Preconception and

Antenatal care
Antenatal care is the clinical assessment of mother
and fetus during pregnancy, for the purpose of
obtaining the best possible outcome of both the
.mother and the child
:The Preconception Visit

The ideal first antenatal visit is at preconception clinic

where health education and risk assessment can be
.directed towards the planned pregnancy
At that time the patient general health can be fully
.assessed
History, examination and investigations are needed
accordingly rubella, hepatitis and HIV status can be
established and appropriate action taken were indicated
General advice can be given at this time
Advice can be given regarding the avoidance of teratogens,
Cigarettes smoking and alcohol while insuring the optimal
.dietary intake of folic acid
For the women with diabetes mellitus, abnormal glucose
control during the preconceptional period is associated
.with an increased incidence of fetal abnormalities
This is also an ideal time to ensure that such factors have
been taken care of by some dietary education and proper
treatment and we can check for the control of blood sugar
.by estimation of HbA1c
:The Aims of the Antenatal Care

Assessment and management of maternal risk and .1

.symptoms
Assessment and management of fetal risk .2
Prenatal diagnoses and management of fetal .3
abnormality
Diagnoses and management of perinatal .4
complications
Decision regarding timing and mode of delivery .5
Parental education regarding pregnancy and .6
childbirth
Parental education regarding child-rearing .7
Schedule of Antenatal Visits:

o Old schedule
Monthly visits till 32 week, fortnightly visits till 36
week, weekly visits till delivery.
o New schedule which consist of the following visits:
 Pre conception clinic visit
 8-14 week visit
 20-24 week visit
 36-38 week visit
 41-42 week visit
This new schedule will help us to observe the pregnant lady in
1st,2nd&3rd trimester.
Every trimester has its own risks complications.
If pregnancy is passing uneventfully these visits are enough
but if complications arise we need more visits.
In each visit we have to hear from the lady about her own
complaints.
Full history& clinical exam is mandatory with concentration
on abdominal examination.
Base line investigations such as blood group, haemoglobin
level, general urine exam,fasting blood
sugar&ultrasonography are performed.
Further investigations are sent if needed
Every women should have a record file and every event
should be written in it.
Advice regarding nutrition, exercise& health education for
the pregnant lady is mandatory.
First Trimester Visit
During first trimester visit we have to confirm
intrauterine pregnancy and assess the gestational
age.
The assessment of gestational age depends on the
estimated date of delivery calculated according to
Neageles rule(280 days from the LMP) and its
correlation with the gestational age as estimated by
ultrasound measurements.
We have to deal with complications that present
with vaginal bleeding and abdominal pain. Women
can be investigated using
history,examination,biochemical testing &
transvaginal U/S to exclude non-viable
pregnanacy.ectopic pregnanacy or hydatiform mole,
Second Trimester Visit
Assessment of maternal health & fetal growth &
welbeing are persude through these visits.
The results of tests performed at 1 st trimester visit
are reviewed with the mother
The results of the U/S scan for fetal abnormality are
also reviewed.
Any incidental maternal symptoms are dealt with
,this period is also important in insuring the
education of the woman regarding the rest of
pregnancy & her delivery,
Third Trimester Visit
(Usually around 36- 38 weeks)
The primary objective of this visit is to anticipate
any problems regarding the prospective delivery.
Uterine fundal height ,fetal lie, presentation &
position are mandatory.
Vaginal examination will help us to check for any
abnormaity in the pelvis,cervical status ,fetal
presenting part,station & position.
Mode of delivery & planned contraception after
delivery shoud be discussed at this time,
 Post Dates Visit [ 41 – 42 weeks ]

With accurate pregnancy dating, true post dates

pregnancy are identified,
At this visit , a joint decision is taken as to whether
an induction of labour is appropriate, this is current
practice because of the reported assossiation
between post dates pregnancy & pregnancy
outcome.
Induction of labour usually performed by the 42 nd
week.
There are two main methods of induction
1.amniotomy or surgical induction ;
2.medical methods using prostaglandin or oxytocin
 Post Dates Visit [ 41 – 42 weeks ]

With accurate pregnancy dating, true post dates

pregnancy are identified,
At this visit , a joint decision is taken as to whether
an induction of labour is appropriate, this is current
practice because of the reported assossiation
between post dates pregnancy & pregnancy
outcome.
Induction of labour usually performed by the 42 nd
week.
There are two main methods of induction
1.amniotomy or surgical induction ;
2.medical methods using prostaglandin or oxytocin
In summery at each visit the following procedure and
examination should be performed :
History:
•Record new complaints
•Ask about alarming signs
•Ask about fetal movement and fetal growth
•Provide continues health education
•Encourage institutional delivery
Examination:
General
•Weight
•BP
•Edema of lower limbs
Abdominal
•FL
•Fetal lie
•Fetal presentation
•FHS
Laboratory investigations
•Screening of diabetes at 28 weeks of pregnancy
•Urine exam by dipstick for protein, glucose and
ketones
Assessment of fetal well being in a low risk
pregnancy
•Fetal size: assessment of the FL or the symphyseal-
fundal height (Recommendation grade: B)
•Fetal kick count: at least 10 movements/12 hours
(a change in the kick count is more important than
the absolute number)
•Fetal movements: absence proceeds intrauterine
fetal death (IUFD) by 48 hours
•Fetal heart sounds (bradycardia and or
tachycardia indicate possible fetal compromise)
At 37 weeks
•Assessment of fetal size, lie and presentation
•Assessment of pelvic capacity if there is suspicious
of pelvic inadequacy (stature<145cm, pelvic
fractures, or previous CS for cephalopevlic
disproportion )
Health Education for Pregnant Women
Adequate nutrition
Calories (2500 Kcal/day)
Protein (60gm/day)
Calcium (1.2 gm /day)
Iron (30 mg of ferrous / day)
•Animal source: liver and red meat
•Plant source : dark green vegetable
•Drug sources : ferrous gluconate, ferrous
fumarate, ferrous sulfate
•A dose of 30mg elemental iron per day should be
enough for most woman
60-100 mg/day is given for large women, twin, and
those women who book for ANC late in pregnancy
 •Anemic woman should take 200 mg/day
•Iron requirements are increased only in the later
half of the pregnancy
•Insufficient iron in the diet leads to maternal iron
deficiency anemia.
*** Note: if iron and calcium are prescribed, they
should be taken 6-12 hours apart.
Sexual activity
•Sexual activity is allowed in moderation
•It’s to be avoided in pregnant women with
threatened abortion, preterm labor or APH
Travel
•Travel is allowed when comfortable
•Car safety belts have to be adjusted to be comfortable
for woman
•Those traveling more than three hours (either by car
or airplane) must take a break every 4 hours and walk
for about of minutes to decrease the risk of DVT
Weight gain (11-16 kg)
•Normal weight women should gain 11.5-15 kg
•Underweight women should gain 12.5-18 kg
•Obese women should gain no more than 7 kg
Baths
•Showers are preferable over tub baths to avoid falling
•Vaginal douches are not allowed
Immunization
Alarming Symptoms and signs
•Vaginal Bleeding
•Severe edema
•Escape of fluid from the vagina
•Abnormal gain or loss of weight
•Decrease or cessation of fetal movement
•Sever headache
•Epigastric pain
•Blurred vision
•Fever
•Abdominal pain
Conclusion
Antenatal care is an essential aspect of health care
delivery for improving pregnancy out come.
By this service we can detect high risk pregnancies and we
can direct them for proper management