INTRODUCTION
Antenatal care is the care for women during pregnancy. It is essential even for a
normal and healthy pregnant woman for her own well being and the baby, and there is no
pregnancy and child birth is free from risk for both mother and baby. Ideally the care should
start immediately after conception but practically as early as possible during the first
trimester and should continue through the second and third trimester.
When couple is seen and counseled about pregnancy, its course and outcome well
before the time of actual conception is called preconception counseling. It is a very new
concept. Its objective is to ensure that a woman enters pregnancy with an optimal state of
health which would be safe to herself and also fetus. Organogenesis is completed by the first
trimester. By the time woman is seen first in the antenatal clinic it is often too late to advice
because all the adverse factors have already begun to exert their effect.
In the ideal world antenatal care would commence at the preconception stage where
health education (general advice about nutrition, lifestyle, avoidance of teratogens, folic acid
supplementation, etc) and risk assessment has been focused toward a planned pregnancy.
Preconception counseling is of much greater importance among married women.
DEMOGRAPHIC DATA
Name of the mother :Mrs. Sobana
Age : 22years
Educational level : 7th std
Name of Husband : Mr.Ramesh
Age : 27 Years
Educational level : X Std
Religion :Hindu
Address sekkanur
Madurai (Dt)
Occupation : Autodriver
Income : Rs. 10000- / per month
Admitted on : 27/11/2019@ 08.45AM
I.P.No. :77845
Ward : Antenatal Ward
Unit : I OG
Diagnosis : 8 MONTHS AMENORRHOEA WITH POLYHYDRAMNIOS
Obstetrical score :G2P1L1A0
REASON FOR HOSPITALIZATION/NEED FOR SEEKING HEALTH CARE:
Mother got admitted for difficulty in breathing since yesterday night
PERSONAL HISTORY:
A. Nutrition : Non vegetarian
Frequency of meals : 3-4 times a day
Food allergy : She has no allergies to any food
B. Habits : There are no habits such as Alcohol, Smoking, Chewing pan,
Using snuff.
C. Drugs : There is no history of drug intake except iron supplements and
antihypertensive and no allergic reactions to any drug.
D. Sleep : She sleeps 6-8 hours at night time and 2 hours at day time.
E. Rest : She takes adequate rest in between household activities.
F. Hygiene : Maintains optimal personal hygiene.
G. Exercises :She is doing mild exercises like walking.
H. Urinary pattern :She voids about 8-10 times a day and no urinary incontinence
or retention.
I. Bowel pattern : She defecates one time a day. No constipation
J. Menstrual history : She attained menarche at the age of 13 years
Irregular cycle with normal blood flow
No history of dysmenorrhea.
K. Marital history :Married since 6 years back , married at the age of 16 yrs
There is no consanguineous marriage.
IV.SOCIO ECONOMIC STATUS:
She belongs to a moderate socio economic status and lives in her own concrete house
with adequate facilities such as electricity, ventilation, water supply through street pipes,
closed drainage facilities and used RCA type of latrine . Her husband is the bread winner of
the family. He works as a autodriver and earns about Rs.10000/- per month. She is a
housewife. There is no kitchen garden and pet animals.
FAMILY MEDICAL HISTORY
Multiple pregnancies : There is no history of multiple pregnancies.
Communicable diseases : There is no history of communicable diseases like pulmonary
tuberculosis, chicken pox, measles and non communicable diseases like bronchial asthma,
anemia, heart diseases, hypertension and diabetes mellitus.
Mental illness : No history of mental illness such as mental retardation,
psychosis, depression, etc.
Genetic disorder : No history of any genetic disorders in her family
Any other : No history of food and drug allergies.
MEDICAL HISTORY:
Childhood illness : There is no history of childhood illnesses
Previous illness : There is no history of medical illness or surgical illness
GENOGRAM
56YRS 52YRS 60YRS 50YS
28YRS
35YRS 27YRS 21YRS 22YRS
P
KEY FACTORS P
MALE 5YRS
-MALE
- -FEMALE
P -PREGNANCY
OBSTETRICAL HISTORY:
a. Past obstetrical history:
Year Antenatal Intranatal Postnatal Newborn Birth Breast Remarks
of period period period sex weight feeding
delive
ry
There is no
2013 During Normal postnatal Female 2.250 Upto Nil-
antenatal vagninal complication baby kg 1year
period delivery line PPH and
there is no .baby cried anyother illness
complicatio soon after
n birth
Present obstetrical history:
Date of booking :18-06-2019 LMP:NOTKNOWN
Gestation at 1st visit :9 weeks EDD:NOTKNOWN
Height :156Cms Weight: 78kg
First trimester
Registered, routine investigations done.
Inj. TT 2 doses received.
No history of excessive vomiting, drug intake, pica, constipation, exposure to drugs.
History of folic acid tablet intake since third month of pregnancy
Second trimester
Quickening felt at 4 months of amenorrhea
Undergone routine medical check up
No history of head ache, blurring vision, abdominal pain, decreased urine output and
muscle cramps.
Third trimester
Able to perceive fetal movements
No history of abdominal pain, constipation
History of frequency of micturition
Overdistension of abdomen in gestational age
b. Attendances :
Date Weight Urine B.P FHR Finding Treatment Rema
(Mm Hg) rks
18/06/19 65 kg hCG +ve 110/60 - Normal
Albumin-Nil
Sugar –Nil T.FST
21/07/19 67.5 kg - 140/70 + (USG) Hypertensi 335 mg - BD Chron
on T.BCT ic
18/8/19 70 kg Albumin-Nil 130/70 152/min Normal 5 mg – BD hypert
Sugar –Nil T. Calcium ensive
20/10/19 72.4 kg - 120/70 146/min Normal lactate mothe
Normal 300 mg – OD r
Normal T.Labetalol
100mg BD
27/11/19
74 kg Albumin-Nil 120/70 USG Polyhydra
Sugar –Nil AFI-25.2 mnios
-
VIII.PHYSICAL EXAMINATION:
General appearance
Conscious, oriented to time, place and person.
Moderate built, well groomed
Afebrile
Skin
Fair in skin complexion
Dry skin, skin turgor is good
No inflammation, redness or itching.
NO any skin changes
Hair and Scalp
Hair is black in colour and equally distributed
Scalp is clean, no dandruff and pediculosis.
There is no excessive growth of the hair
Eyes
Normal vision in both eyes
Conjunctiva is slightly pale, Sclera is white.
Eyes are clean and no sign of inflammation.
Nose
Nostrils are patent and clean
Septum in midline, no discharges
Ears
Symmetrical ears, hearing aquity is normal in both ears
Auditory canal is clean
No accumulation of wax and no discharges.
Mouth and throat:
Lips
Lips are dried and pink in colour
No cyanosis and no angular stomatitis
Tongue
Pink in colour
Coated tongue is present
No halitosis
Adequate oral hygiene is maintained.
Teeth
Dental alignment is normal
Dental carries present in 2 teeth
Gum and oral mucosa
No sign of inflammation and Euplis syndrome
Neck
Carotid pulse is felt on both sides
Range of motion is good
No swelling in neck and no lymphadenopathy
Trachea in midline
No thyroid gland enlargement
Chest
Symmetrical in shape
Breathing movements are symmetrical
Normal vesicular breath sounds heard
OBSTETRIC EXAMINATION
Breast
Symmetrical, moderate in size
Nipples are normal and not contracted or retracted
Primary and secondary areola is present
Montgomery tubercle is present
No sign of inflammation and discharges
No palpable masses and auxiliary lymph nodes
Colostrums is present
Abdomen
Inspection:
Size : It is not Appropriate to gestational week (32 weeks)
Shape : Ovoid shape
Contour : Firm
Skin changes : Striae gravidarum and linea nigra is present
Scar : No scar
Umbilicus : Located in midline and protruded
Flanks : Fullness
Visible fetal movements: Present
Visible veins : No visible abdominal veins
Abdominal girth: 95 cms
Fundal height :36cms, . It is not appropriate to the gestational age
Palpation:
Fundal palpation : A broad soft mass presents in the upper pole of uterus, it indicates
fetal buttocks.
Lateral palpation :
Left side – continuous curvature like resistance felt that indicates foetal spine
Right side – Irregular buds like projections that indicate fetus extremities.
Pelvic palpation :
Grip I – Not engaged
Grip II –Convergent
Auscultation :Fetal heart rate is 152 beats/minutes
SUMMARY OF FINDINGS:
Lie : Longitudinal
Position : Left occipito anterior
Presentation : Cephalic presentation
Attitude : Universal Flexion
Height of the fundus : 36cms
Engaged/Not engaged: Not engaged
Foetal heart rate :152 beats/minutes
Extremities
Range of motion is good
No pedal edema
No scar or injuries
No clubbing of fingers
Back and spine
Spine curvature is in Lordosis shape
No pressure ulcer and scar.
Perineum
No vaginal edema
No ulcer or discharge
Urethral meatus is clean and patent
History of Normal micturition
Vital signs :
Temperature :98.20 F
Pulse : 84 beats/minute
Respiration : 22 beats/minute
Blood pressure: 120/80 mm Hg
SPO2 : 100 % on room air
Pain score :0
LAB INVESTIGATION/DIAGNOSTIC PROCEDURE:
S.No Name Client Value Normal Value Remarks
1 Blood Mild
Hemoglobin 11.0gms% 12-16 gms% anemia
Hematocrit 45 % 37-47 % Normal
Total count 6000 cells/cumm3 4000-11000 cells/cumm3 Normal
Blood glucose 120 mg% 80 – 120 mg% Normal
Serum Urea 13 mg/dl 8-23 mg/dl Normal
Serum Creatinine 0.9 mg/dl 0.6 – 1.2 mg/dl Normal
HIV 1 & 2 Ab Non reactive Non reactive Normal
2 Urine
Urine albumin Nil Nil Normal
Urine sugar Nil Nil Normal
SPECIFIC INVESTIGATIONS
Blood group : O Positive
Abdomen and pelvis scan report : Single live intra uterine pregnancy
27/11/2019 Gestational age 32 weeks
Placenta posterior
AFI- 25.2 cm severe polyhydramnios
Cardio topography : Normal
GCT 1HOUR : 115mg/dl normal value 160mg/dl
2 HOUR 108mg/dl normal value 135 mg /dl
3 HOUR 105mg/dl normal value 120 mg /dl
HEALTH EDUCATION
Antenatal check up
Regular compliance with treatment measures like iron, folic acid supplementation,
anti hypertensive medications.
Fetal monitoring by antenatal examination, Ultrasonography and other measures
Antenatal diet
It includes high calories, high protein, iron rich diet and folic acid supplementation.
Easily available iron rich foods such as green leafy vegetables, jaggery, red gram
dhal, dates.
Adequate fluid intake to maintain adequate hydration.
Avoid pica and goitrogens during pregnancy.
Practice small and frequent diets.
Includes all diet includes pulses, cereals, vegetables, fruits, oils and seeds, milk and
milk products.
Encourage to take vitamin c rich foods like oranges, lemon, papaya, amla, gooseberry
in order to enhance the absorption from the body.
Includes more vegetables for balanced diet
Adviced the mother to restrict salt
Measures to treat minor and major disorders or discomforts
It includes heartburn, dyspepsia, fatigue, dyspnea, peripheral edema and back pain.
Encourage to take food 2-3 hours prior to sleep
Eat small and frequent diets
Avoid lying down immediately after taking food
Avoid beverages includes alcohol, soft drinks and other artificial energy drinkers.
Encourage to sleep in left lateral position.
Maintain correct posture, gait as much as possible while sitting, standing and carrying
articles.
Demonstrate deep breathing and abdominal breathing exercises.
Avoid more sodium in diet to prevent pedal edema by intracellular fluid depletion
Avoid taking medicines without prescription to avoid over counter reactions and
teratogenic effects.
Preparing for safe delivery process
Regular antenatal check up will reduce the chance of acute, existing diseases or
changes.
Appropriate nutritional pattern will reduce the chance of energy depletion during
birth process.
Iron and folic acid supplementation will prevent anemia during antenatal period.
Oral hygiene measures like brushing 2 times a day, rinsing mouth after feeding to
prevent infection.
CONCLUSION
In this clinical presentation I gained more knowledge about the history collection
physical examination,& obstetrical examination of the client and polyhydramnios causes ,
types ,diagnostic methods ,and also management of polyhydramnios ,nursing care to the
client with polyhydramnios .
I would like to thank our respected faculties for giving this wonderful opportunity
REFERENCES
Book reference:
1. Diane. M.Fraser. Margaret. A. Copper,. (2007). Textbook for Midwives. 14 thedition.
Philadelphia: Elsevier publishers.
2. Deifer. (2011). Introduction to Maternity and Pediatric Nursing. 6th edition. Bangalore:
Elsevier publisher.
3. LowdermilkDeitra. (2007). Maternity and Womens Health Care. 9th edition.
NewYork: Mosby Publishers.
4. D.C.Dutta. (2015). Textbook of obstetrics. 5th edition. Kolkata. Saunders publishers.
5. Annamma Jacob. (2012). A Comprehensive Textbook of midwiferyand gynaecological
Nursing. 3rd edition. New Delhi: Jaypee brothers and Medical Publishers.
6. Nima Bhasker. (2015). Midwifery and Obsterical Nursing. (2015). 2nd edition.
Bangalore:EMMESS Medical publishers.
Net reference:
1. https://en.wikipedia.org/wiki/Maternal physiological changes in pregnancy
Journal
1. https://www.ncbi.nlm.nih.gov/pmc/articles/Physiological Maternal Changes
POLYHYDRAMNIOS
DEFINITION
Polyhydramnios is defined as amniotic fluid volume more than 2000 ml at any
period of gestation
- D.C. DUTTA
TEXT BOOK OF OBSTETRICS AND GYNAECOLOGY
DEFINITION 11
Polyhydramnios is the excessive accumulation of amniotic fluid the fluid that
surrounds the baby in the uterus during pregnancy
-NETSOURCE
INCIDENCE
0.5-1.6%
1 in 200 pregnancies
BIBLIOGRAPHY:
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agencies private limited.
2. Myles,2011,”Text book for Midwives”,15th edition,published by Churchill Livingston
pvt ltd.
3. Annamma Jacob,2012 “A comprehensive textbook of midwifery and Gynaecological
Nursing”,3rd edition,published by Jaypee brothers pvt ltd.
New delhi, Jaypee brothers.
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New delhi, Jaypee brothers .
5. Sanju sira,2010,”Text book of Obstetrics and Midwifery”,2 nd edition,published by
lotus publishers.
6. Sadar. A. Orshan, “Maternity Newborn women’s health nursing”, Bangallur,
Lippincott pvt ltd.
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by S.Vikas company pvt ltd.
8. Marie Elizabeth,2012,”Midwifery for Nurses”,2nd edition,published by CBS publishers
and distributer.
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Edition.
10.NET REFERENCE:
www.google.com
www.wikipedia.com
www.pubmed.com..
