Antenatal care

              Risk screening dose not reliably detect women at high risk. All women are at risk of pregnancy complications and should be encouraged for hospital delivery.
Warning signs during pregnancy:
·       Swelling of feet, hands and face.
·       Pale conjunctiva, tongue, palms and nail beds.
·       Persistent vomiting.
·       Jaundice.
·       Bleeding from vagina( before 24 weeks).
·       Severe or continued headache, blurred vision.
·       Severe abdominal Pain.
·       Rupture of the membrane.
·       High fever with chills.
·       Foul smelling discharge from vagina.
·       Risking BP in serial examination.
·       Diminished or loss of foetal movement.
·       Epigastric pain/tenderness.
·       Multiple pregnancy.
·       Abnormal lie/ Breech presentation.
·       Unusual rapid enlargement of abdomen with difficulty in breathing
Exam:
·       Height: It is baseline information.
·       Weight: It is baseline information. It will help to assess maternal weight gain and foetal growth.
·       BP: Higher than 160/90 is a risk factor.
·       BP: Less than 90/60 is a risk factor.
·       Pulse higher than 110 consider infection or anaemia or other medical problem.
·       Skin/mucous membranes.
·       Extremities.
Per- abdominal examination:
·       Fundal height.
·       Presentation, position and lie.
·       Feel for foetal movements, foetal parts.
·       Foetal heart sound.
Per- Vaginal examination:
·       Perineum- look for lesions.
·       Vagina- look for lesions, discharge, dilation
·       Pelvic- assess for contracted pelvis.
Investigation:
·       Urine for sugar Albumin.
·       Hemoglobin.
·       VDRL
·       Hepatitis B, HIV
·       Blood grouping/RH typing
·       Malarial parasites(as needed)
·       RE/stool examination(as needed)
·       RE/ urine examination(as needed)
Consideration for Rh immunoglobulin:
·       If mother is Rh positive – no action.
·       If mother is Rh negative – Check the Rh  factor of baby.
·       If baby is Rh negative – no action.
·       If baby is Rh positive – consider Rh immune globulin.
If warning signs during pregnancy also management :
·       Counsel on adequate rest.
·       Counsel on breast care and breast feeding.
·       Counsel on harmful effects of smoking and alcohol intake.
·       Counsel on nutrition education.
·       Carbohydrate, fat.
·       Protein.
·       Green leafy vegetables, fruits.(vitamins minerals).
·       Iodides salt.
·       Counsel on personal hygiene.
-         Daily bath.
-         Dental care.
-         Breast care.
-         Private part care.
·       Hand washing.
·       Discuss plan for delivery place of delivery and clean delivery practices.
·       Discuss warning signs of pregnancy.
·       Give iron and folate.
·       Provide TT immunization.
·       Counsel on spacing.

·       Discuss postpartum family trimester routinely.

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