ANTENATAL CARE Flashcards
What is ANC
ANC refers to the comprehensive care given to a pregnant woman so she safely goes through pregnancy, labour and perpeurium with the delivery of a healthy baby
What approach to ANC is admonished by the STG
Focused antenatal care with focus on quality rather than quantity
Least number of visits recommended by STG
4 comprehensive visits
Schedule for respective visits
Booking visits: Before the 14th to 16th week
1st Visit: 16-20 weeks
2nd Visit: 24-28weks
3rd Visit: 28-32 weeks
4th visit: About 36 weeks
The pregnant woman is advised to report to the hospital if she doesn’t deliver after —————— of her due date
2 weeks
Assessments done at booking visit
History
Maternal examination
Obstetric examinations
LMP and Gestational age
Investigations
Histories that are taken during the booking visit
Past medical history
Surgical history
Obstetric history
Family history
Social history
Maternal examinations conducted at booking visit
Examine all systems.
Obstetric examinations conducted at the booking visit.
Obstetric examination to confirm pregnancy
Measure SFH
Measure FHR
Purpose of checking FHR
To assess foetal wellbeing
Normal FHR
120 or 110 or 100 -160bpm
Assessment done at follow-up visits
Asess health of mother
Blood pressure (limit of 140/90mmHg)
Maternal examinations
Test urine albumin and proteins
Obstetric examinations
Check foetal activity
When is foetal activity checked
After 20 weeks ideally during second ANC visit
Investigations done during ANC visits
Full blood count
Fasting blood sugar
Urine and stool analysis
Ultrasound scans
Genetic tests
Infectious disease tests
Obstetric examinations done during follow-up visits
Fetal heart rate
Foetal heart sounds
Uterine size (SFH)
Lie, presentation and descent of presenting part in the 3rd trimester
Maternal examinations done at followup visits
Check for anemia, weight gain, preeclampsia and complications
When is stool analysis done
At the booking visit
When is urine analysis done
At each visit
Purpose of urine analysis
Test for proteinuria and glucosuria
Schedule for full blood count
0, 28 and 36 weeks
Tests used for Syphilis screening in pregnancy
VDRL: Venereal Disease Research Laboratory
TPHA: Treponema pallidum hemagglutination
RPR: Rapid plasma reagin test
Genetic tests that are done in pregnancy
G6PD activity
Sickling
Blood group and antibody screen
Ultrasound scans in pregnancy
Early ultrasound scan
Fetal anomaly scan between 18-24 weeks
Late screening at 36 weeks
Infectious diseases tested for in pregnancy
Malaria using Blood film
Syphilis
HIV
Hepatitis B
Schedule for fasting blood glucose
0, 28 and 32 weeks
Purpose of early ultrasound scan
To rule our ectopic pregnancy
To estimate foetal age and expected delivery date
Purpose of late screening scan
Placenta position
Foetal wellbeing
Objectives for ANC care
Ensure good health throughout pregnancy, labour and perpeurium
Detect and treat any condition
Prevent malaria and anemia
Deliver a healthy baby
Diabetes screening tests in pregnancy
FBG at 0,28 and 32 weeks
Urine glucose
What urine glucose level warrants an OGTT test
1+/2+ on two occasions
3+/4+ on one occasion
Things to avoid in pregnancy
Alcohol
Smoking
Herbs and non-prescribed drugs
Non-pharmacologic management in ANC (malaria)
Encourage use of ITN
Malaria prevention
Counselling in ANC
Danger signs and symptoms in pregnancy
Pregnancy discomforts and management
Healthy diet
Breastfeeding and newborn care
Family planning
When is exercise avoided in pregnancy
PROM
Preterm labour in women with incompetent cervix in 2nd/3rd trim.
Pregnancy induced hypertension
Routine ANC drugs
Anemia prevention
Malaria prophylaxis
Tetanus prophylaxis
Deworming
Four categories of PMTCT
- Primary prevention HIV among women of childbearing age
- Preventing unintended pregnancies among women living with HIV
- Preventing HIV transmission from pregnant woman to foetus
- Treatment care and support for women living with HIV, their children and family.
When is mebendazole given in pregnancy
24-28 weeks
Malaria prophylaxis in pregnancy
SP (Sulmethoxazole-Pyrimethamine/
or Sulfadoxine-Pyrimethamine)
5 doses, 1 month apart
Start at 16 weeks or first quickening, do not exceed 36 weeks
Anemia prophylaxis in pregnancy
Ferrous sulphate 200mg daily, 65mg elemental iron
or
Ferrous fumarate 200mg daily, 65mg elemental iron
or
Iron III hydroxide polymaltose, 100mg elemental iron
+
Folic acid 5mg daily
Passive tetanus prophylaxis in pregnancy
Passive
IM Tetanol 0.5ml
1st dose from 20th week
2nd dose one month later
When is passive tetanus prophylaxis done
If patient hasn’t received any anti-tetanus immunisation
Types of tetanus prophylaxis in pegnancy
Passive
Active
Schedule for active tetanus prophylaxis
TT1 0.5ml SC or IM at any contact with pregnant woman
TT2: Given one month later
TT3: Given 6 months later
TT4 and TT5: given in subsequent pregnancies
Medical conditions that make a pregnancy high risk pregnancy
Diabetes
Hypertension
Asthma
Chronic cough eg. pulmonary TB
Heart disease
Thyrotoxicosis
HIV Positivity
Severe anaemia
SCD
High risk pregnancies
Bleeding at any time before labour
and after labour
Some medical conditions
Multigravidae
Grand multiparity (>=5 children)
Breach presentation
Prolonged pregnancy
Contracted pelvis
Previous instrument delivery
Previous uterine surgery eg. CS, myomectomy.
Preterm labour
Rhesus negative mother with a rhesus positive husband or antibodies
High risk pregnancy factors (foetus factors)
Uterine size smaller than gestational ag
Uterine size larger than gestational age
Foetal growth restriction
Big baby at term
Pat history of stillbirths or death within 1 week of birth
Past history of miscarriages around same gestational age
What is meant by big baby at term
SFH is more than 39-40 cm at term
EFW is 4 kg or higher
Prolonged pregnancy
when the pregnancy lasts longer than 42 weeks
What is contracted pelvis
pelvis too small for the baby to be delivered safely per
vaginam
How can contracted pelvis be easily detected
when the mother is short (< 154 cm)
has small feet (shoe size < 4½ UK)
