ANTENATAL EXAMINATION

According to WHO
PRENATAL OR ANTENATAL period is the process in which a human embryo or fetus gestates during
pregnancy(i.e fetal development or embryology) and from fertilization until birth.
DEFINITION :
Systematic examination of women and fetus during pregnancy is called antenatal examination.
OBJECTIVES OF ANTENATAL EXAMINATION
- To promote , protect and maintain the health of pregnant woman
- To detect high risk cases and give them special attention
- To forsee complications and prevent them
- To remove anxiety associated with pregnancy associated with pregnancy
- To reduce maternal and infant mortality and morbidity
- To teach elements of child care , nutrition, hygiene, and sanitation
- To sensitize her regarding family planning
- To attend the under 5 clinic accompanying the mother
ANTENATAL HISTORY COLLECTION:
Name of patient : Occupation :
Duration of marriage : Address :
W/O : Education :
Age :
HISTORY OF PRESENT PREGNANCY :
OBSTETRICAL HISTORY : POG (WEEKS) :
GPAL:
1. GENERAL PHYSICAL EXAMINATION
 Build: Obese/Average/Thin.
 Height: Less than 145 cm is considered short stature.
 Vital Signs: Temperature, pulse, respiration and
 Blood pressure.
Blood pressure: Normal Between 110-120 mm Hg.)
Systolic Between 75-80 mm Hg. Diastolic Blood Pressure: High range More than
140/90 mm Hg. may indicate eclampsia.

HEAD-TO-TOE EXAMINATION:
 Scalp: Clean, presence of infections and infestation.
 Face: Facial expressions (lethargic, pale, confused), pallor, skin changes (mask of pregnancy)
swelling of the face, eyes, nose, lips, mouth for dental caries and bleeding gums, periorbital edema.
 Neck: Symmetry, shape and lymph adenopathy,
 Breast Examination: Check for symmetry, breast changes, secretion and condition of nipples.
 Upper Extremities: Check for any bony deformity, capillary refill in nails for pallor.
 Legs: Homan's sign, oedema, varicosities and bony deformity
  Back: Normalcy of spine, symmetry and rhomboid of Mchale's.
 Bowel and Bladder: Constipation and incontinence, etc.
 Vagina: Bleeding, discharge, infection, boils, etc.

2 .ABDOMINAL EXAMINATION
Preparation of Woman for Abdominal Examination:

 Ask the woman to empty the bladder before examination.

 Assist her for dorsal or supine position on the examination couch with legs Hexed.
 Provide emotional support.

STEPS OF ABDOMINAL EXAMINATION:

(a) Inspection:
A. Uterus
 Shape and size of abdominal contour.
 Foetal movements.
 Skin changes:
Linea nigra, linea alba and presence of any scar.
(b) Check Abdominal Girth.

(c) Check fundal height:

 Take fundal height in cm and in weeks. Place the ulnar border of the hand at the highest point of the
uterine fundus and compare it with accepted levels for the different periods of gestation. Each 4
week period is equal to the width middle 3 fingers.
(v) Foetus in Utero:
Foetal Lie: The term foetal lie refers to the relationship of the long axis of the foetus to the long axis of
centralised uterus or maternal spine.
Presentation: The term presentation refers to the part of the foetus that occupies the lower pole of the
uterus.
Attitude: The term an attitude refers to the relationship of foetus parts to one another.
Denominator: It is an arbitrary fixed point on the presenting parts which comes in relations with the various
quadrants of maternal pelvis.
Position: It is the relationship of denominator to the different quadrant: of maternal pelvis.
Presenting Part: it refers to the part of presentation which lies over the internal OS.
(H) PALPATION IN SEQUENCE:
FUNDAL GRIP
-The palpation is done facing the patient’s face
-The whole of the fundal area is palapated using both hands laid flat on it to find out which pole of the fetus
is lying in the fundus.
 Broad, soft, and irregular mass suggestive of breech
 Smooth, hard, and globular mass suggestive of head
LATERAL GRIP
-The hands are to be placed flat on either side of the umbilicus to palpate one after other
-The sides and front of the uterus is palpated to find out the position of the back , limbs and the anterior
shoulder
 The back is suggested by smooth curved and resistant feel
 The limb side is comparatively empty and there are small knob like irregular parts
PELVIC GRIP
-Four fingers of both the hands are placed on either side of the midline in the lower pole of the uterus and
parallel to the inguinal region
-The fingers are pressed downwards and backwards in a manner of approximation of finger tips to palpate
the part occupying the lower pole of the uterus (presentation)
If it is head , the characteristics to note are:
 Precise presenting area
 Attitude
 Engagement
PAWLIK GRIP
-The examination is done facing toward the patient’s face
-The overstretched thumb and four fingers of the right hand are placed over the lower pole of the uterus
keeping the ulnar border of the palm on the upper border of symphysis pubis
-When the fingers and the thumb are approximated, the presenting part is grasped distinctly (if not
engaged) and also the mobility from side to side is tested
-In transverse lie the pawlik grip is empty
AUSCULTATION : Foetal heart sounds an be hard with the Stethoscope from 18-20 weeks onwards. It
states whether the foetus is alive or not. Normally, the foetal heart rate ranges from 120-140 beats/minute
with an average of 140 beats/minute.
(d) VAGINAL EXAMINATION: Vaginal examination is generally done by the doctor when needed,
especially towards the end of pregnancy to ensure normalcy and adequacy of pelvis to deliver the baby.
(e) LABORATORY INVESTIGATIONS: It is necessary to take laboratory investigation for abdominal
examination. The following are the laboratory investigations.

 Haemoglobin.
 Urinalysis (albumin. sugar and pus cells). (iii) Blood grouping and rhesus typing. (iv) VDRL and
HIV testing.
  Pap smear.
 Blood sugar.

(f) CALCULATING EXPECTED DATE OF DELIVERY:

This is done according to Nagele’s formula, it. expected date of delivery a Last menstrual period +9 months
and 7 days, e.g., if last menstrual period (LMP) date is 14/11/06 then the expected date of delivery will be
21/08/07.
Indicators of the Foetal Well-Being:

 Uterine size compatible with gestational age of the foetus.

 Normal and regular foetal movements (10 in 12 hours.)
 Foetal heart rate in range of 120-160/mt. (iv) Desired increase in maternal weight occurs. Normally,
there is 11 kg weight gain during pregnancy out of which maximum weight gain occurs during the
2'"1 and the 3" trimester.
ADVICE T0 PREGNANT WOMAN IN ANTENATAL PERIOD
1. Nutrition: Balanced diet. It should include: meat, fish, cheese, peas, beans, lentils, milk, eggs, fresh fruits
and vegetables. Avoid stale and spicy food and excess of fat. Take short frequent meals. The tom! caloric
requirement in antenatal period is 2500 kcal/day. Meals should be light, nutritious and wily digestible. The
woman should take iron and folic acid supplementation after the first trimester (which contains 60 mg of
elemental iron and 0.3 mg folic acid).
2. Follow-up: Regular follow-ups as the dates are given by the health personnel.
3. Rest: Take rest when necessary in afternoon. Avoid remaining in one position for a long time. Elevate
legs while taking rest to relieve oedema in legs.
4. Exercise and Work: Exercise and work to be continued till the woman can do them comfortably.
5. Comfort Measures: Wear comfortable clothes. Make modifications as per the need. Wear a well-fitting
bra, shoes and panties. Avoid travel in the I" and the III"I trimester. Take the doctor’s advice before going
on travel. Assume comfortable positions. Avoid long hours of Standing or sitting in one position.
6. Warning Signs of Pregnancy: The woman should know the warning signs of pregnancy. Report to the
doctor as soon as possible when these signs are present. The following are the warning signs of pregnancy:

 Bleeding or leaking of amniotic fluid per vagina.

 Loss of or excessive foetal movements. 0 Severe continuous headache.
 Dimness or blurring of vision.
 Flashes of light or dots before the eyes. 0 Pain in epigastric region.
 Persistent vomiting.
 Chills and fever.
 Dysuria o Oedema of face and abdomen.

7. Minor Disorders of Pregnancy: Manage them with proven home remedies. If severity increases, consult
the doctor.
8. Sex: Avoid sexual intercourse in the Ist and the IIIrd trimester. Assume alternate positions and methods
which are comfortable for the couple.
9. Preparation for Confinement Collect articles for mother and the baby. The mother should know the signs
of true labour and be ready with the articles in the last 6 weeks of gestation. Arrange transport in time.
SUMMARY :
A. ANTENATAL EXAMINATION

B. GENERAL PHYSICAL EXAMINATION

 BUILD
 HEIGHT
 VITALS
 HEAD TO TOE

C. ABDOMINAL EXAMINATION
 PREPARATION
 INSPECTION
 PALPATION
 AUSCULTATION

D. ANTENATAL ADVICES

CONCLUSION :
Prenatal care, also known as antenatal care, is a type of preventive healthcare. Its goal is to provide regular
check-ups that allow doctors or midwives to treat and prevent potential health problems throughout the
course of the pregnancy and to promote healthy lifestyles that benefit both mother and child.
WHO RECOMMENDATIONS :
The World Health Organization (WHO) reported that in 2015 around 830 women died every day from
problems in pregnancy and childbirth.[3] Only 5 lived in high-income countries. The rest lived in low-income
countries.[3]
A study examined the differences in early and low-weight birth deliveries between local and immigrant
women and saw the difference caused by prenatal care received. The study, between 1997 and 2008, looked
at 21,708 women giving birth in a region of Spain. The results indicated that very preterm birth (VPTB) and
very low birth weight (VLBW) were much more common for immigrants than locals (Castelló et al., 2012).
The study showed the importance of prenatal care and how universal prenatal care would help people of all
origins get proper care before pregnancy/birth (Castelló et al., 2012).
The WHO recommends that pregnant women should all receive four antenatal visits to spot and treat
problems and give immunizations. Although antenatal care is important to improve the health of both
mother and baby, many women do not receive four visits.[4]
 The essential elements of a focused approach to antenatal care
• Identification and surveillance of the pregnant woman and her expected child • Recognition
and management of pregnancy-related complications, particularly pre-eclampsia
• Recognition and treatment of underlying or concurrent illness
• Screening for conditions and diseases such as anaemia, STIs (particularly syphilis), HIV
infection, mental health problems, and/or symptoms of stress or domestic violence
• Preventive measures, including tetanus toxoid immunisation, de-worming, iron and folic acid,
intermittent preventive treatment of malaria in pregnancy (IPTp), insecticide treated bednets
(ITN)
 • Advice and support to the woman and her family for developing healthy home behaviours
and a birth and emergency preparedness plan to
• Increase awareness of maternal and newborn health needs and self care during pregnancy and
the postnatal period, including the need for social support during and after pregnancy
• Promote healthy behaviours in the home, including healthy lifestyles and diet, safety and
injury prevention, and support and care in the home, such as advice and adherence support
for preventive interventions like iron supplementation, condom use, and use of ITN
 Support care seeking behaviour, including recognition of danger signs for the woman and the
newborn as well as transport and funding plans in case of emergencies
 Help the pregnant woman and her partner prepare emotionally and physically for birth and care of
their baby, particularly preparing for early and exclusive breastfeeding and essential newborn care
and considering the role of a supportive companion at birth
Promote postnatal family planning/birth spacing.
WHO RECOMMENDATIONS FOR ANTENATAL EXAMINATIONS :
Sample recommendations:
 A minimum of eight contacts are recommended to reduce perinatal mortality and improve women’s
experience of care.
 Counselling about healthy eating and keeping physically active during pregnancy.
 Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron and 400 µg
(0.4 mg) folic acid for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth
weight, and preterm birth.
 Tetanus toxoid vaccination is recommended for all pregnant women, depending on previous tetanus
vaccination exposure, to prevent neonatal mortality from tetanus.
 One ultrasound scan before 24 weeks’ gestation (early ultrasound) is recommended for pregnant
women to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies,
reduce induction of labour for post-term pregnancy, and improve a woman’s pregnancy experience.
 Health-care providers should ask all pregnant women about their use of alcohol and other substances
(past and present) as early as possible in the pregnancy and at every antenatal visit.