Antenatal Care
§ Follow up and care during pregnancy
§ Importance:
1. To ensure the mother reaches the end of pregnancy in a healthy state.
2. Detect any complications at an early stage and manage.
3. Mother delivers a healthy baby.
4. For the mother to discuss her anxiety and fear of pregnancy.
5. To prepare the couple for childbirth, childcare, breast feeding.
6. Avoid complications during pregnancy or to minimize them.
7. Make sure baby is growing well and is healthy.
8. To know when to interfere and terminate the pregnancy.
9. To prepare the mother for labor and delivery.
10. To build her blood volume, iron and bone.
11. To know her blood group
§ Timing:
Pre-pregnancy counseling à
1. Control diseases if there are any.
1st step in management of a patient with chronic condition is to refer her to consultation of her case.
DM à endocrinologist
Epilepsy à Neurologist
Ro follow her condition during pregnancy
To change her medication to non or less teratogenic
2. If she has genetic disease à proper genetic counseling
3. Medical care
4. General health
5. Smoking, alcohol
6. Diet
In normal pregnancy;
v First 28 weeks (1st 7 months) à every 4 weeks.
v 28 – 36 weeks (8th & 9th month) à every two weeks
v 37 weeks < à every week.
According to the maternal condition and fetal status, she might have more or less frequent visits.
§ 1st visit:
v History, examination, investigations, radiology …
v Give her supplements;
Ø 1st trimester à
1. Folic Acid à prevent anomalies (CNS, Renal)
When to give higher dose?
Multiple pregnancies, epileptic, DM, anemic
Through all pregnancy
Ø 2nd trimester à
1. Iron & Ca++
§ Investigations:
v Routine antenatal work up (once):
1. CBC
Hb, platelet
2. Blood group
A. If she needs blood transfusion
B. If she needs anti-D or not
3. Antibody screening
D&K à worse ones
L à benign
4. Toxoplasma & Rubella (IgG)
5. Hepatitis B surface antigen
6. Urine analysis
Base line à glucose, ketone, protein
Pus or bacteria (culture)
7. Random/fasting blood glucose
GTT 2 hours
24 – 28 weeks
v US:
1. 1st trimester à gestational sac, ectopic or intrauterine, make sure it is normal or molar, number of fetus, correcting gestational age.
2. 2nd trimester à anomaly scan (22nd – 24th week)
3. 3rd trimester à for growth, presentation, placenta …(32nd – 34th weeks)
§ Every visit:
v What happened since last visit.
v Ask if there are any problems.
v Ask about supplements.
v Heartburn à antacid
v Constipation à laxative
v Fetal movements
v Check weight, blood pressure, urine dipstick …
v Examination of the abdomen; edema, fundal high, growth
§ Examination:
v Abdominal
v Pelvic
§ Diet à no restrictions unless she has a special condition
§ Exercise à walking is advisable, no heavy lifting
§ Coitus à not contraindicated unless placenta previa, bleeding or preterm labor
§ Alcohol à fetal alcohol syndrome
§ Drugs à avoid teratogenic drugs
§ Clothing à avoid tight
§ Immunization à non-live vaccines
§ Travelling à contraindicated if she’s at risk