S. specific Time content Teaching A.V.

aids Evaluation
n. Objective learning
activity
ANTENATAL CARE
What do you
1. Define 2min DEFINITION – Antenatal care is defined as the systemic examination & understand
antenatal advices given to the pregnant women at regular & periodic intervals based on About
care. the individual needs starting from the beginning of pregnancy till delivery. antenatal care?
Antenatal examination is carried out whenever visit the clinical the clinical
for antenatal check up.

AIMS OF ANTENATAL CARE – Explain the

2. Enlist the 5 min 1 To screen the high risk cases aims of
aims of 2 To prevent or detect & at the earliest any complication Antenatal
antenatal 3To ensure continued medical surveillance & prophylaxis care?
care. 4 To educate the mother about physiology of pregnancy & labour
5 To discuss with the couple about the place, time,& mode of delivery & care
of the newborn.
6 To motivate the couple about to the need of family planning & also
appropriate advice to couple seeking medical termination of pregnancy.

COMPONENTS OF ANTENATAL CARE – What are the

3. Discuss 10min  Setting up antenatal clinical with all facilities compo-
the  Registration nents of
compone  History taking antenatal
nt of  Antenatal examination Care?
antenatal  Abdominal examination
care  Vaginal examination
 Health education
Setting up Antenatal clinic –
 Examination table
 Draping sheet
 Screen or curtain
 Urine testing articles & bottle for specimen
 Temperature tray
 Weighing scale
 BP apparatus
 Kidney tray
 Paper bag
 Torch
 Stethoscope
 Tape measure

HISTORY TAKING – How to take

1) Identification of data – Age, marital status, education, occupation, and history
family.The data includes complete socio cultural & economic background of From the
the client & her family. patient?
2) Reason for visiting the clinic
3) History taking –
 Surgical History –
-History of any operation
-Injury or accident, etc
-History of blood transfusion
 Family history –
-Both maternal & paternal history of breech delivery
-Twins delivery
-Hypertension
-Heart disease
-Diabetes &
-Congenital malformation
 Personal History-
-History of heart disease any disease since childhood likes
-Rheumatic fever
-Pulmonary disease
-Convulsion
-allergy
Renal disease
 -Diabetes
 Menstrual History –
-Age of first menstrual period
-Last menstrual period date
-Duration of each period
-Any complaints like dysmenorrhoea
-Amount of blood flow
 Obstetrical History –
-Gravida Para
Past obstetrical history nature of pregnancy
RH and ABO blood type
Labour
Puerparium
New born sex, healthy
Age at first pregnancy
-Present pregnancy

INVESTIGATION
 Urine – Albumin & sugar
 Blood –Hb
 Blood group Define
 VDRL TORCH?
 HIV Test
 Ultra sonography –
 TORCH Test
T- Toxoplasmosis
O- Other viral infection
R-Rubella
C-Cytomegalovirus
H- Herpes virus

Discuss 15 mint PHYSICAL EXAMINATION

4 the This include complete systemic examination of each system & assessing its
Physical function –
examinati A. Height – Height indicate is pelvic size
on of B. Weight – Obesity can lead to risk of Gestational diabetes
antenatal First trimester – 1kg
care Second & third trimester – 5kg How to do
Total weight gain during pregnancy is approximately 11kg physical
C .Blood pressure – Blood pressure be recorded during each visit. Any Examination of
reading above 140/90 should be reported ante-
D.Vital Signs – Temperature, pulse, Respiration to be recorded in each visit Natal mother?

HEAD & TOE EXAMINATION

 Hair & Scalp – Healthy or infection
 Eyes
Observe the color of the conjunctiva – yellow ,pink or normal
Sclera – Normal, yellow ting suggest anemia
Infection, discharge
 Mouth –
Hygiene
Gums & teeth – Healthy, cavity, infection

 Ear, nose & throat –

Healthy, enlargement or infection
 Breast changes –
1- 3-4 week Prinking & tingling sensation
2- 6 weeks – Enlargement, tense, Painful
3- 8weeks – Bluish surface, veins visible
4- 8-12 weeks –
5- Montgomery can be expressed
 Nipple-
Normal, flat or introverted, discharge, skin and glandular change.
 Abdomen – Palpate for liver or spleen enlargement or any other
abnormality
 Skin – Observation for any scar or infection
 Extremities – Upper : Check Hands, Color of nails – pink or pale, Shape
of nails
Lower – Any pain, tenderness, varicose veins, presence of oedema
 Back & Spine –
 Observe the back Spine for any deformity
-Observe the symmetry of the rhomboids of michaelis which is a diamond
shaped area formed anteriorly by the 5th lumber vertebra laterally by the
dimples of the superior iliac spine & posterior by the gluteal cleft.
 Cardio-respiratory system-Breathing
pattern,cough,wheezing,infection,respiratory rate,rhythem,auscultation
findings.
 Genito-urinary system-Urination difficulties and deviation,genital lesion
and infection,history of hormone therapy.
 Vaginal : Vaginal examination is done in antenatal clinic .the patient
must empty her bladder prior to the examination and is placed in the
dorsal position with the thighs flexed along with the buttocks placed on
the foot end of the table.
-Inspection: By separating the labia-using the left two fingers (thumb and
index).the character of the vaginal discharge if any is noted .Presence of
cystocele or uterine prolapsed or rectocele is to be elicited.
-Speculum Examination: in this bivalve speculum is used . The cervix and the
10mit vault of vagina is inspected is inspected with the help of good light source
Demonstr placed behind. Cervical smear for exfoliative cytology or a vaginal swab from
5 ate the the upper vagina, in the presence of discharge, may be taken.
procedur -Bimanual: Two fingers of the right hand are introduced deep into the vagina
e of with separating the labia by left hand. Gentle and systematic examination is to
antenatal be done to note, 1.Cervix-consistency, direction and any pathology. 2. Uterus-
care.
size, shape, position and consistency . 3. Adnexae- any mass felt through the
fornix. If the introitus is narrow, one finger may be introduced for the
examination.

 Muscular,skeletal and vascular system-Status of joint,muscles and

extremities,appearance of nails and finger.
 Central nervous system-Speech and memory,complaints of
vertigo,convulsion or loss of consciousness,mental status,motor
symptoms,sensory symptoms
 Lymphatic and hematopoetic system-Lymph nodes,bruising
 tenencies,blood dyscrasis.

PROCEDURE FOR EXAMINATION

1) Physical Examination-
 Collect all required articles
 Keep room ready – adequate light
 Privacy
 Wash hand before procedure
 Warm or as per season
 Prepare the mother explain the procedure
 Ensure that the bladder is empty
Give a comfortable & relaxed position

 Stand on the right side of the women or the examination table

 Collect relevant history which includes identification data ,Socio-
economic data, culture, medical, surgical, Family & personal history
 Collect information about previous pregnancies & the present one &
record in the Performa or the card
 Drape the mother & provided enough privacy by curtain or screen
 Do a thoroughly physical examination from head to toe & record the
finding are also recorded on

 Any complaints related to pregnancy or minor ailments

 Explain & assist in routine investigation like urine, stool, blood
Abdominal Examination –

General instruction to be kept in mind during abdominal examination:-

o Make your hands warm before examining
o Explain the procedure
o Touch the abdomen lightly to reduce reflexive reaction
o Explain the women to lie dorsal position with thighs slightly flexed with
upper part of the body supported by a small pillow & expose the abdomen
fully
o Do systemic examination inspection followed by palpation & finally
 auscultation
o Keep the fingers together & use the palms surface of the finger
o Use smoothly applied pressure to palpate the returns
o Palpation should be continuous do not lift your hand till the whole
palpation is done .Follow the four sequential steps of palpation. This will
help you to gain & improve accuracy of your findings maneuver
o Do not press hard with fingers as it is painful
INSPECTION-
 Linear Pigmentad zone (linea niagra) extending from symphysis pubis
to ensiform cartilage may be visible as early as 20 weeks .
 Striae (both pink or white) or varying degree are visible on the Explain fundal
abdomen. height?
PALPATION –
Abdomen palpation should be done between 16-20 weeks of gestation on
words, when fetal parts are palpable
I. Fundal height – Can be measured by measuring the distance between the
symphysis pubis & the fundal curve using tape measure or fingerbreadth.
This information gives progressive growth of pregnancy. Umbilicus is
usually taken as a landmark for measuring or assessing fundal height.
MECDONALD’ S height is done by using the tape measures
Using 3 finger breadths – Which is approximately equivalent to 5cm or
2inches or 4 weeks of lunar mother. The growths chart of foetus as per
finger measurement is given below-
12 weeks – Uterus is just about the symphysis pubis s
18 weeks – Uterus half way between the symphysis pubic & umbilicus
20 weeks – Above the half way but 2.5 cms below the
24 weeks – Fundus will be present at the upper margin of the umbilicus
about 20cms from the symphysis pubis or 3 finger breadth above 20 weeks
28 weeks – Fundus is 1/3rd from the umbilicus to the xiphisternum or 30cms
from the symphysis approximately
32 weeks – 2/3rd distance from the umbilicus & xiphisternum, 6 finger
above the umbilicus
36 weeks – 3/3rd distance which means at the level of xiphisternum
approximately 35cms or 13-14 inches
 40 weeks – Mostly lightening takes place & uterus descends down to the
level of 32 weeks
Sometimes fundal height does not correspond with period of gestation & the
reason could be
o Multiple pregnancy
o Polyhydramnios
o Big baby
o Wrong dates
If the fundal height is less than the period of gestation then it could de due
to:
o Abnormal foetal presentation
o Growth retarded foetus
o Congenital malformations
o Oligohydramnios
o IUD
o Wrong Dates
Assess abdominal Girth: Abdominal circumference is measured with help
of tape measure. Normal increase of 1 inch or 2.5cms.per week after 30
weeks. Measurement in inches is same as the weeks of gestation after 32
weeks pregnant mother may be 32 or 31 inches.
3) Grips used in abdominal palpation is done using 5 types of grips which What is fundal
are: grip ?
o Fundal grip
o Lateral grip
o Pelvic grip – Deep pelvic palpation
o Pelvic grip – pawlick Maneuver
o Combined grip
FUNDAL GRIP – You should stand facing patient’s head, use the tips of the
fingers of both hands to palpate the uterine fundus.
- When foetal head is in the fundus it will be felt as a smooth hard,
globular, mobile & ballot able mass.
When breech will be in the fundus it will be felt as soft irregular, round,& less
mobile mass
LATERAL GRIP(Second Leopold ) This maneuver will enable to assess the
lie of the foetus is the relationship between the axis of the foetus & the long
axis of the uterus. The lie is longitudinal or transverse but occasionally it may
be oblique. This palpation or maneuver also helps in identifying the foetus
which lies over the pelvis. The commonest presentation is mostly vertex.
Second Maneuver – Lateral palpation For performing the lateral grip also you
keep facing the patient head place your hands on either side of the abdomen.
Steady the uterus with your hand on side & palpate the opposite side to
determine the location of the foetal back.

- The back area will feel firm

- Small baby parts like hand, arms & legs will be felt like irregular
mass & may be actively or passively mobile. This grip helps to
identify the relationship of the foetal body the front or back &
sides of the maternal pelvis. The possible position is posterior,
anterior etc.
PELVIC GRIP (First pelvic or first Leopold ) - During this grip you will face
patient’s feet. Gently move your fingers down the sides of the abdomen
towards the pelvis until the fingers of one hand encounter the bony
prominence.
-If the cephalic prominence is one the same side of the women as the fetal
back , the prominence is occiput and indicates a fece presentation .
-If both hands will encounter simultaneously a hard mass, which is equally
prominent on both sides, it is indicative of broe presentation due to partial
flexion of the head. The occiput and sinciput is felt at the same time .
-At the brim of the pelvis your hand is converge around the presenting pert
with the finger tips of your two hands touching in the midline indicating the
presenting part is not engaged .It is above the pelvic brim or floating .
-The hands will diverge away from the presenting part and the midline
indicating the presenting part is engaged .
PAW LICK GRIP (Second pelvic or third Leopold )– Place the thumb and
middle finger of the overstretched hand above the symphysis pubis .Press
gently onto the abdomen in order to feel the presenting part below and
between your thumb and finger .
-A movable part is felt if the presenting part is not engaged.
 -If the presenting part is the head and that is engaged , it may not be readily
movable .

AUSCUTATION –
1) Monitor the FHS Which type of
Describe 5mint 2)Other sound heard in the abdomen are tunic soufflé, counted by the antenatal
6 the rushing of the blood through the umbilicus arteries & uterin soufflé Advice you
antenatal caused by the gush of blood passing through the uterine blood vessels. should
advice Given?

ANTENATAL ADVICES
Need based health education should be given related to:
 Diet in pregnancy
 Personal hygiene
 Care of breast
 Dental care
 Antenatal exercise
 Regular medication
 Care of the bowel
 Posture

SUMMARY
Antenatal care is defined as the systemic examination & advices given to the
pregnant women at regular & periodic intervals based on the individual needs
starting from the beginning of pregnancy till delivery
Indore (M.P.)

SUBJECT: OBSTETRIC AND GYNAECOLOGY NURSING

 DEMONSTRATION on

SUBMITTED TO: SUBMITTED BY:

RESP.U.PERWAL MS AASHA SURAGE
MADAM M.SC.NURSING
GOVT COLLEGE OF PREVIOUS YEAR
NURSING

LESSON PLAN
DATE:
TIME: 1 hr
PLACE: M.Y.Hospital
SUBJECT : Obstetric and gynecology nursing
GROUP : M.Sc. Nursing 1st yr.
TOPIC : antenatal assessment
METHOD OF TEACHING : Lecture cum Discussion
TEACHING MATERIALS : Black Board, PowerPoint, Chart, OHP, video clip
 LANGUAGE : English
NO. OF STUDENTS : 5
NAME OF STUDENT TEACHER : Ms Aasha surage
NAME OF EVALUATOR : MRS.U. Perwal madam

REVIEW OF PREVIOUS KNOWLEDGE:

Students have basic knowledge about antenatal care.

CENTRAL OBJECTIVE: At the end of the class the students will come to know about the demonstration of antenatal care.

CONTRIBUTORY OBJECTIVES: After the class the students can:

Define antenatal care.
Enlist the aims of antenatal care.
Discuss the component of antenatal care
Discuss the Physical examination of antenatal care
Demonstrate the procedure of antenatal care

BIBLIOGRAPHY
 Brews & Holland (1991).Manual of Obstetric ( ed.), New Delhi B.I. Churchill Livingston;130
 Dutta, D.C.(2001).Textbook of Obstetrics, (VIII) Edition, Kolkata New Central book agency; 105
 Dutta, D.C.(2003).Textbook of Gynecology including contraception, (12th ed.) ,Calcutta Dawn books;145
 Dr. Dawn, C.S. (1990). Textbook of Obstetrics & Neonatology, (11th ed.), Calcutta. Dawn books; 120
 Jacob Annamma (2005). A Comprehensive Textbook of Midwifery, 1st ed., New Delhi Jaypee Brothers (P)
Ltd; 98
 www.newmowasat.com/pdf/Antenatal_care
 www.authorstream.com/...