Antenatal Assessment: Antenatal Assessment Presented by Maj Ajitha K Slide 2: Everything grows rounder and wider and weirder,

, and I sit here in the middle of it all and wonder who in the world you will turn out to be. - Carrie Fisher History Taking: History Taking General information Name, age, gravidity, parity, edn qualification, occupation, income, religion, marital status Husband - age, edn , occupation, income, religion Current problem/ complaint History of current complaint Slide 4: Menstrual H istory - Age at menarche Cycle, duration Amount of Flow Dysmenorrhea Intermenstrual bleeding LMP and EDD Marital History - years of marriage, consanguineous marriage, late marriage Contraceptive H istory - use and type of devices Past Obstetrics History: Past Obstetrics History Pregnancy Gestational age at time of delivery Outcome of pregnancy Labour/delivery Normal vaginal delivery, C-section Labor- Normal, prolonged Length of labor D & E D & C Place of delivery (at home or at the hospital) Any other complications Past Obstetric History: Puerperium Any complications Baby Gender of baby Age of baby Breast fed, l ength of breast feeding Birth weight Past Obstetric History Present obstetric history: Present obstetric history Date of booking No of antenatal visits 1 st Trimester Ask about nausea, vomiting Other associated symptoms such as fever Abdominal/pelvic/back pain, b urning micturition Vaginal discharge Bleeding per vagina Use of folic acid tablets (small yellow colored pills) Was an ultrasound done at 6 or 7wks (Dating scan) Present obstetric history: 2 nd Trimester Ask about regular use of folic acid, iron and calcium supplements Ultrasound at 18-22wks (Anomaly scan ) Quickening: fetal movements (normally felt around 20 weeks gestation) Fever, rash , abdominal pain 3 rd Trimester Tetanus toxoid vaccine at 28 wks & 32 wks Regular doctor checkups Ultrasound Present obstetric history Obstetric history: General - Any history of disease Hyperemesis Bleeding , dizziness,urinary complications Head ache,visual disturbances, constipation, edema, abdominal pain, indigestion History of drugs ,radiation Total weight gain Obstetric history Slide 10: Past History Past medical: HTN , Diabetes, TB, Seizures, Asthma , heart disease, malaria, kidney disease, syphilis Past Surgical - pelvic surgeries, abdominal surgeries, caesarian, lower genital tract infections Blood Transfusions Vaccination up-to-date Family History :- heart disease, hypertension, DM , TB History of breast cancer, ovarian cancer, uterine cancer History of obstetrical disorders, twin pregnancy, abortion Slide 11: Personal History Appetite Sleep Bowel Micturition Recent weight gain/weight loss History of any addictions (such as smoking, alcoholism , tobacco chewing etc..) History of any allergies to foods or medicines Dietetic History Veg/ non veg, meal pattern, food fads, habits, likes, dislikes for food, pica, cultural beliefs Slide 12: Social History Family members Earning members Approximate income Living condition Psychosocial History Slide 13: Aspects of Antenatal Assessment Head to toe examination Breast examination Abdominal palpation

Physical Examination: General Examination Height Weight Temperature, Pulse, Respiration Blood Pressure Physical Examination Physical Examination: General Appearance Build Pallor Jaundice Gait Physical Examination Physical Examination: Head and Scalp Scalp, infection , infestation Hair Quality Tongue Teeth Gums Tonsils Thyroid Physical Examination Physical Examination: Physical Examination Breasts Pregnancy c hanges Size Nipples Inverted Flat Retracted Cracked Slide 18: Skin Colour changes Texture Striae Gravida Linea Nigra Physical Examination Physical Examination: Abdomen Size: Liver, Spleen Shape: Scaphoid, Pendulous Umbilicus: Protuberant, Dimpled Extremities Oedema Varicosities Deformities Physical Examination Physical Examination: Perineum Oedema of v ulva Discharge Soreness of v ulva Vaginal bleeding Bartholins cyst Perineal hygiene Physical Examination Abdominal Examination: Aim observe signs of pregnancy assess foetal size and growth assess foetal health diagnose the location of foetal parts detect any deviation from normal Abdominal Examination Investigations: Investigations ABO blood group, Rh typing Haemoglobin and haematocrit Blood sugar fasting, postprandial VDRL HIV Rubella immune status Urinalysis Ultrasonography Slide 24: A baby is something you carry inside you for nine months, in your arms for three years and in your heart till the day you die. - Mary Mason