Antenatal Care

Primary Health Care
6. Antenatal and post natal care

Maha A. Basodan MBChB, MSc, MPH
Every year there are millions of pregnancies in the world. Each of
these pregnancies is at risk for an adverse outcome for the women
and her infant. The risk can’t be totally eliminated, but can be
reduced through effective, affordable and acceptable maternity
care. This health care should begin early in the pregnancy and
continue at regular intervals.
Intended learning outcomes
By the end of this lecture, student should be able to;
Define antenatal and post natal care
Identify goals of antenatal and post natal care
Describe schedule of antenatal visits and component of care
Discuss common discomforts of pregnancy
Identify
Definition of Antenatal care
Comprehensive and systematic health supervision of a

pregnant woman during pregnancy.
Or it is planned care( examination, observation and guidance) given

to the pregnant woman from conception till the time of labor.
MMR in high income countries 2017: 11/100,000
MMR in low income countries 2017: 462/100,000
MMR Yemen 2017: 164/100,000
https://www.who.int/europe/news-room/fact-sheets/item/maternal-mortality#:~:text=A%20woman's%20lifetime%20risk%20of,45%20in%20low-income%20countrie
Antenatal Goals
To reduce maternal and perinatal mortality and morbidity rates
To improve the physical and mental health of women and
children
To early detect and properly treat complicated conditions that
may endanger the life or affect health of the mother or the fetus.
To prepare the woman for labor, lactation and care of infant
The objective to ensure normal pregnancy with delivery of
healthy baby from a healthy mother
Criteria for successful normal pregnancy: delivery of single alive

fetus in good condition at term with no maternal complication
Normal pregnancy duration post conception is 266 days= 38 weeks
LMP 280 days or 40 weeks.
Antenatal care
History Health
Examination Investigation education
-Personal history -Pallor, BP, edema -Blood: Hb, grouping, - Diet -Lactation
-Family history -Woman’s Height RBS, HBS Ag. - Hygiene -Smoking
-Medical and surgical history -Weight gain -Urine - Teeth -Medication
-Menstrual history -Fundal height -Ultra sound - Weight gain –Family p
-Obstetrical history -Fetal heart -Bladder + bowel
-History of present pregnancy -Presentation at term -Sign of complication
Schedule for Antenatal Visits:
The first visit or initial visit should be made as early is pregnancy
as possible.
Return Visits: Schedule for appointments:
- Nulliparous + uncomplicated pregnancy= 10
Once every month till 28 w. - Parous + uncomplicated = 7
Once every 2 weeks till the 36 w

Once every week, till labor. Minimum ANC visits:
- 1st visit : around 16 week
-2nd visit: around 24-28 weeks
-3rd visit: at 32 week
-4th Visit : at 36 week
But do all pregnant women follow their pregnancy?
Economic
factors
Cultural Social
factors factors
Health facility Demographic

related factors
factors
Common Discomforts of Pregnancy, Etiology,
and Relief Measures :
Urinary frequency Hemorrhoids
Fatigue Constipation
Nausea and vomiting Backache
Heartburn Faintness
Dependent edema Leg cramps
Varicosities
ANC First visit
OBJECTIVE:
-Establish baseline information
-Asses health of woman and fetus and screen out high risk pregnancy and plan for
subsequent management
1st ANC visit

History Examination Investigation
-Personal history -Pallor, BP, edema -Blood: Hb, CBC,grouping, RBS, HBS Ag.
-Family history -Woman’s Height -Urine
-Medical and surgical history -Weight gain -Ultra sound
-Menstrual history -Fundal height -Fetal heart
-Obstetrical history -Fetal heart -HBS Ag
-History of present pregnancy -Presentation at term -VDRL
-Presentation at term
Uterus lower than expected: Uterus higher than expected:
-Small baby, intrauterine -Large fetus,multiple pregnancy
growth retardation -Polyhydramnios
-Oligohydramnios -Mistaken period of gestation
-Mistaken period of gestation
Abdominal examination:
-fundal height
-Fetal heart beats
-Fetal movement+ parts
-Multiple pregnancy
-Fetal lie and presentation
-Scar/ relevant findings
Subsequent visits Second visit 24-28 Week
 General complaint  Symphesis-fundal height
 Gestational age to be calculated  Multiple pregnancy
 General examination
 Identification of problem
 Health education
 Plan of delivery Fourth visit 36 Week
Third visit 32 Week  Lie
 Anemia  Presentation
 Multiple pregnancy  Position
 Pre-eclampsia  Plan for delivery
 Intra uterine Growth retardation
Screening for gestational diabetes Anaemia
 risk factors for gestational diabetes :  Normal range:11 g/100 ml
 body mass index above 30 kg/m2 at first contact and 10.5
 previous big baby weighing 4.5 kg or above g/100 ml at 28 weeks)
 previous gestational diabetes (refer to 'Diabetes  should be investigated and
in pregnancy iron supplementation
considered .
 family history of diabetes
Blood grouping and red-cell alloantibodies
 Women should be offered testing for blood group and rhesus D status in
early pregnancy.
 To give anti-D at 28 weeks and post delivery if the baby (+)
Hepatitis B virus
 Serological screening for hepatitis B virus should be offered to pregnant
women so that effective postnatal interventions can be offered to infected
women to decrease the risk of mother-to-child transmission.
Asymptomatic Bacteriuria
 Women should be offered routine screening for asymptomatic bacteriuria
( bacteria in Urine)by midstream urine culture early in pregnancy.
 Identification and treatment of asymptomatic bacteriuria reduces the risk of
pyelonephritis.
Basic components of Antenatal care
General
Routine BP
medical and
physical measurement Uterus size Lab tests
obstetric
examination & weight
history
Vitamins &
BP measurement
mineral Health education Plan for delivery
& weight
supplementation
Nutritional Supplements
Folic Acid Iron
• Start before conception and • Iron supplementation should
throughout the first 12
not be offered routinely to
weeks.
all pregnant women. It does
• reduces the risk of having a
not benefit the mother's or
baby with a neural tube
defect (for example, the baby's health and may
anencephaly or spina bifida). have unpleasant maternal
• The recommended dose is side effects.
400 micrograms per day.
Natal care
Basic emergenecy obstetric and Neonatal care
(BEmONC)
Objective; to decrease preventable maternal and neonatal deaths by
providing with effective referral system and safe blood transfusion
services.
PARENTRAL Manual removal Neonatal

ANTIBIOTICS of placenta resuscitation
PARENTRAL Extraction of Care for low birth

OXYTOCIN residues weight infant
PARENTRAL Instrumental Parentral Abs for

ANTICONVULSANT delivery neonates
Comprehensive emergency obstetric and
neonatal care (CEmONC)
Provides similar services to BeMONC plus:
Operation theatre
C-section delivery
Safe blood transfusion
Post natal care
Objectives:
Prevent adverse development that may arise after childbirth by
providing postnatal care as early as possible and within 42 days
Promote birth spacing by providing family planning services
Ascertain outcome of each pregnancy and follow up the survival
of newborn
Post natal care
Aims:
Promote physical wellbeing of mother and baby
Ensure physiologic changes are occurring normally
Help mother to establish a satisfactory feeding routine and
emotional bond
Teach mother how to care of baby and strenghten woman’s
confidence
Post natal care
• The pueperium is the period following childbirth during which
the uterus and other organs return to the pre-pregnancy state. It
begins after placenta is expelled and lasts for 6 weeks.
• During this period many physiologic and psychologic changes
happens:
Rep organs return Lactation Start responsibility Woman recovers

to non-preg state established of caring for baby from stress
Post natal care ( woman)
Assessment of maternal health status
Promotion of breast feeding
Assessment of urgent need for interventions both in mothers and
infants
Post natal care (woman)
Blood pressure
Fundal height
perineum
symptoms of depression
Contraceptive counselling
Common health problems in postpartum
infection Anemia
Mastitis
Hemorrhoid Breast problems
constipation
Bleeding Depression
Infant health challenges in the post natal period
• Preterm and small for gestational age
• Congenital anomalies
• Severe bacterial infection
• Neonatal tetanus
• Hypothermia
• Jaundice
• Ophtalmia neonatorum

Antenatal Care

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Primary Health Care

6. Antenatal and post natal care

Comprehensive and systematic health supervision of a

Or it is planned care( examination, observation and guidance) given

Criteria for successful normal pregnancy: delivery of single alive

Once every 2 weeks till the 36 w

Health facility Demographic

1st ANC visit

PARENTRAL Manual removal Neonatal

PARENTRAL Extraction of Care for low birth

PARENTRAL Instrumental Parentral Abs for

Rep organs return Lactation Start responsibility Woman recovers

Hemorrhoid Breast problems

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