ANTENATAL CARE

dr. Ova E, M.Med.Ed., Sp.OG., Ph.D

Ante Natal Care (ANC)

Goal : healthy mother and baby

Term:
G3 P2 A0

Gravida : number of pregnancy

Paritas : viable baby
Abortus : non viable baby
Nuligravida / Nulipara
Primigravida / Primipara
Multigravida / Multipara
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Gestational age
Calculated from LMP
Gestational age: 280 days or 40 weeks
Naegel formula : LMP = 10-6-1999
EDD = 17-3-2000
Trimester : represent period of 3 months
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First visit
As soon as the period is late:
Anamnesis
Physical examination
Obstetrics examination
Supporting examination (USG)
Lab. test
Objective: obtain base line data.
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Advices
See the doctor in following conditions:
Vaginal bleeding, oedema, headache,
blurred vision, abdominal pain,
excessive vomits, fever, dysuria, and
vaginal discharge.

Sebsequent visits
Every 4 weeks until 28 weeks of GA
Every 2 weeks until 36 weeks of GA
Every week until delivery

At least 4 ANC visits at various trimester

Monitor
Mother: weight gain, blood pressure,
anemia, fundal height, subjective
complains
Fetus: EFW (estimated fetal weight), lie,
presentation, single/ twin, movement, FHR
(fetal heart rate)
Lab: Hb, urine, TORCH etc
At week 36th (primigravida): bimanual
examination

Weight gain during pregnancy

Range between 7-13 kg, i.e:
Fetus
3,5 kg
Plasenta
0,5 kg
Amniotic fluid 1,0 kg
Uterus
1,0 kg
Blood
2,0 kg
Breast
1,0 kg
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Nutrition during pregnancy

1. Calori :

2. Protein :
3. Mineral :
4. Vitamin:

Non pregnant 2000 cal

Pregnant
2300 cal
Lactation
2800 cal
Non pregnant 0,9 g/kg bw/day
Pregnant
1,5 g/kg bw/day
Iron
17 mg/day
Calsium
1 gram/day
food or supplement
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Sexual activity
As needed
Abstinence when:
1. History of habitual abortion
2. Vaginal bleeding
3. Partus prematurus imminens
4. Rupture of the membrane
5. Dilatation of cervix

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Drugs during pregnancy

Basic principle: drugs are toxin, should be used
with caution (teratogenic).
Only prescribed by appropriate indication, and
consider contraindication or side effect.
Teratogenic features depend on:
1. Type and dosage
2. Developmental period
3. Plasental barrier
4. Sensitivity of the organism
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Highly Teratogenic
Talidomide
Anti

tumor drugs
Hormones (corticosteroid, androgen,
progestogen)
Valproat (anticonvulsan)
Isotretionin
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Anti tumor drugs

Alkilating

agent (chlorambucyl,
cyclophosphamyde, busulfan etc)
Anti metabolit (e.g. aminopterin,
metotreksat)
Alkaloid (vincristin, vinblastin)
Antibiotika (actinomysin D)
MTX (methotrexate): highly
teratogenic
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Hormone
Cortison

: platoschisis
Androgen and progestin: virilisation
of female fetus
Estrogen: clear cell adenocarcinoma

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Anticonvulsant
Phenytoin, trimetadion, and
carbamazepin
Anomaly: labioschisis, palatoschisis,
mental retardation, gingiva
hypertrophy, and sceletal anomaly.

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Cigarete (nicotine)
Increase the incidence of abortus
and premature labor
Increase the incidence of low birth
weight baby.
Congenital anomaly: congenital
heart disease such as tetralogi Fallot
and patent ductus arteriosus.

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Alcohol (chronic)
Microsephal, palatoschisis
Cardiovascular disorder
Intra uterine growth retardation
Mental retardation

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Antimalaria
Quinine:

cause abortus (oxitosic effect ) &

eight nerve disorder
Chloroquine may interfere histogenesis of
central nervous system (retina and 8th nerve)
eye disorder or congenital deafness
Primaquine and pentaquine relatively safe.
Pirimetamine: anti folic acid that is used as
antimalaria and antitoksoplasmosis.
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Tetracyclin
Trimester I, bone growth disorder,
micromelia and syndactili.
Trimester II, yellow teeth and enamel
hipoplasia. (but no disturbance of
the strength or resistance of caries)

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Aminoglicoside
streptomycin, kanamycin,
gentamycin and vancomycin.
Eight nerve and labyrinth (congenital
deafness) disorder

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Vaccine
Vaccination

in trimester I, increase
the abortus risk
Vaccine rubella is prohibited during
pregnancy and two month before
pregnancy

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