Antenatal Assessment

Antenatal Assessment

What do we mean by …….

Antenatal Assessment??

Antenatal/prenatal care

Systematic supervision of a woman during pregnancy is called antenatal (prenatal care)

Why is it important?

Determines the wellbeing of the newborn and chance for survival (mother history)

AREA OF CONCERNS:

Pre-conception counselling Assessment of risk factors Ongoing assessment of fetal well-being Ongoing assessment of complications Education Discussion of birthing care options

Timing of antenatal visits:

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.

PROCEDURE AT THE FIRST VISIT 

> Detailed Health History

> Physical Examination

> Breast and Pelvic Examination

Vital statistics:

NameAgeWard/unitIP noAddressReligionOccupationEducation

LMPEDCGAObstetric score Blood group

Gravida:

nulligravida

primigravida

multigravida

Parity:

nullipara

primipara

multipara

grandmultipara

Maternal history

Present ob. History:Diagnosis?Planned/unplannedMinor disordersImmunizationExposure to drugs/radiation

Pregnancy tests

Maternal History and Risk Factors

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.

abortion

31% of pregnancies end in miscarriageOnly rarely would an abortion cause

problems in a subsequent pregnancyincreased risk of miscarriage only in

women who have had multiple induced abortions.

Risk Factors

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.

Risk Factors

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.

Risk Factors

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.

Risk Factors

Maternal HypertensionComplicates 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.

Risk Factors

Diabetes:Increase the risk for CV and CNS

malformations, and metabolic disturbances.When appears during pregnancy (Gestational

Diabetes Mellitus, GDM).Treatment: glycemic control.

Risk Factors

Infections Diseases:Infections can be transmitted to fetus.Early screening and detection of the infection is

important.Complicated by the rupture of the membrane.

Risk Factors

Problems in Placenta, UC, and Fetal Membrane:

premature rupture : causes 50% of preterm births.

UC : Prolapse, short, single artery (3%)Placental problems

Antenatal assessment

HeightWeightPallorJaundiceVital signs

BREAST EXAMINATION

flat (nipple does not protrude with stimulation)

retracted (nipple pulls back slightly)

inverted (nipple pulls inward when compressed)

Breast examination

INVERTED NIPPLESGrade 1

Grade 2:the nipple is inverted or retracted under the areola

Grade 3There is no projection of the nipple, elements of nipple are usually buried under the breast and will not come out.

Abdominal examination

InspectionSizeShapeContourFlankSkinBladderFetal movements

palpation

Measuring SFH

After 14 weeks gestation the SFH in centimeters = Number of weeks of gestation + 3 cm.

Antenatal schedule

Investigations

First visit: Hb, Blood group, Rubella, Hep B and C and HIV screening.

10-12 weeks: Chorionic villous sampling15-18 weeks: USG, serum AFP/triple

test , amniocentesis28 weeks: Hb ,TC/DC, ferritin, GTT, and

low vaginal swab to exclude Group B strep.

36 weeks: Hb

Antenatal chart should record the following: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

Antenatal Assessment

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

Clinical Uses of Ultrasound

Identify pregnancy.Determine fetal age.Observe amniotic fluid

abnormalities.Detect fetal anomalies. Identify placental abnormalities.Determine fetal position.Examine fetal HR, and RR

Embryo at 6 weeks

Antenatal Assessment

AMNIOCENTESISIs 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%).

Antenatal Assessment

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.

Antenatal advicesDietexerciseRest and sleepBowelBathingClothingDental careCoitusCare of breast Immunisation

FHR Monitoring