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How to Do You Give a Complete Antenatal Care During Pregnancy ?

Updated on May 14, 2014
THE COMPLETE ANTENATAL CARE
THE COMPLETE ANTENATAL CARE | Source

Antenatal Care Definition :

DEFINITION :

Antenatal care consists of two components :

  1. Antenatal examination and monitoring.
  2. Health education on maternal and child health.

These two components of antenatal care forms a complete check up.Throughout pregnancy, there should be minimum 5 check ups for normal pregnancy and there should be minimum ten check ups for high risk pregnancy. You should start an antenatal care at an early months. It is compulsory for all pregnant women.

Check ups at normal pregnancy :

  • 10 weeks,
  • 18 weeks,
  • 24 weeks,
  • 30 weeks and 36 weeks.

Check ups at high risk pregnancy :

  • 10 weeks,
  • 18 weeks,
  • 24 weeks,
  • 28 weeks,
  • 30 weeks,
  • 32 weeks,
  • 34 weeks,
  • 36 weeks,
  • 38 weeks,
  • 39 weeks and 40 weeks.


Examination at First Check up :

  • PERSONAL HISTORY :

Name, address, age, gravida, parity and social history should be taken.

  • CONTRACEPTIVE HISTORY :

Any contraceptive device used should be clarified.

  • MENSTRUAL HISTORY :

First day of last menstrual period should be asked to calculate the estimated delivery date. Estimated delivery date is calculated by 9 calender months and 7 days to the first day of last menstrual period.

  • OBSTETRIC HISTORY :

Obstetric history should be asked to clear the history of previous pregnancy whether normal or caesarian delivery. To clear for any complications.

  • OTHER HISTORY :

Diet history, drug history, past medical history , surgical history, immunization history, allergic history and family history should be asked to clear.


GENERAL EXAMINATION :

  • Initially patients height,weight, abdominal examination, and vaginal examination should be done.
  • Next investigations like hemoglobin, random blood glucose, HbsAg, HIV, VDRL and blood grouping should be done.
  • Family history of coagulation disorders, diabetes and hypertension should be asked.
  • Most of the hemophilic carrier women are nowadays prone to postpartum heamorrhge. So complete coagulation work up is necessary for those hemophilic carrier pregnant women.
  • Glucose Tolerant Test should be done at 20th week to rule out gestational diabetes.
  • Pulse, blood pressure, and obstetric examination should be done thoroghly.

VAGINAL AND BIMANUAL EXAMINATION :

  1. If there is any early pregnancy loss or if there is any pregnancy complications, vaginal examination should be avoided.
  2. In normal pregnancy where there is no complications or early pregnancy loss or repeated pregnancy losses, vaginal examination can be done.

PROCEDURE FOR DOING VAGINAL AND BIMANUAL EXAMINATION:

  • Inspect the vulva, vaginal introitus on separating the labia by left hand.

Cuscos speculam is introduced to inspect the cervix for bluish discoloration.

  • women passes urine before vaginal examination.Legs drawn up on the edge of the table.

On separating the labia majora by left thumb, left index finger,right index and middle finger is lubricated with lignocaine jelly,fingers are gently introduced into vaginal canal to reach the cervix.

  • Left hand is placed on lower abdomen
  • Uterus is palpated for its enlarged size,softness and position,
  • vaginal fornices are palpated for any normal lump.


LABORATORY TESTS DONE AT 10TH AND 18TH WEEK :

  • Blood hemoglobin should be 10 gm %.
  • Second hemoglobin is necessary for the patients, where the hemoglobin level is below 9 % which is done at 32 weeks.
  • Blood group should be checked regularly to avoid rhesus incompatibility complications like Hydrops Foetalis.
  • Blood VDRL test to be done regularly.

CHECK UP AT 18th and 24th WEEK :

  • Pregnant lady should gain average weight of 1.5 kg for every four weeks.
  • The total weight gain should be 10 to 12 kilograms throughout pregnancy.
  • ANEMIA :

Anemia should be checked regularly till last trimester of pregnancy.

  • BLOOD PRESSURE :

Blood pressure should be checked carefully in supine posture.

  • Edema :

Edema should be looked for in ankle and legs.

 
MOTHERS WEIGHT GAIN
FOETAL WEIGHT GAIN
WEIGHT
5 KG
2.5KG
 
6KG
2.6KG
 
7KG
2.7KG
 
8KG
2.8KG
 
9KG
2.9KG
 
10KG
3KG

OBSTETRICS EXAMINATION :

INSPECTION :

  1. Uterine fundus :
  • At the level of 18th week , uterine fundus will be 4cm below the fundus.
  • At the level of 24th week the uterine fundus will be at the level of the umbilicus.
  • Lower two third distance between umbilicus and ensiform cartilage uterine fundus will be around 32 weeks.
  • Below the subcostal arch, uterine fundus will be around 36 weeks.
  • When it reaches subcostal arch, uterine fundus will be around 38 weeks.
  • At 40th week, it comes lower below 36th week but lies above 32nd week.

PALPATION :

  1. Usually the palpation of the uterine fundus is done by the left palm for measuring the fundus . Both the palms are used for palpating the fundal grip .For measuring the lateral grip, the abdomen is adjusted to come in the midline, then the left palm is touched little bit hard to palpate the left side of the abdomen and the same time right palm is felt on the right side of the abdomen to feel the irregular limb parts of the foetus present on the right side of the abdomen.
  2. Pelvic grip :

For the pelvic grip ,foetal head is gripped at the lower part of the pregnant uterus by outstretched right palm. If soft smooth rounded balloted structure is present , it indicates foetus head.If foetal head is present at the lower part,foetus is in cephalic presentation. If broad irregular nodules are present ,it indicates the foetus lower part of the back .If buttocks is present in lower part, it indicates the foetus is in breech presentation. If the foetus is positioned transverse , no foetal part is present at the lower part and the foetus is in transverse position,the foetus part will also be lying transversely.

AUSCULTATION :

  • Foetal heart sound can be heard by sthethoscope or pinard’s foetoscope at the side of foetal back.
  • Normal foetal heart rate : 120 – 140/min.
  • In breech presentation the foetal heart sound will be heard above the umbilicus.
  • In transverse presentation, the foetal heart sound will be heard at the level of the umbilicus.

Antenatal Advice to the Pregnant Women :

  • Food education should be given to the pregnant ladies during entire pregnancy.
  • Patient is advised to take 10 to 12 glasses of boiled and cooled drinking water.
  • Fried and spicy foods like samosa, cutlet,fried rice and pickles are avoided during pregnancy.
  • Two hours of afternoon nap is essential for the pregnant women to gain weight during entire pregnancy.
  • Women who go for work can come and take rest after coming from work. Eight hours of sleep is necessary for the pregnant women at nighttime.
  • Intake of iron and folicacid tablets is compulsory for the pregnant women in entire pregnancy.
  • Tetanus immunization is necessary in 18 and 24 weeks respectively.

Diet Chart for the Pregnant Women :

FOOD ITEMS
NONVEGETARIAN
VEGETARIAN
EARLY MORNING 6AM
1 cup tea or coffee, 2 biscuits ,
1 cup tea or coffee, 2 biscuits ,
BREAKFAST 8AM
2 piece of bread toast with butter, 1 cup vegetables, 1 egg, 1 cup of cereals or pulses, 1 cup of milk
2 piece of bread toast with butter, 1 cup vegetables, 1 egg, 1 cup of cereals or pulses, 1 cup of milk
LUNCH 12 PM
3 cups of boiled rice, 4 chappathi, 1 cup cereals , 1 cup dhal, 1 cup salads, 1 cup vegetables, 2 piece of fish curry, 1 cup curd.
3 cups of boiled rice, 4 chappathi, 1 cup cereals , 1 cup dhal, 1 cup salads, 1 cup vegetables, 1 cup of curd.
EVENING 4PM
1 cup tea or coffee, 2 biscuits, Mixed fruits of about 1 cup ( guava, banana,apple and pomegranate ) Fruit juices like sweet lime juice or orange juice.
1 cup tea or coffee, 2 biscuits, Mixed fruits of about 1 cup ( guava, banana,apple and pomegranate ) Fruit juices like sweet lime juice or orange juice.
NIGHT 8PM
3 cups of boiled rice, 4 chappathi, 1 cup cereals , 1 cup dhal, 1 cup salads, 1 cup vegetables, 2 pieces of fish curry,chicken curry,
3 cups of boiled rice, 4 chappathi, 1 cup cereals , 1 cup dhal, 1 cup salads, 1 cup vegetables,
AT BED TIME
Milk with sugar
Milk with sugar
DIET ADVICE FOR THE PREGNANT WOMEN
DIET ADVICE FOR THE PREGNANT WOMEN | Source
DIET CHART
DIET CHART | Source
FRUIT JUICES - MANDATORY FOR THE PREGNANT WOMEN
FRUIT JUICES - MANDATORY FOR THE PREGNANT WOMEN | Source

To Look for Danger Signs in Entire Pregnancy :

  1. Vaginal bleeding.
  2. Swelling of the face,legs and fingers.
  3. Continuous headache.
  4. Diminution of vision.
  5. Abdominal pain.
  6. Persisting fever, vomiting , difficulty in micturition.
  7. Vaginal discharge.
  8. Reduced or absence of foetal movememts.

General Care :

  • Light household work is permitted.
  • Daily exercise is advised for the pregnant women. Apart from that, walking in open air is mandatory in last three months of pregnancy.
  • Long travel is avoided in early 1st three months of pregnancy and last three months of pregnancy.
  • Hearing mild music, meditation and mild yoga like breathing exercises is necessary in last three months of pregnancy.
  • Sexual intercourse is avoided in first and last three months of pregnancy, since there is a risk of abortion in first trimester and abruptio placenta and placenta previa in last trimester.
  • Dangerous drugs are avoided during pregnancy. Medication should be taken only if prescribed by the gynecologist.

Source

CONCLUSION :

  • Finally by giving an extra, concerning and efficient antenatal care to the pregnant women, the uncomplicated normal pregnancy is ensured and the healthy normal baby is delivered by normal vaginal delivery as confidently as possible.
  • Apart from treatment pregnant women needs some concerning care, affection and motivation and boldness encouragement to normal delivery to happen.Please provide them all these including your treatment.
  • Your lovable care is essential for them to receive the entire antenatal care.




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