LU 4.1 Antenatal Care

What are the causes for maternal death?

• obstetric embolism

• ectopic pregnancy

• postpartum haemorrhage

• gestational hypertension with significant proteinuria

What are the causes of infant mortality?

• birth defects

• preterm birth and low birth weight

• maternal complications of pregnancy

• Sudden Infant Death Syndrome (SIDS)

What are the risk factors for maternal & infant death?

• gestational diabetes

• anaemia

• multiple pregnancy

• smoking

• hypertensive

• ddomestic violence

What are the principles of maternal health ?

• all women have access to contraception to avoid unintended pregnancies

• all pregnant women have access to skilled care at the time of birth

• all those with complications have timely access to quality emergency obstetric care

What are the objectives of antenatal care ?

• promote and maintain good physical and mental health during pregnancy

• detect early and treat “High Risk” conditions that would endanger the life of mother or baby

• monitor fetal growth and well being of fetus

• prepare the women for labor, lactation and care of the newborn

What are the examples of early antenatal care ?

• identify and manage with medical problems

• screen women for risk factors

• booking visit

What are the frequency of antenatal visit ?

• <28 weeks gestation : once per month

• 28-36 weeks gestation : every 2 weeks

• 36 weeks and above : weekly

When should booking visit be done and what are actually done during booking visit ?

• Before 12 weeks gestation

• First routine medical examination (RME) by doctor

What are things to take note during history taking ?

• last menstrual period

• regularity of cycles

• contraceptive usage

What are things to take note during social history taking ?

• occupation of woman and partner

• smoking, drugs and alcohol consumption

• education level

What are things to take note during family history taking ?

• diabetes mellitus

• multiple pregnancies

• hypertension

• asthma

• thalassemia

What are things to take note during past obstetric history taking ?

• previous recurrent miscarriage

• preterm labour

• previous lower segment caesarean section (LSCS)

• intrauterine death (IUD)

• early or late neonatal death

What are things to take note during current obstetric history taking ?

• gravida

• para

• LMP / EDD

What are things to take note during medical history taking ?

• allergies

• blood transfusion

• medical problems

• infections

• thalassemia / anaemia

What are the general physical examination of the mother during visit?

• height

• weight

• blood pressure

• the mother’s gait : any bony deformity of pelvis

What are the things to check for during head to toes examination of the mother ?

• pallor, cyanosis

• oral hygiene

• clubbing

• thyroid enlargement

• cardiovascular system

• respiratory system

• breast

What is the function of abdominal palpation ?

• to observe signs of pregnancy

• to assess fetal size and growth, fetal health and wellbeing

• diagnose the location of fetal parts and detect any deviation from normal

What to inspect before abdominal palpation ?

• size

• shape

• scar

• skin condition

• skin infection

What type of palpation are done during abdominal palpation ?

• first manoeuvre : fundal palpation

• second manoeuvre : lateral palpation

• third manoeuvre : Pawlick’s grip

• fourth manoeuvre : pelvic palpation

What are the routine laboratory test done during antenatal care ?

• urinalysis to check for protein, sugar and bacteria

• blood specimens such as doing rapid test for HIV

• blood grouping such as ABO and Rhesus factor

What is the immunisation dose of Anti-tetanus toxoid (ATT) for Primigravida and multigravida ?

• Primigravida : first dose at quickening (12 weeks) and repeated dose 4 weeks later

• Multigravida : Single dose between quickening and before 37 weeks of gestation

What is the investigation done for antenatal ?

• ultrasound scan

• done ASAP at 20 weeks or second trimester for accuracy

What are the management for antenatal care ?

• iron supplementation and folic acid

• health education such as :

• i) diet during pregnancy

• ii) exercises during and after pregnancy

• iii) basic baby care

• iv) breastfeeding

• referral

• appointment for the next visit

• documentation