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Premium member Presentation Transcript GOOD MORNING: GOOD MORNING By: Mrs Shirley P D’souza Lecturer in FMCO NursingPrenatal or antenatal care: Prenatal or antenatal care Systematic supervision of a woman during pregnancy is called antenatal care.Antenatal care: Antenatal care It is the education, supervision and treatment to a pregnant woman so that her pregnancy and labour will terminate with delivery of a mature healthy living baby , without injury to the mind or body of the mother.OBJECTIVE OF ANTENATAL CARE: OBJECTIVE OF ANTENATAL CARE To ensure a normal pregnancy with delivery of a healthy baby from a healthy mother.AIMS OF ANTENATAL CARE: AIMS OF ANTENATAL CARE 1. To monitor the progress of pregnancy in order to ensure maternal health and normal fetal development. 2. To recognise the deviation from the normal and provide management or treatment as required. 3. To ensure that the woman reaches the end of her pregnancy physically and emotionally prepared for her delivery.CONTINUED…..: CONTINUED….. 4.To identify high risk pregnancy and for their proper management. 5.To reduce or prevent maternal and perinatal mortality and morbidity. 6.To help and support the mother in breast feeding and parenting. 7. To offer family welfare advices on parenthood.ANTENATAL CARE COMPRISES? : ANTENATAL CARE COMPRISES? 1. Registration of pregnancy 2. History taking 3. Antenatal examinations [general and obstetrical] 4. Laboratory investigations 5. Health education1. Registration of pregnancy: : 1. Registration of pregnancy: The registration of pregnancy must be done in an antenatal clinic within 12 weeks.2. History taking: 2. History taking A complete history of the woman including the following are collected in the first visit. 1. Demographic data (Name, age, address, marital status, religion, education, occupation etc) 2. Menstrual history. 3. Personal history. 4. Past medical and surgical history.CONTINUED…..: CONTINUED….. 5. Family history. 6. History of present pregnancy (last menstrual period LMP, Expected date of delivery EDD, etc. 7. Obstetrical history (number of pregnancy, any abnormality in previous pregnancies and deliveries).3. Antenatal examination: 3. Antenatal examination A complete general examinations of the body is conducted, including 1.Height: The height is carefully recorded, as patients measuring 5 feet or less is more likely to have a small pelvis that may cause difficulty during delivery. 2. Weight: Weight should be regularly taken using an accurate weighing machine. Periodic and regular weight checking helps in detecting abnormalities.PowerPoint Presentation: 3. Pallor: Colour of conjuctiva , soft palate, tongue, and nail beds are to be noted. (Paleness indicates anemia) 4. Jaundice: Eyes and mouth are to be observed for yellow discolouration . (yellow discolouration indicates of jaundice) 5. Tongue, teeth, gums: Observe for signs of infection and malnutrition.PowerPoint Presentation: 6. Legs: Legs are to be examined for oedema . 7. Breasts: Examination of the breasts is mandatory, to note the presence of pregnancy charges and condition of the nipples (cracked / depressed / inverted).PowerPoint Presentation: 8. Abdominal and vaginal examinations: Position of the uterus is noted in abdominal examination. Unless necessary, vaginal examinations is not routinely done except for the first time when the woman attends the clinic to confirm pregnancy.Preliminaries : Preliminaries Before performing obstetric examination of mother she should evacuate the bladder. Make her lie down in dorsal position. She is made to flex her knees while doing pelvic palpation. Examination is performed by fully exposing the abdomen. Examiner stands on right side of mother.Inspection : Inspection Size and shape of the uterus is assessed An examiner can also observe fetal movements. Ovoid in primigravid woman Multiparous woman – pendulous abdomen in which uterus sags forward. Skin condition and presence of any scar is noted. Linea nigra may be seen.Palpation: Palpation Warm hands before palpation Centralize uterus, place ulnar border of left hand on upper most level of fundus and measure till symphysis pubis with help of an inch tape. Fundal height:……cm Abdominal girth: measure around abdomen at the level of umbilicusPelvic Grip or Leopold maneuver: Pelvic Grip or Leopold maneuver Leopold's Maneuvers are a common and systematic way to determine the position of a fetus inside the woman's uterus; they are named after the gynecologist Christian Gerhard Leopold.First Leopold maneuver. : First Leopold maneuver. FUNDAL PALPATION: The uterine fundus is palpated to determine which fetal part occupies the fundus .Second Leopold maneuver. : Second Leopold maneuver. LATERAL PALPATION: Each side of the maternal abdomen is palpated to determine which side is the fetal spine and which is the extremities. Spine : smooth curved and resistent feel Limbs : small knob like irregular partsThird Leopold/Pawlik’s maneuver.: Third Leopold/ Pawlik’s maneuver. One hand applies pressure on the fundus while the index finger and thumb of the other hand palpate the presenting part to confirm presentation and engagement.Fourth Leopold maneuver. : Fourth Leopold maneuver. The area above the symphysis pubis is palpated to locate the fetal presenting part and thus determine how far the fetus has descended and whether the fetus is engaged. If hands are converging indicates unengagement ; diverging indicates engagement of head.4. Laboratory investigations: 4. Laboratory investigations 1. Complete blood count including a) haemoglobin level b) Blood grouping and Rh typing. c) Blood for VDRL 2.Urine examinations: Urine should be tested for albumin, sugar, pus cells, One to two doses of tetanus toxoid is given to immunize against tetanus infection. Iron and folic acid supplements is givenSUBSEQUENT VISITS: SUBSEQUENT VISITS Up to 28 week -- the antenatal check up should be done at an interval of 4 weeks from the first visit. Beyond 28 weeks , the antenatal check up should be done at Interval of 2 weeks upto 36 week and thereafter weekly, till the expected date of delivery. At each visit, the findings are to be recorded in the same card for better evaluation.5. Health education: 5. Health education 1. Diet: The diet during pregnancy should be adequate to provide for a. the maintenance of maternal health. b. the needs of the growing fetus. c. the strength and vitality required during labour and d. the successful lactation.PowerPoint Presentation: The pregnancy diet should be light, nutritious and easily digestible. It should be rich in protein, minerals vitamins and fibres and of the required calories. Dietary advice should be given with due consideration to the socio-economic condition, food habits and taste of the individual. Supplementary iron therapy is needed for all pregnant mothers from 20 weeks onwards.PowerPoint Presentation: 2. Personal hygiene: 1. Rest and sleep: The woman may continue her usual activities throughout pregnancy. Hard and strenuous work should be avoided. On an average, a patient should have 10 hours of sleep (8 hours at night and 2 hours at noon) 2. Bowel: As there is a tendency of constipation during pregnancy , regular bowel movement may be facilitated by regulation of diet taking plenty of fluids, vegetables and milk.PowerPoint Presentation: 3. Bathing: Daily baths and preferably twice a day are advised. 4. Clothing: The patient should wear loose but comfortable dresses. High heel shoes are better avoided. 5. Dental hygiene: The dentist should be consulted at the earliest, if necessary.PowerPoint Presentation: 6. Care of the breasts: Cleanliness of the breasts is maintained. If anatomical defects are present advise to seek medical help. 7. Coitus: Contact with the husband to be avoided during the first trimester and last 6 weeks. 8. Travel: Long distance travel better to be avoided. Rail route is preferable.PowerPoint Presentation: 9. Smoking and alcohol: Smoking and alcohol are to beavoided totally during pregnancy as both cause variable injuries to the fetus. 10. The pregnant women should avoid over-the counter drugs (drugs without medical prescription). The drugs may have teratogenic effects on the growing fetus especially during the first trimester.General advice: General advice She is instructed to report to the doctor even at an early date and if the following warning signs and symptoms symptoms arise: · intense persistent headache · severe oedema · disturbed sleep with restlessness · low urine output (less than 500 ml per day) · epigastric painPowerPoint Presentation: . persistent vomiting · painful uterine contractions · sudden gush of watery fluid per vaginum · active vaginal bleeding etc. You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.