DEVIANA S.

RIU

Physical health, mental and social mothers and babies,

through education: nutrition, personal hygiene and delivery

Detection & treatment of complications of pregnancy Prepare and plan for labor and especially if complications occur

Helping mothers to breastfeed exclusively, through a period

of normal childbirth and good care of your baby physically, psychological and social.
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Should be as early as possible.

anamnesis : age, parity, last menstrual periode, menstrual

history physical examination, Height, Weight, BP, and pregnancy testing. laboratory examination : Hemoglobin, hematocrit, blood type, rhesus psychological support to pregnant women to have stable emotions.

Positive sign

Palpation Fetal heart beat Stetoscope of Laennec /fetoscop 18 weeks Doppler 12 weeks Ultrasound 6-7 weeks (fetal pool), 7-8 weeks (pulse), 8-9 weeks (fetal movement), 9-10 weeks (placentae), 12 weeks (BPD). hCG test.

Probable sign:
Amenorrhea, nausea and vomiting, mastodinia, quickening, urinary frequency, constipation, weight gain, increased basal body temperature, cloasma

Naegeles rule
EDC (estimated day of confinement)

=(LMP+7) (month-3) (Year +1) example: LMP 26/4/2004 EDC 3/2/2005

Fundal height
Quickening: 16 weeks in multigavida, 18 weeks in primigravida
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EFW = (fundal height N) x155

N = 12, if the vertex is at or above the ischial spine. N = 11, if the vertex is below the spines. Example:

G3P1A1, examination fundal heigh was 34 cm, the head is floating. EFW = (34-12)x155 = 3410 g.
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Mc Donald
Fundal height X abdominal circumference

This include not only determining the pregnant womans overall health status, but also identifying factors which may adversely affect pregnancy outcome.

It will not identify all of women with the risk, but it is critically important to identify and manage complications as they arise among all pregnant women.
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Age younger than 17 or older than 40 Grand multipara Short stature Obstetric history of any previous complication, including surgery.

Special emphasis should be placed on identifying the acute complications of unsafe abortion and ante-partum haemorrhage. Other complication, such as hypertensive disease, anemia, diabetes, malaria, or an STD, are less obvious and require more detailed physical examination. Treatment for existing health conditions should be undertaken.

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Height blood pressure, search for oedemas, proteinuria, and haemoglobin (if indicated by clinical sign), uterine growth, fetal heart rate and presentation should be recorded.

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Good maternal nutrition is a major determinant of normal fetal growth and development. The recommended minimum nutritional requirements for a pregnant woman have been eat at 2300 kcal/ day of a balanced and culturally acceptable diet. Supplementary food may be require if the basic food ration available or distributed is inadequate. The offer of supplement food can be a good incentive to get women to attend for antenatal care. Health care providers should be alert to signs of iron deficiency anemia and iodine deficiency disorders.
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Calcium must be supplemented during pregnancy to meet fetal needs and preserve maternal calcium stores. Supplemental iron is needed during pregnancy for the fetus and to prevent depletion of the maternal iron stores, especially during the latter part of pregnancy. Iron is the only mineral that usually must be prescribed.
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Educational activity related to antenatal care:

Choosing the safest place for delivery Clean delivery The major simptoms of complications (bleeding, severe

abdominal pain, headache) Where and when to seek care for complication Exclusive breast feeding Maternal nutrition STD/HIV/AIDS prevention Immunisation Family planning
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Iron folate prophylaxis anemia occurs in 60% of pregnant women in developing countris Tetanus toxoid immunisation Vitamin A supplement Antimalarials according to country policies Antihelminthics (hookworm) in endemic areas Iodized oil/salt may be given in areas of moderate or severe IDD and following national protocols

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Record the patients correct name, address, birth date, phone number, choice of whom to call in emergency, and special personal preferences.

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Record the vital sign blood pressure, pulse, and respiration. Note weight, height, body build, and state of nutrition. Assess general condition (skin, hair, neck, breast, abdomen, extremities) Pelvic examination vulvar and vaginal varicosities; cervical consistency, position, effecement, and dilatation; pelvic masses, pelvic measurement.

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Obstetric hystory
First day of the last menstrual period (LMP) Duration of the menstrual cycle (regular or irregular) Method of contraception prior to conception Symptom of pregnancy Nausea & vomiting Frequency of micturition Excessive lassitude Breast tenderness and heaviness Fetal movement

Previous obstetric hystory

Gravidity & parity (term, premature, abortion), living

children Previous pregnancy Gynecologic hystory Previous medical hystory

DM, renal disease, hypertension, cardiac disease, thyrotoxicosis, TBC, hepatitis, HIV

Family history Medication, drug reaction, allergic hystory Sosial factor

Height : small pelvis ? Weight Blood pressure : patient supine in the left lateral supine position to avoid compression of vena cava by the gravid uterus Head & neck

Breast Heart & Lungs

Chloasma Anemia Icteric Dental hygiene Thyroid

Abdomen
Striae gravidarum Linea nigra

Hepatosplenomegaly ?
Fundal height Measurement of symphysial fundal height Measurment of abdominal girth Leopold Fetal heart

Not routinely
External genitalia Vagina Cervical secretion are increased Cervix Softening

Uterus
Adnexa

Clinical pelvimetri

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Obviously, laboratory tests must be individualized for each patient. They should be done as early as possible.
Full blood count
Urinalysis HBs Ag

VDRL

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Diagnosis record the duration of pregnancy and any anticipated complications. Prognosis record an initial prediction of EDC and outcome of her pregnancy (vaginal or CS). The prognosis must be altered if obstetric problems develop. Plan & treatment project the care necessary for this gravida and pregnancy.
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Can still do the job every day.

Activity is limited when : prematurity , rupture of the membrane, suffer from heart disease.

Coitus is not allowed when:

vaginal bleeding Recurrent abortion history Abortion / partus prematurus imminens Rupture of the membrane Cervix has been opened
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Stockings that are too tight : disrupt blood flow high heels : add back pain : lordosis>>

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Defecation become irregular because:

The influence of smooth muscle relaxation by

estrogen Pressure of the enlarged uterus The influence of pressure head has entered the pelvis.

Constipation be prevented by:

Quite a lot of drinking Sports Giving mild laxative : fruit juice
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