Ante – Natal Care

(GARBHINI PARICHARYA)

By

Dr. Seemantini.J
 Definition

• Systemic supervision
(examination & advice) of a
woman during pregnancy is
called Antenatal (prenatal)
care
 Aims & Objectives
• To screen the high-risk cases.
• To monitor the progress of
pregnancy.
• To recognize the deviation from
the normal.
• To educate the mother about the
physiology of pregnancy &
labor.
• To ensure that the woman
reaches the end of her pregnancy
physically and emotionally.
• To discuss with the couple
about the place, time and mode
of delivery, provisionally and
care of newborn.

• To help and support the

mother in her decisions
regarding lactation (promote
breast feeding).

• To motivate the couple about

the need of family planning.

• The objective is to ensure a

normal pregnancy with delivery
& a healthy baby from a healthy
mother.
 First Visit……..
• Objectives :
– To assess the health status of the mother &
fetus.
– To screen for “At Risk” pregnancies &
formulate plan for subsequent management.
– To obtain base-line information important for
determination of Gestational age
• For this, history taking becomes an
important aspect in the first visit.
• This should include :
– Vital statistics.
– Complaints
– H/O Present pregnancy.
– Obstetrical history
– Menstrual history
– Past medical history
– Past surgical history
– Family history
– Personal history.
 Clinical examination
• Built
• Nutrition
• Height – weight
• Pallor, jaundice
• Tongue, teeth, gums & tonsils
• Neck
• Oedema of the legs
• TPR, BP
• R/S, CVS, CNS, Pelvic examinatios
• Breast examination
 Obstetrical examination
• Abdominal :
– Tone of the abdominal muscles
– Previous incisional scar
– Herniation, if any
– Skin condition
– FHS
• Routine investigations
– Examination of the blood :
• Haemoglobin estimation
• Blood group & Rh factor
• VDRL
• Screening for blood glucose
 – Urine examination:
• Protien
• Sugar
• Pus cells
• Special investigations:
– Serological tests for Rubella &
Hepatitis-B

– Maternal serum alpha feto-protien

or triple test at 16-18 weeks.

– Ultrasound examiation at 18-20

weeks for
• Detailed fetal anatomy survey, detect
any structural abnormalities including
cardiac.
• Placental location
• Amniotic fluid quantity (by Amniotic
fluid Index).
 Some of the known adverse factors
• Primigravida age >35
• Pregnancy associated with medical complications
• Clinical evidence of Poly or Oligo- hydramnios.
• Previous H/O still birth or neonatal death.
• H/O recurrent abortions or preterm delivery
• Rh – isoimmunization
• Maternal illness during 1st trimester.
• Previous child born with congenital anomalies
 Prasooti tantra
• The topic of Prasoothi Tantra itself it divided into
three areas viz.
• The ante-natal phase - which includes - diagnosis
of pregnancy and care during pregnancy - garbhini-
paricharya.
• Natal phase - the process of delivery - from the
onset of the labour pains upto delivery of the
placenta - prasava kaala paricharya.
• Post-natal phase - the post-partal period or looking
after the new-born baby, care of the mother during
lactation - soothika paricharya.
 Diagnosis of Pregnancy
• The first phase of garbhini-paricharya starts off
with the diagnosis of pregnancy. Diagnosis of
pregnancy can be based on:
• Presumptive signs and symptoms
( Sadyogruheeta- garbha-lakshanas )
• Probable signs
• Positive signs (Vyaktha-garbha-lakshanas )
 Sadhyogrihit garbha
• "Nishteevika gowravamangasaadas-tandra
apaharshow hrudaye vyatha cha trupthischa
beejagrahanam cha yonyaam garbhasya
sadhyonamgathesya lingam" (Cha. Sam., Sha. 2/23).
• The early pregnancy symptoms include :
– ÌlɸÏuÉ- repeated spitting
– aÉÉæUuÉ- heaviness,
– AXûxÉÉS- malaise,
– iÉlSìÉ- drowsiness
– mÉëWûwÉï- horripilation
– WØûSrÉ urÉjÉÉ- pain in the chest
– iÉ×ÎmiÉ¶É oÉÏeÉaÉëWûhÉqÉ- a feeling of satisfaction
• Sushrutha lists them as "Shramoglaanihi pipaasaa
sakthisadanam shukrashonithayoravabandhaha
sphuranam cha yonehe" (Sus. Sam., Sha. 3/10).
• i.e.fatigue, langour, excessive thirst, lassitude of the
thigh’s, retention of shukra and shonitha (absence of
menstrual and coital discharges) and quivering in the
vagina.
• Vaagbhatta II states "...angagrahaha, trupthirgurutwam,
sphuranam shukraasraananubandanam, hrudaya
spandanam thandra trudglaanihi lomaharshanam" (Ash.
Hru., Sha. 1/37-38).
• i.e. body pain, satisfaction, heaviness, quivering, retention
and combination of shukra and aarthava, palpitation,
dizziness, excessive thirst, langour, horipulation are the
immediate sings of pregnancy Vaagbhatta I includes
nausea and excessive salivation also in the list of
symptoms.
• There are various interpretation of the term
"sadyogruheetha". According to some Aachaaryas
these are the signs and symptoms which are seen
and felt by the pregnant woman immediately after
conception i.e. the moment the shukra and
aarthava unite, or even just after maithuna
(copulation) which results in conception.
According to others they are the signs and
symptoms which appear within seven days of
conception. Some others say that they are the
signs and symptoms before the cessation of
menstruation. It is also explained as signs and
symptoms of women having become recently
pregnant .
 Vyaktha garbhalakshana /
dowhrudya lakshana
• These are the signs and symptoms observed
after the growth of the embryo becomes
conspicuous. Charaka explains these signs
and symptoms as that of dowhrudyam or
that of having two hrudayas and states that
their knowledge is essential to facilitate
their management. These signs and
symptoms are seen during the third month
of gestation.
• They are described by Charaka as :
"Aarthavaadarshanamasya samsravanam
anannaabhilasha chardihi arochakomlakaamatha
cha visheshena shraddha
pranayanamucchaavacheshu bhaveshu
gurugaatratwam chakshusho glaanihi sthanayoho,
sthanyamoshtayoho
• stanamandalayoshcha kaarshynyamatyartham,
shwayathuhu paadayoreeshallomaraajyudgamo
yonyaaschataala twamithi garbhe paryaagate
roopani bhavanthi". (Cha. Sam., Sha. 4/16).
• The vyakthagarbha lakshanas are amenorrhea,
excessive salivation, dislike for food, vomiting,
anorexia, craving for sour substances, alternate
desires for article which are of high or low quality
(beneficial/non-beneficial), heaviness of body,
langour of eyes, milk secretion in breasts,
blackening of lips and areola, slight odema of feet,
development of romaraji (the vertical streak of
hair line extending to the umblicus) and dilation of
vagina
• In addition to these, Sushrutha and
Bhaavamisra mention - repeated drooping
of eyes, vomiting without apparent cause,
aversion to good smells and excessive
salivation and tiredness as symptoms (Sus.
Sam., Sha. 3/11) and Bha. Pra. Poo. Gar.
3/42). Vruddha Vaagbhatta in Ashtaanga
Sangraham along with the other signs and
symptoms also mentions - "yatha yatha cha
garbho vruddhimaapnothi tatha bharahara
- rasaapchaaraatcha sthriyaa balakshaya"
• i.e. the increase in the weight of the embryo
causes diversion for her nuterients and thus her
energy also decreases (Ash. San. Sha. 2/9 and 59).
Vaagbhatta in Ashtaanga Hrudaya - adds the
symptoms emaciation, indigestion, burning
sensation of the whole body and expression of
various desires.
• In Charaka Samhitha and Kaashyapa Samhitha,
the signs and symptoms for each month
maasaanumaasika-lakshana have also been
described from the fourth upto seventh month
which are as follows:
• Fourth month - Chathurthi maasi
sthiratwam apadyathe garbhaha thasamaat
tada garbhini guru gaathrathwam adhikam
aapadyathe visheshna" (Cha. Sam., Sha.
4/20).
• i.e. due to stability in the foetus the woman
feels more heaviness in the body
• 5th month : Charaka states : "Panchame maasi
garbhasya, maamsa shonitopachayo bhavathi,
adhikam anyebhyo maasebhyaha tasmaat tada
garbhini kaar-shyamaapadyathe visheshena
• During the fifth month, there is an excessive
increase of flesh and blood of the foetus in
comparison to the other months; due to this the
pregnant woman grows excessively thin (Cha. Sam.,
Sha 4/21). Kaashyapa has also mentioned a similar
symptom namely "Garbhinee panchemaasi tasmaat
kaarshyen yujyate"
• i.e. in the fifth month the pregnant woman
is associated with leanness. (Kaa. Sam.,
Sha. Asa.). Chakrapani Datta’s
commentary on Charaka’s lines are "Yatho
garbha maamsaadi poshanenaiva ksheena
ahaara rasona maathur maamsaadi samyak
poshayathi" i.e The nutrition of the mother
is utilised for the growth of the child during
this month, hence the mother grows thin.
• Sixth month - Charaka states that Shashte
maasi garbhasya bala varnopachayo
bhavatyadhikamanyebhyo, maasebhyaha,
thasmattada garbhini balavarnahaanim,
aapadyathe visheshena i.e. there is a
comparitive increase in the strength and
complexion of the foetus during the sixth
month of gestation. Therefore the lady loses
her strength and complexion considerably
(Cha. Sam., Sha. 4/22).
• Seven month - Sapthame maasi garbha
sarvairbhaavaihi aapyaayyathe, thasmaat tada
garbhini sarvaakaaraihi klaanthathama. (Cha.
Sam., Sha. 4/23). There is an all round development
of the fetus during the seventh month of gestation.
Therefore, a pregnant women becomes exceedingly
deficient in all aspects of her health Though there
has been reduction in the physical state of the
mother, in the seventh month all the factors viz.,
flesh, blood, etc. Get reduced simultaneously
(Chakrapani Datta’s commentary on Cha. Sam.,
Sha. 4/23)
 Garbhini paricharya
• 1st Month
• Charaka :
– Intake of milk repeatedly.
– Normal food twice.

• Sushruta : (1-3mths)
– Madhura, Sheeta & Drava ahara.

• Vagbhata :
– Medicated milk & ghrita – 1st 12
days
– Water boiled with gold & silver
– Madhura, Sheeta & Satmya ahara.
 2nd Month

• Charaka :
– Milk + Madhura ahara
– Madhura drugs
 3rd Month
• Charaka & Vagbhata :
– Milk with Honey & Ghrita.

• Sushruta :
– Madhura, sheeta & drava ahara, especially
cooked with shasthi rice in milk.
 4th Month
• Charaka & Vagbhat:
– Butter extracted from milk – 1 aksha pramana
– Milk with butter.

• Sushruta :
– Cooked shasthi rice with curd
– Paya navneetha
– Samskrita ahara
– Jangala mamsa
 5th Month
• Rapid development of body occurs.
• Charaka :
– Ghrita prepared with butter extracted from milk

• Sushruta :
– Cooked shasthi rice with milk & jangala
mamsa.
 6th Month

• Charaka :
– Ghrita prepared from milk
medicated with drugs of
madhura groups

• Sushruta :
– Ghrita or rice gruel medicated
with gokshura.
 7th Month
• Charaka :
– Ghrita prepared from milk medicated with
drugs of madhura groups

• Sushruta :
– Ghrita medicated with prithakparnyaadi group
of drugs.
 8th Month
• Charaka :
– Rice gruel + milk & ghrita

• Sushruta :
– Asthapana Basti  anulomana of vata
– Madhura, snigdha dravya ahara
 9th Month
• Charaka :
– Anuvasana basti with taila of
madhura gana dravya
– Pichu of this taila kept in
vagina for lubrication of
garbhasthana & garbhamarga.

• Vagbhat II :
– Meat soup with rice & ghrita

• Harita :
– 9th & 10th month – different
varieties of cereals should be
given
 COMPLICATIONS DURING
PREGNANCY
To deliver a healthy child

An uneventful pregnancy
Common complications to anticipate during each trimester

First trimester Second trimester Third trimester

Abortions Hypertension/ APH

Pre Eclampsia
Ectopic pregnancy Pre-eclampsia
Cardiac lesions
Hydatiform mole Hydramnios
Hydramnios
Hyper emesis PROM
gravidarum Dyspnoea
Some of the medical disorders to be screened through out the
pregnancy are:
• Aneamia
• Essential Hypertention
• Glycosuria
• Gestational Diabetes
• Asthama
Some of other disorders complicating pregnancy are
• Thyrotoxicosis
• Chronic renal disorders
• Fibroid during pregnancy
• Genital prolapse with pregnancy
• Retroverted gravid uterus
• Obesity
• Pulmonary tuberculosis
• Jaundice
• STD during pregnancy
 DRUGS TO BE AVOIDED
DURING PREGNANCY
• Organogenesis occurs from 18 – 55days after conception. To have a
teratogenic effect, a drug must be in the body during this critical
time.Some of the drugs are………
• Drug Defects most commonly reported
 Phenytoin Craniofacial, limb
 Carbamazepine CNS,Limb, cardiac
 Valproate Nural tube, others
 warfarin Chondrodyplasia punctata
 Retiniods Multiple
 Lithium Cardiac
 Danazol masculinisation
  blocker IUGR {when taken from early
pregnancy}.
 Tetracyclins Tooth discolouratin
 Asprin Neonatal haemorrage{when taken
within 5days before delivery}
 Indomethacin Nectrotizing enterocolitis,
Intracranial haemorrage,
{used at end of pregnancy-
premature closure of the dutus
arteriosis}
 Tetracyclins like streptomycin,Gentamycin, Recently developed drugs
likeMetronidazole,Ciprofloxicin,Erythromycin, chloramphenicol,
 Certain anti- tubercular drugs like Rifampicin and anti parasitic agents
like Mebendazole, Should be used with caution as they may lead to
teratogenic effects like ototoxicity, dyplasia of teeth and bones.
Maternal effects like abortions, post natal bleeding etc..