Antenatal care refers to the care given to a pregnant woman to ensure that she goes through pregnancy, labour and the puerperium very healthy with the delivery of a healthy baby born to a happy family.
To this end a good history and examination should be done at each visit to identify problems that are likely to have an adverse effect on the pregnancy (risk factors). Any problems (or risk factors) identified are treated. High risk pregnancies (pregnancies that are likely to have one or more risk factors) should be referred to a hospital or obstetrician.
Notes
• It is important to keep accurate records of all findings
• High risk mothers should go to a hospital for antenatal care
• It is very useful to bring all the mothers together for health talks and discussions (health education)
Examine the mother:
• Does the mother look ill?
• Does she look well nourished?
• Anaemia: Check to see if the mother is anaemic
• Weight: Should gain about half kilogram per week. Sudden weight gain or weight loss are both very worrying
• Blood pressure: The upper limit of normal is 140 mmHg for the systolic pressure, and 90mmHg for the diastolic pressure
• Uterine size (symphysio-fundal height after 20 weeks gestation)
• Presentation and position of the baby: Near the time of delivery, the head of the baby should be above the pelvis. Women with abnormal presentation should be referred to a hospital
• Foetal heart sounds: Usually between 120 and 160 beats per minute
INVESTIGATIONS
• Full blood count
• Blood film for malaria parasites
• Sickling (if necessary Hb electrophoresis)
• G6PD activity
• Urine and stool analysis
• Blood glucose
• Blood group and antibody screen
• VDRL or RPR test
REFER
High-risk mothers include:
• Bleeding at any time in the pregnancy before labour
• Young (<18 years) and elderly (>35 yrs) mothers in their first pregnancy
• Severe anaemia, hypertension, diabetes mellitus and asthma, chronic cough such as pulmonary tuberculosis
• Sickle-cell disease
• Women with more than 5 children (the grand multiparous mother)
• Past history of bleeding after delivery or retained placenta
• Abnormal presentation and position of the baby in the womb at term - transverse lie or breech presentation
• Multiple pregnancies
• Prolonged pregnancy (when the pregnancy lasts longer than 42 weeks)
• Contracted pelvis (pelvis too small for the baby to be delivered safely per vaginam). This is obvious when the mothers are short (<154 cm tall or have small feet
• Big baby at term - when the symphysio-fundal height is more than 39-40 cm at term or when the estimated foetal weight is 4 kg or higher
• Past history of stillbirths or children who die within the first week of life, especially if they die of the same problem
• Past pregnancy history of miscarriages around the same gestational age
• Decrease in growth of the baby - uterine size smaller than the gestational age
• Uterine size much bigger than the gestational age with one foetus present
• Previous instrumental delivery (vacuum extraction or forceps delivery)
• Previous operation on the womb such as Caesarean section, myomectomy or when the uterus is repaired after perforation during D&C
• Preterm labour (labour before 37 completed weeks)
• HIV positive pregnant women
TREATMENT
Therapeutic Objectives
• To ensure that the patient goes through pregnancy delivery and the puerperium in good health
• To ensure delivery of a healthy baby
Non-Pharmacological Treatment
Health education including a healthy balanced diet and exercise.
Pharmacological Treatment
• Ferrous sulphate, oral, 200 mg 3 times a day
• Folic acid, oral, 5 mg once daily
• Calcium, oral, 500 mg-1 g once daily
• Malaria prophylaxis (see Section on Malaria in Pregnancy)
• Tetanus prophylaxis
• IM Tetanol 0.5 ml: 1st dose from 20th week gestation; 2nd dose 1(one) month after initial dose, if patient has not previously had anti-tetanus immunisation
