Antenatal care

Urvashi jhala
 Goals of antenatal care
• To reduce maternal and perinatal mortality and
morbidity rates.
• To improve the physical and mental health of
women and children.
• To prepare the woman for labor, lactation, and
care of her infant.
• To detect early and treat properly complicated
conditions that could endanger the life or impair
the health of the mother or the fetus.
Definitions
• It is a planed examination and observation
for the woman from conception till the
birth .
Or
• Antenatal care refers to the care that is given
to an expected mother from time of
conception is confirmed until the beginning
of labor
 Objectives
• Antenatal care support and encourage a
family’s healthy psychological adjustment to
childbearing
FACTORS AFFECTING MOTHERS
UTILIZATION OF ANTENATAL CARE
• Demographic and Biological Factors
• Socioeconomic Factors
• Psychosocial Factors
• Health Services Factors
• Environmental Factors
Assessment and physical
examination
 Component of antenatal care
Assessment:
1. The initial assessment interview can
establish the trusting relationship between
the nurse and the pregnant woman.
2. getting information about the woman’s
physical and psychological health,
3. obtaining a basis for anticipatory guidance
for pregnancy .
• During the firs visit, assessment and
physical examination must be
completed. Including:

 history.
 Physical examination.
 Laboratory data.
 Psychological assessment.
 Nutritional assessment.
 History

• Welcome the woman, and ensure a quite place

where she can express concerns and anxiety
without being overheard by other people.
• Personal and social history:
This include: woman’s name, age, occupation,
address, and phone number. marital status,
duration of marriage, Religion , Nationality
and language, Housing and finance
 Current problems with pregnancy :

Ask the patient if she has any current problem, such as:
- Nausea & vomiting.
- Abdominal pain.
- Headache.
- Urinary complaints.
- Vaginal bleeding.
- Edema.
- Backache.
- Heartburn.
- Constipation.
• Obstetrical history:
This provides essential information about the previous
pregnancies that may alert the care provider to
possible problems in the present pregnancy. Which
includes:

 Gravida, abortion, and living children.

 Weight of infant at birth & length of gestation.
 Labor experience, type of delivery, location of birth,
and type of anesthesia.
 Maternal or infant complications.
• Family history:
Family history provides valuable information about
the general health of the family, and it may reveal
information about patters of genetic or congenital
anomalies.
Including:
- D.M.
- Hypertension.
- Heart disease.
- Cancer.
- Anemia.
 Physical examination
Physical examination is important to:
detect previously undiagnosed physical
problems that may affect the pregnancy
outcome.
 and to establish baseline levels that will
guide the treatment of the expectant mother
and fetus throughout pregnancy.
 General Examination
Examine general appearance:
• Observe the woman for stature or body build and
gait
• The face is observed for skin color as pallor and
pigmentation.
• Observe the eyes for edema of the eyelids and
color of conjunctiva. Healthy eyes are bright and
clear.
 Musculoskeletal system
• Posture and gait:
Body mechanics and changes
in posture and gait should be
addressed. Body mechanics
during pregnancy may
produce strain on the
muscles of the lower back
and legs.
 Neurological system

• Deep tendon reflexes should be evaluated

because hyperreflexia is associated with
complications of pregnancy.
 Legs:
* Legs should be noted for edema.
* They should be observed for varicose veins
* The calf must be observed for reddened areas which
may be caused by phlebitis and white areas which
could be caused by deep vein thrombosis.
* Ask the woman to report tenderness during
examination.
* The legs should be observed for unequal length or
muscle wasting which may be an indication of
pelvic abnormalities.
• * Hemoglobin will be repeated:
• - At 36 weeks of gestation.
• - Every 4 weeks if Hb is<9g/dl.
• - If there is any other clinical reason.
 Ultrasound
Is performed to:
• estimate the gestational age.
• Check amniotic fluid volume.
• Check the position of the placenta.
• Detect the multifetal pregnancy.
• The position of the baby.
• Fetal kick count:
• The pregnant woman reports at least 10
movements in 12 hours.

* Absence of fetal movements precedes

intrauterine fetal death by 48 hours.
 Schedual of antenatal care:
• a medical check up every four weeks up
to 28 weeks gestation,

• every 2 weeks until 36 weeks of gestation

• visit each week until delivery

• More frequent visits may be required if

there are abnormalities or complications
or if danger signs arise during pregnancy
 health education:
• Follow up:
• Advice the mother to follow up according
to the schedule of antenatal care that
mentioned before, advise the mother to
follow up immediately if any danger sings
appears, describe the important of follow up
to the mother.
Health teaching during
pregnancy
• Danger signs of pregnancy
• Vaginal bleeding including spotting.
• Persistent abdominal pain.
• Sever & persistent vomiting.
• Absence or decrease fetal movement.
• Sever headache.
• Edema of hands, face, legs & feet.
• Fever above 100 F( greater than 37.7C).
• Dizziness, blurred vision, double vision & spots before
eyes.
• Painful urination.
Dental care:
• The teeth should be brushed carefully in the
morning and after every meal.
• Encourage the woman the to see her dentist
regularly for routine examination &
cleaning.
• Encourage the woman to snack on nutritious
foods, such as fresh fruit & vegetables to
avoid sugar coming in contact with the teeth.
• A tooth can be extracted during pregnancy,
but local anesthesia is recommended.
Dressing:
• Woman should avoid wearing tight cloths
such as belt or constricting bans on the legs,
because these could impede lower extremity
circulation.
• Suggest wearing shoes with a moderate to
low heel to minimize pelvic tilt & possible
backache.
• Loose, and light clothes are the most
comfortable.
Travel:
Many women have questions about travel
during pregnancy.
• Early in normal pregnancy, there are no
restrictions.
• Late in pregnancy, travel plans should take
into consideration the possibility of early
labor.
Exercises:
• Exercise should be simple. Walking is
ideal, but long period of walking should be
avoided.
• The pregnant woman should avoid lifting
heavy weights such as: mattresses furniture,
as it may lead to abortion.
• She should avoid long period of standing
because it predisposes her to varicose vein.
• She should avoid setting with legs crossed
because it will impede circulation.
 • Purpose:
• 1. To develop a good posture.
• 2. To reduce constipation & insomnia.
• 3. To alleviate discomvortable, postural back
ache& fatigue.
• 4. To ensure good muscles tone& strength
pelvic supports.
• 5 To develop good breathing habits, ensure
good oxygen supply to the fetus.
• 6- to prevent circulatory stasis in lower
extremities, promote circulation, lessen the
possibility of venous thrombosis
• Guide lines for exercises during pregnancy:
• -Maintain adequate fluid intake.
• -Warm up slowly, use stretching exercises but
avoid over stretching to prevent injury to
ligaments.
• -Avoid jerking or bouncing exercises.
• Be careful of loose throw rugs that could slip&
cause injury.
• Exercises on regular basis (three times per week).
• After first trimester, avoid exercises that require
supine position.
 Contraindications:
• -Vaginal bleeding.
• -Sever anemia.
• -History of preterm labor,
• -Extreme over or under weight.
• -Hypertension, heart, lung, thyroid diseases
Sleep:
• The pregnant woman should lie down to relax
or sleep for 1 or 2 hours during the afternoon.
• At least 8 hours sleep should be obtained every
night & increased towards term, because the
highest level of growth hormone secretion
occurs at sleep.
• Advise woman to use natural sedatives such as:
warm bath & glass of worm milk.
• A good sleeping position is sims’ position,
with the top leg forward. This puts the
weight of the fetus on the bed, not on the
woman, and allows good circulation in the
lower extremities.
• avoid resting in supine position, as supine
hypotension syndrome can develop.
 • Hazards

• Occupational hazards: lead, mercury, X ray

s& ethylene oxide.
• Infection: rubella, toxoplasmosis,
syphilis.......................
• Smoking & alcohol: increase risk for
pregnancy, prematurity, fetal death, mental
retardation & congenital anomalies.
• Drugs: as sedative & analysis,
anticoagulant, antithyrodism, hormones&
antibiotics.
Immunization:
the nurse instructs the woman to receive
immunization against -tetanus to prevent the
risk for her and her fetus.
Also, it is important that every pregnant
mother should receive a tetanus vaccination
card with her first tetanus dose and keep it to
record subsequent doses
• Diet:
• -Daily requirement in pregnancy about
2500 calories.
• - Women should be advised to eat more
vegetables, fruits, proteins, and vitamins
and to minimize their intake of fats.
• Purpose:
– *Growing fetus.
– *Maintain mother health.
– *Physical strength & vitality in labor.
– *Successful lactation.