Antenatal Care (ANC)
Antenatal care is a medical activity, in which therapeutic care is provided to the pregnant woman and her fetus during the period of gestation.
ANC is very important during pregnancy, to provide an antenatal meeting. During the period of pregnancy an antenatal meeting can be provided to the pregnant woman as one per month at least four antenatal meetings must be performed for every woman during the period of gestation which are as follows--
First meeting, at the time of registration first month.
Second meeting, 4th month of pregnancy.
Third meeting, 7th month of pregnancy.
Fourth meeting, 9th month of pregnancy.
Objectives Of ANC
• To decrease maternal mortality & infant mortality.
• To identify any complication of pregnancy as early as possible.
• To ensure proper growth of fetus.
• To ensure vaccination of mother during pregnancy.
• To provide health education to the mother.
• To identify high risk pregnancies (HRP).
• To provide proper nutrition to mother during pregnancy.
• To prevent & manage common problems of pregnancy.
Components Of ANC
Antenatal care does have three components, which must be followed during every antenatal meeting. These component of antenatal meeting are as follows--
(A). Antenatal Examination/Assessment
(B). Antenatal Treatment
(C). Antenatal Advice
(A). Antenatal Examination/Assessment
1. EDD Calculation (Expected Date of Delivery)
2. Vital Sign Assessment
3. Physical Examination
4. Breast Examination
5. Blood Examination
6. Blood Glucose Estimation/ O.G.T.T
7. Urine Examination
8. Abdominal Examination
9. Per Vaginal Examination
1. EDD Calculation
The expected date of delivery must be calculated at the time of the first antenatal meeting. The formula of calculation of EDD is as follows
EDD = Last menstrual period(LMP)+9 months +7 days
Here LMP is the first day of the last menstrual period. If menstruation started in a woman from 23rd May, then calculate EDD
EDD = 23 may + 7 days + 9 months= 7 march
2. Vital Sign Assessment
Vital signs must be assessed for every pregnant woman at the time of the ANC meeting.
Blood Pressure assessment is very important to identify GIH or PE.
3. Physical Examination
At the time of the antenatal meeting, a complete physical examination must be performed by the nursing officer, which includes
• Assessment of skin changes.
• Assessment of body weight.
• Assessment of edema.
• Assessment of dietary pattern.
4. Breast Examination
Breast examination is also performed at every antenatal meeting. It includes
• Size of breast secondary areola & Montgomery tubercle.
• Cracked and inverted nipple.
5. Blood Examination
A blood examination is a very important tool of assessment during the antenatal period. Blood examination of pregnant women is performed for
• Assessment of hemoglobin, to identify anemia.
• Complete blood cell count.
• Blood grouping
• HIV test
• Syphilis & gonorrhea test
• RDT (Rapid Diagnostic Test) for malaria. (At every ANC meeting in malaria-endemic area)
6. Blood Glucose Estimation/ O.G.T.T
Blood Glucose level assessment is a very important part of ANC. Blood glucose level of pregnant woman is assessed by glucometer, to identify gestational diabetes mellitus (GDM) in pregnant woman.
Usually at every ANC meeting blood glucose level is assessed by using oral glucose tolerance test (O.G.T.T).
O.G.T.T is a standard test, which is performed for pregnant woman. In this test following action are taken
Step 1
First the procedure is explained to the pregnant woman.
Step 2
Now 300 ml of water is taken in a beaker/ jug and then 75gm of glucose is dissolved in this water.
Step 3
Now this dissolved glucose water is given to mother to drink slowly within 5-10 minutes.
Step 4
Now pregnant woman is observed for next 30 minutes, that if she vomits or not.
Step 5
Now if woman vomits within 30 minutes, then procedure must be repeated & if she does not vomit, then continue the procedure.
Step 6
Now after 2 hours of drinking glucose water by pregnant woman, her blood glucose level is assessed by using glucometer.
Result
Now according to blood glucose level of pregnant woman. Following interpretation is made--
• If blood glucose level is <130 mg/dl, then it means pregnant woman does not have Gestational Diabetes Mellitus (GDM).
• If blood glucose level is 131-199 mg/dl, then it means pregnant woman does not have GDM, but she is prediabetic.
• If blood glucose level is > 200 mg/dl, then it means she is affected by GDM.
7. Urine Examination
Urine examination must always be performed at every ANC meeting for every pregnant woman. Urine examination is performed for assessment of
• Protein in urine( for proteinuria)
• Glucose in urine( for GDM)
• Nitrate in urine( for infection)
• Leukocyte in urine ( for infection)
8. Abdominal Examination
Abdominal examination is a very important method of diagnosis performed for the diagnosis of any pregnant woman at the time of ANC meeting.
An abdominal examination can only be performed after a 20 week (5 months) pregnancy because before 5 months abdomen examination is not helpful to identify any growth of the pregnancy. For abdominal examination, a pregnant woman must lie down flat over the examination table, and her abdomen must be exposed. At the time of abdominal examination following assessment is made
• Assessment of linea nigra & starie gravidarum
• Assessment of lie and presentation of the fetus by using pelvic grips.
• Assessment of fundal height by using interpretation usually fundal height in centimeters is equellent to a week of pregnancy.
• For example, if fundal height is 28 cm then pregnancy is also 28 weeks.
• Assessment of engagement of fetal head in maternal pelvis.
• Assessment of FHR (Fetal Heart Rate).
9. Per Vaginal (PV) Examination
PV examination is a manual examination which is performed by a nursing officer for any pregnant woman during ANC & during labor.
PV examination is a very important to identify status of pregnancy & also to identify status of labor in any mother.
During ANC PV examination is performed at last trimester of pregnancy while as at the time of labor PV examination is performed at every 4 hours.
Process of PV examination & its outcomes are as follows
• First of all procedures is explained to mother.
• Now dorsal recumbent position is provided to mother so that her valued area is exposed.
• Now examiner performs handwashing, glowing & then apply providing iodine over two fingers.
• Now examiner does insert two fingers in vaginal canal in vertical direction.
• Now examiner rotates his/her fingers from vertical to horizontal direction.
• Now examiner does feel cervical ring & then spread fingers to assess cervical dilatation.
If both fingers are spread maximum, & cervical ring can not be touched by both fingers together then it is full dilation of cervix, which is 10 cm.
• Now examiner does assess 'pelvic adequacy' for this assessment both ischial spine are felt by fingers, when maximum spread. If both ischial spine can not be felt together, then it is considered adequate pelvis.
• Now fingers rotated in vertical direction & fingers are withdrawn from vaginal canal to assess spinal curve. If fingers of examiner does not touch to spinal curve then it means pelvic is adequate for normal delivery.
• Now color of amniotic fluid is also assessed at the fingers.
10. USG (Ultrasonography)
USG is also performed at the antenatal meeting for assessment of mother & fetus. USG can perform four times in normal pregnancy & according to requirement it can be performed in for identification of
• Age of pregnancy in weeks
• Number of fetus
• Fetal body weight
• Fetal body height/ length
• Anomaly of fetal body
• Amniotic fluid amount
• Position, lie, and presentation of fetus
• Placental implementation
• Umbilicus cord length & position
(B). Antenatal Treatment
During antenatal period every pregnant woman does need some treatment for prevention and control certain health problem of pregnancy. Treatment during ANC is as follows--
1. Treatment Of Anemia
2. Calcium Supplementation
3. Management Of Morning Sickness
4. Immunization
1. Treatment Of Anemia
Anemia is the most common complication of pregnancy, which must be managed properly. Anemia in any pregnant woman is clinically identified, if Hb level is < 1gm/dl of blood.
For treatment of anemia high iron diet is provided to the pregnant woman with IFA tablets doses of IFA tablets during pregnancy are as follows--
If hemoglobin level is above 11gm%
Iron folic acid (IFA) tablets
180 tablets OD for 180 days
Starting from 4th month of pregnancy
If hemoglobin level is < 11gm%
360 tablets of IFA BD [2 tablets per day] starting from 4th month of pregnancy
If anemia is moderate to severe in grade, then IFA tablets are given with iron sucrose infection and blood transfusion.
2. Calcium Supplementation
Calcium supplementation is a very important part of ANC management. Calcium must be given to every pregnant woman during pregnancy. Usually in second trimester total minimum 100 mg calcium tablet (1 per day) is given to pregnant woman.
3. Management Of Morning Sickness
Morning sickness is a very common complication during pregnancy, which can be managed by
• Providing a toast or bread or roti in morning when pregnant woman wake-ups.
• Antiemetic drugs can also be provided according to requirement.
4. Immunization
Immunization of a pregnant woman is very important for prevention of infection in mother as well as fetus.
Following vaccine are given to pregnant woman.
TT, Third month, IM, 0.5ml
TT2, Fourth month, IM, 0.5ml
(C). Antenatal Advices
Antenatal advice is the health education provided to pregnant woman for good health during pregnancy period. Common health educations are as follows
1. Health Education Regarding Nutrition
During pregnancy following health education is provided to pregnant woman regarding her nutrition.
• Mother must eat 25% more fruits, then her normal daily diet.
• Mother must eat rich iron diet such as green leafy vegetables, wheat, root, Jagger etc.
• Mother must eat rich calcium diet such as milk, egg, fish, nuts etc.
• Mother must eat low sodium diet & low oily spicy diet.
2. Health Education Regarding Exercise
A pregnant woman must also be educated about daily routine exercise such as
• Mother must perform normal function of home such as cooking.
• Mother must perform light exercise such as walking, knee bending.
• Mother must not perform pushing or lifting heavy weight.
3. Health Education Regarding Sleeping
A pregnant woman must take sleep of 8 hours in nighttime & 2 hours in say time.
4. Health Education Regarding Hygiene
Following health education must be provided to every pregnant woman regarding maintenance of personal hygiene.
• Mother must take bath daily.
• Mother must maintain perineal hygiene.
• Mother must wear clean clothes.
5. Health Education Regarding Family Planning
Although health education of family planning is not related with pregnancy, but family planning education must be provided to every woman & her husband during pregnancy. She must tell about
• At least 3 years of gap in between two children.
• Methods of temporary and permanent family planning.
6. Health Education Regarding Breastfeeding
Although breastfeeding is also not related with the health of pregnancy, but breastfeeding is very important after delivery. So proper health education regarding breastfeeding must be provided to every pregnant woman.
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