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Antenatal Care

Antenatal/Prenatal is a critical phase in the life of the mother which

starts from conception up to the period before delivery. Initial and periodic
health assessments are needed to prevent complications where possible and
ensure that problems during pregnancy will be detected early and treated
properly. Ways of determining pregnancy are given in Table 8-2.
The objective of prenatal care is to reach all pregnant women, to give
sufficient care to ensure a healthy pregnancy and the birth of a full term
healthy baby.
Community health nurses, barangay health workers, traditional birth
attendants or hilots, midwives, and other community members concerned
and advise them to submit for prenatal care as early as possible in their first
Table 8-2 How to Determine Pregnancy
Missed menstrual period
A palpable uterus during an abdominal examination, if she has missed
more than 3 menses.
Symptoms such as nausea, fullness of breasts and frequency of
More frequent prenatal care visits should be done for pregnancy at risk
or with complications. Hence, the standard prenatal visits should be:
1st prenatal visit during the first trimester (the first 3 months/up to 12
2nd prenatal visit during the second trimester (the middle 3 months/1327 weeks)
3rd prenatal visit during the third trimester (the last 3months/28 weeks
and more)
And subsequent prenatal visits every 2 weeks, after the 8th month of
pregnancy till delivery
Table 8-3. Guide to Antepartal Case Visit
Initial Visit
1. Obtain the general data
Full name, age, civil status and occupation
Husbands name, age and occupation
2. Obstetrical History
Last menstrual period
Expected date of confinement

Age of Gestation
Number of pregnancies: gravida/parity
History of previous deliveries: full/pre-term, abortion, living
including the type and place of delivery, date and sex of baby
3. Antepartal Supervision
Name of health center/clinic, hospital or private physician
Date of first pre-natal check-up
Frequency of next visit to the clinic
Medications dose and frequency
Routine laboratory examination requested (e.g. urinalysis, CBC,
VDRL test)
4. Health instructions during pregnancy
Proper diet and nutrition
Personal hygiene
Rest and sleep
Activity and exercise
Initial and Periodic Health Appraisal
First Trimester
Perform general appraisal to determine changes in pregnancy and
detect early signs of illness
1. Weight
2. Height
3. Blood pressure
4. Temperature
5. Pallor/anemia conjunctiva, mouth, palms of her hands
6. Abdomen presence of scars, fundic height, perform leopolds
7. Edema or varicosities
8. Vaginal infections
Second Trimester
Same with the first trimesters general appraisal
Auscultate the fetal heart tone (normal range 120-160 bpm)
Assessment and Preparation for delivery
1. Plan for delivery (home/lying-in/hospital)
2. Preparation of articles for care of the post partum and the new
3. Preparation of the family members for the incoming of the baby
Third Trimester
Same with the first and second trimester
Recognition of signs of false and true labor pains
Knowledge of the mechanism of labor
Final preparations for delivery

1. Home Delivery
- Preparation of place and supplies necessary in the
management of home delivery
- Provision of a birth attendant who will perform safe and clean
- Instructions on when to call for assistance for delivery
2. Hospital Delivery/Lying-in Clinic
- Definite hospital/lying-in clinic to go and its policies for
- Things to prepare for confinement
Dental Care
The mother should practice good oral hygiene by regular toothbrushing
with fluoride toothpaste and using dental floss to remove food deposits in
between teeth. Visiting the dentist during the second trimester of pregnancy
is the safest and most stable period for necessary dental treatment. Invasive
treatment however, such as tooth extraction, root canal therapy and other
surgical procedures should be delayed and done after birth.
All births attendants must have the knowledge, skills, facilities and supplies
to perform clean and safe delivery and to provide postpartum care to mother
and newborn. They must ensure to implement the 3 CLEANS during delivery.
How to Implement the 3 Cleans during Delivery
Clean Hands
Wash your hands with soap and water thoroughly as frequently as
Use sterile gloves
Clean Delivery Surface
The delivery area must be kept clean.
A clean lining which can easily be replaced when soiled is necessary.
Clean Cutting and Care of the Cord
Sterile instruments must be used
Cord dressing must be done aseptically
If the mother is to deliver at home, the cleanest part of house that is wellventilated and provides privacy should be prepared, as well as a clean mat,
clean blanket, pillow and other things for home delivery.
Things to Prepare for Home Delivery
For the Mother:
2 sterile forceps/1 scissors
Sterile gloves

Basin of warm pre-boiled water

Basin for the placenta
Povidone iodine
A pack of cotton
Sterile or ironed soft cloth/sanitary napkins
Plastic lining/rubber sheet to be placed under the mothers buttocks
Waste container
Blanket for draping
5 clean towel/diapers
Housedress (duster) with opening in front
For the Baby
Rubber suction bulb (for suctioning secretions)
Basin of warm pre-boiled water
Baby oil
Ophthalmic solution (Credes prophylaxis)
Sterile gloves
1 sterile forcep and scissor
70% isopropyl alcohol
Povidone iodine
1 sterile cord dressing pack (containing 9 cotton balls, 1 rubber ring,
cotton applicator)
Cord clamp (optional)
Babys blanket
Babys clothes (sando, diapers, binder)
Spring type weighing scale
Tape measure
Note: BP apparatus and stethoscope, PHN bag containing the sterile
instruments for delivery are necessary for home delivery.