Anc Care

Antenatal care and
counselling
What is Antenatal care
• Periodic and regular supervision including examination and

advice of a woman during pregnancy is called Antenatal care.
• The supervision should be of a regular and periodic nature in
accordance with the need of the individual.
Aims
The aims are-

•To screen the high risk cases
•To prevent or detect or treat at the any earliest complication
•To ensure continued medical surveillance and prophylaxis
•To educate the mother about the physiology of pregnancy and
labour by demonstrations, charts and diagrams so that fear is
removed and psychology is improved
Aims (cont’d)
• To discuss with the couple about the place, time and mode of
the delivery, provisionally and care of the newborn
• To motivate the couple about the need of family planning
• To advice the mother about breast-feeding, post-natal care and
immunization
Objectives
To ensure a normal pregnancy with delivery of a
healthy baby from a healthy mother
Criteria of normal
pregnancy
Delivery of a single baby in good

condition at term with no maternal
complication
Services
As per WHO recommendation at least 4 visit-
•1st visit around 16 weeks
•2nd visit between 24-28 weeks
•3rd visit at 32 weeks
•4th visit at 36 weeks
Services (cont’d)
Generally-
•At interval of 4 weeks up to 28 weeks
•At interval of 2 weeks up to 36 weeks
•At weekly interval up to EDD
Antenatal care comprises of-
• Careful history taking and examination and investigation

• Advice given to the pregnant woman
THE FIRST VISIT
• History taking
• Examination
• Investigation
History taking
1. Particulars of the patient
2. Chief complaints with duration
3. Past history
4. Obstetric history
5. Menstrual history
6. Family history
7. Drug History
8. History of immunization
9. Socio-economic history
10. Contraceptive history
11. History of allergy
Particulars of the patient
1.Name
2.Age
3.Address
4.Marital status
5.Date of Admission
6.Date of Examination
Chief complaints with duration
1. Period of amenorrhea
2. Nausea & vomiting, vertigo
3. Increased frequency of micturition
4. Constipation
5. Heaviness of breast
6. Rise of temperature
7. Edema
8. Pain in the abdomen
9. Backache
10. Vaginal bleeding
Past history
1.HTN
2.DM
3.BA
4.Renal Disease
5.Psychiatric illness
6.IHD
7.Any previous operation
Obstetrical History
• Duration of marriage
• Gravida
• Para
• ALC
Menstrual History
Age of menarche
Menstrual period
Menstrual cycle
LMP
EDD
Family history
a)HTN
b)DM
c)Multiple pregnancy
Drug History
Antihypertensive
Hypoglycemic
Antidepressant
Corticosteroid
Anticoagulant
Physical examination
General examination
Abdominal examination
General examination
• Appearance
• Height of patient
• Weight of patient
• Anemia
• Jaundice
• Edema
• Cyanosis
• Clubbing
• Koilonychia
• Leuconychia
General examination (cont’d)
• Temperature
• Pulse
• BP
• RR
• Breast
• Heart sound
• Lungs
Abdominal examination
Inspection
Palpation
percussion
Auscultation
Inspection
Shape of the uterus

Striae
scar mark
Palpation
• Assessment of fundal height

• Lie
• Abdominal girth
• Fundal grip
• Lateral grip
• First pelvic grip
• Second pelvic grip
Auscultation
Normal FHR is 110-160 b/m

Causes of fetal tachycardia (>160 b/m)
Causes of fetal bradycardia (<110 b/m)
Causes of fetal tachycardia
(>160 b/m)
1. Maternal high fever

2. Fetal distress
3. Maternal tachycardia
Causes of fetal
bradycardia (<110 b/m)
1. Fetal distress
2. Fetal cardiac conduction defect
Investigation
• CBC
• Blood grouping & Rh typing
• Urine R/E
• RBS
• VDRL
• HBS Ag
• Ultrasound
Ultrasound
early pregnancy (preferably at 10-13 weeks) to:

•Determine gestational age
•Detect multiple pregnancies
•Help with later screening for Down's syndrome
Ultrasound (cont’d)
At 11-14 weeks:
offer nuchal translucency screening for Down's syndrome, with
other tests if available.
At 18-20 weeks:
offer screening with ultrasound for congenital anomalies.
At 36 weeks:
for fetal maturity, placenta previa.
In subsequent visit
• Patient complains
• General examination
• Gestational age to be calculated
• Identification of problem
• Fetal movement
• SFH measurement
• Health education
• Prophylaxis & treatment of anemia
• Developing individualized birth plan
Second visit (24-28 weeks)
SFH measurement
To detect Multiple pregnancy
Third visit (32 weeks)
Screen for-
1.Preeclampsia
2.Multiple pregnancy
3.anemia
4.IUGR
Fourth visit (36 weeks)
• Identification of fetal
1.Lie
2.Presentation
3.Position
• Update birth plan

Antenatal advice
Principles:
1.To impress the patient about the importance of regular
check up
2.To maintain or improve the health status of the woman to
the optimum till delivery by judicious advice regarding diet,
drugs and hygiene
3.To improve and tone up the psychology and remove the
fear of pregnancy by talking sympathetically to the patient
and explaining the principle changes and events likely to
occur during pregnancy
Antenatal advice (cont’d)
Following advices are to be given:
• Diet • Smoking & alcohol
• Rest & sleep • Immunization
• Bowel • Drug
• Personal cleanliness • Mental preparation
• Clothing, shoes & belt • Exercise
• Dental care • Child care
• Care of breast • Birth plan
• Coitus • Warning sign
• Travelling • Family planning
Diet
Diet should be:

1.nutritious
2.balanced
3.light
4.easily digestible
5.rich in protein, mineral and vitamin
6.with woman’s choice
DDA of a woman during pregnancy (2nd
half)
Food element pregnancy
Kilocalories 2500
Protein 60 gm.
Iron 40 mg
Folic acid 400 g
Calcium 1000 mg
Vitamin A 6000 I.U.

Rest and sleep
• 8 hour sleep at night

• At least 2 hour sleep after mid-day meal
• Hard strenuous work should be avoided in first
trimester and last 4 weeks
Bowel
• Regular bowel movement may be facilitated by
regulation of diet, taking plenty fluid, vegetable and
milk
Coitus
Should be avoided in
•1st trimester
•last 6 weeks
Travelling
Should be avoided in
•1st trimester
•last 6 weeks
Air travelling is contraindicated in
•Placenta previa
•Preeclampsia
•Severe anemia
Immunization
Indicated-
•TT
•HAV
•HBV
•Rabies
Contraindicated-
•Live virus vaccine (rubella measles, mums, varicella)
Warning sign
1. Headache
2. Blurring of vision
3. Convulsion
4. Vaginal bleeding
5. Fever
Preconceptional care
 Preconceptional care is the one step ahead of antenatal
care.
 When a couple is seen and counseled about

pregnancy, its course and outcome before the time of
actual conception, is called Preconceptional care.
 Objective: to ensure that, a woman enters pregnancy

with an optimal state of health which would be safe
both to herself and the fetus.
Preconceptional care includes:
 Identification of high risk factor
 Basal level health status including BP recording
 Rubella & Hepatitis immunization
 Folic acid supplementation
 Maternal health is optimized preconceptionally such as
overweight anemia
 Patient with medical disease like hypertension, diabetes
are stabilized in an optimal state by intervention
Preconceptional care includes: (cont’d)
 Drugs used before pregnancy are verified and changed

if required to prevent any adverse effect of the fetus;
e.g., warfarin is replaced with heparin, oral anti-
diabetic drug with insulin
 Advise to stop smoking, alcohol and drug abuse
 Proper counseling to those with history of recurrent
foetal loss or family history of congenital abnormalities
 Counseling regarding health care cost
 Find out supporting or helping people to help the
mother and care of the new born
•Thank you

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Antenatal care and

• Periodic and regular supervision including examination and

The aims are-

Delivery of a single baby in good

• Careful history taking and examination and investigation

Shape of the uterus

• Assessment of fundal height

Normal FHR is 110-160 b/m

1. Maternal high fever

early pregnancy (preferably at 10-13 weeks) to:

• Update birth plan

Diet should be:

Folic acid 400 g

Vitamin A 6000 I.U.

• 8 hour sleep at night

 When a couple is seen and counseled about

 Objective: to ensure that, a woman enters pregnancy

 Drugs used before pregnancy are verified and changed

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