Prenatal Care

1. Mrs.Mahdia Samaha Kony Prenatal Care

2. Definition • Ante partal or prenatal care refers to the medical and nursing supervision and care given to the pregnant woman during the period between conception and the onset of labor. Mrs.Mahdia Samaha Kony

3. Aims of antenatal care (1) Prevention of complication. (2) Modification of those complications that may develop. (3) Support of the patient's goal to carry the infant to term and deliver a healthy baby. (4) Education of the mother-to-be and her family for the parenting role. (5) Inclusion of the family as a whole in the concept of "family-centered maternity care." Mrs.Mahdia Samaha Kony

4. Health Care Professionals (1) Physicians. They are primarily involved in diagnosing normal and abnormal conditions associated with the childbearing cycle. (2) Nursing personnel. Nursing personnel serves as teachers, counselors, and resource personnel. They have the responsibility to develop and implement nursing care plans. (3) Others: (a) Dietitians. (b) Laboratory technicians. (c) Social services. (d) Occupational therapists. (e) Similar support personnel. Mrs.Mahdia Samaha Kony

5. Choice of Health Care Professionals • The pregnant woman is responsible to choose the type of individual she prefers to consult for prenatal supervision and care. • She may choose a private obstetrician, family practice physician, clinic with no control over which physician provides the care, or a nurse midwife. • The primary concern is whether the individual she chooses meets her goals, desires, and expectations. Mrs.Mahdia Samaha Kony

6. Early Care. Early, competent care is essential for the patient to avoid unnecessary risks to herself and her fetus. Mrs.Mahdia Samaha Kony

7. Components of prenatal care: • Confirming the diagnosis of pregnancy and establishing the estimated gestational age. • Obtaining a full history and conducting a physical examination with laboratory evaluation. • Conducting regular periodic examinations with ongoing patient education. • Meeting routine health care needs over the length of the pregnancy, solving acute medical problems, and identifying and addressing pregnancy complications. Mrs.Mahdia Samaha Kony

8. 1) CONFIRMING PREGNANCY The signs and symptoms of pregnancy are: • Presumptive signs lead a woman to believe that she is pregnant. • Probable signs are highly suggestive of the diagnosis of pregnancy. • Positive signs of pregnancy: ascertain the presence of pregnancy. Mrs.Mahdia Samaha Kony

9. Presumptive signs and symptoms a) Amenorrhoea: 4+ weeks • Following imlpantation of the fertilized ovum the endometrium undergoes decidual change and menstruation does not occur throughout pregnancy. • Amenorrhoea almost invariably accompanies pregnancy and in sexually active woman, who has previously menstruated regularly, should be considered to be due to pregnancy unless this is disproved. Mrs.Mahdia Samaha Kony

10. Presumptive signs and symptoms b) Nausea and vomiting may be experienced:4- 14 weeks • Nausea and vomiting may decrease and for some women cease altogether around 12 weeks . Lacroix et al. (2000) report the mean duration of nausea to be 34.6 days with 50% of women relieved by 14 weeks' gestation. Mrs.Mahdia Samaha Kony

11. Presumptive signs and symptoms of pregnancy c) Breast changes • Discomfort, tingling and a feeling of fullness of the breasts may be noticed as early as the third or fourth week of pregnancy, as the blood supply to the breasts increases. The superficial veins on both the chest and breasts dilate. • Around 16 weeks of pregnancy the breasts start to secrete a little clear fluid called colostrum. This persists throughout pregnancy and for the first few days after delivery until milk is produced. A secondary areola may appear Mrs.Mahdia Samaha Kony

12. Presumptive signs and symptoms of pregnancy d) Frequency of micturation: • This is due to pressure from the enlarging uterus and increased vasculrity of the bladder. • Around 16 weeks Pressure on the bladder is relieved because the enlarging uterus has risen out of the pelvis, which reduces the frequency of micturation experienced by the woman. Mrs.Mahdia Samaha Kony

13. Presumptive signs and symptoms e) Skin changes: • The linea nigra: Which is the line of pigmentation from the symphysis pubis to the umbilicus • The chloasma (mask of pregnancy). • The nipples become more prominent • Montgomery's tubercles are visible on the areola. • Secondary areola. Mrs.Mahdia Samaha Kony

14. Presumptive signs and symptoms f) Quickening: • The first fetal movements may be felt by primigravidae at 19+ weeds and by multigravidae at 17+ weeks. • Quickening sometimes described as flutters and a feeling of bubbles coming to the surface' rather than recognizable movements, an unreliable indicator of gestational age. • At about 24 weeks fetal parts and movements may be felt on abdominal palpation. Mrs.Mahdia Samaha Kony

15. Presumptive signs and symptoms g) Enlarged uterus: • At 12 weeks the enlarged uterus is just palpable above the symphysis pubis. • At 16 weeks the fundus of the uterus is midway between the upper border of the symphysis pubis and the umbilicus. • At 20 weeks the fundus of the uterus is just below the umbilicus. • Around 24 weeks the fundus can be felt just above the umbilicus. • From 28-40 weeks the fungus continues to rise until at 36 weeks it reaches the xiphisternum and remains at that level until the fetal head engages Mrs.Mahdia Samaha Kony

16. Mrs.Mahdia Samaha Kony

17. Probable signs of pregnancy • Hegar's sign: softening of the vagina and cervix is noted • Osiander's sign: Pulsation of the uterine arteries through the lateral fornices can be detected. • Jacquemier's sign: Increased vascularity of the vagina and cervix result in a lilac discoloration of those tissues. • Enlargement of the uterus is noted and compared with the period of gestation. • Internal ballottement may he elicited from 16 weeks. Mrs.Mahdia Samaha Kony

18. Probable signs of pregnancy • Colustrum may be expressed from the breasts • Uterine soufflé • Braxton Hicks contraction • Pregnancy tests: • Urine pregnancy tests are very sensitive and may be positive as early as 1 week after embryo implantation or within days of the first missed menstrual period. • Radioimmunoassay for serum testing of the beta subunit of human chorionic gonadotropin (hCG) may be accurate up to a few days after implantation (or even before the first missed period). Mrs.Mahdia Samaha Kony

19. The positive signs of pregnancy • Positive pregnancy test, possible from the day of the expected period. • Fetal heart sounds, which may be detected at 6weeks by US, at10 weeks using Sonicaid ultrasonic equipment. At 24 weeks' gestation these sounds can be heard with the Pinard fetal stethoscope. • Fetal movements felt by the examiner. • Palpation of fetal parts. • Radiology shows the fetal skeleton at 14-16 weeks X-rays should the avoided, however, as irradiation can damage the developing fetus. • Ultrasonography. A gestational sac may be visualized at 5 weeks. Mrs.Mahdia Samaha Kony

20. There are various indications for US • Enabled better assessment of gestational age, • Detection of multiple pregnancies • Earlier diagnosis of clinically unsuspected fetal abnormalities. • Many units now offer USS at 11-14 weeks' gestation, which may predict a risk of chromosomal abnormality by measuring the amount of fluid behind the neck of the fetus, computer recorded in conjunction with maternal age, and used to determine a predictive risk rate. Mrs.Mahdia Samaha Kony

21. Booking visit • Once pregnancy has been diagnosed, the woman usually books a visit at the antenatal clinic. • This is the longest but most important visit. It used to take place at 8–12 weeks’ gestation. • The woman’s medical state is assessed so that the current pregnancy • Baseline data are essential at this point and are obtained from the history, an examination, and relevant investigations. Mrs.Mahdia Samaha Kony

22. 2) History • Menstrual and contraceptive history: • Gynecologic history: • Obstetric history: • Medical and surgical history • Environmental exposures • Family history • Social factors: Mrs.Mahdia Samaha Kony

23. Physical Examination • The woman’s height shoe size. • Weight in pregnancy • Presence of anemia should be checked • Examination of the teeth included • Check for thyroid gland is enlarged. • The blood pressure is taken • The spine should be checked for any tenderness, kyphosis and scoliosis • The legs should be examined for oedema and varicose veins. • The abdomen is inspected for scars of previous operations Mrs.Mahdia Samaha Kony

24. Physical Examination • A vaginal assessment was traditionally performed at the booking visit. • Fetal size will soon be checked by ultrasound Mrs.Mahdia Samaha Kony

25. 3) Laboratory Evaluation • Haemoglobin concentration or mean cell volume • ABO and rhesus groups • Group B Streptococcus (GBS) Mrs.Mahdia Samaha Kony

26. Specialized screening tests: • Rubella antibodies. • Hepatitis B antibodies. • Toxoplasmosis antibodies (if clinically appropriate). Mrs.Mahdia Samaha Kony

27. Leopold’s Maneuver Purpose: is done to determine the attitude, fetal presentation lie, presenting part, degree of descent, an estimate of the size, and number of fetuses, position, fetal back & fetal heart tone - use palm! Warm palm. Prep mother: 1. Empty bladder 2. Position of mother in supine with knee flex (dorsal recumbent – to relax abdominal muscles)

28. 1st maneuver: • place patient in supine position with knees slightly flexed; put towel under head and right hip; with both hands palpate upper abdomen and fundus. Assess size, shape, movement and firmness of the part to determine presentation

30. 2nd Maneuver: • With both hands moving down, identify the back of the fetus ( to hear fetal heart sound) where the ball of the stethoscope is placed to determine FHT. • Get V/S(before 2nd maneuver) PR to diff: Uterine soufflé – maternal H rate

32. 3rd Maneuver: • Using the right hand, grasp the symphis pubis part using thumb and fingers. To determine degree of engagement. • Assess whether the presenting part is engaged in the pelvis )Alert : if the head is engaged it will not be movable).

34. 4th Maneuver: • the Examiner changes the position by facing the patient’s feet. With two hands, assess the descent of the presenting part by locating the cephalic prominence or brow. To determine attitude – relationship of fetus to one another.

36. Mrs.Mahdia Samaha Kony