2. Objectives * Prevention, early detection and treatment of pregnancy related complications as pre-eclampsia, eclampsia and haemorrhage. * Prevention, early detection and treatment of medical disorders as anaemia and diabetes. * Detection of malpresentations, malpositions and disproportion that may influence the decision of labour. * Instruct the pregnant woman about hygiene, diet and warning symptoms. * Laboratory studies of parameters may affect the foetus as blood group, Rh typing, toxoplasmosis and syphilis. www.freelivedoctor.com
3. Frequency of antenatal visits >Every month during the first 6 months. >Every 2 weeks during the 7th and 8th months. >Every week during the last month. >More frequent visits are indicated in high risk pregnancy. www.freelivedoctor.com
4. The first visit * History. * Examination: general, abdominal and local. * Laboratory investigations: o Blood grouping. o Rh typing. o Haemoglobin. o Toxoplasma and / or VDRL if needed. o Urine analysis particularly for albumin and sugar. www.freelivedoctor.com
5. Return visits History: ask the patient about any complaint. Examination: o Blood pressure. o Weight. o Oedema. o Abdominal examination. Investigation: urine for albumin and sugar. www.freelivedoctor.com
7. Diet The daily requirements are: * Calories: 2500 Kcal. * Proteins: 60 gm. * Carbohydrates: 200- 400 gm. * Lipids: should be restricted. * Vitamins: o Vitamin A: 5000 IU. o Vitamin B1 (Thiamine): 1mg. o Vitamin B2 (Riboflavin): 1.5 mg. o Nicotinic acid: 15mg. o Ascorbic acid (vit. C): 50mg. o Vitamin D: 400 IU. o Folic acid: 0.5 mg. * Minerals: o Iron: 15 mg. o Calcium: 1000 mg. www.freelivedoctor.com
8. So the suggested daily diet should include: * One litre of milk or its derivatives, * 1-2 eggs, * fresh vegetables and fruits. * 2 pieces of red meat replaced once weekly by sea fish and once by calf ’s liver. * Cereals and bread are recommended also. Coffee and tea: should be restricted. www.freelivedoctor.com
9. Smoking: should be avoided as it may cause intrauterine growth retardation or premature labour. Rest and sleep: 2 hours in the midday and 8 hours at night. Exercises: violent exercises as diving and water sports should be avoided. House work short of fatigue and walking are encouraged. www.freelivedoctor.com
10. Clothing * Lighter and looser clothes of non synthetic materials are more comfortable due to increased BMR and sweating. * Clothes which hang from the shoulders are more comfortable than that requiring waste bands. *Breast support is required. * Avoid tight elastic hosiery or its bands. www.freelivedoctor.com
11. Bathing: Shower bathing is preferable than tube or sea bathing for fear of ascending infection. Vaginal douching should be avoided. www.freelivedoctor.com
12. Shoes: High - heeled shoes should be discouraged as they increase lumbar lordosis, back strain and risk of falling. www.freelivedoctor.com
13. Breasts: to reduce the incidence of retracted and/ or cracked nipples postpartum, the patient is instructed to massage them with a mixture of glycerine and alcohol during the last 6 weeks of pregnancy. www.freelivedoctor.com
14. Bowels: Constipation is avoided by increasing vegetables, fluids and milk intake and mild exercise. Liquid paraffin should not be used for long period as it interferes with absorption of fat- soluble vitamins (A and D). www.freelivedoctor.com
15. Coitus: Whenever abortion or preterm labour is a threat, coitus should be avoided. Otherwise, it is allowed with less frequency and violence. Some obstetricians advise abstinence in the last 4 weeksof pregnancy for fear of ascending infection. www.freelivedoctor.com
16. Travelling: long and tiring journeys should be avoided particularly ifthe woman is prone to abortion or preterm labour. Flying is not contraindicated but not the long ones and near term. www.freelivedoctor.com
17. Medications: not to be taken without obstetrician advice due to risk of teratogenicity www.freelivedoctor.com
18. Exposure to infections: is to be avoided particularly those of documented teratogenicity e.g. rubella, cytomegalovirus, herpes hominis and varicella zoster viruses. www.freelivedoctor.com
19. Exposure to irradiation: is to be avoided whether diagnostic or therapeutic. www.freelivedoctor.com
20. The warning symptoms: which indicate immediate contact to the obstetrician are: * vaginal bleeding, * gush of fluid per vagina, * abdominal pain, * persistent headache, * blurring of vision, * oedema of lower limbs or face, * persistent vomiting. www.freelivedoctor.com
