antenatal care

Question 1

Goal

Answer 1

“Safe mother and safe baby”
* To prevent Maternal and perinatal mortality and morbidity

Question 2

Objectives

Answer 2

1. To confirm pregnancy, dating and to rule our early complications
2. Screen for high risk pregnancy
3. Monitoring foetal growth
4. Prevention, screening, early diagnosis and management of maternal and foetal complications.
5. Supplementation, immunization
6. Education/counselling
7. Planning delivery

Question 3

Schedule

Answer 3

• First visit-6w
• Second-12w
• Third visit-18w
• Fourth visit - 24 weeks
• Next visit - 28 weeks
• 2 weekly till 36 weeks
• Weekly till 40 weeks

Question 4

History taking

Answer 4

• Detailed profile
• Parity Index, LMP/EDD/POG
• Current pregnancy history
  -Booking visit details
  -First trimester history
  -Second trimester history
  -3rd trimester history
• Past obstetric history
• Past/personal/family/social history.

Question 5

Clinical Examination

Answer 5

• General Physical
  üHeight, weight, pallor, edema, BP
• Systemic ü CVS,RS,SPINE
• Abdominal
  -Fundal height > 12 weeks
  -Symphysio fundal measurement > 20 weeks -Presentation>32-34 week
  -Foetal heart> 24 weeks
• Local:
  üFirst visit to rule out local pathology

Question 6

Investigations-1st Visit(Booking)
10 things

Answer 6

• Blood:
  CBC, Blood Group& type HIV, Hepatitis, VDRL, TSH
  -MGTT for high risk cases
• Urine analysis:
  Albumin
  Sugar
  *Microscopy
• Ultrasound scan: Dating scan

Question 7

Investigations-further visits

Answer 7

• CBC repeat at 24 and 37 weeks
• MGTT@ 24-28 weeks
• Urine analysis: every visit
• Ultrasound:
  Nuchal Transparency scan at 11-13 weeks Anomaly screen scan: 18-20 weeks
  Growth scan at 30-32 weeks

Question 8

Education& Counselling

Answer 8

• Education
  -Diet-Balanced, iron-calcium-fiber rich diet
  -Exercise-30 minutes/day(5 days/week),Moderate Degree aerobic exercise -Travel-Avoid long travel
  -Work
  -Common symptoms, warning signs :Pain, bleeding, headache, fetal movement, leaking
• Counselling
  -Trisomy screen
  -Referral
  -Fetal anomalies
  -Preoperative
  -Plan of delivery

Question 9

Supplementation &Immunization

Answer 9

• Tab Folic acid - 0.5mg to 5mg daily (Preconception-16 weeks)
• Iron Tablets-60mg elemental iron(200 mg Ferrous Sulphate/Fumarate) daily from 16
  weeks till 6 weeks following delivery)
• Tab Calcium 1gm daily till 6 weeks following delivery.
• Injection Tetanus Toxoid/Td 2 doses 4-6 weeks apart

Question 10

Planning for delivery &emergencies

Answer 10

• Place of delivery
• Obstetric Team
• Mode and timing of delivery
• Choice of analgesia/anesthesia
• Emergency plan