Antenatal Care
Antenatal care means clinical care offered to a woman during her pregnancy with the aim of ensuring an optimal maternal outcome.
BASIC CARE
- Regular Antenatal visits, minimum one visit in T1, monthly visits till 30 weeks, every 2 weekly till 36 weeks and weekly visits till delivery.
- Blood investigations for Hb, Blood grouping and Rh Typing, VDRL, RBS, and Urine R & ME.
- A repeat Hb and Urine Sugar to be done in third trimester.
- Immunisation with 2 doses of Td / TT.
- Iron, Folic Acid and Calcium Supplements.
- At least one Ultrasound for congenital anomalies should be done before 20 weeks of pregnancy.
- Delivery by a doctor or a trained birth attendant.
- Education on nutrition, diet and hygiene.
- Education in breast feeding and birth spacing and-contraception methods.
ADDITIONAL CARE & INVESTIGATIONS
- A special sub group of pregnant women may require additional care and services.
- Preconception counseling and care.
- Counseling for HIV, HbsAg and HCV testing.
- Counseling and screening for Thallesemia, Down’s syndrome.
- Repeat Hb, Blood sugarand Urine evaluation in each trimester
- Ultrasound evaluation once in each trimester.
- Institutional delivery recommended.
- additional screening for infections, growth retardation, thyroid dysfunctions.
This sub group includes pregnant women with the following:
Women who have experienced any of the following in their previous pregnancies also need additional care
- Recurrent pregnancy loss
- Preterm birth
- Severe pre-eclampsia, HELLP syndrome or eclampsia
- Rhesus isoimmunisation or other significant blood group antibodies
- Uterine surgery including caesarean section, myomectomy or cone biopsy
- Antepartum or postpartum haemorrhage
- Previous MRP
- Puerperal psychosis
- Grand multiparity (more than five pregnancies)
- A baby with a congenital anomaly (structural or chromosomal).
The first visit
this is the most important interaction point as it creates the first impression and sets the stage for a healthy doctors-patient relationship . We make sure to provide as much time as possible with the patient so that all anxieties are allayed and patient develops confidence in her doctor. Detailed history taking is done and risk stratification is done . This is followed by a thorough complete clinical examination and all the signs and symptoms of pregnancy related ailments and normal changes in body are explained to the woman. All the do’s and don’ts are explained. Wherever possible, we provide written instructions as well. Full ANC plan of management is explained and provided as a handout where all the tests required to be done are given with the dates when to be done . This makes sure that the patient does not miss out on the tests even if she misses her checkup due to any reason. Birth Plan : some fleeting idea is given and she is told to discuss this at a later stage. Medications are prescribed and instructions are provided regarding the dose and time of medication. Follow up visit dates are given.
Total number of antenatal visits
in a low risk mother with a single foetus , besides the first visit, monthly visits are recommended till 31 weeks or end of 7 months. Fortnightly visits in the 8th month or 32-36 weeks and weekly visits in the last month or 37-40 weeks are recommended. Besides these, if any emergency arises or any medical / surgical complications develop, then visits are customised.