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ANTENATAL CARE

OBJECTIVES OF ANC

Detect

and manage complications


during pregnancy, whether medical,
surgical or obstetrical

Antenatal Care: Overview

and maintain the physical,


mental and social health of mother and
baby by providing education on
nutrition, personal hygiene and birthing
process

Promote

Develop

birth preparedness and


complication readiness plan

Help

prepare mother to breastfeed


successfully, experience normal
puerperium, and take good care of the
child physically, psychologically and
socially

DURING ANTENATAL CARE

A 28 year old G1P0A0 woman came to your office


for initial antenatal visit. Her last menstrual period
was on June 3rd, 2009. She felt nausea and
vomitted several times. She also had headache and
hypersalivation. She asked whether her condition
was normal and what should she do to overcome it.
From anamnesis, you revealed family history of
hypertension.

Medical terms

G1P0A0

symptoms of pregnancy: nausea, vomiting and


hypersalivation

Question
What

What

is her gestational age?

should the doctor do during


initial antenatal care?

INITIAL ANTENATAL CARE

A.

Diagnosis of pregnancy

B.

Calculation of gestational age and estimated date


of delivery

C.

1.
2.

3.

History:
previous pregnancy
medical history many medical disorder
exacerbated by pregnancy (such as
cardiovascular and endocrin disorder), maternal
infection (such as TBC), sexually transmitted
disease
Surgical history : History of previous
gynecological surgery

4. Family history: a family history of diabetes mellitus


alert the physician to possible gestational diabetes,
awareness of familial disorder
D. Physical examination Vital sign, Leopold
Maneuvers, FHT, fundal height
E. Laboratory test: Hb, Hematocrit, White blood cell
count, blood type group, Rh factor, hepatitis B and
urinalysis

DIAGNOSIS OF PREGNANCY
Sign

1.
2.

and symptoms of pregnancy:


presumptive/probable
positive manifestation of pregnancy

PROBABLE MANIFESTATION
Pelvic organs changes:
Chadwicks sign: bluish or purplish discoloritation
of the vagina and cervix
Leukorrhea

Hegars

sign: compressibility of the uterines


isthmus on bimanual examination

POSITIVE MANIFESTATION
1.

Fetal heart tones (FHT): Using hand held Doppler the


FHT could easily be heard at 10 weeks gestation

2.

Palpation of fetus: fetal movement could be palpated


after 18 weeks.

3.

Ultrasound examination of fetus

PREGNANCY TEST

What does it measure?


subunit of hCG

Urine Pregnancy test vs Serum Pregnancy test

SUBSEQUENT ANTENATAL CARE

During subsequent visit a month later, she


complaint of frequent urination and profuse vaginal
discharge with itchy and burning sensation in the
vulva.

Medical terms
Frequent urination
Profuse vaginal discharge
Itchy and burning sensation on the vulva

Question

Are the symptoms normal?

What is the standard schedule for antenatal care?

What should the doctor do during subsequent


antenatal care?

1.

Physical exam: Vital sign, maternal weight gain,


fundal height, documentation of FHT, Leopold
Maneuvers (fetal position), and fetal size
(estimated fetal weight)

2.

Laboratory exam: urine should be checked for


protein and glucose or urinalysis if it is indicated

Common complaints during pregnancy


1.

2.

3.

Ptyalism: excessive salivation severe nausea


and vomiting of pregnancy
Pica: the ingestion of substances that have no
value as food
Frequency of urination vascular engorgement
of the pelvis and hormonal changes. Late in
pregnancy pressure on bladder

4.

5.

6.

Leukorrhea (vaginal discharge) should


distinguish normal vaginal discharge from infected
vaginal discharge (candidiasis, bacterial
vaginosis)

Varicose Veins should be examined carefully


for signs of deep vein thrombosis
Joint pain, backache and pelvic pressure due
to pregnancy, the pelvis is unstable pain. Also,
hyperlordosis backache wear shoes with 3
cm heel.

7.

8.

9.

Leg cramps reduced level of diffusible serum


calcium or elevation of serum phosphorus
calcium carbonat or calcium lactat supplement or
magnesium citrate 300 mg/d

Breast soreness
Discomfort in the hands periodic numbness and
tingling of the fingers due to brachial plexus
syndrome not serious

PHYSICIANS ADVICE

Intercouse

Dental care: Can drilling and filling with local


anesthesia be done during gestation?

Immunization: Can immunization be safely


administered during pregnancy? What is the
prerequisite?

Travel

Successful breastfeeding promotion

Birth preparedness

Complication readiness

Family planning promotion

NUTRITION DURING PREGNANCY

Recommended weight gain: 11, 5 16 kg, but for


obese women should only gain weight 7 11,5 kg.

Nutrional requirement:
Protein
: 80g/d
Calcium : 1.5g/d
Iron: 30 mg/d during 2nd and 3rd TR
Vitamin and mineral: Folic acid 0.4 mg/d before
conception through 6 12 weeks of pregnancy