Documente Academic
Documente Profesional
Documente Cultură
1 Identification data 02
2 Central objectives 03
3 Specific objectives 03
8 Antenatal examination 09
9 Antenatal advice 13
11 Summary 20
12 Assignments 20
13 Abstract 21
14 Bibliography 23
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LESSON PLAN ON ANTENATAL CARE:
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Central objective:
At the end of the class, the student will be able to gain in depth knowledge
regarding the meaning of antenatal care, its objectives, aims, its components,
antenatal examination, antenatal advice and value of antenatal care.
Specific objective:
At the end of the class, the student will be able to:
Introduction of antenatal care
Aims and objectives
Discuss history collection and Antenatal examination
Discuss about Antenatal advices
Describe Values of antenatal care
Explain antenatal counseling
Introduction:
Introduced my self and the discuss the topic related to the presentation and
asked some question and checked the previous knowledge regarding the
antenatal care.
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SR.NO TIME OBJECTIVES CONTENT TEACHER’S STUDENT’S EVALUATION
ACTIVITY ACTIVITY
the pregnant women. The supervision should about the Interact with
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is the question.
antenatal
care? Takes down
the notes.
3 3 Aims of the AIMS: Asked to Student listen What is the aims
minute antenatal care? To screen the “high risk” cases students the of the antenatal
To educate the mother about the physiology aims with Given the
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to couple seeking medical termination of
pregnancy.
4 2 Discuss the OBJECTIVES: Explain the Listen the What is the
Minute objectives of The objective is to ensure a normal pregnancy objectives to explaination. objectives of the
antenatal care with delivery of a healthy baby from a healthy student with antenatal care?
obstetrical] consist in
minute registration of Registered the pregnancy as soon as possible to registration listen the registration of
pregnancy. the near PHC. After the confirmation of the of pregnancy explaination. the pregnancy.
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pregnancy to registered the pregnancy and to
do first antenatal visit.
7 10 Describe HISTORY COOLECTION: Asked to Student listen Which history
minute history At the first visit to taken the history of the student about the should be
collection of preganant women. History taking are as follow: which type of explaination. collected during
pregnant Name history antenatal care?
women. Age should be Interact with
Address antenatal
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trimester of the present pregnancy are
to be noted. Number of previous
antenatal visit, immunization status, has
to be noted.
Obstetric history: This is only related
with multigravidae. The previous
obstetric events are to be recorded
chronologically like pregnancy event,
labor event, method of delivery,
puerperium, baby
Menstrual history: Cycle, duration,
amount of blood flow and first day of
the last normal menstrual period
(LNMP) are to be noted
(spontaneous). From the LNMP, the
expected date of delivery (EDD) has to
be calculated. Calculation of the
expected date of delivery (EDD): This is
done according to Naegele’s formula
(1812) by adding 9 calendar months and
7 days to the first day of the last normal
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(28 days cycle) period.
Past medical history: Relevant history
of past medical illnesses (urinary tract
infections, tuberculosis) is to be elicited.
Past surgical history: Previous
surgery—general or gynecological, if
any, is to be enquired.
Family history: Family history of
hypertension, diabetes, tuberculosis,
blood dyscrasia, known hereditary
disease, if any, or twinning is to be
enquired.
Personal history: Contraceptive
practice prior to pregnancy, smoking or
alcohol habits are to be
enquired. LMP may be a withdrawal
bleed following pill usage.
8 5 Describe the ANTENATAL EXAMINATION: Explain the Student listen Explain the
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Height the physical Interact with
Weight examination, the teacher.
Pulse abdominal
Minute breast to note the presence of pregnancy changes but breast the breast
examination. also to note the nipples (cracked or depressed) examination. explaination. examination.
10 5 Discuss the VAGINAL EXAMINATION: Examination is explain how Student listen Explain the
minute vaginal done in the antenatal clinic when the patient to do vaginal the vaginal
examination. attends the clinic for the first time before 12 examination. explaination. examination.
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weeks. It is done: (1) to diagnose the Given the
pregnancy, (2) to corroborate the size of the answer the
uterus with the period of amenorrhea and (3) question.
to exclude any pelvic pathology. Internal
examination is, however, omitted in cases with Takes down
previous history of miscarriage, occasional the notes.
vaginal bleeding in present pregnancy.
Ultrasound examination has replaced routine
internal examination. It is more informative
and without any known adverse effect.
Steps of vaginal examination: Vaginal
examination is done in the antenatal clinic. The
patient must empty her bladder prior to
examination and is placed in the dorsal
position with the thighs flexed along with the
buttocks placed on the foot-end of the table.
Hands are washed with soap and a sterile glove
is put on the examining hand (usually right).
Inspection: By separating the labia—using
the left two fingers (thumb and index), the
character of the vaginal discharge, if any, is
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noted. Presence of cystocele or uterine prolapse
or rectocele is to be elicited.
Bimanual: Two fingers (index and middle) of
the right hand are introduced deep into the
vagina while separating the labia by left hand.
The left hand is now placed suprapubically.
Gentle and systematic examinations are to be
done to note: (1) Cervix: consistency, direction
and any pathology. (2) Uterus: size, shape,
position and consistency.
Early pregnancy is the best time to correlate
accurately uterine size and duration of
gestation. (3) Adnexa: any mass
felt through the fornix. If the introitus is
narrow, one finger may be introduced for
examination. No attempt should
be made to assess the pelvis at this stage.
11 10 Discuss the ABDOMINAL EXAMINATION: Discuss about Student listen How to do the
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striae, surgical scars (midline or suprapubic). to the Interact with
Palpation: (a) To note the height of the students with the teacher.
abdominal palpation will help to identify fetal about the Takes down
minute antenatal providing antenatal advice to pregnant question to the antenatal advise
advice. the student explaination. given to the
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women and her family are as followed: about the pregnant
PRINCIPLES: (1) To counsel the women which type of Interact with women?
about the importance of regular checkup. (2) health advice the teacher.
the woman to the optimum till delivery by given to the Given the
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As previously mentioned, there is negative iron
balance during pregnancy and the dietetic iron
is not enough to meet the daily requirement
especially in the second half of the pregnancy.
Thus, supplementary iron therapy is needed for
all pregnant mothers from 16 weeks onwards.
Above 10 g% of hemoglobin, 1 tablet of ferrous
sulfate (Fersolate) containing 60 mg of
elemental iron is enough. The dose should be
proportionately increased with lower
hemoglobin level to 2–3 tablets a day. Three
tablets provide 45 mg of absorbable iron.
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Recreational exercise (prenatal exercise class)
is permitted 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
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should wear loose but comfortable garments.
High 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 should avoid
coitus if they feel such increased uterine
activity.
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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, preeclampsia, severe
anemia and sickle cell disease. 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
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restriction.
IMMUNIZATION: Fortunately, most of life-
threatening epidemics are rare. In the
developing countries, immunization in
pregnancy is a routine for tetanus; others are
given when epidemic occurs or traveling
to an endemic zone or for traveling overseas.
13 2 Explain value VALUES OF ANTENATAL CARE: Describe the Student listen What is the
Minute of antenatal To screen the high risk cases values of the values of the
care. Detection of high risk factors antenatal explaination. antenatal care?
morbidity
Optimize the health level
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SUMMARY:
ASSIGNMENT:
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ABSTRACT:
BACKGROUND
Antenatal care (ANC) is one of the evidence based interventions to decrease the
probability of bad health outcomes for mothers and their newborns. Effectiveness of
antenatal care, however, relies on the quality of care provided during each antenatal
care visit. Hence this study attempted to assess the quality of antenatal care services at
public health facilities of Bahir-Dar special zone, North Western Ethiopia.
METHODS
RESULTS
Pregnant mothers attending ANC clinics were found to receive only part of
recommended care components. Venereal Disease Research Laboratory (VDRL) test,
blood group and Rhesus factor tests were done only for 73 (19.8%) and 133 (36.0%) of
the women, respectively. Moreover 236 (64.0%) of the mothers missed the opportunity
of receiving iron/folic acid supplement during their ANC visit. Three hundred fifty five
(96.2%) of the women received tetanus toxoid vaccine. And only 226 (61.2%) of the
women had their conjunctiva checked for anemia. Lack of reagents partly explained the
problems observed in the provision of recommended care components.
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CONCLUSION
Almost half, 175 (47.7%) of the study women were not satisfied and a large
proportion of mothers are missing opportunities to receive screening (like blood
pressure and weight measurements) and preventive components of antenatal care
(iron/folic acid supplementation). Therefore, efforts should be targeted to avoid missed
opportunities by taking quality improvement measures including the fulfillment of all
necessary resource.
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BIBLIOGRAPHY:
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