Antenatal care

• Antenatal care refers to care given to a pregnant

woman from the time conception is confirmed
until the beginning of labour. The midwife should
provide a woman-centred approach to the care
of the woman and her family by sharing
information with the woman to help her make
informed choices about her care.
 Antenatal care aims
• provide effective antenatal care
• monitor the progress of pregnancy and fetal
development
• the midwife critically evaluates the physical,
psychological and sociological effects of pregnancy on
the woman and her family
• discuss the initial assessment visit, define its objectives
and consider the significance of the different
components of the woman's history taken by the
midwife.
• describe the physical examination and psychological
support of the woman at the initial assessment and
during subsequent visits
• Discover early pregnancy complication
 Five steps to help to sensitivity and evidence
for practice

• Finding out what is important to the woman and

her family.
• Using information from the clinical examination.
• Seeking and assessing evidence to inform
decisions.
• Talking it through.
• Reflecting on outcomes, feelings and
consequences.
 Antenatal visiting pattern

• Booking appointment(s) with midwife by 10 weeks if possible

• • 10–14 weeks: ultrasound scan for gestational age
• • 16 weeks: midwife
• • 18–20 weeks: ultrasound scan for fetal anomalies
• • 25 weeks: midwife (nulliparous women)
• • 28 weeks: midwife
• • 31 weeks: midwife (nulliparous women)
• • 34 weeks: midwife
• • 36, 38 weeks: midwife
• • 40 weeks: midwife (nulliparous women)
• • 41 weeks: midwife (discuss options).
 Objectives for the initial assessment

• To assess levels of health by taking a detailed history

and to offer appropriate screening tests
• To ascertain baseline recordings of blood pressure,
urinalysis,
• To identify risk factors by taking accurate details of past
and present midwifery, obstetric, medical, family and
personal history
• To provide an opportunity for the woman to express and
discuss any concerns
• To give public health advice
• To build a trusting relationship with pregnant women
 Abdominal examination & pelvic
examination
• In the initial presentation, full physical examination
should be done.
• Abdominal & pelvic examination remains important exam
for pregnant women because it is the easiest method of
fetal monitoring.
• Abdominal examination is carried out from 25
weeks' gestation to establish and affirm that fetal
growth is consistent with gestational age during
the pregnancy.
• The specific aims are to:
• • observe the signs of pregnancy
• • assess fetal size and growth
• • auscultate the fetal heart when indicated
• • locate fetal parts
• • detect any deviation from normal.
 Methods of examination

• 1- Inspection
– Size of the uterus: assess
• If the length & breadth are both increased  multiple
pregnancies, polyhydramnios
• If the length is increased only  large baby
– Shape of the uterus: length should be larger than broad
this indicates longitudinal lie. But if the uterus is low and
broad indicates transverse fetus lie.
– Fetal movement
– Contour of the abdomen: full bladder may be visible
in late pregnancy. Umbilicus may become everted
– Skin changes: look for stretch marks, linea nigra, scars
that indicates previous surgeries
 Methods of examination

• 2- Palpation (A): by Leopold maneuver-4

maneuvers
– Palpate the fundus (to determine if it contains breech,
head)
• By gentle pressure:
– if soft consistency/ indefinite outline  breech
– If hard, smooth, well defined  head
• Move your fingertips over the fetal mass to
determine mobility and sixe
– If can’t move independent from the body 
breech
– If moves freely between fingertips  head
Essential definitions that you should know to
understand the physical examination
findings:
• The presentation:
is the part of the
fetus in the lower
pole of the uterus
overlying the pelvic
brim (cephalic,
breech)
• The lie of the fetus: is the relation of the
long axis of the fetus to the uterus (could
be longitudinal, oblique or transverse. only
longitudinal lie is normal)
• The attitude: is the posture of the fetus
(flexion, deflexion, extension)
• The position: of
the baby in relation
to the presenting
part of the mother’s
pelvis. It is
expressed
according to the
denominator which
is :
• occiput in vertex
presentation
• sacrum in breech
presentation
• mentum in face
presentation
Station & engagement
Station: is the relation
of the presenting part
to the ischial spine. If
the presenting part is
at the level of ischial
spine, station =0
Engagement: the
descent of the
biparietal diameter
through pelvic brim. If
the head is at the
level of ischial spine
the head must be
engaged.
 Method of abdominal exam
• Lateral Palpation (B): (determine the position of
the fetal back and small parts)
• Hands are placed on each side of the umbilicus.
The fetal spine will palpate as firm, flat and
linear. The fetal extremities are palpable by their
varying contour and movements. The purpose of
this maneuver is to determine whether the fetal
back is left or right.
 Method of abdominal exam
• Pelvic palpation (C): 2 maneuvers
• Grasp the lower poles of the uterus between fingers
and thumbs and comment of the size, flexion and
mobility of the head.
• To determine the position of the vertex presentation: try
to palpate the prominences (occiput @ the same side
of the back & sincipital @ the opposite side of the
back)
Pawlik's manoeuvre, where the midwife grasps the lower pole of the uterus
between her fingers and thumb, which should be spread wide enough apart to
accommodate the fetal head
 Method of abdominal exam
• 3- Auscultation: help assess
fetal well being
Auscult the whole abdomen
trying to locate the point of
maximum intensity
After you examine a pregnant women
you should answer the following
questions
1. What is the fundal
height?
It is estimated by
centimeters from
upper border of the
fundus to the pubis
symphasis by taping
measure. The
height of the fundus
correlates well with
the gestational age
especially during the
weeks of
pregnancy.
After you examine a pregnant women you
should answer the following questions
2. lie of the fetus: only longitudinal lie is normal
3. Attitude: normally it is full flexion and every fetal
joint is flexed.
4. presentation: normally cephalic
5. position: according to the dominator
6. Is the vertex engaged?
• THANKS for your
Attention