INTRODUCTION

INTRODUCTION The major goal of prenatal care is to ensure the birth of a healthy baby with minimal risk for the mother. There are several components involved in achieving this objective: Early, accurate estimation of gestational age Identification of the patient at risk for complications Ongoing evaluation of the health status of both mother and fetus Anticipation of problems and intervention, if possible, to prevent or minimize morbidity Patient education and communication

The percentage of pregnant women who initiate prenatal care in the first trimester is one of the standard clinical performance measures used to assess the quality of maternal health care. In the United States in 2006, 83 percent of pregnant women obtained prenatal care in the first trimester, but 3.6 percent received no care or initiated prenatal care in the third trimester [1]. The optimal components of prenatal care have not been rigorously examined in randomized trials [2-6]. A systematic review of observational studies and randomized trials concluded that there was no conclusive evidence that prenatal care improved birth outcomes [2,4]. Randomized trials have also shown that enhanced prenatal care (eg, extra office visits, health education, home visits, telephone contact, psychosocial support) did not result in improved outcomes compared to routine prenatal care [7,8]. Further, comparison of pregnancy outcomes in women who receive and do not receive prenatal care is consistently confounded by socioeconomic and other factors that influence access to prenatal care and maternal/perinatal outcome. In the developing world, if prenatal care is not readily available, then adequate delivery of other health care and social services often also are not readily available. This is important since complications resulting in serious morbidity or mortality are most likely to occur at delivery.

AIMS OF ANTENATAL EXAMINATION

the condition being screened for is an important health problem the screening test (further diagnostic test and treatment) is safe and acceptable the natural history of the condition is understood early detection and treatment has benefit over later detection and treatment the screening test is valid and reliable

treatments or interventions should be effective there are adequate facilities for confirming the test results and resources for treatment the objectives of screening justify the costs.

STEPS IN ANTENATAL EXAMINATION

Pelvic examination
Routine antenatal pelvic examination does not accurately assess gestational age, nor does it accurately predict preterm birth or cephalopelvic disproportion. It is not recommended.

Breast examination
Routine breast examination is not recommended.

Weight
The patient should be weighed and her height measured so that her body mass index can be calculated as: BMI = weight in kilograms/(height in metres)2. This can be used as a baseline for future weighing where it is clinically indicated.

Urine
Test for asymptomatic bacteriuria early in pregnancy using dipstick testing; send mid-stream specimen of urine (MSU) if indirect test is positive. Test for proteinuria every time BP is taken. Check for glycosuria at every visit; if more than 2 then test random plasma venous glucose and determine need for an oral glucose tolerance test on the basis of that result; there is no evidence of benefit from routine screening for gestational diabetes mellitus. See separate article Glucose Tolerance Tests.

Blood pressure
Measure BP at presentation and at every subsequent appointment. Assess risk factors for pre-eclampsia: o Age >40. o Family history. o Previous history of pre-eclampsia. o BMI >35 at presentation. o Multiple pregnancy. o Vascular disease, e.g. hypertension, type 1 diabetes.

Schedule further appointments accordingly to allow appropriate monitoring of BP.

Previous history
Enquire into the areas listed below, and ask about any previous significant physical or psychiatric illness. Women with a history of significant psychiatric illness should be offered a referral to psychiatric services to screen for problems, and for advice on appropriate support: 1

Occupation for any associated risks. Smoking. Alcohol and recreational drug use. Domestic violence.5 Psychiatric illness.

Advise and refer accordingly if any areas of concern come to light. PURPOSE OF ANTENATAL EXAMINATION This update has also provided an opportunity to look at a number of aspects of antenatal care: the development of a method to assess women for whom additional care is necessary (the antenatal assessment tool) information giving to women lifestyle: vitamin D supplementation alcohol consumption screening for the baby: use of ultrasound for gestational age assessment and screening for fetal abnormalities methods for determining normal fetal growth placenta praevia screening for the mother: haemoglobinopathy screening gestational diabetes pre-eclampsia and preterm labour chlamydia.

AIMS OF ANTENATAL EXAMINATION

the condition being screened for is an important health problem

the screening test (further diagnostic test and treatment) is safe and acceptable the natural history of the condition is understood early detection and treatment has benefit over later detection and treatment the screening test is valid and reliable treatments or interventions should be effective there are adequate facilities for confirming the test results and resources for treatment the objectives of screening justify the costs.

Dear SNA Members, You may be aware that the new office bearers of TNAI have been elected during the TNAI Biennial Conference conducted at Ernakulam (Kerala) on 24 November 2010. The special centennial issue of Nursing Journal of India was also released during the same Conference. Now the Nursing Journal of India (NJI) has entered the next century and we also have entered into the New Year with many new hopes and expectations. May God shower each one of us with blessings to work with commitment and to achieve personal and professional growth. During the TNAI Council & HOD meeting at Ernakulam (Kerala) there was a discussion on the XXIV SNA Biennial Conference. As decided there, this year we will have our SNA Conference at Karnataka. The State branch of Karnataka has given consent for organising and hosting this National Biennial Conference. So, we request all State branches to plan and conduct State level competitions and to cooperate with the host branch to make the Conference a grand success. The month and dates of the National Conference and other relevant information will be published periodically in the forthcoming issues of the Nursing Journal of India. The theme of the XXIV SNA Biennial Conference 2011 is Preparation of Nursing Students for Leadership Role. The sub themes of the Conference are: Impact of Social Change on Nursing Education Challenges before Nursing Students in Health Care Delivery Information Technology & Nursing Education The Scientific Paper Presentation will be made by the Student Nurses on the above mentioned sub-themes. The guidelines regarding Scientific Paper Presentation are as follows: 1. The Scientific Paper to be presented in the Conference should be on any one of the conference sub-themes. 2. The paper should contain Introduction, Objectives, Review of Literature, Brief description of Methods and Procedures, Findings and Interpretation, Conclusion, Recommendation and Bibliography. 3. Two copies of the typeset Scientific Paper containing not more than 1500 words (4-5 pages in A4 size) should be submitted to the State SNA Advisor by 30 May 2011. 4. Best three Scientific Papers, one from each sub-theme, selected at the State Level are to be forwarded by the State SNA Advisor to the TNAI Headquarters by 30 June 2011 for final evaluation at national level. The author(s) of Best three papers, one from each sub theme, selected by the TNAI Headquarters will give their presentation at National level SNA Conference 2011.

Participation of SNA delegates in SNA National Biennial Conference The State level SNA Advisor, Vice President and Secretary would be participating in the SNA General Committee meeting. For other meeting (SNA General Body meeting) and the Conference the SNA Unit Level Vice President, the Secretary, the SNA Advisor and other students taking part in various competitions and educational Plenary Sessions may attend. Remember to nominate those representatives from your State / Unit SNA, who would be able to take part in discussions and participate in all meetings / sessions and functions and contribute valuably. She/He should be well informed of the unit activities to present a clear and concise report and give back the Conference report to the branch/unit on return. The representatives (delegates) should be thoroughly conversant with the SNA Rules & Regulations and Byelaws, etc., to be able to contribute and take part in various issues discussed. Copy of SNA Rules & Regulations and Byelaws is available with TNAI Headquarters at Rs.10 per copy plus postal charges. Units who have not availed of this facility should obtain a copy of this at the earliest. Agenda Items Agenda items for the SNA General Committee Meeting have to be prepared well in advance. Issues of national level should be enlisted as agenda items. Members should have readily available factual information for these if required. These are to be sent to the TNAI Headquarters by the State SNA Advisor who should duly approve and sign them. SNA Biennial Reports Each Branch is expected to present SNA Biennial Report during the Business Session. The best procedure would be to send printed copy to the SNA Advisor four weeks prior to the Conference for smooth functioning. State SNA Biennial Best Performance Award The SNA State performance is also evaluated at the national level for selecting the Best SNA Branch. In this regard we would be sending a specific proforma, which is to be duly filled in and returned to the TNAI Headquarters. This will be sent well ahead of the Conference dates. SNA Unit Obtaining Maximum Prizes at the Biennial Conference This award is given to the SNA Unit, which receives the maximum number of prizes for the various competitions held during the SNA Conference. As decided in the SNA General Committee meeting on 22 September 1997, the following points will be given for group and individual items. a) Group Items - First Prize: 10 Points; Second Prize: 7 Points; Third Prize: 5 Points b) Individual Items - First Prize: 5 Points; Second Prize: 3 Points; Third Prize: 1 Point Based on the points, the unit receiving the maximum number of points will be considered the winner. Poster Presentation The topic for poster presentation will be published in one of the forthcoming issue of the Nursing Journal of India. For each poster presentation only one entry, either individual or group will be allowed from each State. As decided in the SNA General Body meeting 2004, the size for both individual and group Poster Presentation will be the same. The criteria for Poster Presentation are given below: Size: Standard size approx 22"x 26", for both individual and group poster presentation. Topics: Ideas depicted in the poster should be relevant to the topics.

Lettering and design of the poster should be bold and big enough to be visible from a distance. For bringing clarity of the poster, restrict yourself to one idea relevant to the topic. The layout of the picture in the poster must be properly balanced to give a correct sense of proportion. Extra fixing of clippings/cuttings or any other form on the poster should be avoided. SNA Competitions On-the-Spot Painting: The topic for this will be given just before the competition. Only one individual entry will be permitted from each State. Participants should bring their own material, but the organisers will provide the paper. No mechanical devices, e.g. use of stencils, etc. will be permitted. Time allotment will be One Hour. Floor Decoration (Rangoli): The Size for Floor Decoration is 3x3 feet. Participants need to bring their own material. No mechanical devices e.g., use of stencils etc. will be allowed. Theme/Topic will be given on the spot. Only one individual entry will be permitted from each State. Time allotted for Rangoli will be Two Hours. Health Education:Health Education will be in the form of Drama/Skit/Puppet Show/Poetry/Song and folk form/Couplets, etc. A group entry should not have more than three participants. Language of the topic will be either Hindi or English. Only a single entry either in Hindi or English will be allowed from each State. Time allotment will be for Five Minutes. Topic will be announced later. Biennial SNA Diary Evaluation 2011 : Unit Secretaries of SNA, who are maintaining SNA Diaries, may please send them to the State SNA Advisors by 15 April 2011, so that these could reach this office by 30 May 2011 latest for evaluation and award at the national level. Unit SNA Advisors after entering their remarks and signatures at the end of one years recording should forward it to his/her counterpart at the State level. The State SNA Advisors may kindly ensure that the consolidated (2009 and 2010) evaluated Diaries are graded according to the set criteria. Only two outstanding Diaries at the State level are to be forwarded to the TNAI Headquarters. Recitation/Poetry: The topics will be announced on the spot and would be related to health or Professional Nursing. Participants will be given ten minutes to prepare and three minutes (maximum) to recite on the given topics. Medium of presentation will be either English or Hindi. The competitions in English and Hindi will be conducted separately. Participants may choose only one of these languages. Please note that only one individual entry either in English or in Hindi will be allowed from each State. Sports: The events are - 100 Meters Race, Discus throw and Javelin throw. Competitions for these events will be held separately for male and female contestants. Personality Development Competitions: As per the Minute No. SNA/G.C./37/2007/5 (ii) MR. and MS. SNA Beauty Pageant Competition has been renamed as Personality Contest. The best entries (one female and one male) selected at the state level are to be forwarded by the State SNA Advisor to the TNAI Headquarters for national level competition. Talent Night: Each State will be given one item for presentation at the national level.

Only one best folk (or) classical dance either individual or group from each State will be accepted for competition at the national level. Time: 3 Minutes for Classical and for Folk Dance 7 minutes. Establishment of SNA Units: The State SNA Advisors in their respective State/UTs should work out strategies to establish units in every institution and the already established units should remain updated by paying timely annual subscription to TNAI Headquarters and the State Branch, as repeatedly discussed in SNA General Committee Meetings. At present the SNA subscription amount is Rs.100 per year per student. The SNA subscription has to be paid every year by every student for their entire training period including internship period. SNA to TNAI Members: The role of the senior members of the profession is vital in enrolling student members soon after their graduation as TNAI Life Membership offers a concessional rate for fresh graduates. Timely guidance and assistance from the Nursing Superintendents, Principals, Tutors and other Senior Nurses would not only strengthen the TNAI but it will also go a long way in helping out young Nurses to be in continuous contact with their professional organisation and benefit from the organisation. With their consistent touch with the Association they can utilize its privileges whenever the need arises. Best wishes for your efforts in the forthcoming SNA Conference. Mrs. Nanthini Subbiah, Dy. Secretary-General
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