, age, address, occupation, duration of marriage,

consanguinity,

​ ​and​ ​potentially​ ​harmful​ ​habits. 

● Complains

​ ​in​ ​detail​ ​and​ ​duration. 

● Menstrual

​ ​history:​ ​LMP​ ​(1st​ ​Day)​ ​and​ ​calculation​ ​of​ ​gestational​ ​age​ ​EDD. 

● Obstetric

​ ​history:​ ​antepartum​ ​care,​ ​labour,​ ​puerperium​ ​of​ ​previous​ ​pregnancies. 

○ Mode

​ ​of​ ​termination 

○ Number

​ ​of​ ​living​ ​children 

○ Birth

​ ​weights 

○ Mode

​ ​of​ ​infant​ ​feeding 

○ Date

​ ​of​ ​last​ ​Labour​ ​and​ ​last​ ​abortion 

● Present

​ ​obstetric​ ​history: 

○ Symptoms

​ ​of​ ​pregnancy 

○ Symptoms

​ ​of​ ​preeclampsia 

1

​ ​of​ ​4 

○ Symptoms

​ ​of​ ​disease​ ​in​ ​other​ ​organ​ ​systems 

○ Fetal

​ ​movements 

● Family

​ ​history:​ ​​ ​DM,​ ​​ ​BP,​ ​​ ​multiple​ ​pregnancies,​ ​​ ​congenital​ ​anomalies. 

● Medical history: DM, BP, UT troubles, heart disease, viral infections, drugs, and

allergies.

​ ​Others:​ ​​ ​blood​ ​transfusion,​ ​​ ​Rh​ ​incompatibility,​ ​​ ​X-ray​ ​exposure. 

● Surgical history: previous operations, dilation and curettage, vaginal repair,

caesarean

​ ​section,​ ​and​ ​non​ ​gynaecological​ ​operations. 

● Family

​ ​planning​ ​history 

● Immunisation

​ ​history 

● Breastfeeding

​ ​history 

Examination:

​ ​​ ​(minimal​ ​physical​ ​parameters​ ​to​ ​be​ ​evaluated) 

● General

​ ​(systemic): 

○ Physical

​ ​signs 

○ Chest

​ ​examination 

○ Breast

​ ​examination 

○ Skeletal

​ ​or​ ​neurological​ ​abnormalities 

● Local

​ ​(Obstetric): 

○

​ ​Inspection 

■ Contour

​ ​and​ ​size​ ​of​ ​abdomen 

■ Scars

​ ​from​ ​previous​ ​operations 

■ Signs

​ ​of​ ​pregnancy 

■ Fetal

​ ​movements 

■ Varicose

​ ​veins 

■ Hernial

​ ​orifices​ ​and​ ​back 

■ Oedema 

○

​ ​Palpation: 

■ Fundal

​ ​height 

■ Fundal

​ ​grip 

■ Umbilical

​ ​grip 

2

​ ​of​ ​4 

■ First

​ ​and​ ​second​ ​pelvic​ ​grips 

○

​ ​Auscultation: 

■ At

​ ​10​ ​weeks 

■ At

​ ​20​ ​weeks 

○

​ ​Investigation: 

■ Stool

​ ​analysis​ ​for​ ​ova​ ​and​ ​parasites 

■ Blood

​ ​analysis 

● Complete

​ ​blood​ ​count 

● ABO

​ ​grouping​ ​and​ ​RH​ ​typing 

● Blood

​ ​sugar​ ​level 

■ First

​ ​level​ ​ultrasound 

Alarming

​ ​Symptoms​ ​and​ ​Signs: 

● Vaginal

​ ​Bleeding: 

○ Before

​ ​the​ ​20th​ ​week:​ ​Threatened​ ​Abortion 

○ After

​ ​the​ ​20th​ ​week:​ ​Antepartum​ ​Hemorrhage 

● Escape

​ ​of​ ​fluid​ ​from​ ​the​ ​vagina​ ​(PROM) 

● Persistent

​ ​vomiting 

● Fever 

● Chills 

● Symptoms

​ ​of​ ​Preeclampsia: 

○ Severe

​ ​persistent​ ​headache 

○ Blurring

​ ​of​ ​vision 

○ Epigastric

​ ​pain  

○ Generalized

​ ​edema 

● Dysuria 

● Abdominal

​ ​pain​ ​(placental​ ​abruption) 

● Too

​ ​small/Too​ ​big​ ​abdominal​ ​size​ ​for​ ​the​ ​gestational​ ​age  

Periodic

​ ​Visit​ ​Procedures: 

● Record

​ ​any​ ​new​ ​complaints 

3

​ ​of​ ​4 

● Perform

​ ​examination: 

○ General:

​ ​Weight​ ​&​ ​BP. 

○ Local:

​ ​Fetal​ ​Size,​ ​Lie,​ ​Presentation,​ ​&​ ​Heart​ ​Sound. 

● Assess

​ ​Fetal​ ​Well-being: 

○ Maternal

​ ​weight:​ ​Little​ ​or​ ​no​ ​gain​ ​indicates​ ​fetal​ ​jeopardy.  

○ Fetal

​ ​size:​ ​through​ ​Fundal​ ​Level. 

○ Fetal

​ ​kick​ ​count:​ ​at​ ​least​ ​10​ ​movements​ ​/​ ​12​ ​hours.  

○ Fetal

​ ​movements:​ ​Absence​ ​indicates​ ​Intrauterine​ ​Fetal​ ​Death​ ​(IUFD).  

○ Fetal

​ ​Heart​ ​Sounds. 

○ Ultrasonography. 

Basic

​ ​health​ ​education​ ​plan​ ​for​ ​women: 

● Adequate

​ ​Nutrition: 

○ Calories

​ ​2500​ ​C/day.​ ​High​ ​Levels​ ​in​ ​Mothers:​ ​Predispose​ ​to​ ​Eclampsia  

○ Protein

​ ​85​ ​gm/day: 

■ Low

​ ​Levels​ ​in​ ​Fetuses:​ ​Premature​ ​Baby  

■ Low

​ ​Levels​ ​in​ ​Mothers:​ ​Anemia  

○ Calcium

​ ​1.5​ ​gm/day  

■ Low

​ ​Levels​ ​in​ ​Infants:​ ​Rickets  

■ Low

​ ​Levels​ ​in​ ​Mothers:​ ​Osteomalacia  

○ Iron

​ ​30​ ​mg/day.​ ​Low​ ​Levels​ ​in​ ​Mothers:​ ​Iron​ ​Deficiency​ ​Anemia  

○ Folic

​ ​Acid​ ​1​ ​mg/day.​ ​Low​ ​Levels​ ​in​ ​Mothers:​ ​Megaloblastic​ ​Anemia  

● Tetanus

​ ​Toxoid: 

○ Tetanus

​ ​Toxoid​ ​Vaccination: 

■ 1st

​ ​dose:​ ​at​ ​4th​ ​month​ ​of​ ​pregnancy​ ​(gives​ ​no​ ​protection)  

■ 2nd

​ ​dose:​ ​1​ ​month​ ​after​ ​1st​ ​dose​ ​(gives​ ​protection​ ​for​ ​3​ ​years)  

■ 3rd

​ ​dose:​ ​6​ ​months​ ​after​ ​the​ ​2nd​ ​dose​ ​(gives​ ​protection​ ​for​ ​5​ ​years)  

■ 4th

​ ​dose:​ ​1​ ​year​ ​after​ ​the​ ​3rd​ ​dose​ ​(gives​ ​protection​ ​for​ ​10​ ​years)  

■ 5th

​ ​dose:​ ​1​ ​year​ ​after​ ​the​ ​4th​ ​dose​ ​(gives​ ​protection​ ​for​ ​15​ ​years) 

4

​ ​of​ ​4