ANTENATAL CARE

Systemic supervision (examination and advice) of women during pregnancy is called antenatal (pse-nstal) care.

Importance/Purpose:-

⦁ Diagnosis of high risk Pregnancies

⦁ Provision of continuous treatment & Prophylaxis

⦁ Explain physiology of Pregnancy & Labor for removing fear.

⦁ Place, type & time of delivery can be determined.

⦁ Parents can be taught act case of new born

⦁ Family planning advise

⦁ To detect any abnormality in fetus by USG

⦁ Manage any complication

⦁ Anxiety is reduced

⦁ Delivery of healthy baby from & healthy mother.

Principles:-

⦁ To tell Impotence of regular check-up

⦁ Advise are given regarding drugs, diet & hygiene 

⦁ To Maintain health status of a Pregnant women

Advise:-

(1) Regarding diet:-

⦁ Diet should be light nutritive & easily digestible

⦁ Full fill the requirement of fetus

⦁ During Pregnancy fetal maternal & placental tissue growth is increased so that calorie requirement also.

⦁ Contain plenty of proteins, Minerals & Vitamins

⦁ 1 liter of milk Vegetable & fruit are added

⦁ Supplementary Iron therapy should be given

⦁ Supplementary vita & folic acids tabs.

Note:- Daily calorie requirement in Pregnancy 300 Kito Calories  more than that of Non-Pregnant (2200+300 K cal)

Daily calorie requirement in lactating mother (2200+500) Kilo ealarics.

Nutrient Non-pregnant Pregnant Lactation

L.Veb 2200 2200+300 2200+500

Protein     50 gm     50+15 gm         50+25 gm

Fat     20 gm     30 gm         45 gm

Calcium     500 gm     1000 mg         1000-1500 mg

Iron     30 gm     40 gm         30 gm

Supplementary Nutritional therapy:- Supplementary iron therapy is needed for all pregnant mothers for 16 w on wards

If Hb level is > 10 gm I tab ferrous sulphate

If Hb level is < 10 gm 2 to 3 tab/dry fetus substrate.

Balance diet for Pregnant Mother

Energy dieting Food Body Building Foods Protective Food

Carbohydrate Protein Vitamins Minerals 

Fat

eg-cereals eg- Meat eg-fruits Low sodium diet 

roots & tubers egg green leafy

sugar cane pulses- poor main meat Vegetable

Honey oilseeds (AIIMS 2016) (RRB 2015)

Highest energy requirement is Nuts

(Sixth to 1 year) (PGI-2015)

Protein – 4 k cal 17 kj  (1 k cal = 4.25 kj)

Carbohydrate – 4 k cal  17 kj

Fat- 9 kcal 37 kj

Balance diet (g) for normal, Pregnant and Lactating, women’s (Moderate Cost) 

Food stuffs Normal (Moderate) Pregnancy Lactation

(NV) (V) (V) (NV) NV V

Cereals     300-310 - - 100  110

Pulses 50-60 20 - - 40

Green leaf 100 - - - -

Vegetables

Other Vegetable 75 - - - -

Fruits 60 50 50 50 50

Milk 250 400 200 300 600

Fats and oils 40 - - 20 20

Meat & fish 40 - 25 40 -

Egg         30 - - - -

(2) Rest& Sleep:-

⦁ Do her daily activities through out pregnancy except hard work like lifting , heavy wt.

⦁ She should take rest at least 10 hrs. (8 in night & 2 hrs.)

(3) Psychological:-

⦁ Removing fear & tension during antenatal period labor & delivery

⦁ Mental comfort & happiness

(4) Bowel care:- 

Constipation may occur in pregnancy due to backache & abdominal discomfort.

Take plenty of fluids & remove constipation mild laxatives  

(5) Antenatal Hygiene:-

⦁ Regular bathing

⦁ Wearing clean & comfortable cloths (choose cloths)

⦁ Dental care

⦁ Care of Breast- Simple cleaning 

⦁ High healed shoes & belts should be avoided.

(6) Coitus:- Avoid in 1st trimester & last 6 weeks

⦁ Avoid through out pregnancy in risk of preterm labor/Abortion.

⦁ Generally not restricted but release of prostaglandins and oxytocin with coitus may cause uterine counteraction.

(7) Smoking & alcohol:- Avoid during pregnancy

(8) Immunization:-

⦁ TT vaccine 1st dose is given as soon as Preg. Is diagnosed 

⦁ TT-2 after one month.

⦁ MMR contraindicated in Pregnancy-candies defect, Deafness and cataract.

(9) Travel:- No travelling in vehicle which gives jerks.

> 36 week seat belt should be under abdomen .

(10) Drugs:-

⦁ Should not be taken without doctor’s advise

⦁ All most drugs cross the placenta to search the fetus.

(11) Check-up:-

Pregnant women should convey to antenatal

Clinic for regular check-up

⦁ Every 4 weeks from 28 to 30 w

⦁ Every 2 weeks from 30-36 Weeks

⦁ Weekly after 36 weeks

Note:- Hospitalization should be in following condition-

⦁ Pain full uterine contractions

⦁ Leaking per vaginum (LPV)

⦁ Bleeding per Vaginum (BPV)

Schedule for Antenatal visits in India:-

⦁ Monthly visits up to 28 weeks (7 visit)

⦁ 2 weekly visit b/w 28 to 36 week (4 visit)

⦁ Visits 36 week on wards weekly (3-4 visits)

Total visit – 12-15

WHO Recommends at least 4 visit:-

Ist at 16 weeks

IIst at 24-28 weeks

                IIIst at 32 weeks

                IV at 36 weeks

As per Indian Seen aria- Minimum 3 visit are essential-

1st at 20 weeks (or as soon as Pregnancy is know)

2nd at 32 weeks

3rd at 36 weeks

⦁ The first visit that a women makes to a health care facility is called the booking visit

⦁ Booked case – a case that has made at least 3 visit with at least two in the last trimester.