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:

 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
Maternal history

 Present ob. History:

Diagnosis?
Planned/unplanned
Minor disorders
Immunization
Exposure 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 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.
 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 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.
 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

 Height
 Weight
 Pallor
 Jaundice
 Vital signs
 BREAST EXAMINATION

 flat (nipple does not protrude with

stimulation)

 retracted (nipple pulls back slightly)

 inverted (nipple pulls inward when

compressed)
 Breast examination

INVERTED
NIPPLES
Grade 1
Grade 2:
the nipple is
inverted or
retracted under the
areola
Grade 3
There is no projection
of the nipple, elements
of nipple are usually
buried under the
breast and will not
come out.
 Abdominal examination

 Inspection
 Size
 Shape
 Contour
 Flank
 Skin
 Bladder
 Fetal 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 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
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
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%).
 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 advices
 Diet
 exercise
 Rest and sleep
 Bowel
 Bathing
 Clothing
 Dental care
 Coitus
 Care of breast
 Immunisation
 
FHR Monitoring