Antenatal Care

It is a comprehensive health supervision of pregnant woman from the time of conception to the time of delivery. It consists of examination, observation, and guidance given to the pregnant woman. Pregnancy is divided into three trimesters. Each trimester has its own physiological and biological changes. The aim of good antenatal care is to ensure that pregnancy goes smoothly during these trimesters and avoid complications to the mother, and to keep the fetus healthy over the course of pregnancy.

The components of antenatal care (ANC) include:

Risk identification: Prevention and management of pregnancy-related or concurrent diseases, and health education.
To screen the “high risk” cases: High risk pregnancy is defined as one which is complicated by a factor or factors that adversely affect the pregnancy outcome—maternal, prenatal, or both.
ANC reduces maternal and prenatal morbidity and mortality both directly, through detection and treatment of pregnancy-related complications, and indirectly, through the identification of women at increased risk of developing complications during labor and delivery.
During check-ups, pregnant women receive medical information regarding normal physiological changes, biological changes, proper nutritional requirement, daily activities, exercises, psychological support, and those alarming signs where medical help needs to be accessed immediately. Not only do they get information regarding pregnancy, but they are also better prepared for postnatal care, including breast feeding.
All information relating to the pregnancy is entered in a patient-held Maternity Case Record.

Schedule for antenatal visit :

The first visit or initial visit should be made as early as pregnancy is confirmed.

Return visits:
• Once every month till 28 weeks
• Once every 2 weeks till the 36 weeks
• Once every week, till labor

The recommended antenatal care model consists of minimum of eight visits to health care facilities that will help to reduce prenatal mortality / morbidity and improve woman’s experience of care

Discomfort during pregnancy

There are some physiological changes during pregnancy due to which women feel certain discomfort and uneasiness. During the first trimester, which is the first three months of pregnancy, women can have nausea, vomiting, urinary frequency, fatigue, palpitation, and breast tenderness.
Body changes differently in later half of pregnancy. During those changes, women may complain of heartburn, ankle swelling, engorged leg veins, constipation, backache, leg cramps, faintness, and sometimes difficulty in breathing.
Reassurance is of utmost importance, as the women’s body is changing, which might bring fear and anxiety. During their antenatal visits they are educated with those normal physiological changes. This will help women to understand about these changes and will help them to cope without anxiety.
There are some routine investigations recommended during the antenatal period. These investigations include blood, urine, and ultrasound scans. In blood, woman’s hemoglobin, platelet count, group, serology, and glucose level are tested. It is important to screen for gestational diabetes and Down syndrome, as well.
Ultrasound scan is performed initially to define the site of pregnancy and viability of an embryo. Later, in around eleven weeks, it is done to see the nuchal thickness and nasal bone of the fetus. At twenty weeks, detailed anomaly scan is performed to rule out any congenital abnormalities.

Folic acid, which is vitamin B 9, is important to take two to three months prior to conceiving. This man-made vitamin plays an important role in the production of red blood cells, and helps in development of brain and spinal cord. It gives protection to a baby from having neural tube defect resulting in a condition known as spina bifida. It is advisable to take 400 mcg of folic acid every day. Foods that contain folic acids are broccoli, brussels sprouts, spinach, asparagus, peas, chick peas, etc.
Daily oral iron 30 mg to 60 mg is recommended after second trimester of pregnancy to prevent maternal anemia, puerperal sepsis, low birth weight of the baby, and preterm delivery. In populations having low dietary calcium intake, supplementation with 1.5–2.0 g oral elemental calcium is recommended during pregnancy.
Raised blood pressure during pregnancy is an important cause of life threatening morbidity, long-term disability, and death among both mothers and babies. During pregnancy, blood pressure is raised in conditions referred to as pre-eclampsia and eclampsia. These conditions are associated with increased mortality and morbidity. Increasing calcium intake during pregnancy has been shown to reduce raised blood pressure. Effective education is given to pregnant women about diet and healthy eating. They are provided with information about food sources of vitamins and minerals in order to prevent anemia during pregnancy.

Danger Signs of Pregnancy :

There are some signs and symptoms indicating danger for the woman or the baby. Being aware of these danger signs can help them to know when they may need to consult the doctor. When these following symptoms appear, women should promptly visit the hospital, regardless of her scheduled antenatal visit.

• Vaginal bleeding
• Rupture of membranes
• Swelling of the fingers, face, eyes
• Headache
• Visual disturbances
• Persistent abdominal pain
• Chills and fever
• Painful urination
• Persistent vomiting
• Change in fetal movements

Most women have uneventful pregnancies and childbirth, but sudden and unpredictable complications may happen at any time to any woman. Where problems do occur, it is important to ensure that they are acted upon without delay.