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INTRODUCTION –
Every Year there are an estimated 200 million pregnancies in the world. Each
of these pregnancies is at risk for an adverse outcome for the woman and
her infant.
While risk can not be totally eliminated, they can be reduced through
effective, and acceptable maternity care.
MEANING-
Systematic supervision (examination&advice) of a woman during pregnancy
is called antenatal (Prenatal) care. The supervision should be regular and
periodic in nature according to the need of the individual.
DEFINITION-
1. Antenatal care refers to the care that is given to an expected
mother from time of conception is confirmed until the
beginning of labor.
2. Planned examination and observation for the woman from
conception until the beginning of labor.
OBJECTIVE –
OBJECTIVES –
1. To assess the health status of the mother and fetus.
2. To assess the fetal gestational age and to obtain baseline investigation.
3. To screen out the “at risk” pregnancy and to formulate the plan of
subsequent management.
HISTORY TAKING –
1. Vital statistics
a) General Examination of the Mother name, age, gravida,
parity, expected date of delivery.
b) Period of gestation
Gravida denotes a pregnant state both present and past
irrespective of the
period of gestation.
Parity denotes the state of previous pregnancy beyond
the period of viability.
c) Duration of marriage- This is relevant to note the fertility or
fecundity. A pregnancy long after marriage without taking any
method of contraception is called low fecundity and soon after
marriage is called high fecundity. A woman with low fecundity
is unlikely to conceive frequently.
d) Religion
e) Occupation – It is helpful to interpret symptoms of fatigue due
to excess physical workor stress occupation hazard. Such
women should be informed to reduce such activities.
f) Occupation of husband-
To access the socioeconomic condition of the patient,
To anticipate the complications likely to be associated
with low social status such as anaemia, pre-eclampsia,
prematurity etc.
To give reasonable and realistic antenatal advice during
family planning guidance.
g) Period of gestation- The duration of pregnancy is to be
expressed in terms of completed weeks, a fraction a week of
more than 3 days is to be considered as completed week. In
the early pregnancy it is calculated from the first day of last
normal menstrual period(LNMP) and in later month of
pregnancy it is calculated from the expected date of delivery.
2. Complaints
Calculation of EDD
5. Past Obstetrical History
Ask for details, Date of pregnancy, Outcome, Gestation, Weight and
sex of the baby, wellbeing now, Problems in labor or pregnancy,
delivery mode.
6. Menstrual History
Age at menarche, frequency, duration and amount of flow,
premenstrual symptoms, dysfunctional uterine bleeding.
Calculation of the expected date of delivery(EDD)- This is done
according to Naegele’s formula by adding 9 calendar month and seven
days to the first day of the last menstrual period. Alternatively, one can
count back 3 calendar months from the first day of last period and then
add 7 days to get the expected date of delivery.
9. Family History
Family History of diabetes, hypertension, tuberculosis, multiple
pregnancy, non-hereditary disease if any or twinning, congenital
anomaly of fetus is to be inquired.
PHYSICAL EXAMINATION-
To assess-
Fetal well being.
Lie , presentation, position and number of fetuses.
Anaemia, pre-eclampsia, amniotic fluid volume and fetal growth.
To organize specialist antenatal clinics for patients with problems
like cardiac disease and diabetes.
To select, time for ultrasonography amniocentesis or chorionic
villous biopsy when indicated.
History Collection
Appearance of any new complaints, quickening, lightening, examination.
Weight, pallor, oedema of legs, BP monitoring Abdominal examination.
1st trimester: Height of the fundus
2nd trimester: External ballotment, fetal movements, palpation of the fetal
parts, fundal height
3rd trimester: Identify lie, presentation, position, growth pattern,
engagement, girth of the abdomen, fundal height.
Vaginal Examination:
Vaginal examination in the early weeks of pregnancy helps
To establish the diagnosis of pregnancy
To decide whether the pregnancy is uterine or extra uterine.
To ascertain whether there there are any tumors or abnormalities in
the genital tract complicating pregnancy.
In the later weeks and particularly near team, it helps in the diagnosis of
the presentation and position of the fetus and in assessing the pelvis. The
risk of infection by a careless vaginal examination is always present:
hence the examination should be with all antiseptic solution.
ANTENATAL ADVICE:
Principles:
IMMUNISATION:
Fortunately most of the life threatening epidemics are rare. In the
developing countries immunization in pregnancy is a routine for
tetanus; others are given when epidemic occurs or travelling to an
endemic zone or for travelling overseas.
Drugs: Almost all the drugs given to mother will cross the placenta to
reach the fetus. Possibility of pregnancy should be kept in mind while
prescribing drugs to any woman of reproductive age.
GENERAL ADVICE:
High risk pregnancy is one in which mother, fetus and new born is or will be
at increased risk for modality and morbidities due to problems and
complication during pregnancy.
Purpose
To provide better services for all, but with special attention to those who
need the most.
A high-risk pregnancy is one in which some condition puts the mother, the
developing fetus or both at higher-than-normal risk for complications during
or after the pregnancy and birth.
A) Biophysical Assessment
1. Ultrasonography
2. Radiology in Obstetrics
3. Magnetic Resonance Imaging
B) Biochemical Assessment
1. Amniocentesis
2. Alpha-fetoprotien (AFP)
3. Percutaneous Umbilical Blood Sampling (PUBS) or Cordocentesis
4. Chrionic Villus Sampling
5. Maternal Blood Assessments
6. Placental Biopsy
7.
C) Electronic Monitoring
1. Nonstress test
2. Contraction Stress Tests/ Oxytocin Challenge test
3. Daily Fetal Movement Count (DFMC) or Kick Counts.
ABSTRACTS-
2. Both the under 18 conception and birth rates are falling. However,
despite this, the United Kingdom has a high rate of teenage pregnancy
compared to similar countries in Western Europe. Young mothers and
their babies have poorer access to maternity care and experience worse
obstetric outcomes than older mothers. It is likely that the risks
associated with teenage pregnancy reflect a significant interplay
between the socio-demographic status of many of these teenagers, their
nutritional status and their uptake of antenatal care. This review looks at
the complications associated with teenage pregnancy and how the
implementation of specialized antenatal care aims to improve outcomes.
[ CITATION Whi17 \l 1033 ]
BIBLIOGRAPHY-