Antenatal Care

Dr. Ahmed Al Harbi

Obstetrics/Gynecology Consultant

Aims Of Antenatal Care

To prevent, detect and manage those factors that adversely affect the health of the baby To provide advice, reassurance, education and support for the woman and her family To deal with the minor ailments of pregnancy To provide general health screening

Classification Of Antenatal Care

Shared Care
1.

Hospital Maternity Team General Practitioner (GP)

2.

3.

Community Midwives

Community-Base Care

Hospital-Based Care

Advice, Reassurance & Education

Reassurance & explanation on pregnancy symptoms:

1. 2. 3. 4. 5. 6.

7.
8. 9.

Nausea Heartburn Constipation Shortness Of Breath Dizziness Swelling Back-ache Abdominal Discomfort Headaches

Information regarding:
1.

Smoking
Alcohol Consumption Drugs (Both LEGAL and ILLEGAL)

2.

3.

Confirmation of the pregnancy

1.

The symptom of the pregnancy

Breast tenderness Nausea Amenorrhea Urinary Frequency

2.

Positive urinary or serum pregnancy test

are usually sufficient confirmation of a pregnancy.

3.

Dating Pregnancy, confirms the

pregnancy and accurately dates it.

Dating Pregnancy
A.

Menstrual EDD

B.

Dating by ultrasound

Benefits of a dating scan:

1.

2.

3.

4. 5.

Accurate dating women with irregular menstrual cycles or poor recollection of LMP. Reduced incidence in induction of labor for prolonged pregnancy Maximizing the potential for serum screening to detect fetal abnormalities Early detection of multiple pregnancies Detection of otherwise asymptomatic failed intrauterine pregnancy

Booking History
1.

Past Medial History Past Obstetric History

2.

3.

Previous Gynaecological History

Family History Social History

4.

5.

Booking Examination
Full Physical Examination:

Cardiovascular
Respiratory Systems

Abdominal
Full Pelvic Examination

Full Breast Examination

 Examination for most

healthy women :
1.

Accurate measurement of blood pressure

Abdominal examination to record the size of

2.

the uterus
3.

Recognition of any abdominal scars indicative of previous surgery

4.

Measurement of height and weight for calculation of the BMI. Women with a low BMI are at greater risk of fetal growth restriction and obese women are at greater risk of fetal growth restriction and obese women are at significantly greater risk of most obstetric complications, including gestitational diabetes, pre-eclampsia, need for emergency caesarean section and anaesthetic difficulties.

5.

Urine examaniation: asymptomatic bacteriuria

is more likely to ascend and cause pyelonephritis in pregnancy.

This causes significant maternal morbidity, but also predisposes to pregnancy loss and preterm labour. All women at booking should wither have a midstream urine sent for culture or be tested with a dipstick which recognizes nitrates, the presence of which sensitivity predicts the presence of significant bacteria.

Booking Investigation
1. 2.

Full Blood Count

Blood Group & Red Cell Antibodies

Women found to be rhesus negative will be offered prophylactic anti-D administration at 28 and 34 weeks gestation to prevent rhesus isoimmunization and future HDN. Other possible iso-immunization events, such as threatened miscarriage after 12 weeks gestation, antepartum haemorrhage and delivery of the baby, may require additional anti-D prophylaxis in rhesus-negative women.

3.

Rubella

Women who are found to be rubella nonimmune should be strongly advised to avoid infectious contacts and should undergo rubella immunization after the current pregnancy to protect themselves for the future.

4.

Hepatitis B

Vertical transmission to the fetus may occur, mostly during labour, and horizontal transmission to staff or the newborn infant can follow contact with body fluids. A baby born to a hepatitis B carrier should be actively and passively immunized at delivery.

5.

Human Immunodeficiency Virus

In known HIV-positive mothers, the use of antiretroviral agents, elective Caesarean section and avoidance of breastfeeding reduces vertical transmission rates from approximately 30% to less than 5%.

The Department of Health guidelines now recommend that all pregnant women should be offered an HIV test at booking.

6.

Syphilis

Haemoglobin Studies

Tests for thalassaemia and sickle cell disease are usually reserved for women who have an ethnic background and those from the Middle East.

Gestational Diabetes
1.

Random Blood Sugar

2.

Fasting Blood Sugar

Formal Oral Glucose Tolerance

3.

Pattern Of Follow Up Visits

4 weekly appointments from 20 weeks until 32 weeks Followed by fortnightly visits 32 weeks to 36 weeks and weekly visits. The minimum number of visits recommended by the Royal College of Obstetricians and Gynaecologists is 5, occurring at 12, 20, 28-32, 36 and 40-41 weeks.

Content Of Follow Up Visits

General questions regarding maternal well-

being.

Enquiry regarding fetal movements (24

weeks).

Measurement of blood pressure (a screen for

pregnancy-related hypertensive disorders).

Urinalysis, particularly for protein, blood and

glucose: this is used to help detect infection, pre-eclampsia and gestational diabetes.

 Examination for oedema:

Oedema is common in pregnancy and is

mostly an insensitive marker of preeclempsia. Oedema of the hands and face is somewhat more important as a warning feature of pre-eclampsia.
Abdominal palpation for fundal height:

If repeated symphysisfundal height measurement are made throughout a pregnancy, the detection of fetal growth problems and abnormalities of liquor volume increased.

 Auscultation of the fetal heart:

There is no evidence that this practice is of any benefit in a woman confident in the movements of her baby; however, it provides considerable reassurance and will occasionally detect an otherwise unrecognized intrauterine fetal death.
A full blood count and red cell antibody

screen is repeated at 28 and 36 weeks. particular unit, women at 28 weeks may be tested for gestational diabetes.

Depending on the screening policy of the

 From

(longitudinal, transverse or oblique), its presentation (cephalic or breech) and the degree of engagement of the presenting part should be assessed and recorded. It is often at this appointment that a decision is made regarding the mode of delivery (i.e. vaginal delivery or planned Caeserean section).

36 weeks, the lie of the fetus

 At

regarding the merits of induction of labour for prolonged pregnancy should occur. An association between prolonged pregnancy and increased perinatal morbidity and mortality means that women are usually advised that delivery of the baby should occur by 42 completed weeks gestation.

41 weeks gestation, a discussion

This will usually mean organizing a date for induction of labour at approximately 12 days past the EDD.

Antenatal complications dealt with in customized antenatal clinics

 Endocrine (diabetes, thyroid, prolactin and

other endocrinopathies)

Miscellaneous medical disorders (e.g.

secondary hypertension, autoimmune disease)

disorder)

Haematology (thrombophilias, bleeding Substance Misuse Preterm labour

Multiple gestation
Teenage pregnancy

THE END