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1 Identification data 02

2 Central objectives 03

3 Specific objectives 03

4 Introduction of antenatal care 04

5 Aims of antenatal care 05

6 Objectives of antenatal care 06

7 Components of antenatal care 06

8 Antenatal examination 09

9 Antenatal advice 13

10 Values of antenatal care 19

11 Summary 20

12 Assignments 20

13 Abstract 21

14 Bibliography 23


 Student name: Miss Ravina patel

 Name of the course: MSc Nursing
 Name of the subject: Obstetrics and midwifery
 Name of the unit:
 Name of the topic: Antenatal care
 Class:
 Size of the class:
 Date and time: / /2019
 Vanue:
 Previous knowledge of level: student had some knowledge regarding
 Method of teching: Lecture cum discussion
 Media of teaching: Blackboard, Powerpoint, chart
 Name of evaluator:
 Designation:

 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.


1 5 Explain INTRODUCTION: Discuss the Listens to the Explain the

minute antenatal care? Antenatal care is a systematic supervision of introduction explaination. antenatal care.

the pregnant women. The supervision should about the Interact with

be regular and periodical in nature according to antenatal the teacher.

the need of the individual. Actually prenatal care

care is the care in continue that start before
pregnancy and end at the delivery and the
postpartum period.
2 3 Define the DEFINITION: Write the key Student listen What is the
minute antenatal care Systematic supervision (examination and point on the the antenatal care?

advice) of a women during pregnancy is called blackboard. explaination.

Antenatal Nursing Care (ANC). Review the

definition Interact with
using the teacher.
question the Given the
student what answer the

is the question.
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 prevent or to detect and treat at the what is the explaination. care?

earliest any complication, aims of the

 To ensure continued risk assessment and to antenatal Interact with

provide ongoing primary preventive health care? Then to the teacher.

care, discuss the

 To educate the mother about the physiology aims with Given the

of pregnancy and labor by demonstrations, students. answer the

charts and diagrams (mothercraft classes), question.

so that fear is removed and psychology is

improved, Takes down

 To discuss with the couple about the place, the notes.

time and mode of delivery, provisionally

and care of the newborn,
 To motivate the couple about the need of
family planning and also appropriate advice

to couple seeking medical termination of
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?

mother. the help of

5 2 List down the COMPONENT: Asked to Answer the Which are the

Minute component of  Registration of pregnancy student about teacher component

antenatal care.  History taking the which question. consist in the

 Antenatal examinations [general and component anenatal care?

obstetrical] consist in

 Laboratory investigations antenatal

 Health education care? Explain

component of
6 3 Describe the REGISTRATION OF PREGNANCY: Explain the Carefully Explain the

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.

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

 Date of first examination taken during the teacher.

 Address antenatal

 GPAL visit? Given the

 Duration of marriage Discuss with answer the

 Religious student about question.

 Occupation of women and her husband the which

 Period of gestation type of Takes down

 Complain: ask to women for any history the notes.

complain and to be noted. should be

 History of present illness: elaborate taken.

the chief complain as regard their onset,
duration, severity, use of medication
 History of present pregnancy: The
important complication in different

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

(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
 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

minute antenatal  General physical examination: antenatal the antenatal

examination.  Built examination explaination. examination.
which include

 Height the physical Interact with
 Weight examination, the teacher.

 Pulse abdominal

 Respiration rate examination, Given the

 Blood pressure vaginal answer the

examination question.
 Pallor
with the use
 Jaundice
of chart and Takes down
 Tongue, teeth, gum
powerpoint. the notes.
 Edema
 Systematic head to toe examination
9 5 Explain the EXAMINATION OF THE BREASTS helps discuss the Student listen Explain the

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.

and skin condition of the areola. The purpose is Interact with

to correct the abnormality; if any, so that there the teacher.

will be no difficulty in breastfeeding Takes down

immediately following delivery. the notes.

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.

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

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

minute abdominal Inspection: Abdominal enlargement, the the abdominal

examination. abdominal explaination. examination?
pregnancy marks—linea nigra,

striae, surgical scars (midline or suprapubic). to the Interact with
Palpation: (a) To note the height of the students with the teacher.

fundus above the symphysis pubis. (b) In the the help of

second trimester, to identify the fetus by the chart. Given the

external ballottement, fetal movements, Asked answer the

palpation of fetal parts and auscultation of fetal question to question.

heart sounds. (c) In the third trimester, the student

abdominal palpation will help to identify fetal about the Takes down

lie, presentation, position, growth pattern, How to do the notes.

volume of liquor and also any abnormality. abdominal

Examination also helps to detect whether the examination?

presenting part is engaged or not. Girth of

abdomen is measured at the level of umbilicus.
The girth increases by about 2.5 cm per
week beyond 30 weeks and at term, measures
about 95–100 cm. (d) Others—any uterine
mass (fibroid) or tenderness. Fetal activity
(movements) is also recorded.
12 5 Discuss the ANTENATAL ADVICE: Asked Student listen List down the

minute antenatal providing antenatal advice to pregnant question to the antenatal advise
advice. the student explaination. given to the

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.

To maintain or improve the health status of you have to

the woman to the optimum till delivery by given to the Given the

judicious advice regarding diet, drugs and pregnant answer the

hygiene. (3) To improve the psychology and to women? question.

remove the fear of the unknown by counseling

the woman. Takes down
the notes.

DIET: The diet during pregnancy should be

adequate to provide: (a) good maternal health,
(b) optimum fetal growth, (c) the strength and
vitality required during labor and (d) successful
lactation. During pregnancy, there is increased
calorie requirement due to increased growth of
the maternal tissues, fetus, placenta and
increased basal metabolic rate.

Supplementary nutritional therapy:

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.


uncomplicated cases, the following advices are
to be given:
Rest and sleep: The patient may continue
her usual activities throughout pregnancy.
However, excessive and strenuous work should
be avoided especially in the first trimester and
the last 4 weeks.

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

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
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

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

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?

 Pregnancy should be regularly care Interact with

supervised the teacher.

 Acceptance of advise Takes down

 Reduction of maternal mortality and the notes.

 Optimize the health level


Antenatal care is the systematic examination and supervision of the pregnant

women. The supervision should be regular and periodical in nature according to the
need of the individual. Actually prenatal care is the care in continue that start before
pregnancy and end at the delivery and the postpartum period. Antenatal care consist of
the antenatal examination its include physical, breast, vaginal, abdominal examination
etc, and antenatal advices. During the antenatal care provide the antenatal advice to the
pregnant women and her family. Antenatal care should be provided for the optimum
health of the women and fetus, early detection of high risk, prevent for complication etc.


1. Define the antenatal care. Explain the antenatal advices.

2. Write down about the abdominal examination of the pregnant women.



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.


A facility based cross-sectional study employing both quantitative and qualitative

methods was conducted from March to April 2010 in Bahir-Dar special zone, North
Western Ethiopia. Quality of care was measured as a proportion of patients receiving
recommended components of care. To measure the indicators, data was collected from
369 pregnant women who attended ANC clinics in eight public health facilities, during
the data collection period. Data were collected through exit interviews with ANC
attendees, observation during consultation, and in-depth interviews with health care


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.


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.


1. Annamma Jocob. A Comprehensive Textbook Of Midwifery And Gynecological

Nursing: antenatal care. Fourth Edition. New Delhi: Jaypee Brother Medical
Publisher (P) Ltd; 2015. Pp (112-119)
2. D.C. Dutta’s. Text Book Of Obstetrics: Antenatal care. Seventh Edition. New Delhi:
New Central Book Agency (P) Ltd; 2010. Pp (94-102)
3. Dr. Shally Magon. Sanju Sira. Textbook Of Midwifery And Obstetrical Nursing:
Antenatal examination. Third Edition. New Delhi: Lotus Publisher; 2013. Pp (53-
4. Myles. Text Book For Midwives: Abdominal examination. Fifth Edition. UK:
Churchill Livingstone Elsevier; 1964. Pp (263-268)
5. Nima Baskar. Midwifery And Obstetrical Nursing: Antenatal care. Seventh
Edition. Bangalore: EMMESS Medical Publisher; 2015. Pp (134-141)