Antenatal care

Routine antenatal check-ups are essential for monitoring the health of the mother and fetus throughout pregnancy. These visits help identify any potential complications early and ensure both mother and baby remain healthy.

Objectives:

Monitor Maternal Health: Assess physical and emotional well-being.
Monitor Fetal Health: Ensure proper growth and development.
Educate: Provide information on pregnancy, labor, and delivery.
Identify Risks: Screen for complications or risk factors.

Frequency of Visits Minimum required is 4 in case if ideal situations:

First Trimester: Every 4 weeks (up to 28 weeks).
Second Trimester: Every 4 weeks (28-36 weeks).
Third Trimester: Every 2 weeks (36-38 weeks) and weekly until delivery.

Components of Routine Antenatal Check-Ups

Medical History and Assessment

Obstetric History: Previous pregnancies, complications, and outcomes.
Medical History: Chronic conditions, surgeries, and medications.
Family History: Genetic disorders or familial health issues.
Physical Examination

Vital Signs: Blood pressure, heart rate, weight, Pallor, Icterus, Cyanosis, Lymphadenopathy, edema & Urine albumin.
Abdominal Examination: Fundal height measurement, Abdominal girth measurement, fetal positioning, Fetal Heart rate localization and auscultation.
Pelvic Examination: If indicated, to assess cervical length and other factors.
Laboratory Tests: Blood Tests: Hemoglobin levels, Blood Group, Screening for anemia (HPLC), infections (e.g., HIV, syphilis, HbsAg, HCV), FreeT3, FreeT4,TSH levels.

Urinalysis: Check for protein, glucose, and infections.
Glucose Screening: Typically performed between 24-28 weeks to assess for gestational diabetes.
Special Obstetrics Tests: Dual Marker, Penta Marker or Quadruple marker,NIPS.
Fetal Monitoring

Fetal Heart Rate: Assessment via Doppler or electronic fetal monitoring (NST)
Ultrasound: May be performed to confirm fetal viability, assess fetal growth, anatomy, and gestational age and Doppler to assess fetal wellbeing.
Health Education and Counseling

Nutrition: Importance of a balanced diet and prenatal vitamins.
Exercise: Recommendations for safe physical activity.
Signs of Complications: Educate on warning signs such as bleeding, severe headaches, or reduced fetal movement.
Labor Preparation: Discuss birth plans, pain management options, and breastfeeding.
Immunizations

Vaccinations: Recommend influenza and Tdap vaccines during pregnancy.

Additional Considerations
Risk Assessment: Identify high-risk factors such as advanced maternal age, obesity, or multiple gestations, and plan appropriate follow-up.
Mental Health Screening: Assess for anxiety or depression, offering referrals as needed.

Ultrasonography in Pregnancy

Ultrasonography, or ultrasound, is a vital imaging tool in obstetrics used to visualize the fetus and monitor maternal health throughout pregnancy. It is a non-invasive procedure that employs high-frequency sound waves to create images of internal structures.

Indications

Ultrasound is used for various purposes during pregnancy, including:

Confirming Pregnancy: Establishing the presence of a fetus.
Estimating Gestational Age: Determining the due date and assessing fetal growth.
Assessing Fetal Anatomy: Identifying structural abnormalities and monitoring development.
Monitoring Fetal Heartbeat: Checking for signs of fetal distress or health.
Identifying Multiple Gestations: Confirming twins or higher-order multiples.
Assessing Placental Location: Evaluating placenta previa or placental abruption.
Monitoring Amniotic Fluid Levels: Assessing conditions like oligohydramnios or polyhydramnios.
Guiding Procedures: Assisting in amniocentesis or other interventions.

Types of Ultrasound

Transabdominal Ultrasound
Description: Conducted with a transducer placed on the abdomen.
Usage: Commonly used during routine check-ups and for assessing fetal growth and anatomy.
Transvaginal Ultrasound
Description: Involves inserting a transducer into the vagina.
Usage: Used in early pregnancy for better visualization, assessing ectopic pregnancy, or pelvic issues.
Timing of Ultrasound in Pregnancy

1. First Trimester (6-12 weeks):
– Confirmation of pregnancy and viability.
– Estimation of gestational age.
– Assessment of fetal heartbeat.
– Evaluation of ectopic pregnancy.
2. Second Trimester (18-20 weeks):
– Detailed anatomical survey (anatomy scan).
– Assessment of placental location and amniotic fluid.
– Evaluation of fetal growth and development.
3. Third Trimester (28 weeks and beyond):
– Assessment of fetal position and presentation.
– Monitoring fetal growth and wellbeing.
– Fetal Doppler to asses blood supply to baby.
– Evaluation of placental health and any potential complications.

Non-Stress Test (NST)

The Non-Stress Test (NST) is a common prenatal test used to assess fetal well-being, particularly during the third trimester of pregnancy. It evaluates the fetal heart rate (FHR) in response to fetal movements, helping to identify potential issues such as fetal distress.

Purpose
– To assess fetal heart rate patterns.
– To determine if the fetus is receiving adequate oxygen.
– To evaluate fetal well-being in high-risk pregnancies.

Indications for NST

High-Risk Pregnancies:
– Maternal conditions (e.g., diabetes, hypertension).
– Previous stillbirth or fetal growth restriction.
– Post-Term Pregnancy: Monitoring in pregnancies beyond 42 weeks.
– Decreased Fetal Movement: Maternal report of reduced fetal activity.

Procedure

Preparation: The patient is positioned comfortably, usually in a lateral position to optimize blood flow to the fetus.

– An electronic fetal monitor is used to assess FHR. A tocometer may also be applied to monitor uterine contractions.
– The test typically lasts 20-40 minutes.
– The fetal heart rate is monitored continuously, and maternal movements are recorded.

Reactive NST: At least two accelerations in FHR of 15 bpm or more above baseline for at least 15 seconds within a 20-minute period.

Non-Reactive NST: Lack of sufficient accelerations, which may require further evaluation.