Antenatal Care and Check up

Antenatal Care and Check-up

Definition:- 

Systematic supervision of a woman during pregnancy is called antenatal or prenatal care. The antenatal care should start from the beginning of pregnancy and end at delivery.

Aim:- 

• Screening of high risk pregnancy.
• Medical complication and its management.
• Educate the mother about physiology and labour.
• Planing with the couple about time, place and mode of delivery.
• Motivation about family planing.

Objective:-

Normal pregnancy with delivery of a healthy baby from a healthy mother. 

Delivery between 38-40 weeks.

Foetal weight >2.5 kg.

Number of visits for ANC:-

Earlier Four-visit focused ANC (FANC) model was recommended. FANC was established in 1990 by World Health Organization (WHO).

According to recent WHO recommendation, 28 March 2018.

Minimum eight ANC visits/contacts are recommended to reduce perinatal mortality and improve women's experience of care.

It recommends pregnant women to have their first contact in the first 12 weeks of gestation, with subsequent contacts taking place at 20, 26, 30, 34,36,38 and 40 weeks of gestation.

History of mother:-

General history of couple.

Menstrual history to calculate the expected date of delivery ( EDD). 

Obstetrical history of mother about previous deliveries.

Examination of mother:-

General Examination:-

weight               :

height                :

Build                 : Obese or Average or Thin

Blood pressure  : Average 120/80 mm Hg.

pulse                 : Average 72 beats per minute

Systemic Examination:-

Chest:-             Lungs, Heart

Breast:-            Nipples, Condition of areola ( area around nipple).

Abdomen:-      Liver, Spleen, kidneys, and most important is fundal height mesurement for the                                     estimation of gestational age of foetus

Investigation:-

Routine Investigations:- 

Examination of blood:  

• Haemoglobin estimation to asses the anaemia.
• Total and Differential Count to asses any infection.
• Blood Group: ABO and Rh factor.
• Random Blood sugar

Examination of urine:

• Protein
• Sugar
• Pus cells
• Red blood cells

Special Investigation:-

Serological tests:-

for-

• Rubella, Toxoplasmosis, Cytomegalovirus, Herpes simplex virus ( ToRCH).
• Hepatitis viruses- Hepatitis B, Hepatitis C, Hepatitis E
• HIV
• VDRL for syphilis
• Maternal Serum Alpha Feto Protein (MSAFP) for foetal neural tube defect, Down's syndrome, other chromosomal anomalies.

Radiological Examinations:-

X-ray is not safe during the pregnancy.

Ultrasonography:- As far as is known it is safe, however it should be used only when there is a good clinical reason.

1.First trimester Scan , up to 12 weeks of gestation:

                                           Two methods are used in first trimester Scan

• Very early pregnancy by trans vaginal scan ( TVS ), in which trans-vaginal probe is used.
• Early pregnancy by trans abdominal scan ( TAS ), in which curvilinear probe is used.                

    Importance of first trimester utrasonography are:

• Early detection Pregnancy, whether it is intrauterine or extra uterine.
• Accurate dating
• Number of foetuses
• Gross foetal anomalies like anencephaly.
• Any uterine, ovarian or adnexal pathology

2. Second trimester scan, between 13 to 28 weeks of gestation:

      Importance of second trimester ultrasonography are:

• In addition to importance of first trimester scan
• Structural foetal anomalies
• Localization of placenta

3. Third trimester scan, above 29 weeks of gestation:

 Importance of third trimester ultrasonography are:

• In addition to importance of second trimester scan
•  Lie, presentation and position of foetus
• Intrauterine growth retardation of foetus
• Amniotic fluid volume assessment

Management:-

Diet:-

During pregnancy diet should be increased and adequate to provide maintenance of foetus and mother health. Iron, Folic acid and calcium should specially be added in diet. Adequate liquid food, fruit juice is very nessesary for the maintenace of liqure. Plenty of water is needed in day time. Daily dietary requirement is increased during the pregnancy. Calorie requirement is increased +300 k Cal . Protein requirement is increased +15grams. 

Antenatal Hygiene:-

Adequate rest , sleep is required. Bathing,clothing, no smoking, no alcohol is mandatory.

Immunisation:-  

Against tetanus

Treatment:- 

Specific treatment should be needed according to the minor and major ailments during the pregnancy period. 
Minor ailments like common cold, lower abdomen pain, low back pain, weakness, malaise, egigastric discomfort, dyspepsia, dehydration etc.
Major ailments 1. Medical diseases like Gestational diabetes mellitus, any heart problem, lungs disease, anaemia, thyroid dysfunction, jaundice viral diseases, urinary tract infection etc
                            2.Surgical diseases like Cervical incompetence, acute appendicitis, uterine fibroid, ovarian diseases etc.

References

- Text Book of Obstetrics 5th edition 2001 by D. C Dtta, M.B.B.S., D.G.O., M.O.

- Manual of diagnostic ultrasound, New Millennium Edition, WHO, Geneva 2007 

    edited by P.E.S. Palmer

- www.who.int