Pregnancy is a physiological event that occurs in the process of development and birth of a mammal.It is great gift to the humankind from God.It is very complex procedure which goes on and gives outcome as a beautiful baby and lots of happiness.
So we will be talking today about antenatal care.
Antenatal Care is the systemic supervision(examination and advice) of a women during pregnancy.
It comprises of -careful history taking and examinations ,necessary investigations and advices given.
Aims and objectives of antenatal care are :-
•To screen 'high risk' cases
•To prevent or to detect and treat at the earliest any complications
•To ensure continued risk assessment and to provide ongoing primary preventive health care
•To educate the mother about the physiology of pregnancy and labor
•To discuss with the couple about the place,time and mode of delivery
•To educate them about newborn care
•To motivate the couple about the need of family planning and also appropriate advice to couple seeking medical termination of pregnancy.
The main objective is to ensure a normal delivery of a healthy baby from a healthy mother.
The first visit shouldn't be deferred beyond the second missed period.It may be earlier if the patient desires to terminate the pregnancy.
During the first visit the obstetrician do take proper history and examination.The patient is also asked to do routine investigations like Blood (Hemoglobin,ABO,Rh grouping,Blood glucose and VDRL),Urine(Protein,sugar,pus cells) . An ultrasonography is also advised.
Generally,check up is done at interval of 4 weeks upto 28 weeks;at interval of 2 weeks up to 36 weeks and thereafter weekly till delivery.
In developing countries, as per WHO recommendation the visit should at least 4;first in 2nd trimester around 16 weeks,second between 24 and 28 weeks,the third visit at 32 weeks and fourth at 36 weeks.
Antenatal Advice:-
Diet- The diet should be adequate to provide a good maternal health,optimum fetal growth,the strength and vitality required during labor and successful lactation.There is a increased caloric requirement is to the extent of 300 over the nonpregnant state due to increased growth of the maternal tissues,fetus,palcenta and increased basal metabolic rate.Daily energy requirement is 2500 kcal of which protein should be of 60g and iron 40mg (supplementation may be needed).
Women with normal BMI should gain at least 10-11 kg of weight.Obese women should limit their weight gain as it may cause intra and antepartum complications.
Supplementary iron and folic acid therapy is given.
Antenatal Hygiene-
In otherwise uncomplicated cases, the following advices are to be given:
Rest and sleep: The patient may continue her usual activities throughout pregnancy. However, excessive and strenuous work should be avoided especially in the a first trimester and the last 4 weeks. Recreational exercise (prenatal exercise class) is permited as long as she feels comfortable.
There is individual variation of the amount of sleep required. However, on an average, the patient should be in bed for about 10 hours (8 hours at night and 2 hours at noon), especially in the last 6 weeks. In late pregnancy, lateral posture is more comfortable.
Bowel: Constipation is common. It may cause backache and abdominal discomfort. Regular bowel movement may be facilitated by regulation of diet taking plenty of fluids, vegetables and milk or prescribing stool softeners at bedtime. There may be rectal bleeding,painful fissures or hemorrhoids due to hard stool.
Bathing: The patient should take daily bath but be careful against slipping in the bathroom due to imbalance.
Clothing, shoes and belt: The patient should wear loose but comfortable garments, IHigh heel shoes should better be avoided in advanced pregnancy when the center of balance alters, Constricting belt should be avoided.
Dental care: Good dental and oral hygiene should be maintained. The dentist should be consulted, if necessary. This will facilitate extraction or filling of the caries tooth, if required, comfortably in the second trimester.
Care of the breasts: Breast engorgement may cause discomfort during late pregnancy. A well-fitting brassiere can give relief.
Coitus: Generally, coitus is not restricted during
pregnancy. Release of prostaglandins and oxytocin with coitus may cause uterine contractions. Women with increased risk of miscarriage or preterm labor shouldavoid coitus if they feel such increased uterine activity.
Travel: Travel by vehicles having jerks is better to be avoided, especially in first trimester and the last 6 weeks. The long journey is preferably to be limited to the second trimester. Rail route is preferable to bus route, Travel in pressurized aircraft is safe up to 36 weeks.
Air travel is contraindicated in cases with placenta previa, pre-eclampsia, severe anemia and sickle cell diease. Prolonged sitting in a car or aeroplane should be avoided due to the risk of venous stasis and thromboembolism. Seat belt should be under the abdomen.
Smoking and alcohol: In view of the fact that smoking is injurious to health, it is better to stop smoking not only during pregnancy but even thereafter. Heavy smokers have smaller babies and there is also more chance of abortion, Similarly, alcohol consumption is to be drastically curtailed or avoided, so as to prevent fetal maldevelopment or growth restriction.
Immunization:-
Live virus vaccines (rubella, measles, mumps, varicella, yellow fever) are contraindicated. Rabies, hepatitis A and B vaccines, toxoids can be given as in non-pregnant state.
Tetanus: Immunization against tetanus not only protects the mother but also the neonates. In unprotected women, 0.5 mL tetanus toxoid is given intramuscularly (IM) at 6 weeks interval for 2 such, the first one to be given between 16 and 24 weeks. Women who are immunized in the past, a booster dose of 0.5 ml IM is given in the last trimester.
Prenatal classes are found to be helpful.
This is actually an extensive topic and I hope this little post will help somebody .
Thank you
