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ANTENATAL CARE

The antenatal period is defined as the period between conception of the fetus and
delivery.

What is antenatal Care?

Antenatal care is defined as specialized health care that should be received by all
women who are pregnant.

What is the importance of Antenatal Care?

The main objective of antenatal care is to ensure a healthy mother and infant at the
end of the pregnancy.

1) Health Education: The antenatal care can provide the right opportunity for health
education. These health talks can cover topics such as physiological changes during
pregnancy, nutrition, hygiene, care of the teeth, sexual intercourse during pregnancy,
immunization, relaxation, travel and exercise during pregnancy and after delivery.
One can also use this opportunity to dispel any myths and fears about pregnancy.

2) Monitoring of fetal well being.

3) Screening to detect fetal abnormalities.

4) Detection and treatment of complications of pregnancy.

5) Detection of possible problems in labour ,before the labour commences.

How many times do I need to make antenatal visits during a pregnancy?

The total number of antenatal visits to be made by a pregnant lady varies. It depends
on the risk factors ( Like previous history of stillbirth etc), the woman might have.

If the visits are made less frequently, it might be difficult to identify complications. If
visits are made too frequently, it might increase the number of interventions.

For a pregnant lady with no risk factors, the following visits are recommended:

Prenatal visits should be regular: The booking (First visit) around 12 to 14 weeks of
pregnancy, ideally in a hospital antenatal clinic.

0-28 Weeks: Every 4 weeks

28-36 Weeks: Every 2 weeks.

After 36 weeks: Weekly, till delivery


What is the booking visit?
This is the first antenatal visit, and it should be comprehensive. Ideally a thorough
history and examination should be done on every pregnant woman in the first visit.
This is to identify any risk factors if present.

The booking visit, which is the first antenatal visit to your hospital/clinic is very
important because it allows your doctor to identify any risk factors that may adversely
effect your pregnancy.

Feel free to disclose confidential issues such as previous abortions, stillbirths,


contraceptives etc.

A.A detailed history and a comprehensive examination will be done by medical


doctor during this visit

a) History of the Current Pregnancy:

It is important that a careful menstrual history be taken from a pregnant woman.

Are her menstrual cycles regular or irregular? If it is regular, what is the length of the
normal cycle? The date of her last known menstrual period (LMP) is ascertained.

b) History of Past Deliveries (Past Obstetric History)

This is an extremely important aspect of the history taking during the booking visit.
A summary should be made of all previous pregnancies (including stillbirths and
abortions).

The details of the pregnancy such as the year , duration of pregnancy, wheather
labour was induced or spontaneous, duration of labour, method of delivery, problems
during delivery will be questioned.

c) Calculation of the EDD (Expected Date of Delivery):

On average the pregnancy lasts for 40 weeks from the date of the last menstrual
period.

The expected date of delivery(EDD) can easily be found by adding 9 months and 7
days to the last menstrual period( LMP).

B Medications:

Do not take any medications unless prescribed by your doctor/health care provider.

C Diet:

i) Eat a balanced diet with proteins , carbohydrates and vegetables.


ii) Take prenatal vitamins with iron and folic acid . Vitamin A should be avoided as
retinol/ retinoic acid can cause human birth defects (Teratogen).

iii) Pregnant women should not diet to loose weight. They should expect to gain about
20-40 lb.

iv) Eat fresh foods and vegetables.

v) Avoid eating raw meat or fish. Fish suspected of having high levels of mercury
should also be avoided.

vi) Reduction in caffeine intake (reduce to 1 cup of coffee, 1 cup of tea or 1 cup of
caffeinated cola daily).

D) Birth Classes:

Pregnant women and their partners should be encouraged to join birth classes.
Antenatal classes may come in various forms, but all have the same aim -- to help
prepare you for labour, birth, and early parenthood. These days, it is common for
hospitals to offer these classes as part of antenatal care.

Antenatal classes generally cover topics such as:

• Looking after yourself in pregnancy, including suggestions about good


nutrition preparation of healthy foods and what not to eat.
• Emotional and physical changes you might experience during pregnancy.
• Care of your back.
• Exercise (including pelvic floor exercises).
• Practice of various breathing techniques for managing pain in labour.
• Options available for a pain-free delivery.
• Relaxation techniques.
• Prenatal yoga and asanas for maintaining flexibility and stamina.

E) Rest and Activity:

Adequate rest must be taken every day.

Strenuous physical activities/exercise should be avoided by pregnant women.

However mild to moderate exercises are recommended.

Heart rate should be kept to below 140 beats/ minute during exercise.
F) X-Rays and other Noxious Exposures:

Avoid all X-rays unless approved by your physician.

Always inform your physician, dentist and other health care provider that you are
pregnant or you are planning to conceive.

Chemical and radiation hazards should be avoided (especially for industrial workers)

Avoid excessive heat, like spending long time in hot water tubs.

Handling of cat faeces should be avoided.

Gloves should be worn during gardening.

G) Alcohol:

Alcohol should be avoided in pregnancy as there is no safe limit for the level of
alcohol intake. The baby can suffer from fetal alcohol syndrome which can result in
permanent damage to the central nervous system of the baby.

H) Cigarette Smoking:

Cigarette smoking results in fetal exposure to carbon monoxide and nicotine.

Premature delivery occurs more commonly among cigarette smokers (20% more
frequently among smokers).

The birth weight of the fetuses of smoking mothers are on average 200g less than the
fetal birth weight among non-smokers.

Passive smoking is equally dangerous to pregnant women and their fetuses as it is to


any other human beings .

It is also important for a woman to alert her doctor immediately if anything unusual
occurs during pregnancy, such as:

• The baby's movement is greatly reduced or stops.


• If you experience vaginal bleeding or cramping.
• If you develop swelling of her hands and face, or persistent headaches.
• She leaks amniotic fluid from her vagina.
• She develops pain in her abdomen.

Improved technologies and more accurate prenatal tests now make it possible to spot
complications earlier and take appropriate action in time to save the fetus and/or the
mother.

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