antenatal care

TBILISI STATE MEDICAL UNIVERSITY - UNICEF GEORGIA

Antenatal care


1. Prenatal (Antenatal) care.

• Antenatal care (ANC) means “care before birth”

ANC includes:

• Education

• Counseling

• Screening

• Treatment


2. Antenatal cares goal

• The major goal of prenatal care is to ensure the birth of healthy baby with minimal risk for mother.

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3. Type of prenatal care

• midwife/general practitioner-managed care

• obstetrician/gynecologist-led shared care

• The clinical efficacy of the two groups in low risk woman is similar (A).

Khan-Neelofur et.all”Who should provide routine antenatal care for low-risk women and how often”

WHO Antenatal care trial research group,1998

4.Frequency of prenatal visits

• Antenatal care is not a single intervention,instead it represents a series of assasment and interventions over time

• The median number of visits is 8 and 5

• The minimum number is 4

• More frequent visits may be of benefit in monitoring women with pregnancy complications


5.New model of antenatal care

• First visit-less than12 weeks

• Second visit-26weeks

• Third visit-32weeks

• Fourth visit-38weeks



6.Organization of prenatal care

• preconceptional care

• prompt diagnosis of pregnancy

• initial presentation for pregnancy care

• subsequent prenatal visits


7.Preconceptional care

Preconceptional care program has the potential to assist women:

• By reducing risks

• Promoting healthy lifestyles

• Improving readiness for pregnancy

W. Obs.


8. Prompt diagnosis of pregnancy.

• Symptoms and signs

• Home urine pregnancy test

• Confirmatory testing for human chorionic gonadotropin

• Ultrasonic recognition of pregnancy

Up To Date


9. The presumptive signs of the pregnancy

• Frequent urination. • Nausea and Vomiting (Morning Sickness)• Change of appetite and taste• Pigmentation of the face, abdomen and the areola• Enlargement of breast and increase of firmness • Enlargement of abdomen


10. The possible signs of the pregnancy

• Amenorrhea • Swollen and cyanotic cervix and vagina• Changes in the form and consistency of

the uterus• Enlargement of the uterus• Hegar - Horvits sign• Snegirov’s sign• Immunological tests


11. Home pregnancy tests

• A detection limit of 12,5 m IU/ml would be required to diagnose 95 percent of pregnancies of the time of missed menses.

• Detection of hCG in maternal blood and urine provides the basis for endocrine tests of pregnancy

• With a sensitive test the hCG can be detected by 8 to 9 days after ovulation.

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12. Confirmatory testing for human chorionic

gonadotropin

• Fetal heart action

• fetal movements

• Ultrasonic scan


13.The positive signs of the pregnancy

• A gestational sac may be demonstrated:

• By abdominal sonograpy after only 4 to 5 weeks menstrual age.

• By transvaginal sonograpy-1-1,5weeks earlier

• By 35 days all normal sacs should be visible.


14. Ultrasonic recognition of pregnancy

• Prenatal care should be initiated as soon, as there is a reasonable likelihood of pregnancy.

• The major goals are:– to define the health status of the mother and

fetus.– to estimate the gestational age of the fetus.

- to initiate the plan for continuing obstetrical care.


15. Initial prenatal evaluation


16.Estimated date of Delivery

•Menstrual age (Naegel’s rule)

•Ovulatory or fertilization age


17. Ultrasound examination

.First trimester ultrasound examination can lead to:

- earlier detection of fetal malformations

-earlier delection of multiple pregnancy.

- predict more accurate the actual data of delivery

18.Normal pregnancy duration

• 280 days

• 40 weeks

• 10 lunar months

• 9 calendar months


• I trimester- extended trough the completion of 14 weeks

• II trimester – trough 28 weeks

• III trimester- included the 29th trough 42 weeks of pregnancy


19. Pregnancy trimesters

• Nulligravida

• Gravida

- primigravida

- multigravida

• Nullipara

• Primipara

• Multipara


20.Definitions


21. The elements of the patients history

• .Personal and demograpic information

• .past obstetrical history

• .Personal and family medical history

• .Past surgical history

• .Genetic History

• .Menstrual and gynecological history

• .Current pregnancy history• .Psychosocial information


22. Psychosocial screening

• .Cigarette smoking

• .Alcochol and illicit drugs

• .Domestic violence


23. Physical examination

• Height• Constitution• Skin• Abdomen• Internal organs• Baseline blood pressure• Calculation of body mass index


24. Pelvic examination

• Examination of cervix using mirrors

• .Digital pelvic examination:

-Palpation of the cervix

-Determination of the size and form of the uterus

-Determination of conditionsof adnex


25. Routine laboratory tests(1)

• .Rhesus type and antibody screen

• .Hematocrit or hemoglobin

• .Cervical cytology (a Pap smear)

• .Rubella immunity testing

• .Urinary infection testing


26. Routine laboratory tests(2)

• .Syphilis testing

• .Hepatitis B-antigen testing

• .Human immunodeficiency virus

• .Down syndrome screening


27. Additional laboratory tests(1)

• Testing for infections:

• - N. gonorrea

• - Tuberculosis

• - Toxoplasmosis

• - Hepatitis C antibodies

• -Chlamydia testing


28. Additional laboratory tests(2)

• Testing for infections:

• - Varicella

• - Bacterial vaginosis

• -Herpes simplex virus

• Testing for heritable discorders

• - Thyroid function


29. Patient education

• Potential areas for patient education:

• Number and frequency of prenatal visits

• Routine pregnancy monitoring

• How to reach the provider after the business hours

• Confidentially issues.


30. Common concerns (1)

• Exercise

• Employment

• Travel

• Seat belts


31. Common concerns (2)

• Bathing

• Clothing

• Bowel habits

• Sexual activity


32. Recommendations for weight Gain

• A pregnant women with a normal BMI should gain11,5- 16 kg during pregnancy

• Normal BMI is 18-35kg/m2

• The pregnant women can eat what she wants in amounts she desires and salted to taste


33. Recommended dietary (1)

• Vitamins

• Minerals


34. Recommended dietary allowances (2)

• Calories

• Protein


35. Subsequent prenatal sits

• At each prenatal visit, steps are taken to determine the well being of:

• mother

• fetus

• To diagnosis :

• Preeclampsia

• Fetal malpresentation


36. Prenatal surveillance (1)

• Fetal assesment

• - Heart rate

• - Size – current and rate of change

• - Amount of amniotic fdluid

• - Presenting part and station (late in pregnancy)

• - Activity


37. Prenatal surveillance (2)

• Maternal assesment

• - Blood pressure

• - weight

• - Symptoms

• - Height of uterine fundus from symphysis

• - Confirmation of the presenting part


39. Subsequent laboratory tests

• Maternal serum screening at 16 to18 weeks for detecting open neural tube defects and chromosomal anomalies.

• Hemoglobin and hematocrit should be repeated at about 28 to 32 weeks.

• Antibody screening

• Retesting of HIV

• The urine screening for protein


40. Sonography

• Ultrasound examination must be repeated at 18-20weeks of gestation

• The routine use of ultrasound in the third trimester (after 24weeks)) in low risk women has not effective for, improving outcome (evidens A)


41. Common complaints (1)

• Nausea and Vomiting

• Heartburn

• Ptyalizm

• Backache

• Headache


42.Common complaints (2)

• Varicosities

• Hemorrhoids

• Fatigue

• Leucorrhea


43.Warning signs of the pregnancy(1)

• Severe head ache

• Fatigue

• Blurred vision

• Pain in the epigastrium or right upper quadrant of abdomen.

• Generalized oedema

• Smelly discharge form vagina


44. Warning signs of the pregnancy (2)

• Pain during urination

• Fever

• Vaginal bleeding

• Early discharge of the amniotic fluid

• Stopping of the movoment of fetus


45. Effectiveness of prenatal care

• The use of prenatal care significatly lowered the rate:

• Of neonatal death associated with several high – risk conditions

• Of preterm births

• Of pregnancy – related maternal death

antenatal care

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