 Antenatal care (Prenatal care) refers to the regular

medical and nursing care recommended for women

during pregnancy
 Antenatal care is a type of preventative care with the
goal of providing regular check-ups that allow
doctors or midwives to treat and prevent potential
health problems throughout the course of the
pregnancy while promoting healthy lifestyles that
benefit both mother and child.
Essential Health Sector Interventions for
Safe Motherhood
SAFE
MOTHERHOOD

Clean/safe Delivery

Essential Obstetric Care

Postpartum Care
Family Planning

Antenatal Care
Postabortion

BASIC HEALTH SERVICES

EQUITY

EMOTIONAL AND PSYCHOLOGICAL

SUPPORT

Antenatal Care: Overview 3

 Goals of Antenatal Care

Goals:
*To reduce maternal mortality and morbidity
rates.
* To improve the physical and mental health of
women and children.
* To prevent, identify maternal and fetal
abnormality that can adversely affect
pregnancy outcome.
*To decrease financial recourses for care of
mothers.
 Promote and maintain the physical, mental and social
health of mother and baby by providing education on
nutrition, personal hygiene and birthing process
 Develop birth preparedness and complication
readiness plan
 Help prepare mother to breastfeed successfully,
experience normal Puerperium, and take good care of
the child physically, psychologically and socially
 Antenatal care support and encourage a
family’s healthy psychological adjustment to
childbearing
FACTORS AFFECTING MOTHERS UTILIZATION OF
ANTENATAL CARE:

 Demographic and Biological Factors

 Socioeconomic Factors
 Psychosocial Factors
 Health Services Factors
 Environmental Factors
Assessment:
1. The initial assessment interview can
establish the trusting relationship
between the nurse and the pregnant
woman.
2. establishing rapport
3. getting information about the woman’s
physical and psychological health,
4. obtaining a basis for anticipatory
guidance for pregnancy .
 During the firs visit, assessment and
physical examination must be completed.
Including:

➢ history.
➢ Physical examination.

➢ Laboratory data.
➢ Psychological assessment.

➢ Nutritional assessment.
History:
•Personal history
•Family history
•Medical and surgical history
•Menstrual history
•Obstetrical history
•History of present pregnancy
Welcome the woman, and ensure a quite place
where she can express concerns and anxiety
without being overheard by other people.
 Personal and social history:

This include: woman’s name, age, occupation,

address, and phone number. marital status,
duration of marriage, Religion , Nationality and
language, Housing and finance
 Family history:
Family history provides valuable information
about the general health of the family, and
it may reveal information about patters of
genetic or congenital anomalies.
Including:
- Diabetes

- Hypertension
- Heart disease
- Cancer

- Anemia
Medical and surgical history:
Chronic condition such as diabetes mellitus,
hypertension, and renal disease can affect
the outcome of the pregnancy and must be
investigated.
Prior operation, allergies, and medications
should be documented.
Previous operations such as cesarean section,
genital repair.
Accidents involving injury of the bony pelvis
A compete menstrual history is important to establish the
estimated date of delivery. It includes:

- Last menstrual period (LMP).

- Age of menarche.
- Regularity and frequency of menstrual cycle.
- Contraception method.
- Any previous treatment of menstrual
- Expected date of delivery (EDD) is calculated as followed:
1st day of LMP −3 months +7 days, and change the year.
Example: calculate EDD if LMP was august 30, 2007.
= June 6, 2008.
Obstetrical history:
This provides essential information about
the previous pregnancies that may alert
the care provider to possible problems in
the present pregnancy. Which includes:

➢ Gravida, para, abortion, and living

children.
➢ Weight of infant at birth & length of
gestation.
➢ Labor experience, type of delivery, location
of birth, and type of anesthesia.
➢ Maternal or infant complications.
 Current problems with pregnancy :

Ask the patient if she has any current problem,

such as:
- Nausea & vomiting.
- Abdominal pain.
- Headache.
- Urinary complaints.
- Vaginal bleeding.
- Edema.
- Backache.
- Heartburn.
- Constipation.
 Height & weight:

An initial weight is needed to establish a

baseline for weight gain throughout
pregnancy.

Preconception:
➢ Wt. lower than 45kg, or Ht. under 150 cm is
associated with preterm labor, and low birth
weight infant.

➢ Wt. higher than 90 kg is associated with

increased incidence of gestational diabetes,
pregnancy induced hypertension, cesarean
birth, and postpartum infection.
▪ Blood pressure:
1. It is taken to ascertain normality and provide a
baseline reading for a comparison throughout the
pregnancy.
2. In late pregnancy, raised systolic pressure of 30
mm Hg or raised diastolic pressure of 15 mm Hg
above the baseline values on at least two
occasions of 6 or more hours apart indicates
toxemia.

▪ Pulse:
The normal pulse rate = 60-90 BPM.
Tachycardia is associated with anxiety,
hyperthyroidism, or infection.
▪Respiratory rate:
The normal is 16-24 BPM.
Tachypnea may indicate respiratory infection,
or cardiac disease.

▪ Temperature:
normal temperature during pregnancy is
36.2C to 37.6C.
Increased temperature suggests infection.
Physical examination is important to:
✓ detect previously undiagnosed physical
problems that may affect the pregnancy
outcome.
✓ and to establish baseline levels that will
guide the treatment of the expectant mother
and fetus throughout pregnancy.
 General Examination
It should be started from the moment the
pregnant woman walks into the examination
room.
Examine general appearance:
 Observe the woman for body build and gait
 The face is observed for skin color as pallor and
pigmentation as chloasma.
 Observe the eyes for edema of the eyelids and
color of conjunctiva. Healthy eyes are bright
and clear.
 Mouth:
 The gum may be red, tender, edematous
as a result of the effects of increased
estrogen. Observe the mouth for:
 Dryness or cyanosis of the lips.
 Gingivitis of the gums.
 Septic focus or caries of the teeth

Intestine:
Assess for the bowel sound.
Assess for constipation or diarrhea.
 Assess breast size, symmetry, condition of
nipple, and the presence of colostrum.
Posture and gait:
Body mechanics and
changes in posture and
gait should be
addressed. Body
mechanics during
pregnancy may
produce strain on the
muscles of the lower
back and legs.
 Venous congestion:
Which can develop into
varicosities, venous
congestion most
commonly noted in the
legs, vulva, and rectum.

 Edema:
Edema of the extremities or
face necessitates further
assessment for signs of
pregnancy-induced
hypertension.
Pelvic measurement:
The bony pelvis is evaluated early in the
pregnancy to determine whether the diameters
are adequate to permit vaginal delivery.
 Inspection:
◦ Size of the uterus: assess
 If the length & breadth are both increased → multiple
pregnancies, polyhydramnios
 If the length is increased only → large baby
◦ Shape of the uterus: length should be larger than broad this
indicates longitudinal lie. But if the uterus is low and broad
indicates transverse fetus lie.
◦ Fetal movement
◦ Contour of the abdomen: full bladder may be visible in
late pregnancy. Protrusion of Umbilicus
◦ Skin changes: look for stretch marks, linea nigra, scars
that indicates previous surgeries
▪ The size of the
abdomen is inspected
for:

- the height of the

fundus, which
determines the period
of the gestation.
 Calculations:
 Calculation of gestation using fundal
height
◦ McDonald’s method: Measure from symphasis
pubis to top of fundus in cm.
◦ Gestation is measurement + or – 2 weeks
 The uterus may be higher than expected :
1. large fetus, multiple pregnancy
2. polyhydrammnios
3. mistaken date of last menstrual period

 The uterus may be lower than expected :

1. small fetus, intrauterine growth
restriction
2. oligohydramnios
3. mistaken date of last menstrual period.
12 weeks :the uterus fills the
pelvis so that the fundus of the
uterus is palpable at the
symphysis pubis .
16 weeks, the uterus is midway
between the symphysis pubis
and the umbilicus.
20 weeks, it reaches the
umbilicus
 Palpation: by Leopold maneuver-4
maneuvers
◦ Palpate the fundus (to determine if it contains
breech, head)
 By gentle pressure:
 if soft consistency/ indefinite outline → breech
 If hard, smooth, well defined → head
 Move your fingertips over the fetal mass to determine
mobility and sixe
 If can’t move independent from the body → breech
 If moves freely between fingertips → head
 Abdominal Palpations
 A: Fundal palpation (First maneuver) is
performed in the upper uterine fundus to
determine the fetal lie and presentation.
 Lie: Longitudinal,Transverse,oblique
 Presentation: Cephalic, Breech
 The lie of the fetus: is the relation of the long
axis of the fetus to the uterus (could be
longitudinal, oblique or transverse. only
longitudinal lie is normal)
 The presentation: is
the part of the fetus
in the lower pole of
the uterus overlying
the pelvic brim
(cephalic, breech)
B:Lateral palpation(Second maneuver) :to
determine the fetal position or identify the
relationship of the fetal back and the small
parts to the front, back, or sides of the
maternal pelvis.
*Determine what fetal body part lies on the
side of the abdomen. Reverse the hands
and repeat the maneuver. If firm, smooth,
and a hard continuous structure, it is likely
to be the fetal back; if smaller, irregular,
protruding, and moving, it is likely to be
the small body parts (extremities).
 The position: of
the baby in
relation to the
presenting part
of the mother’s
pelvis. It is
expressed
according to the
denominator
which is :
 occiput in vertex
presentation
 sacrum in breech
presentation
C:Pawlik's grip (Third maneuver) :to
determine the portion of the fetus that is
presenting.
The head will feel firm and globular. If not
engaged into the pelvis, the presenting
part is movable. If immobile, engagement
has occurred.
Station & engagement
Station: is the relation of
the presenting part to
the ischial spine. If the
presenting part is at
the level of ischial
spine, station =0
Engagement: the descent
of the biparietal
diameter through
pelvic brim. If the head
is at the level of ischial
spine the head must be
engaged.
 D:Pelvic Palpation (Fourth maneuver) :to
determine fetal attitude or the greatest
prominence of the fetal head over the pelvic
brim
 The attitude: is the posture of the fetus
(flexion, deflexion, extension)
 fetal heart beat can be heard by
stethoscope after the 20th week, or Doppler
after 8th week. Normal fetal heart rate is
120-160 beats/min.
 Legs:
* Legs should be noted for edema.
* They should be observed for varicose veins
* The calf must be observed for reddened areas
which may be caused by phlebitis and white areas
which could be caused by deep vein thrombosis.
* Ask the woman to report tenderness during
examination.
* The legs should be observed for unequal length or
muscle wasting which may be an indication of
pelvic abnormalities.
 Deep tendon reflexes should be evaluated
because hyperreflexia is associated with
complications of pregnancy.
 Vaginal discharge:
* Ask the woman about any increase or
change of vaginal discharge.
 Report to the obstetrician any mucoid loss
before the 37th week of pregnancy.

Vaginal bleeding:
* Vaginal bleeding at any time during
pregnancy should be reported to the
obstetrician to investigate its origin.
Test Purpose
Blood group To determine blood type.
Hgb & Hct To detect anemia.

Venereal disease tests should be performed To screen for syphilis

(VDRL)
Rubella To determine immunity

Urine analysis To detect infection or renal disease.

protein, glucose, and ketones
Pap test To screen for cervical cancer

Chlamydia To detect sexual transmitted disease.

Glucose To screen for gestational diabetes.

 * Hemoglobin will be repeated:
 - At 36 weeks of gestation.
 - Every 4 weeks if Hb is<9g/dl.
 - If there is any other clinical reason.
Is performed to:
 estimate the gestational age.

 Check amniotic fluid volume.

 Check the position of the placenta.

 Detect the multifetal pregnancy.

 The position of the baby.

 Fetal kick count:
 The pregnant woman reports at least
10 movements in 12 hours.

* Absence of fetal movements precedes

intrauterine fetal death by 48 hours.
 a medical check up every four weeks
up to 28 weeks gestation,

 every 2 weeks until 36 weeks of

gestation

 visit each week until delivery

 More frequent visits may be required

if there are abnormalities or
complications or if danger signs
arise during pregnancy
1. What is the fundal
height?
It is estimated by
centimeters from
upper border of
the fundus to the
pubic symphasis
by taping
measure. The
height of the
fundus correlates
well with the
gestational age
especially during
the weeks of
pregnancy.
2. lie of the fetus: only longitudinal lie is
normal
3. Attitude: normally it is full flexion and
every fetal joint is flexed.
4. presentation: normally cephalic
5. position: according to the dominator
6. Is the vertex engaged?
 Danger signs of pregnancy
 Vaginal bleeding including spotting.
 Persistent abdominal pain.
 Sever & persistent vomiting.
 Sudden gush of fluid from vagina.
 Absence or decrease fetal movement.
 Sever headache.
 Edema of hands, face, legs & feet.
 Fever above 100 F( greater than 37.7C).
 Dizziness, blurred vision, double vision &
spots before eyes.
 Painful urination.