DR MYO HLA MYINT

AIMS
To prevent, detect and manage factors
that adversely affect the health of mother
and baby.
Detection of any psychological or physical
problems during pregnancy
Mother Gives birth to HEALTHY baby
Couple prepared for the birth and for child
rearing, including receiving info about
diet, childcare and family planning
Classification of antenatal
care
Shared
care
Shared care
Service provided by Hospital maternity
team , GP and community midwives.
Women with risk factors
Community Based care
Booking appointment done by community
midwives.
Routine scans and investigations
requested
Ideally for low risk women
Hospital based care
Highly specialized antenatal care eg :
antenatal clinic for women with diabetes,
High risk women
PATTERN OF VISITS
FIRST 28 WEEKS 4 WEEKS
ONCE
28-36 WEEKS EVERY 2 WEEKS
36 weeks -DELIVERY once
WEEKLY

The Booking Visit
Confirmation of pregnancy
Breast tenderness, nausea, amenorhhea,
urine frequency)
+ Urine test
Booking History
Dating the Pregnancy-EDD
time of delivery
LMP-Naegeles rule OR Ultrasound
For risk assessment from history
taking, physical exam and investigations
Booking History

Personal Info
Past medical History
Immunisation history Rubella, Hep B,
Tetanus
Hypertension -epilepsy
Kidney Disease -asthma
DM -collagen disease
Heart Diseases -Thyroid disorders
Others
Personal information
IC No
Mothers Name
Race
citizenship
Education level
Occupation
Home Address
Husbands name
Husbands
occupation
Husbands working
add
LMP
EDD
Gravida _ para _
Age (DOB)
Tel no :
Husbands IC NO
Husbands Tel No:


AN
PN
Previous Pregnancy Info
Year of
pregnancy
Result of
pregnancy

Type of
Delivery

Place of
delivery

Sex

Birth weight

Childs
condition at
present

Breast
feeding/
duration

Complication
Previous Gynaecological History
History of infertility
Recurrent miscarriage
Any gynae surgery
Family History
Type II DM
Thromboembolic disease
Social History
Smoking
Alcohol
Usage of illegal substances-Cocaine,Amphetamine
Domestic Violence

BOOKING EXAMINATION
Check BMI
Thyroid exam
Cardiovascular
Measurement of BP
Loud Heart sound
Flow murmur
Respiratory
Breast exam
Abdominal exam
Any abdominal scar
Size of uterus
Vaginal exam cervical smears and vaginal swabs NOT
routinely done

-Abdominal exam
ANY abdominal scar
Size of uterus
Vaginal exam cervical smears and vaginal
swabs NOT routinely done

Height of fundus
Booking Investigations
Full blood count Hemoglobin 10.5-15.0g/dl
Hematocrit normal>35
MCV and MCH
Blood Group and RHESUS Antibodies
Infection screening (Rubella, Hepatitis B, HIV, Syphilis)
Assess screening for MOGTT
Urinalysis For asymptomatic bacteriuria

COLOUR CODES FOR ANTENATAL
CARE
OBJECTIVE: Its Important in managing the pregnant mothers
based on their risk factors.
Red hospital admission
Yellow To be refered to the O&G Specialist in Hospital/
Health Clinics
Green To be seen by the Medical Officer in Health Clinics by
appointments
White Can be seen by Community Nurses or Staff nurses in
the health clinics
WHITE 1- TO BE DELIVER IN HOSP
WHITE 2-CAN BE DELIVERED AT HOME
RED tag
1. Eclampsia
2. Pre-eclampsia High blood pressure with albumin urea 1+ or with
symptoms or B.P>160/100
3. Heart disease in pregnancy with signs and symptoms ( Breathless,
palpitation)
4. Breathlessness with light activity ( Activity spt, sweeping and
washing plates)
5. Mother with uncontrolled diabetes
6. Bleeding during pregnancy (inclusive of abortion)
7. Fetal Heartbeat abnormal
FHR <110/min at or after 26/52 week
FHR >160/mim after 34/52 week ( FHR may be high at term
8. Anaemia with symptoms at any period of gestation
9. Premature contraction of uterus
10. Leaking liquor/ not in labour
11. Asthma - severe

YELLOW
1. Mother HIV positive
2. Mother Hepatitis B positive
3. Blood pressure >140/90 <160/110 mmHg
with urine albumen negative
4. Mother diabetic Urine yellow or orange
5. No foetal movements felt >32 weeks
6. More than 7 days after EDD

GREEN TAG
1. Rhesus negative
2. Weight of mother at booking <45 kg
3. Associated medical condition Psychiatric
or deformity except diabetes or
hypertension
4. H/O Gynaecological surgery
5. Cigarette smoker or alcohol drinker
6. Unsure of dates -LMP
7. H/O recurrent miscarriages =>3 times

8. Bad Obstetric history
a. LSCS
b. PIH/ Eclampsia/ diabetes
c. Perinatal mortality
d. Babys weight <2.5 kg or >4 kg
e. 3
rd
degree perineum tear
f. Retained placenta
g. PPH
i. Instrumental delivery
j. Prolonged labour
9. Multiple pregnancy
10. Blood pressure > 140/90 and urine
albumen negative
11. Haemoglobin <11.0 Gm
12. Urine sugar green 2 times
13. Urine albumen >1+
14. Weight gain >2 Kg in 1 week
15. Weight of mother >80 Kg
16. Height of fundus less or more than
POA
17. Breech/ oblique/ transverse lie with
no labour pain > 36/52 weeks of
pregnancy
18. Head not engaged at 36/52 weeks of
POA for a primigravida
WHITE I -DELIVER AT HOSPITAL
1. Primigravida
2. Age <18 and >40 years
3. Gravida 6 and above
4. Interval from last delivery <2
years or >5 years
5. Mothers
( i ) Height <145 cm
( ii ) Single mother
( iii ) Home environment not
suitable

WHITE II -DELIVER AT HOME
1. Gravida 2 to 5
2. No bad obstetrics history
3. No associated medical problem
4. No complication during pregnancy
5. Home environment suitable
6. Height >145 cm
7. Age of mother >18 and <40
8. POA >37 weeks and <41 weeks
9. Married and support by family
10. Estimated babys weight >2 kg and <3.5 kg

Content of follow up visits
General Questions on
well being
Fetal movements -24
weeks within 12 hours
BP measurements
Urine : Albumin, sugar
Blood : Hb
Weight
Edema
POA, Gestation weeks
Symphysis fundal
height
From 36 weeks-fetal
lie, presentation,
engagement degree
Fetal Heart sound
Symphsis-fundal height graph
Antenatal imaging and assesment
of well being
Ultrasound
CTG

BENEFITS OF SCAN
confirm the fetal viability
Provide an accurate estimation of gestational
age
Diagnose multiple gestation and chorionicity
Identify markers which would indicate
increase risk of fetal chromosome
abnormality such as Downs S
Identify fetuses with gross deformity

ULTRASOUND MEASUREMENT
CROWN- RUMP LENGTH-
measures from head to buttocks
FORMULA :::: Gestational age
(weeks) = crown-rump length
(cm) + 6.5
An ultrasound showing a
fetus measured to have a
crown-rump length of
1.67 cm, and estimated to
have a gestational age of
8 weeks and 1 day
Biparietal diameter
The diameter
between the 2
sides of the head.
This is measured
after 13 weeks.
FEMUR LENGTH
Measures the
longest bone in the
body and reflects
the longitudinal
growth of the fetus
ABDOMINAL CIRCUMFERENCE
The single most
important
measurement to make
in late pregnancy.
It reflects more of
fetal size and weight
rather than age. Serial
measurements are
useful in monitoring
growth of the fetus.
Diagnostic Ultrasound
In 1
st
trimester
11-14 weeks
Estimation of gestational age
Multiple pregnancy
Nuchal thickness and measurement and
chromosomal abnormalities
2
nd
trimester
18-22 weeks
Fetal anatomical survey to detect any
structural defect
Establish multiple gestation
Locate the placenta exclude placenta previa
Estimate amniotic fluid volume
Measure cervical length to assess the risk of
preterm delivery
3
rd
trimester
Asses fetal growth
BPD,HC,AC &FL-fetal symmetry
Serial measurements are plotted in
graph with normal reference range
Assess fetal well being
Amniotic fluid volume
Maximum vertical pool measured after
general survey of uterine contents
<2cm oligohydromnion
>7cm polyhydromnions
Sum of all vertical pool (from 4
quadrants)
Fetal heart rate

Fetal CTG


Fetal growth chart
Doppler Investigation
Waveform from
umbilical artery
provide information
on feto-placental
blood flow and
placental resistance

Thank you