Antenatal care refers to the care provided to an expectant mother from conception until the start of labor. It aims to ensure the health of the mother and delivery of a healthy infant by detecting and preventing complications through scheduled visits. During visits, the patient's history, physical exam, and tests are conducted to monitor weight, blood pressure, fetal growth and check for signs of issues. Education is also provided on nutrition, self-care, birth planning and danger signs.

2. ANTENATAL CARE

3. DEFINITION
Antenatal care refers to the care that
is given to an expected mother from
time of conception is confirmed
until the beginning of labor
It is a preventative cost effective
service

4. GOALS
1-Ensure mother health.
2- Ensure delivery of a healthy infant.
3-Anticipate problem
4- Diagnose problem early.

5. OBJECTIVES
1-Early detection and if possible, prevention of
complications of pregnancy.
2-Educate women on danger and emergency signs &
symptoms.
3-Prepare the woman and her family for childbirth
4- Give education & counseling on
family planning

6. SCHEDUAL OF ANTENATAL CARE:
Medical check up every four weeks up to 28
weeks gestation
Every 2 weeks until 36 weeks of gestation
Every week until delivery
An average 7-11 antenatal visits/pregnancy
More frequent visits may be required if
complications arise.

7. ON FIRST ANTENATAL VISIT
1-First : Confirm pregnancy by pregnancy test or
US.
2-History
3-Physical examination
4-investigation

8. HISTORY
Personal history
Menstrual history
Obstetrical history
Family history
Medical and surgical history
History of present pregnancy

9. MENSTRUAL HISTORY
- Ask about
- 1-Last menstrual period (LMP).
- 2-Regularity and frequency of menstrual cycle.
- 3-Contraception method used .
- 4-Calculate expected date of delivery (EDD) as
1st day of LMP −3 months +7 days, and change
the year.

10. OBSTETRIC HISTORY
Gravidity? Parity? abortion, and living
children.
Weight of infant at birth & length of
gestation.
Type of delivery, location of birth, and
type of anesthesia.
Maternal or infant complications.

11. 1-Chronic conditions : as diabetes mellitus, hypertension, and renal disease ,cardiac
disease.
2-Prior operation: as cesarean section, genital repair, and cervical cerclag.
3-Allergies, and medications.
4-Accidents involving injury of the bony pelvis
MEDICAL AND SURGICAL HISTORY:

12. HISTORY OF PRESENT PREGNANCY
History suggesting e.g. Diabetes, hypertension
and ante partum hemorrhage.
Ask about episodes of fever or chills
Ask about pain or burning sensation on urination.
Abnormal vaginal discharge, itching at the vulva or
if partner has a urinary problem.

13. IMMEDIATE ASSESSMENT
FOR EMERGENCY SIGNS.
Vaginal bleeding
Severe abdominal or pelvic pain
Severe headache with visual disturbance
Persistent vomiting
Unconscious/Convulsion
Severe difficulty in breathing
High grade Fever
Looks very ill

14. ASSESSMENT AND PHYSICAL
EXAMINATION

15. WEIGHT MEASUREMENT
Maternal height and weight measurements to
determine body mass index(BMI).
Maternal weight should be
measured at each
antenatal visit

16. CHECK FOR PALLOR OR ANEMIA.
1-Look for palmar pallor.
2-Look for conjunctival pallor
3-Count respiratory rate in
one minute.

17. BLOOD PRESSURE MEASUREMENT
Measure BP in sitting position.
If diastolic BP is 90 mm Hg or
higher repeat measurement after
6 hour rest.
If diastolic BP is still 90 mm Hg or
higher ask the woman if she has:
• Severe headache
• Blurred vision
• Epigastric pain
Check urine for protein.

18. Get baseline on the first or following the first visit.
Hemoglobin, blood type
Urine analysis
VDRL or RPR to screen for syphilis
Hepatitis B surface antigen To
detect carrier status or active
disease
Investigations

19. AT EACH VISIT

20. AT EACH VISIT
1-Questions about fetal movement
2-Ask for danger signs during this pregnancy
3-Ask patient if she has any other concerns

21. SYMPHYSIS FUNDAL HIEGHT
• LMP plus 280 days
• Add 7 days,
subtract 3 months
• MacDonald's Rule
(cm = weeks)

22. At third trimester
Do
Leopold’s exam

23. Provide advice on
1.Diet and weight gain
2.Medication
3.Avoid Radiation exposure
4.Self-care during pregnancy
5.Minor complaints.
6.Family planning Breastfeeding
7.Birth place preparation and anticipation of
complication& Emergency situations.

24. DIET IN PREGNANCY:
 Total caloric intake increase to 300 kcal /day due to 15% increase in BMR .
 Diet show contain 20%Protein(better from animal source), 30% fat ,and 50%
carbohydrates .
 Sufficient fluids should be available.

25. SUPPLEMENTATION
1-Folic acid 0.4 mg tab daily
2- iron (ferrous sulphate or gluconate )300 mg/daily
3- Ca 1200mg /daily
4-
• -Those with a normal balanced diet
• probably don’t need extra vitamins

26. WEIGHT GAIN IN PREGNANCY:
There is a slight loss of pounds during early pregnancy if the patient experiences
much nausea and vomiting.
Weight gain of 2 to 4 lbs(0,5-1 kg) by the end of the first trimester.
Gain of 1 lb(0.5)/ per wk is expected during the second and third trimesters.
Monitoring of weight gain should be done in conjunction with close monitoring of BP.

27. MEDICATIONS DURING PREGNANCY
• Antibiotics - some OK, some not
• Local anesthetics - OK
• Local with epinephrine - not OK
• Aspirin - not OK
• Immunizations - some are OK,
some are not
• Antimalarial - some OK, some
are not
• Narcotics - OK except for
addiction issue