What is antenatal care?
Antenatal care is the period a pregnant woman is screened for acceptance into antenatal care. It is the first visit to the hospital for antenatal care.
What Aims Of Antenatal Booking?
- To set up a preventive service with the aim of reducing the need for d desperate measures in pregnancy labor.
- To reduce maternal and perinatal mortality.
- Gives an opportunity to interact with the patient for the overall wellbeing of the fetus – Health talk, immunization, medical screening for certain diseases, etc.
Who Is To Be Booked?
In private practice, all pregnant women who come to the clinic are booked. This is in contrast to the teaching hospitals where patients are selected for booking.
The teaching hospitals consider age, parity, bad obstetrics history, history of infertility, previous third stage abnormality, major medical problems like sickle cell diseases, diabetes, previous gynecologic also surgery, and gross obesity.
Any woman less than twenty years and primigravidae more than thirty years or any woman more than thirty-eight years irrespective of parity are given consideration.
For parity, primigravidae or woman with more than five pregnancies are taken first. Bad obstetric history includes habitual abortions, antepartum hemorrhage, premature rupture of membrane and pre-clampsiasia, and recurrent stillbirths.
The procedure is taking a detailed history from the patient; examination and investigations.
The history antenatal cares
- Obstetric history of past and present pregnancy;
- Past and present medical and surgical history;
- Family history,
- Drug history:
- Social history;
Besides recording the Name age, Address, Marital, Occupation, Religion, Next of Kin, the format is as below:
- Last Menstrual Period (LMP): Record the first day of the last menstrual period
- From this calculate the Expected Date of Delivery (EDD). Do this using Naegele’s rules. Example. LMP20-06-97. EDD Add 7 days to the day of the last menstrual period and nine months to the month of the year the period was the last seen=27-03-98
- Parity: Record the party. If it is the patient’s first pregnancy and she has not had a previous miscarriage. It is recorded first pregnancy, no delivery, no miscarriage G1p °+°. If this is her third pregnancy, and she has had one delivery and one miscarriage, it is recorded thus Gp °+°. If there has been no miscarriage it is recorded G³p² +². if all the two children are alive it is recorded G³p² +”° (2 alive)
- Get and record information on the past pregnancies like a year of birth; duration of pregnancy, any problem in pregnancy abortion of labor problem in labor, mode of delivery: problem in delivery: problem after the birth: sex of the baby; the and health of the baby.
- Get and record information on present pregnancy like problems in the pregnancy such as bleeding and abdominal pain.
Medical history includes any previous serious illness such as, cardiac, respiratory, renal problems, rubella or has had a blood transfusion. Find out if she has had any surgical operation especially gynecological operations, Ask the path of particular illness that runs in their families such as hypertension or Diabetes Mellitus. A family history of twins is relevant. For the social history find out if she smokes cigarettes or drink alcohol and record the quantity per day. Ask of her occupation.
The type of drugs she is taking is of significance too. examination of a pregnant woman will include both general and the examination of the gravid abdomen.
In general, the pregnant woman is examined for pallor, jaundice, cyanosis, pulse, edema, and varicose veins. Then measure the weight of the woman and check the blood pressure.
This blood pressure is called the booking blood press and it is vital in obstetrics. It is a baseline on which future blood pressure readings are compared The abdomen is palpated to check for the fundal height and assessing if it corresponds with a period of amenorrhoea, the lie of The fetus; the presentation and the position are determined.
The position is not usually easy to determine by the nurses and so the emphasis will be placed on it. Then using the fetal stethoscope, auscultate the fetal heart sound if the pregnancy is up to twenty-four weeks.
The fetal lie is either longitudinal, oblique, or transverse. The presentation is either cephalic or breech. Cephalic when the head is pointing down and breech when the head is pointing up. Routine investigations were done on the first day include;
- Hemoglobin level
- Blood group and Genotype
VDRL to exclude syphilis and urinalysis to check for protein and sugar. HIV screening is now necessary.
The patient is advised to visit the clinic monthly until the 28th week; fortnightly until the 36th week and then weekly till delivery.