ANTENATAL ADVICES

AND MINOR DISORDERS

OF PREGNANCY

Presented by:-
Jenee Patel
M.Sc. (N) 1st yr
INTRODUCTION
Pregnancy causes many physical and
psychological changes in a woman. A nurse works
with pregnant women and their families must be
familiar with these changes to provide anticipatory
guidelines and this can be done by providing
adequate prenatal care and advice. One of the way to
keep the expectant more healthy and be able to take
self care is to give timely need based health education
to the women.
DEFINITION
It is a systematic supervision of a woman during
pregnancy.
OR
It is planned examination, observation and guidance
given to the pregnant woman from conception till the
time of labor.
AIMS AND OBJECTIVES
To prevent and treat the complications.
To screen the high risk cases.
To ensure continuous medical
surveillance.
To educate the mother.
To motivate the couple.
To ensure the normal delivery.
PRINCIPLES
To encourage the patient about regular check up.

To maintain or improve health status of woman

to optimum till delivery.

To improve and tone up the psychology and to

remove fear of unknown components.
1) Diet:
Daily requirement in pregnancy about 2500
calories.
Women should be advised to eat more
vegetables, fruits, proteins, and vitamins and to
minimize their intake of fats.
Purpose:
*Growing fetus.
*Maintain mother health.
*Physical strength & vitality in labor.
*Successful lactation.
Nutrition supplements
1. Iron:
Iron therapy is needed from 16th
weeks onwards.
>10gm% Hb, 1 tab of fetus sulfate
containing 60 mg of iron
3 tab provides 45 mg of absorbable
iron.
Due to anemia baby will born too
early or too small.
2. Folic acid:
Start before conception and
throughout the first 12 weeks.
Synthetic form of vitamin B9
also known as folate.
Dose- 400 micrograms per day
Reduces the risk of neural tube
defect:-
e.g. anencephaly, spina bifida
3. Vitamin D:
Pre-pregnancy BMI above
30 kg/M2.
Risks:
Abnormal bone growth
Fractures
Rickets in newborn
Higher risk for pregnancy:
GDM
Preeclampsia
LBW
4. Vitamin A:
Important for babys
embryonic growth like
development of heart,
lungs. Kidneys, eyes and
bones.
Circulatory , respiratory
system and CNS system.
Dose- 700 micrograms/
day
5. .

Start at first trimester.

Dose-1000 to 1500 mg/day
With meals not exceed from 2500 mg/day
Excessive calcium harm baby:
Mild constipation
Muscle weakness
Severe seizures
2) Rest & Sleep:
The pregnant woman should lie down to relax
or sleep for 1 or 2 hours during the afternoon.
At least 8 hours sleep should be obtained
every night & increased towards term, because
the highest level of growth hormone secretion
occurs at sleep.
Advise woman to use natural sedatives such
as: warm bath & glass of worm milk.
 A good sleeping position is sims position,
with the top leg forward. This puts the weight
of the fetus on the bed, not on the woman, and
allows good circulation in the lower
extremities.
Avoid resting in supine position, as supine
hypotension syndrome can develop.
3) Bowel:
Chance of consipation
Advice:
To take easily digestible, light,
high protein
To make daily habits of regular
bowel movements
Intake of more plenty of water
4) Personal Hygiene:
Daily all over wash is necessary
because it is stimulating,
refreshing, and relaxing.
Warm shower or sponge baths
is better than tub bath.
Hot bath should be avoided because they may cause
fatigue & fainting regular washing for genital area,
axilla, and breast due to increased discharge and
sweating.
Vaginal douches should avoided except in case of
excessive secretion or infection.
5) Clothing, Shoes, Belt:
6) Dental Care:
7) Breast care:
Wear firm, supportive bra with wide straps to spread
weight across the shoulder.
Wash breasts with clean tap water. Daily to remove the
colostrum & reduce the risk of infection.
to massage the breast, this may stimulate oxytocin
hormone secretion and possibly lead to contraction.

advise the mother to be mentally prepared for breast

feeding
advise the pregnant woman to expresses colostrums
during the last trimester of pregnancy to prevent
congestion.
8) Coitus:
Sexual intercourse is allowed with moderation,
is absolutely safe and normal unless specific
problem exist such as: vaginal bleeding or
ruptured membrane.

If a woman has a history of abortion, she should

avoid sexual intercourse in the early months of
pregnancy.
9) Travel:
Many women have questions about travel during
pregnancy.
Early in normal pregnancy, there are no restrictions.
Late in pregnancy, travel plans should take into
consideration the possibility of early labor.

Travel by vehicles having jerky movements so it

avoid in 1st trimester and last 6 weeks.
Rail travel is preferable than bus travel.
Air travel is contraindicated.
10) Smoking and alcohol:
It affects on fetus growth
and development.
Heavy smokers have
smaller baby so chances
of abortion will increase.
Alcoholism cause
maldevelopment or
growth restriction.
11) Immunization:
Live virus vaccines: Rubella, Measles, Mumps,
Vericella, Yellow fever (contraindicated)

Rabies, hepatitis A vaccines given at non pregnant

state.

1st dose: at booking visit & then 6 weeks later.

If already taken within last 3 yrs, booster at 36 wks.

12) Medications:
The medications which may cross placental barrier
should be avoided during the pregnancy.

Folic acid- 5 mg during 1st trimester

Fe-100mg
Ca- 1 mg/day

Fe and ca started at 13 wks continued for 3 months

after pregnancy.
13) Exercises:
Exercise should be simple. Walking is ideal, but long
period of walking should be avoided.

The pregnant woman should avoid lifting heavy

weights such as: mattresses, furniture, as it may lead
to abortion.

She should avoid long period of standing because it

predisposes her to varicose vein.

She should avoid setting with legs crossed because it

will impede circulation
 Purpose:

To develop a good posture.

To reduce constipation & insomnia.
To ensure good muscles tone& strength pelvic
supports.
To develop good breathing habits, ensure good
oxygen supply to the fetus.
To prevent circulatory stasis in lower extremities,
promote circulation, lessen the possibility of venous
thrombosis
Guide lines for exercises during pregnancy

Maintain adequate fluid intake.

Warm up slowly, use stretching exercises but
avoid over stretching to prevent injury to
ligaments.
Avoid jerking or bouncing exercises.
Be careful of loose throw rugs that could slip&
cause injury.
Exercises on regular basis (three times per
week).
After first trimester, avoid exercises that require
supine position.
Types of Exercises:
A. Pelvic floor exercises:
B. Ankle exercises:
C. Back and abdominal exercises:
D. Lower limbs relaxation exercises:
E. Breathing exercises:

Abdominal breathing:
Suitable for mild pain.

Lower costal breathing:

Suitable for medium pain.

Apical breathing:
Suitable for severe pain.
During contraction, try to relax & control
breathing.
 Contraindications

Vaginal bleeding.
Sever anemia.
History of preterm labor,
Extreme over or under weight.
Hypertension, heart, lung, thyroid diseases
Danger signs of pregnancy:
Vaginal bleeding including spotting.
Persistent abdominal pain.
Sever & persistent vomiting.
Sudden gush of fluid from vagina.
Absence or decrease fetal movement.
Sever headache.
Edema of hands, face, legs & feet.
Fever above 100 F( greater than 37.7C).
Dizziness, blurred vision, double vision & spots
before eyes.
Painful urination.
MINOR DISORDERS
OF PREGNANCY
AND ITS
MANAGEMENT
1) Nausea and Vomiting:
occur between 4-6 weeks gestation
Causes:
hormonal influences: hcG, progesterone,
estrogen.
emotional factors like tension.

Relief measures:
Avoid food or smells that exacerbate condition.
Eat dry crackers or toast
Eat small, frequent meals
Avoid sudden movements. Get out of bed slowly.
Breathe fresh air to help relieve nausea.
2) Backache:
Cause:
Backache may be due to muscular fatigue and strain that
accompany poor body balance.
It may be due to increased lordosis during pregnancy in an
effort to balance the body.
The pregnancy hormones sometimes soften the ligaments to
such a degree that some support is needed.

Relief measures:
Exercise.
Sit with knee slightly higher than the hips.
Wear shoes with low heels.
Use firmer mattress.
3) Constipation:
Causes:
Intestinal motility decreased during pregnancy
as a result of progesterone.
Iron supplementation.

Relief measures:
the food should have amount of fruit & green
vegetables which contain fibers.
drinking a lot of water.
exercise & walking.
laxatives could prescribed by physician.
4) Leg cramps:
Causes:
Painful involuntary muscle contractions that typically
affect the calf, foot or both- are common during
pregnancy, often striking at night during the 2nd and
3rd trimesters.
While the exact cause of leg cramps is not clear.

Relief measures:
Extend affected leg and dorsiflex the foot.
Elevate lower leg frequently.
Apply heat to muscles.
5) Heartburn:
Causes:
progesterone hormone relaxes the cardiac sphincter of the
stomach and allows reflex or bubbling back of gastric contents
into the esophagus.
the pressure of the growing uterus on the stomach from about
30-40 weeks.

Relief measures:
avoid lying flat.
sleeping with more pillows and lying on the right side.
small frequent meals.
take antacids.
Avoid fried ,spicy, and fatty food
Avoid citrus juices
6) Vericose vein:
Causes:
progesterone relaxes the smooth muscles of the veins and
result in sluggish circulation. The valves of the dilated
veins become inefficient & varicose veins result.
weight of the uterus partially compressed the veins
returning blood from the legs.

Relief measures:
Rest in sims position
Elevate legs regularlly
Avoid crossing legs
Avoid long periods of standing.
7) Hemorrhoids:
Causes:
Constipation can aggravate or even cause
hemorrhoids.

Relief measures:
Maintain regular bowel habits.
Use prescribed stool softness.
Apply topical or anesthetic ointments to area.
Surgical treatment is better to be withheld as the
condition sharply improves the following delivery.
8) Dependent edema:
Causes:
When the enlarged uterus intermittently compresses
the inferior vena cava during recumbency,
obstructing outflow from both femoral vins.
DVT and pre-eclampsia

Relief measures:
Avoid standing for long periods.
Elevate legs when lying or sitting.
Avoid tight stockings.
9) Urinary frequency:
Cause:
Occur due to the pressure of the growing uterus on
the bladder in first trimester and descend of fetus in
last trimester.

Relief measures:
Decreased fluid intake at night.
Maintain fluid intake during day.
Void when feel the urge.
Drawbacks of antenatal care:

Trifling abnormality may be exaggerated.

Quality may not be maintained always.

Faulty dietary advice and prescription of

harmful drugs produce injuries effect on
mother and fetus.
Limitations:

Even with through antenatal supervision,

unexplained and unpredicted complications
may arise such as:

Vaginal bleeding
PROM
Unexplained IUD
Cord prolapse
PPH
Thank
you