based on KFOG guidelines

1. ANTENATAL
CARE
Dr. N.R. Reena.
Consultant Gynecologist,Govt.
Victoria Hospital, Kollam

2. ANC
 ANC is one of the best example of preventive
health care in modern Medicine
 Premarital and preconception counseling in
situations like DM, CVS diseases and epilepsy,
when parents are elderly, h/o congenital
illness and RPL

3. Aim
 To reduce complications
 To pick up complications early
 To reduce maternal and fetal morbidity and
mortality

4. Ante natal care optimally
begins before conception
 General check up
 Folic acid supplementation
 400 microgram in normal women.
4mg in women with history of NTD
 Rubella immunization
 Optimization of medical condition like
DM, Epilepsy, asthma, heart
disease

5. Booking visit
•Pickup preexisting adverse factors
•Estimate gestational age. Dating uss
in first trimester, do not change it
subsequently
•Diagnosing other pelvic pathologies
•Predicting the prospects of
pregnancy
Antenatal care

6. How many visits
At least
 one visit during first
trimester.
 Two in second trimester
 Two in third trimester
Ideally
 Once a month till 28th
weeks
 Once a fortnight till 36th
week
 Then once a week till term

7. Investigations

8. First visit
 Hb,
 Blood group & Rh typing
 VDRL, HBSAg, HIV
 Coumbs test in Rh negative mother
 BMI in all women
 One scan between 12-13 weeks
 GCT in high risk women
[Ideally 75g OGTT also]

9. Screening for Downs syndrome should be offered in
appropriate couples

10. Second trimester
 Anomaly scan around 20 weeks
 75 g OGTT at 24-28 weeks
 Repeat Hb at 24-28 weeks
 Repeat ICT at 28 weeks

11. Third trimester
 Repeat OGTT in high
risk women
 BPP at 38-39 weeks
 CTG 40 weeks

12. What to do at each visit
 Record weight,
 BP ,
 Fundal height in centimeters
 Immunization
two doses ofTT at 4-6 weeks interval
If LCB < 5 years only one booster
 Medications
Folic Acid 5mg in early pregnancy, 0.5 mg
in later months
Iron supplementation 100mg/day from 12-14wks
Calcium 500-1000mg daily

13. Ante natal records
 Should be concise and better left with the
mother To be produced wherever getting
admitted.

14. Counseling
 Proper education through antenatal classes
 Involve husband/relatives in discussions
 Possible complications to be explained
 Delivery and labour to be explained in
simple language
 Advantage of vaginal delivery has to be
highlighted
 Discuss on pain relief, and labour
companion

15. Ante natal classes – Points to
be addressed
1. Diet
2. Exercise
3. Employment
4. Travel
5. Bathing
6. Clothing
7. Bowel habits
8. Coitus
9. Leucorrhoea
10. Candidiasis
11. Bacterial vaginosis
12. Trochomoniasis
13. Dentition
14. Breast care
15. Labour
16. Pueperium
17. Family planning

16. THANK YOU