ANTENATAL CARE

Question 1

What is the definition of antenatal care ?

Answer 1

It is planned examination , observation and guidance given to the pregnant woman from conception till the time labour.

Question 2

What is the AIM/OBJECTIVE of the antenatal care ?

Answer 2

1. To reduce maternal and perinatal mortality and morbidity rates.
2. To improve the physical and mental health of woman and children.
3. To ensure that the pregnant woman and her fetus are in the best possible health.
4. To detect early and treat properly complications.
5. Offering education for parenthood
6. To prepare the woman for labor , lactation and care of her infant.

Question 3

What are the schedule that is proposed in Antenatal care ?

Answer 3

Note :

1) Montly up to 28 weeks
2) 2 weekly between 28 - 36 weeks
3) Weekly from 36 weeks till the estimated date of deliver.

✦ Booking is done at first trimester as early as possible.

✦ This is to ensure correct gestational age and information regarding normal pregnancy and to perform baseline investigation for risk stratification.

Question 4

What are the things that is done in antenatal care ?

Answer 4

1. Medication.
2. Folic acid to prevent neural tube defects ( NTD ) - 0.4 to 1 mg if past history of nueral tube defect - start 12 weeks preconception.
3. Iron supplementation is 2nd and 3rd trimester.
4. Proper nutrition and physical fitness
5. Genetic history and risk factors
6. Infective screening .
7. Hbs Ag , Rubella , +/- HIV , VDRL/THPA
8. Social History
9. Alcohol , Smoking , Drug use
10. Domestic Violence (50% of domestic violence begins in pregnancy)
    Impact on family and occupation ( maternity / paternity )

Question 5

What are the HISTORY that should be taking in the INITIAL VISIT?

Answer 5

HISTORY :

▶ Determine the gestational age (GA) by date from the first day of the LMP ( If there is regular periods and she is sure of her dates/LMP).

▶ If the unsure of LMP —–> get a dating ultrasound ( best weeks 8-12).

▶ Determine estimated date of conception (EDC) using Nagele’s Rule - [ First date of LMP + 7 days - 3 month ] ]

▶ Obtain Obstetrical history of all previous pregnancies. - GTPAL /year/sex/weight/gestational age/mode pf delivery/length of baby / labour/ complication/uterine surgery ( myomectomy , D&C , cone biopsies )

▶ Obtain relevant medical , social and family history.

▶Prenatal classes

Question 6

What are the PHYSICAL EXAMINATION that is performed in Antenatal care ?

Answer 6

✚ Complete physical exam .
✚ Baseline blood pressure (BP) - Important for interpreting subsequent changes .
✚ Baseline Weight .
✚ Pelvic exam .

Question 7

What are the INVESTIGATIONS that is performed in Antenatal care ?

Answer 7

❆ Blood Investigation - FBC , blood group and type , Rh antibodies , Rubella titire , VDRL , HBSag routine , HIV serology should be offered to all (if viral screen not already done preconception )

❆ Urine examination
★Asymptomatic bacteriuria in 5% of pregnant
women .

      ★ If untreated , 25% - 30% will get UTI in 
        pregnancy (Increase risk of preterm labour )

❆ Pelvic exam
★Pap smear ( if none with/in 6 months ) .
★Culture for Gonococcal and Chlamydia .