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ANTEPARTUM Care

Definition

The antepartum or pre-natal period starts when the woman’s pregnancy is diagnosed and ends just before
the baby is delivered. Antepartum care promotes patient education and provides ongoing risk assessment
and development of an individualized patient management plan. The major goal of prenatal care is not only
to ensure that a healthy baby is born but also to promote the optimum health for the mother.

The following are the goals of antepartum care:

• To evaluate the health status of the mother and the fetus

• To estimate the gestational age
• To identify the patient at risk for complications
• To anticipate problems before they occur and prevent them if possible.
• To promote patient education and communication

Diagnosis of pregnancy

• Commercial kits are available for the diagnosis of pregnancy, all of which depend on detection of
human chorionic gonadotropin (hCG) by an antibody. The various techniques used to detect hCG
include agglutination inhibition, radioimmunoassay, enzyme-linked immunosorbent assay, and
immunochromatography. Some tests can detect hCG at levels as low as 25 mlU/mL or as early as 1
week after implantation.
• Home tests have relatively high positive predictive values. Some of these tests, however, may have
high rates of false-negative results.

Estimating Gestational Age

Age of gestation (AOG) should be estimated to calculate the exact date of delivery and the estimated
weight and height of the fetus. The following are some estimates of AOG methods:

• Nagele’s Rule
• McDonald’s Method
• Bartholomew’s Rule
• Haase’s Rule
• Johnson’s Rule

Identifying Patient at Risk for Complications

Risk Factors • Cigarette smoking • Preterm labor (34-37 weeks)

• Age < 16 or > 35
• 2 spontaneous or induced
abortions
• < 8th grade education
• > 5 deliveries
• Abnormal presentation
• Active TB
• Anemia (Hgb <10, Hct <30%)
• Chronic pulmonary disease
• Endocrinopathy
• Epilepsy
• Heart disease class I or II
• Infants > 4,000 gm
• Isoimmunization (ABO)
• Multiple pregnancy (at term)
• Poor weight gain
• Post-term pregnancy
• Pregnancy without family
support
• Previous hemorrhage
• Previous pre-eclampsia
• Previous preterm or SGA infant
• Pyelonephritis
• Rh negative
• Second pregnancy in 9 months
• Small pelvis
• Thrombophlebitis
• Uterine scar or malformation
• Venereal disease
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ANTEPARTUM Care

Promoting Patient Education

Since the goal of antepartum care is to help achieve a maternal and infant outcome as much as possible, this
means that psychosocial issues as well as biological issues needs to be addressed. One of the major
components of pre-natal care is HEALTH TEACHING. The following are some important health teaching
during the antepartum period.

• Nutrition. This is the most important aspect of health teaching.

Nutritional Risk Factors during pregnancy:

1. Teenagers or adolescent
2. Follow food fads
3. Underweight or overweight
4. Low income women
5. Short interval between pregnancies
6. Drug use (including cigarettes and alcohol)
7. Existence of a chronic illness requiring a special diet
8. Lactose intolerance
9. Multiple pregnancy
10. Anemic at conception

Weight gain. The recommended average weight gain in pregnancy is 11.2 to 15.9 kg or 25-35 lbs. Weight
gain in pregnancy occurs at approximately 1 lb per month during the first trimester and then 1 lb per week
during the last two trimesters. For a more accurate estimation of adequate weight gain, computation of
body mass index (BMI) can be done. To calculate for BMI, refer at the box below. The following are the
normal prepregnancy BMI:

• Underweight – under 18.5

• Normal weight – 18.5 – 24.9
• Overweight – 25 – 29.9
• Obese – above 30

Calculating the Body Mass Index (BMI) Example: Mrs. White is 5’4” tall and
weighs 130 lbs. To determine her BMI:
• Convert weight into kilograms. 130 / 2.2 = 59 kg
(divide weight in pounds by 2.2)
• Convert height into centimeters. 5 x 12 = 60 + 4 = 64 inches (foot to inches)
(multiply height in inches by 2.5) 64 inches x 2.5 = 160 cm (inches to cm)
• Convert centimeters into meters. 160 / 100 = 1.6 meters
(divide result by 100)
• Square height in meters. 1.6 x 1.6 = 2.56
• Divide weight in kilograms by 59 / 2.56 = 23 BMI
height in meters squared.
Interpretation of Result:
23 BMI = Normal Weight, thus, Mrs. White enters pregnancy at normal weight.
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ANTEPARTUM Care

• Calorie needs. The easiest way for determining a woman’s caloric intake is assessing the weight she
is gaining. The pattern of weight gain is as important as the total weight gain.
• Protein needs. The daily recommended intake in women is 44 to 50 grams. During pregnancy, the
need for protein increases to 60 g daily. Foods rich in protein are meats, fish, eggs, milk, poultry,
cheese, beans and monggo.

• Vitamin needs.
• Vitamin A – Vitamin A supplement. Foods rich in Vitamin A are eggs, carrots, squash, and all
green and leafy vegetables.
• Vitamin D – Vitamin D supplement. Foods rich in Vitamin D are fish, liver, eggs, milk. Excess
Vitamin D during pregnancy can lead to fetal cardiac problem.
• Vitamin E – sources are green leafy vegetables and fish
• Vitamin B – food sources are same as the foods rich in protein
• Iron – the DRI for iron for pregnant women is 30 mg. Sources: liver and other internal organs,
camote tops, kangkong, egg yolk, ampalaya
• Foods to AVOID in pregnancy
• Foods with caffeine
• Artificial sweeteners
• Weight loss diets
• Smoking. Cigarette smoking causes vasoconstriction which leads to low birth weight infants and
has been a risk factors for some complications during pregnancy. Thus, it is contraindicated during
pregnancy.

• Drugs. Teratogenic drugs can cause congenital defects to the fetus, hence, they are contraindicated
unless prescribed by the physician. The following are medications that are contraindicated during
pregnancy:

1. Thalidomide – can cause Amelia or Phocomelia

2. Steroids – can cause cleft palate and abortion
3. Iodides – can cause enlargement of the fetal thyroid gland leading to tracheal decompression and
dyspnea at birth. Iodides are contained in many OTC cough suppressants.
4. Vitamin K – can cause hemolysis and hyperbilirubinemia
5. Aspirin and Phenobarbital – can cause bleeding disorders and tendencies
6. Streptomycin and Quinine – can cause damage to the 8th cranial nerve
7. Tetracycline – can cause staining of tooth enamel and inhibits growth of long bones.

• Sexual Activity. During the first trimester, there is a decrease in sexual desire as the woman is more
preoccupied with the changes in her body. However, during the second trimester, there is an
improvement in the sexual desire as the woman has already adapted to the growing fetus. During
the third trimester, a decrease in sexual desire is noted as the woman is afraid of hurting the
fetus.Sex in moderation is permitted during pregnancy.

1. During the last 6 weeks of pregnancy, sexual activity is not advised as it has been noted that there is
increased evidence of postpartum infection on women who engage in sex during the last 6 weeks.
2. Sex is contraindicated in the following situations:

• Spotting or bleeding
• Incompetent cervical os
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ANTEPARTUM Care

• Ruptured BOW
• Deeply engaged presenting part

• Employment. As long as the job does not entail handling toxic substances or lifting heavy objects
or excessive physical and emotional strain, there is no contraindication to working. It is important
for the nurse to advise the pregnant woman to walk about every few hours of working long periods
of standing or sitting to promote circulation.
• Traveling. There are no travel restrictions during pregnancy. However, trips should be postponed
on the last trimester of pregnancy. On long trips, it is advisable to allot about 15-20 minute of rest
period every 2-3 hours to walk about or empty the bladder.
• Exercises. The goal of prenatal exercises is to strengthen the muscle that will be used in labor and
delivery. Exercise should be done in moderation. Recommend that moderate exercise should be
done 30 or more minutes daily. Exercises where there is a risk of falling or abdominal trauma
should be avoided. Adequate fluid intake before and after exercise should be practiced by the
pregnant woman. The pregnant woman should stop the exercise and seek medical advice if she
experiences the following:

1. Chest pain
2. Dizziness
3. Headache
4. Decreased fetal movement
5. Signs of labor

Recommended Exercises during pregnancy:

1. Squatting and tailor sitting

2. Pelvic rock
3. Modified knee-chest position
4. Shoulder circling
5. Walking
6. Kegel’s exercise

• Tetanus Immunization. Tetanus Immunization should be given to pregnant women.

• Bathing. Daily baths protects pregnant women from infections that may develop if bacteria
normally present on the skin are allowed to remain and multiply. Advise the pregnant woman to use
nonskid pads in the tub or shower especially during the last trimester, when her balance is altered by
a changing center of gravity and she is prone to falls.
• Hot tubs and Sauna. Caution the woman not to be in sauna for more than 15 minutes or a hot tub
for more than 10 minutes and to keep her head and chest out of water. Maternal hyperthermia,
particularly during the first trimester may be associated with fetal anomalies.
• Douching. Despite increased vaginal discharge, douching is unnecessary before, during or after
pregnancy.
• Breast care. Instruct the expectant mother to avoid using soap on her nipples because it removes
the natural lubricant that forms on the nipples. Advise her to wear bra that fits well and supports her
breasts to prevent loss of muscle tone that can occur as the breast becomes heavier during
pregnancy.
• Alcohol. Alcohol is a known teratogen and maternal alcohol use is a leading cause of mental
retardation.
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ANTEPARTUM Care