Antenatal
Assessment
Mr. Kailash Nagar
Assistant Professor
Dept. Community health
Systematic supervision of a woman during
pregnancy is called antenatal (prenatal care)
Determines the wellbeing of the newborn and
chance for survival (mother history)
Pre-conception counselling
Assessment of risk factors
Ongoing assessment of fetal well-being
Ongoing assessment of complications
Education
Discussion of birthing care options
The first visit should not be deferred beyond
the second missed period.
Once a month until 28 weeks.
Twice a month until 36 weeks.
Every week during the last 4 weeks of
pregnancy.
> Detailed Health History
> Physical Examination
> Breast and Pelvic Examination
Name LMP
Age EDC
Ward/unit GA
IP no Obstetric score
Address Blood group
Religion
Occupation
Education
Gravida: Parity:
nulligravida nullipara
primigravida primipara
multigravida multipara
grandmultipara
Present ob. History:
◦ Diagnosis?
◦ Planned/unplanned
◦ Minor disorders
◦ Immunization
◦ Exposure to drugs/radiation
Comprehensive maternal history and
physical examination is important to point
out the risk factors.
Risk factors can be related to mother,
during pregnancy, during labor and
delivery, or after delivery.
Antenatal assessment starts with
determination of risk factors.
Better knowledge about risk factors better
preparation to care for the patient.
31% of pregnancies end in miscarriage
Only rarely would an abortion cause problems
in a subsequent pregnancy
increased risk of miscarriage only in women
who have had multiple induced abortions.
Preterm Birth:
What is considered preterm??
The second greatest cause of morbidity and
mortality in neonates.
Previous preterm birth increases the
subsequent preterm birth:
1 prior = 15% of subsequent preterm birth.
2 prior = 32% of subsequent preterm birth.
Incompetent Cervix:
Caused by cervical trauma, previous
surgery, or may be congenital.
Usually leads to membrane rupture and
premature delivery.
If severe, a suture around the cervical canal
is performed.
Maternal Smoking and Alcohol
Intake:
In the US, about 10% of pregnant mothers
smoke, drink alcohol or use drugs.
Maternal intake of alcohol leads to fetal
growth problems.
Smoking HBCO decreases availability of
oxygen to placenta and fetus.
Maternal Hypertension
Complicates 6-8% of pregnancies.
Hypertension during pregnancy (after W24) is
termed: Preeclampsia.
Preeclampsia (High BP, proteinuria, edema)
Can lead to placental abruption, and preterm
delivery.
Diabetes:
Increase the risk for CV and CNS
malformations, and metabolic disturbances.
When appears during pregnancy
(Gestational Diabetes Mellitus, GDM).
Treatment: glycemic control.
Infections Diseases:
Infections can be transmitted to fetus.
Early screening and detection of the infection
is important.
Complicated by the rupture of the membrane.
Problems in Placenta, UC, and
Fetal Membrane:
premature rupture : causes 50% of preterm
births.
UC : Prolapse, short, single artery (3%)
Placental problems
Height
Weight
Pallor
Jaundice
Vital signs
flat (nipple does not protrude with
stimulation)
retracted (nipple pulls back slightly)
inverted (nipple pulls inward when
compressed)
INVERTED
NIPPLES
Grade 1
Inspection
Size
Shape
Contour
Flank
Skin
Bladder
Fetal movements
After 14 weeks gestation the SFH in centimeters = Number of
weeks of gestation + 3 cm.
First visit: Hb, Blood group, Rubella, Hep B
and C and HIV screening.
10-12 weeks: Chorionic villous sampling
15-18 weeks: USG, serum AFP/triple test ,
amniocentesis
28 weeks: Hb ,TC/DC, ferritin, GTT, and low
vaginal swab to exclude Group B strep.
36 weeks: Hb
Weight gain (12-15 kg in total)
BP (a diastolic pressure>90, or increase of
>20 from first visit is significant)
Urinalysis (watch for protein, glucose, and
UTIs)
Fetal movements
Uterine size in accordance with dates and
ultrasound
Fetal lie, presentation, and engagement,
especially after 36 weeks
ULTRASOUND
Uses high frequency sound waves.
Hand-held transducer is placed directly
over the mother’s abdomen, and reflected
waves are recorded on screen image.
Can give valuable information about
pregnancy and fetus
Identify pregnancy.
Determine fetal age.
Observe amniotic fluid
abnormalities.
Detect fetal anomalies.
Identify placental
abnormalities.
Determine fetal position.
Examine fetal HR, and RR
AMNIOCENTESIS
Is the procedure of obtaining a sample of
amniotic fluid.
Usually performed after W15 (w15-20).
A needle is inserted through the skin and
uterine wall to the amniotic sac.
Insertion is guided by Ultrasound.
Sample from amniotic fluid is obtained for
analysis.
Very safe procedure (complication rate <1%).
FETAL HEART RATE (FHR) MONITORING
Heart starts to beat between W16-W20, but
beats can be detected as early as W8.
Normal 120-160 bpm.
Becomes very common test.
Diet
exercise
Rest and sleep
Bowel
Bathing
Clothing
Dental care
Coitus
Care of breast
Immunisation
FHR Monitoring
