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INTRODUCTION: -
In out set up antenatal care has slipped slowly but surely from
the hands of family physicians [F. Ph.] to consultant
obstetricians. It is not relevant here to analyze the reasons
but it is not a desirable change. Many a times it is the fear of
unknown that prevents the family physician from giving this
care. This has stemmed from the breakage of continuous
interaction between him and the obstetrician. It is in fact, now
envisaged to establish three/ four satellite F. Ph. centres per
consultant for giving antenatal care.
SATELLITE
CENTERS: -
These are actually clinics of F. Ph. This is where the actual
ANC is given in routine non high-risk case. But they are not
envisaged to be run autonomously. Infact 3 to 4 satellite
centers have one obstetric unit backing them up. Not only does
the obstetrician provide maternity services during labour to
these cases but also has the responsibility to keep the
knowledge of his group upto date.
PRECONCEPTION CARE: -
Never in the history of obstetrics was this concept of taking
care of a prospective mother as pertinent and relevant as is
today. Many preventable conditions like anemia, neural tube
defects, malaria, hepatitis and the like can be treated well
before she conceives. Neural tube defects have significantly
reduced if folic acid is supplemented from 3 months before
pregnancy.
However there are some unpreventable conditions like P.I.H. or
antiphospholipid antibody syndrome which can be effectively
attenuated if treatment is given even before the conception
occurs.
SOME
DYING CONCEPTS: -
The concepts of threatened abortion and missed abortion have
undergone a through over-haul. With every bleeding in early
pregnancy being explainable, the “threat”
of threatened abortion vanished. The concept of procrastination
in missed abortion is dead. It warrants an immediate
intervention as soon as diagnosed. With one condition
effectively affecting one month to the other, the concept of
trimesters has also now taken a dying track.
GENERAL PROCEDURES: -
Once diagnosed, pregnancy has to be cared for immediately. It is
important to know that emesis gravidarum in absence of
dehydration and / or ketosis is a good sign. It signifies that
the conceptus inside is alive and healthy.
As early endosonography will help the F. Ph. to get the exact
wks. of gestation, the due date, multiple pregnancy and rule out
complications like vesicular mole.
History should be aimed to identify the gravidity and parity of
the mother. It should also be aimed to identify high-risk
pregnancy by asking specific histories like that of
hypertension, menorrhagia, lack of spacing, diabetes, recurrent
pregnancy, loss etc. If no high risk factor is forthcoming it is
now desirable to continue ANC, as per routine.
At this stage height, weight, B.P. and routine general
examination is done. Obstetric examination varies as per the
weeks of pregnancy.
Symphysis-fundal height is no doubt a valuable tool in the hands
of a F.Ph. It will help him to judge the growth, of the fetus.
At term it is around 31 to 33 cms. It increases about 1 cm/ week
and is about 4 to 5 cms. less than the weeks of gestation at
that stage of examination. However all this holds well after 15
weeks.
Identification of fetal heart tone is NOT at all difficult. It
only requires practice. But once located they are very
reassuring.
With these procedures of examination, high-risk pregnancies are
identified [Table 1]. Those which are unmanageable are to be
taken care of by the consultant rest others continue at the
F.Ph.s clinic.
It is at this stage that dietary advise is given and nutritional
supplemental in the from of iron and calcium dispensed [Table
2]. Nutritionally compromised individuals are also identified
[Table 3]. A thorough advice regarding the danger signs in
pregnancy is given [Table 5]. It should be ensured that the
mother understands them well.
SUBSEQUENT VISITS: -
The schedule of subsequent visits is monthly upto 28 weeks,
fortnightly upto 36weeks and weekly till she delivers. On each
of these, weight is checked and increase noted. Hemoglobin is
checked periodically. Specific symptoms relevant to the danger
signs are asked for. Obstetric examination including F.H. and
FHS examined. Immunization is done as per the current
recommendations.
Weight gain pattern is depicted in the Table 4. However a mother
with an average weight child, will gain 9 to 12 kgms. by the
time she reaches term.
GENERAL
HYGIENE: -
The mother can do light exercise till she doesn’t get exhausted.
Walking is advisable. She can continue to work till she can but
should not get exhausted. Travel is permitted but not more than
2 to 3 hours at a stretch after which she must be able to lye
down. Loose non-restrictive dressing is advisable. Smoking and
alcoholism be avoided at all costs. Sexual intercourse can be
safely continued in absence of known contraindications.
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