ANTENATAL CARE

DR. V. L. DESHMUKH

AIMS OF ANC

• Assesment of maternal risk• Assesment of fetal risk

• Detection of anamolies• Detection &mgt of perinatal complications• Immunisation & drugs• Timing &mode of delivery• Education –labor,bf,mental preparation

AIMS

• Advice –contraception• Advice-diet,travel, rest• Visit schedule• Monitoring &ongoing care Advice

BOOKED

• ATLEAST 3 ANC VISITS

• ADVANTAGES– LBW– PT LABOR– PNM & MORTALITY– MATERNAL MORTALITY – ANAEMIA

PROVIDERS

• ALL DR

• ANM

• MIDWIFES

• HIGH RISK CASES

• REFER TO HIGHER CENTRES

SCHEDULE

• 1 TO 7 MONTH-ONCE A MONTH

• 8th MONTH-EVERY 15 DAYS

• 9th MONTH-EVERY 8 DAYS

• HIGH RISK PREG-FREQUENT VISITS

• ADMISSION

PRECONCEPTION VISIT

• IDEAL• PLANNED PREGNANCY• ASSES WELL BEING• HIV,HEPATITIS, RUBELLAFOLIC

ACID• AVOID DRUGS, VITA-TERATOGEN• DM-STRICT CONTROL OF BLOOD

SUGAR

FIRST TRIMESTER

• OVERDUE

• UPT

• TVS –SINGLE/TWIN

• CONFIRMATION OF PREG-IU/EXTRAU

• VIABLE /NONVIABLE

• FOLIC ACID

1 TRI

• ADVICE-REPORT IF THERE IS

• Bldg p/v

• Pain in abd

• Excessive nausea, vomitting

• Love tender care

• Previos losses-progesteron, bedrest,aspirin

1 tri

• Investigations

• HB%,PCV,

• URINE-MICRO

• PPTCT

• BLOOD GROUP,VDRL

• HEPATITIS/RUBELLA(IF NEEDED)

SECOND TRIMESTER

• BOOKED-ANC CARD

• WT/HT/BP

• SCAN-ANAMOLIES-NT,

–PLACENTAL LOCAL-LOW LYING

–CX LENGTH

–GES AGE

SECOND TRIMESTER

• INV-HB%,URINE-A,S,M• START-TAB FS-200MG/D,TAB FA 1MGM/D, TAB

CAL1GM/D• DIET-FRUITS, VEG,EGGS,MEAT, FISH,LOT OF

FLUIDS,MILK• NEXT VISIT/• SECOND TRI• EMOTIONAL SUPPORT• PROMOTION OFGOOD HEALTH HABITS• ALLAYING ANXIETY• MENTAL PREPATION FOR LABOR• REDUCE THE INC OF LBW &PTL• INCREASED COMPLIANCE-GOOD RESULTS

THIRD TRIMESTER

• FREQUENT VISITS

• WT GAIN-11KG

• SYM-FUNDAL HT

• USG-PL MIGRATION, CX LENGTH LESS THAN 25 MM,IUGR,AFI

• CHECK THE DRUGS

• TELL HER EDD CLEARLY

THIRD TRIMESTER

• 36 WEEKS-PRIMI-PELVIS ASSESMENT

• RULE OUT MALPRESENTATION

• DISCUSS CONTRACEPTION

• TELL HER IMPORTANCE OF BREAST FEEDING

• S/S OF LABOR

POSTDATE

• CROSSES HER EDD

• ADMIT

• REASSES HER DATES

• CONFIRM GES AGE

• INDUCE LABOR

HIGH RISK

• AGE-18/40

• GRAND MULTY

• INFERTILITY

• MARRIED STATUS

• EDUCATION

• RURAL/URBAN

• JOB

HIGH RISK

• PAST HISTORY• DM,HT,HEART DS, BLDG DISORDERS

• STILLBIRTH,ANAMOLOUS BABY,MACROSOMIA,PIH, PTL, BOH, PREV LSCS,IUGR BABY,CX ENCERCLAGE,MRP,3rd DEGREE TEAR, PROLONGED LABOR,PPT LABOR

HIGH RISK

• BOOKING-HT 5’ OR LESS

• WT-<45KG/>90 KG

• BP->140/90

• PROTEINURIA

• HT INCONSISTENT WITH DATES

• HIGH RISK-ATTENTION

ASSESMENT OF RISK

• AGE-TEEN-IUGR, PTL CPD , ANAEMIA

• ELDERLY-ABORTIONS,ANAMOLIES,HT, DM, FIBROID

• GES AGE-NAGELES RULE –9 MONTHS +7 DAYS

• SUBSTRACT 3 MONTHS.ADD 7 DAYS

ASSES---

• DISPARITY EXISTS-DATING USG

• RULE OUT-TWINS,FIBROID, V MOLE,

• WRONG DATES,FULL BLADDER

• HT IS LESS

• WRONG DATES, IUGR, IUFD, OLIGOHYDRAMNIONS

ASSES---

• OC PILLS

• REG OF CYCLE

• GRAVIDA, PARA

• ABORTION

• ASSO OVARIAN MASS, FIBROID

• POTENTIAL DIABETIC

ASSES---

• HT/WT

• RS/CVS

• FAILURE TO GAIN WT IN 2 VISITS

• PALLOR GRADES OF ANAEMIA

• MILD, MOD, SEVERE

• EDEMA FEET

ASSES---

• 28 WEEKS-BL SUGAR

• PPTCT

• RH NEG

• TENDANCY FOR PTL

• IUGR

• PIH

• PLACENTAL PROBLEMS

WARNING SYMPTOMS

• BLDG P/V• ABD PAIN

• LEAKING• HEADACHE,UNWELL• FM-LESS• CONVULSIONS• BACHACHE/HEAVINESS LOWER ABD

CASE

• XWZ,42YR,100 KG

• TWINS

• ANAEMIC

• PLAN OUT HER PREG

• ASSES THE RISK FACTORS HIGH RISK

• AGE-HT,DM,ANAMOLOUS BABY

• WT-

• TWINS-PIH, PTL,

• 1 TRI-DATING SCAN

• FA,

• CHORIONICITY

• DIET HIGH RISK

• 2nD TRI

• FS/FA/CAL

• DIET

• ANAMOLY SCAN

• EMOTIONAL SUPPORT

• FREQUENT VISITS

• W/F ANY OTHER PROBLEM

• 3rd TRI

• USG

• BL-SUGAR

• TENDANCY FOR PTL

• PLAN HER DELIVERY