by Dr. Esha Charaya, MBBS, MD, Consultant – Obstetrician and Gynaecologist, Patel Hospital, Jalandhar
Health of a baby depends on the health of the mother as we always say healthy mother means a healthy baby. So for a healthy baby, good antenatal care to promote the mother’s health throughout pregnancy is as important as good post-delivery care.
Purpose of antenatal care – Identify women at risk of complication during pregnancy and childbirth
- Prevention of complications
- Patient education
- To reduce the maternal and fetal death rate
Visits – minimum recommended are 8 visits throughout pregnancy but ideally, the patient should come for antenatal visits every 4 weekly till 28 weeks then 2 weekly till 36 weeks then every week till delivery.
Components –
- Maternal and fetal assessment
- Dietary education and promotion of physical activity
- Immunization
- Education of patient about routine pregnancy changes, and childbirth
- Treatment of physiological symptoms
- Promotion of breastfeeding
- Contraceptive advice
- Screening of common ailments and treatment
Dietary counseling and physical activity – purpose- to promote weight gain of 11-16 kg in healthy patients.6-8 kg in obese, 16-18 kg in slim patients include – promotion of simple exercise also with min risk of fetal trauma
- Encouraged to consume high protein and calcium-rich diet
- To include food rich in DHA
- Avoidance of excessive consumption of caffeinated products (coffee, soft drinks, etc)
- Discourage patient to do smoking and consume alcohol, drugs
- Promotion of inclusion of seasonal fruits and vegetables in the diet
- Iron, folic acid, calcium supplementation
- Iodine supplementation in an iodine-deficient area
Maternal Assessment-
Purpose – screening of common ailments and treatment of same
Includes – maternal present and past history of any medical or surgical illness,
- Physical examination
- Assessment of weight BP at each visit
Blood tests- blood count, urine examination, test for syphilis and hepatitis, HIV testing, glucose, and thyroid testing, Pap smear, and blood group. In areas with a high prevalence of thalassemia or in case of consunjugal marriage-inv to rule out thalassemia
Fetal assessment-purpose – to check for fetal growth and development at each visit to reduce the mortality rate
Includes – assessment maternal weight gain at each visit, Maternal abdominal examination to assess fetal growth at each visit, Fetal heart check-up with stethoscope and Doppler, Daily fetal kick count done by mother at home on daily basis, USG monitoring of fetal growth and well being, Screening for malformations by routine level 2 usg at 18-20weeks of pregnancy, Others – usg to look for nasal bone and nuchal translucency, Dual scan, triple marker, quadruple test
Vaccination-
Routine vaccination with tetanus toxoid, Vaccination for influenza, Vaccination for prevention of Diptheria and pertussis- tdap vaccine, Vaccine for covid during pregnancy is still under study in India so contraindicated in our setup
Education about common ailments and treatment
Purpose- promotion of maternal health
Include – education about heartburn, dyspepsia, constipation prevention and treatment with diet and lifestyle changes
Treatment of backache and pelvic pain with physiotherapy acupuncture and simple back exercise
Prevention and treatment of morning sickness- with carbohydrate-rich diet, ginger, camomile.
