Antenatal care

PRESENTED
by
ROBINA.MAJEED

Robina Majeed Sr Lecturer SNC 1

 CONTENTS
• Definition of antenatal
• Importence of ANC
• Visits of ANC
• Activities of ANC
• History taking
• Examinations
• Investigations ,special investigation
• Antenatal advice

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 ANTENATAL CARE

Care of the woman during pregnancy to achieve

healthy mother and healthy baby at the end
of pregnancy.

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 Importance of ANC:-

1.Promote, protect & maintain health during

pregnancy.
2.Detect high risk cases during ANC examination and
take proper action during delivery.
3.Many maternal diseases diagnosed and treated,
which prevent transmission to infant. e.g syphilis,
hepatitis.
4.Tetanus immunization to mother can prevent tetanus
neonatorum to infant.

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 ANC visit:-
Standard:- Total 14 visits
Every 4 week up to 32 weeks.
Every 2 week from 32-36 weeks.
Every week from 36 weeks till delivery.

Intermediate:- Total 5 visits

1st: before 12 week
2nd: 20-22week Minimum:- Total 3 visits
3rd: 28-32 week 1st visit: 4-12 weeks
4th: 34-36week 2nd visit: 24-26 weeks
5th: 38- till delivery 3rd visit: 36-38 weeks

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 Activities during Antenatal visit

1. Registration of the pregnant women.

2. History taking
3. Antenatal examination
4. Essential investigation
5. Advice

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 History
1-General information
Name, age , gravidity, parity, LMP, EDD
2-Chief complaint
3-History of present illness
4-History of current pregnancy
 details of the 1st ,2nd & 3rd trimester
lab tests & USG

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5-Menstrual & gynecological history
• LMP
• Menstrual cycles, flow, dysmenorrhoea,
menorrhagia
• OCP (Oral contraceptive pills)
• Surgical procedures
• History of infertility
• Sexually transmitted diseases
• Uterine anomalies

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 6-Past obstetric history
• Outcome of previous pregnancies in details including the
abortions
• Any significant antenatal, intrapartum or postpartum events
• Previous maternal complications
• Mode of delivery
• Birth Weight
• Life & health of the baby

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7-Past medical/ surgical History
Some medical conditions may have impact on the course
of the pregnancy or the pregnancy may have an impact
on the medical condition examples:

• Heart disease • Kidney disease

• Hypertension • UTI
• DM • Autoimmune disease
• Epilepsy • Psychiatric disorders
• Thyroid disease • Hepatitis
• Bronchial asthma • Venereal diseases
• Any previous • Blood transfusion
surgery.
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8. Drug History
9. Family History
- Hereditary illness → DM., HTN, thalassemias, sickle cell
disease, hemophilia
-Congenital defects e.g.. neural tube defects, Down
syndrome
-Twins
10. Social History → Cigarette smoking, illegal drug use,

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ANTENATAL EXAMINATION

General examination:-
-Height
-Weight
-BP
-Pulse
-Head, eyes, ears, nose & throat no changes
-Thyroid to rule out thyroid disease.

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-Skin pigmentation of the face (chloasma), abdomen (linea nigra)
and vulva
Stretch marks on the abdomen, thighs & breasts
-Breast  nodularity
-CVS HR 
Soft systolic murmur
S2 loud
-Lungs Elevation of the diaphragm  total lung capacity

-Ophthalmoscopy hypertensive /diabetic women

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Abdominal examination
1-Inspection
shape & size
 asymmetry
 fetal movement
surgical scars
cutaneous signs of pregnancy linea
nigra, striae gravidarum, umbilicus flat or
everted, superficial veins

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2-Palpation
 Fundal height
 Obstetrical Grips:-
• Fundal grip
• Two Lateral grip
• Pelvic grip-1st and 2nd
3-Ascultation fetal heart at 13-14 wks
4-Percussion:-no importance

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Vulval &Vaginal examination
-not routinely performed until some complaints.
-done only in 1st visit and during labour.
-Hyper pigmentation
-Look for abnormalities  Varicose veins/
hemorrhoids,
-Warts or herpes
- vaginal secretions
-Cx Softer, pigmented with  thick , yellowish
mucous
-Uterus enlarged

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Routine investigations to be done
1.Hb
2.Blood grouping and RH typing
3.Blood glucose Fasting and Random
4.Urine R/E-to see pus, glucose, protein, albumin
5.Stool R/E-to rule out parasitic infestation
6.HIV test.
7.VDRL for both partners (Venereal Disease Research Laboratory)
8.Hepatitis B

Repeat of the investigations -Hb is repeated at 28th and 36th

week
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 Special investigation done during ANC
Some biochemical and biophysical can be also done in
early pregnancy-
These tests are done to rule out the congenital
abnormality, chromosomal disorders, sex linked
genetic disorders or inborn errors of metabolism.
1.Maternal serum alpha feto protein (MSAFP):-
AFP is protein produced by yolk sac and fetal liver and
is present in the mothers blood.
When MSAFP is elevated, one must suspect of:-
a. open neural tube defects
b. multiple pregnancy
c. anterior abdominal wall defects

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  Low levels are found in Downs syndrome.
 Test is done between 15-18 week.

2.Triple test:-It is a combined biochemical test

which includes maternal serum alpha fetoprotein,
hCG and UE (unconjugated oestradiol). It is done
for detection of Downs syndrome. In the affected
pregnancy level of MSAFP and UE tend to be
low whereas hCG tends to be high. It is also
performed at 15-18weeks. Confirmation to be
done by amniocenteses.
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• Biophysical-
• USG imaging-Fetal CRL.BPD,HC,FL .Routine anomaly
scan done at 18-20weeks.CRL is accurate upto 14
weeks.BPD is reliable upto 28weeks.

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 Antenatal advice-
1. The mother should have nutritious diet rich in
protein, vitamins and minerals. The diet should
contain milk, egg, plenty of green vegetables
and fruits and majority of animal fat containing
vitamin A and D.
2.The women is advised not to have strenuous
work in the first trimester and last 6 weeks.
3. The patient is advised to have sleep for 10 hrs
i.e. 8 hrs at night and 2 hrs at noon.
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4. Coitus should be avoided during first trimester
and also during last 6 weeks for fear of
premature labour and introduction of infection.
5. Smoking and alcohol should be stopped because
this may induce abortion or congenital
anomalies of fetus.
6.Travel by long journey is avoided during 1st
trimester and last 6 weeks .The long journey is
limited during the second trimester.

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7. Advice for regular ANC check-up.
8. She is advised to come to hospital, when there is intense
headache, disturb sleep with restlessness ,urinary
troubles, epigastric pain, vomiting and scanty urination.
9. She is advised to come to the hospital for admission-
10.Painful uterine contraction lasting for more than 10 min
or earlier and continued for at least 1 hr suggestive of
labour.
11. Vaginal bleeding
12.Sudden gush of water per vagina

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 Refrenses
• Chohan,A.2005.obstetrics.antenatal
care.PAK.MAR.publisher.

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