Antepartum Care Module

E-Learning Chapter

Comprehensive Antepartum Care

This module covers the essential physical and psychological changes during pregnancy, comprehensive antepartum assessments, management of potential complications, and effective childbirth preparation methods.

1

Maternal Adaptation & Signs of Pregnancy

Pregnancy involves profound physiological and psychological changes. Recognizing the signs of pregnancy is the first step in antepartum care.

Signs of Pregnancy

Presumptive

Subjective changes experienced by the woman.

  • • Breast changes (tenderness, fullness)
  • • Amenorrhea (absence of menstruation)
  • • Morning sickness (nausea/vomiting)

Probable

Objective findings assessed by the examiner.

  • • Goodell's Sign: Softening of the cervix
  • • Chadwick's Sign: Purplish hue of vagina
  • • Hegar's Sign: Softening lower uterine segment
  • • Braxton-Hicks contractions

Positive

Absolute proof of pregnancy.

  • • Visualization by Ultrasound
  • • Detection of Fetal Heart Tones (FHT)
  • • Active fetal movement palpated by examiner

Systemic & Reproductive Changes

Reproductive System

  • Cervix: Goodell's sign (softening), Chadwick's sign (bluish-purple discoloration due to increased vascularity).
  • Uterus: Hegar's sign (softening of the isthmus).
  • Breasts: Fullness, tingling, darkening of the areola, prominent Montgomery's tubercles.

Systemic Changes

  • Renal: Frequent urination (especially 1st and 3rd trimesters), trace glycosuria, and transient proteinuria.
  • Musculoskeletal: Lordosis (exaggerated forward curvature of the spine) to compensate for shifted center of gravity.
  • Gastrointestinal: Increased risk of hemorrhoids. Intervention: Encourage high-fiber diet, adequate hydration, and warm sitz baths.

Psychological Adaptation

1st Trimester: The primary psychological task is Acceptance. The mother commonly focuses on herself and the reality of the pregnancy, summarizing the phase with the statement: "I AM PREGNANT."

2

Antepartum Assessments

Estimating Gestational Age

Naegele's Rule

Used to calculate the Estimated Date of Confinement (EDC/EDD).

Formula 1: LMP + 9 months + 7 days
or
Formula 2: LMP - 3 months + 7 days + 1 year

McDonald's Rule

Measures the length of the fundus (in cm) from the symphysis pubis to estimate gestational age between 18-32 weeks.

Ultrasound

The most accurate method for early pregnancy dating (Crown-Rump Length in 1st trimester).

Immunizations

Tetanus Toxoid (TT)

Provides protection against maternal and neonatal tetanus.

  • TT1: As early as possible (0% protection)
  • TT2: 4 weeks after TT1 (80% for 3 years)
  • TT3: 6 months after TT2 (95% for 5 years)
  • TT4: 1 year after TT3 (99% for 10 years)
  • TT5: 1 year after TT4 (99% for Lifetime)

Baseline & Grading

Baseline Data & Roll-over Test

Vital signs are recorded as a baseline. The Roll-over test checks for the risk of pre-eclampsia by monitoring blood pressure changes when turning from lateral recumbent to supine position.

Placental Grading

  • Grade 0: Immature (early pregnancy)
  • Grade 1-2: Maturing
  • Grade 3: Fully mature (extensive calcification, common at term)

Weight Gain Guidelines

Trimester Expected Weight Gain Notes
First Trimester 2 - 4 lbs (Total) Minimal gain due to nausea/fetal size.
Second Trimester 1 lb / week Rapid fetal tissue and fluid expansion.
Third Trimester 1 lb / week Fetal fat deposition and growth.
Total Target: Minimum 20-25 lbs | Optimum 25-35 lbs (for a normal BMI woman).
3

Infections & Complications

Vaginal Infections

Vaginitis

Pathogen: Trichomonas vaginalis

Signs: Frothy, yellowish-green discharge, intense itching.

Treatment Metronidazole (Flagyl)

Candidiasis

Pathogen: Candida albicans (Fungal)

Signs: Thick, white, cheese-like vaginal patches.

Treatment Nystatin / Antifungals

Systemic & Viral Infections

  • Hepatitis A & B Viral liver infections. Hep B can be transmitted vertically; neonates receive HBIG and vaccine at birth.
  • HIV Risk of vertical transmission (mother to child). Managed with antiretroviral therapy (ART) during pregnancy.
  • Syphilis Bacterial infection crossing the placenta after 16 weeks, causing congenital syphilis. Treated with Penicillin.
  • Rubella German Measles. Highly teratogenic in the 1st trimester. Classic fetal defect: Congenital Heart Disease (also cataracts, deafness).
  • Cytomegalovirus Often asymptomatic in the mother, but can cause severe fetal malformation, microcephaly, and neurological damage.
4

Childbirth Preparation

Physical Exercises

Kegel's Exercise

Strengthens the pubococcygeal muscle, preventing urinary incontinence and aiding in delivery.

Pelvic Rocking / Tilt

Specifically aimed at relieving lower back pain caused by lordosis.

Other Exercises

Tailor sitting (stretches perineum), Abdominal exercises, and Shoulder circling (relieves chest tension).

Psychophysical Preparation

Bradley Method

Often referred to as husband-coached childbirth, this method emphasizes a natural approach.

  • "Imitations of nature": Relies on natural breathing and relaxation techniques.
  • Active Husband/Partner Participation: The partner acts as the primary coach.
  • Environment: Prefers a darkly lighted, quiet room to enhance relaxation and inward focus.