Documenti di Didattica
Documenti di Professioni
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Antenatal care
+Aims
The aims areTo
To
To
To
+
Aims (contd)
To discuss with the couple about the place, time and mode
of the delivery, provisionally and care of the newborn
Objectives
To ensure a normal pregnancy
with delivery of a healthy baby
from a healthy mother
Criteria of normal
pregnancy
Delivery of a single baby in
good condition at term with
no maternal complication
Services
2nd
3rd
visit at 32 weeks
4th
visit at 36 weeks
+Services
(contd)
GenerallyAt
At
At
+
Antenatal care comprises
of
+
THE FIRST VISIT
History
taking
Examination
Investigation
+History taking
1.
2.
3.
Past history
4.
Obstetric history
5.
Menstrual history
6.
Family history
7.
Drug History
8.
History of immunization
9.
Socio-economic history
10.
Contraceptive history
11.
History of allergy
status
5.Date
of Admission
6.Date
of Examination
duration
Period of amenorrhea
1.
2.
3.
4.
Constipation
5.
Heaviness of breast
6.
Rise of temperature
7.
Edema
8.
9.
Backache
10.
Vaginal bleeding
Past history
1.HTN
2.DM
3.BA
4.Renal
Disease
5.Psychiatric
illness
6.IHD
7.Any
previous operation
+
Obstetrical History
Duration
Gravida
Para
ALC
of marriage
Menstrual History
Age
of menarche
Menstrual
period
Menstrual
cycle
LMP
EDD
Family history
a)HTN
b)DM
c)Multiple
pregnancy
Drug History
Antihypertensive
Hypoglycemic
Antidepressant
Corticosteroid
Anticoagulant
Physical
examination
General
examination
Abdominal
examination
+General examination
+
General examination
(contd)
Temperature
Pulse
BP
RR
Breast
Heart sound
Lungs
Abdominal
examination
Inspection
Palpation
percussion
Auscultation
Inspection
Shape
of the uterus
Striae
scar
mark
+
Palpation
Assessment
of fundal height
Lie
Abdominal
girth
Fundal
grip
Lateral
grip
First
pelvic grip
Second
pelvic grip
Auscultation
Normal
Causes
b/m)
Causes
b/m)
Causes of foetal
tachycardia (>160
b/m)
1. Maternal
2. Foetal
high fever
distress
3. Maternal
tachycardia
Causes of foetal
bradycardia (<120
b/m)
1.
Foetal distress
2.
Investigation
CBC
Urine R/E
RBS
VDRL
HBS Ag
Ultrasound
Ultrasound
early pregnancy (preferably at 10-13 weeks) to:
Determine
Detect
Help
gestational age
multiple pregnancies
+Ultrasound (contd)
At 11-14 weeks:
offer nuchal translucency screening for Down's syndrome, with
other tests if available.
At 18-20 weeks:
offer screening with ultrasound for congenital anomalies.
At 36 weeks:
for foetal maturity, placenta praevia.
Patient complains
General examination
Identification of problem
Foetal movement
SFH measurement
Health education
measurement
+
Third visit (32 weeks)
Screen for1.Preeclampsia
2.Multiple
3.anemia
4.IUGR
pregnancy
of foetal
1.Lie
2.Presentation
3.Position
Update
birth plan
+Antenatal advice
Principles:
1.To
Diet
Bowel
Personal cleanliness
Dental care
Care of breast
Coitus
Travelling
Smoking &
alcohol
Immunization
Drug
Mental
preparation
Exercise
Child care
Birth plan
+Diet
Diet should be:
1.nutritious
2.balanced
3.light
4.easily
5.rich
6.with
digestible
pregnancy
Kilocalories
2500
Protein
60 gm.
Iron
40 mg
Folic acid
400 g
Calcium
1000 mg
Vitamin A
6000 I.U.
At
Hard
+Bowel
Regular
Coitus
Should be avoided in
1st trimester
last 6 weeks
+Travelling
Should be avoided in
1st
trimester
last
6 weeks
praevia
Preeclampsia
Severe
anemia
+Immunization
IndicatedTT
HAV
HBV
Rabies
ContraindicatedLive
Warning sign
1.
Headache
2.
Blurring of vision
3.
Convulsion
4.
Vaginal bleeding
5.
Fever
+Preconceptional
care