comprehensive health supervision of a pregnant woman before delivery Or it is planned examination, observation and guidance given to the pregnant

woman from conception till the time of labor.

 To reduce maternal and perinatal mortality and morbidity rates To improve the physical and mental health of women and children

 To ensure that the pregnant woman and her fetus are in the best possible health. To detect early and treat properly complications

Offering education for parenthood

To prepare the woman for labor, lactation and care of her infant

The first visit or initial visit should be made as early is pregnancy as possible. Return Visits: Once every month till 7th month. Once every 2 weeks till the 9th month Once every week during the 9th month, till labor.

Assessment

History

Examination

Investigation

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

Fundal height Maternal weight Blood pressure measurements Fetal heart auscultation Urine testing for protein and glucose Questions about fetal movement Evidence supporting these practices is variable

 Obesity (more than 20 kg above the weight-height formula) leads to an increased risk of gestational diabetes, pregnancy-induced hypertension and Thromboembolic disorders

Measured from pubic symphysis to uterine fundus

Should measure +/- 2 cm compared to weeks gestation

 Urine should be tested for sugar, ketenes' and protein.

Hemoglobin will be repeated: At 36 weeks of gestation. Every 4 weeks if Hb is < 9 g/dl.

Contraindicated
measles mumps rubella yellow fever

Case Dependent

polio influenza rabies hepatitis A/B pneumococcal tetanus toxoid

 The pregnant woman reports at least 10 movements in 12 hours.

Absence of fetal movements precedes intrauterine fetal death by 48 hours.

 Physiological changes during pregnancy Weight gain Fresh air and sunshine Rest and sleep Diet Daily activities Exercises and relaxation Hygiene Teeth Bladder and bowel Sexual counseling

Smoking : Medications Infection Irradiation Occupational and environmental hazards Travel Follow up Minor discomforts Signs of Potential Complications

 Pregnant woman should avoid contact with infectious diseases especially rubella or (German measles) because it has deleterious effects on the fetus Pregnant woman should avoid exposure to x-ray or irradiation because of possible teratogenic effects on the fetus such as birth defects or childhood leukemia

Urinary frequency

RELIEF MEASURES:
Decrease fluid intake at night. Maintain fluid intake during day. Void when feel the urge.

RELIEF MEASURES: Rest frequency. Go to bed earlier.

RELIEF MEASURES: Wear a good supporting bra. Assess for other conditions.

ETIOLGY: Elevated estrogen levels RELIEF MEASURES :

Avoid decongestants. Use humidifiers, and normal saline drops.

RELIEF MEASURES:

Eat small, more frequent meals.

Use antacids. Avoid overeating and spicy foods.

Avoid standing for

long periods.
Elevate legs when laying or sitting. Avoid tight stockings.

 Rest in sims' position. Elevate legs regularly. Avoid crossing legs. Avoid tight stockings. Avoid long periods of standing

RELIEF MEASURES: Maintain regular bowel habits. Use prescribed stool softeners. Apply topical or anesthetic ointments to area.

RELIEF MEASURES: Maintain regular bowel habits. Increase fiber in diet. Increase fluids. Find iron preparation that is least constipating

RELIEF MEASURES:
Take a daily bath or shower. Wear cotton underwear.

RELIEF MEASURES: Wear shoes with low heels.

Walk with pelvis tilted forward.

Use firmer mattress.

RELIEF MEASURES:
Rise slowly from sitting to standing. Evaluate hemoglobin and Hematocrit. Avoid hot environments

Mother Ambivalence Acceptance Introversion Mood swings Changes in body image

Siblings Sibling rivalry Regression GRANDPARENTS Unsure of their role Support resource

Father Ambivalence about being a parent. Concern of moving into a parenting role. Stress due to financial issues, changing relationship with partner, his role in the pregnancy. Concern about their ability to parent. May exhibit signs or symptoms related to the pregnancy.

 Sudden gush of fluid from vagina Vaginal bleeding Abdominal pain Temperature and chills Dizziness, blurring of vision

Persistent vomiting Severe headache Edema of hands, feet, face and legs Muscular irritability, convulsions Epigastric pain Oliguria, Dysuria Absence of fetal movement

thanks