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Antenatal care. Dr. Rekha Dutt Associate Professor Department of PSM , Dr D.Y. Patil Medical college , Navi Mumbai. It is care of woman during pregnancy Primary aim : to achieve at end of pregnancy a healthy mother and healthy baby. ANTENATAL CARE objectives.

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antenatal care
Antenatal care

Dr. Rekha Dutt

Associate Professor

Department of PSM ,

Dr D.Y. Patil Medical college , Navi Mumbai

slide2
It is care of woman during pregnancy

Primary aim : to achieve at end of pregnancy a healthy mother and healthy baby

antenatal care objectives
ANTENATAL CAREobjectives
  • To promote, protect and maintain the health of pregnant women
  • To detect high risk cases and give them special attention
  • To foresee complications and prevent them
  • To remove anxiety associated with pregnancy
  • To reduce maternal and infant mortality and morbidity
  • To teach elements of child care, nutrition, hygiene and sanitation
  • To sensitize her regarding family planning
  • To attend the under 5 children accompanying the mother
services
SERVICES

Antenatal visit- a minimum of 3 visits

1st visit at 20 weeks

2nd visit at 32 week

3rd visit at 36 weeks

prenatal services
Prenatal services

Health history

Physical examination- wt gain, BP

Lab examination – urine analysis, CBC, blood grouping and Rh, serological examination

Fe and folic acid supplementation

TT immunization

Home visit by female health worker

Referral services

risk approach
RISK APPROACH

It is managerial tool for improved MCH care. Purpose is to provide better services for all but special attention to those who need them most. It is for max utilization of resources.

High risk mothers are:

  • Elderly primi (30 yrs and above)
  • Short primi (140 cm and below)
  • Malpresentation
  • APH ,Threatened abortion
  • Preeclampsia, eclampsia
  • Anemia
  • Twins ;hydroamnios
  • Previous still birth, IUDeath, manual removal of placenta
  • Elderly grandmultipara
  • Prolonged pregnancy (14 days after EDD)
  • H/O previous Caesarean or instrumental delivery
  • Pregnancy associated with general diseases
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Maintenance of records
  • Home visits –at least 1 by ANM or MPHWF
  • Prenatal Advice :
  • Diet – pregnant women requires 300 extra cal per day, additional Fe and folic acid, Ca and other nutrients are also required
  • Personal hygiene ,rest , bowels , exercise ,no smoking and alcohol , oral hygiene, sex
  • Drugs-caution is required
  • Radiation- malformation in fetus
  • Warning signs- swelling of feet, fits, headache, blurring of vision, bleeding or discharge per vagina
  • Child care- nut education, child rearing , FP
slide8
Secific health protection :

Anemia -50-60 % of pregnant women are anemic (Hb < 11 gm %). The GOI initiated a prog in which 100 mg of elemental Fe and 500 mcg of F.A tab are given

Other nut deficiency- protein, vit A,D,iodine

Toxemia of pregnancy – increase in blood pressure and presence of albumin in urine. Check BP regularly.

Tetanus – two doses of TT vaccine

Syphilis – VDRL test at early and late pregnancy. Congenital syphilis is preventable.

Injections of 1 gram procaine penicillin for ten days are adequate.

German measles – congenital malformations

Prevention – rubella vaccine . Before vaccination it is advisable to rule out pregnancy and effective contraception be maintained for 8 weeks .

Rh status – if women is Rh –ve and husband Rh+ve she is kept under surveillance. The blood is examined again at 28 weeks and 34-36 weeks for Abs. Rh anti D immunoglobulin should be given at 28 weeks of gestation to prevent sensitization in first pregnancy. If baby is Rh +ve the Rh anti D immunoglobulin is again given with in 72 hours of delivery . Same should be done after abortion.

HIV infection – prenatal screening . Infected women may choose abortions , informed decision on breast feeding .

Prenatal genetic screening – for chromosomal abnormalities , congenital anomalies, haemoglobinopathies.

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Mental preparation - free and frank talk on all aspects of pregnancy and delivery. Mother craft classes are beneficial .
  • Family planning – more receptive
  • Pediatric component – care to under 5 accompanying the mother