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Prenatal Advice

Maternal and Child Health

Interventions and Counselling

  • Iron and folic acid supplementation

    • One tablet of IFA (100 mg elemental iron and 0.5 mg folic acid) every day for at least 100 days.
    • This is the prophylactic dose of IFA.
    • If a woman is anemic (Hb <11 g/dl or she has pallor), give her two tablets of IFA per day for three months.
    • This means a woman with anemia in pregnancy needs to take at least 200 tablets of IFA.
    • This is the therapeutic dose of IFA.
    • Start IFA at the prophylactic dose as early as possible, preferably as soon as the pregnancy is registered
    • However, ensure that the woman is able to tolerate the intake of IFA, as iron has a tendency of aggravating the nausea and vomiting, which are a part of morning sickness during the first trimester

  • Tetanus toxoid immunization

Administration of two doses of Inj. TT to a pregnant woman is an important step in the prevention of neonatal tetanus
If the woman is not immunized earlier, Give Two doses of TT

  • The first dose of TT should be given just after the first trimester, or as soon as the woman registers for ANC, whichever is later.
    • Second dose one month after the first dose, but preferably at least one month before the EDD
    • Minimum interval between the two doses – 1 month
    • If the women has reported late in the pregnancy, no pregnant woman should be denied even a single dose of TT

If the woman has received Inj. TT during a previous pregnancy; One booster dose would suffice

  • This booster dose would cover even the subsequent pregnancies during the next 5 years

    • It is advised not to inject TT at every successive pregnancy because of the risk of hyper immunization and side effects
    • However, in case of doubt, give two injections

  • Advice about personal care, nutrition, family planning, parenting

  • Identification of high risk cases and referral if necessary

  • Inform the woman about

-Birth preparedness and
-Identification of a skilled provider for birth

  • Explain to her why delivery at a health facility is recommended

-Identify support people
-Signs of labour
-Complication readiness
-Danger signs

  • Location of the nearest health centre/FRU
  • Identification of transportation facilities
  • Preparedness for blood donation
    • Janani Suraksha Yojana and other government initiatives in the area
  • The advice should cover not only pregnancy and delivery concerns but also family and child care.
  • The women should be advised regarding the following:
    • Diet & rest
    • Personal hygiene
    • Drugs
    • Radiation
    • Warning signs
    • Child care
    • family planning education
    • family budgeting etc.

Diet and Rest
Child survival is correlated with birth weight

  • And the birth weight is correlated to the weight gain during pregnancy
  • A normal pregnancy results in a weight gain of appx. 9 – 11 Kg; Thus pregnancy imposed the need for extra calorie and nutrient requirements
  • If maternal stores of iron are poor (as may happen after repeated pregnancies), it is possible that the fetus has insufficient iron stores
    • Such a baby may show a normal Hb at birth, but will lack the stores of iron necessary for rapid growth and increase in blood volume and muscle mass in the first year of life
  • Stresses in the form of malaria and other childhood infections will make the deficiency more acute and many infants become severely anemic during early months of life
  • Lactation demands extra 550 Kcal per day
  • A pregnant woman needs about 300 extra kcal per day compared to her usual diet
  • The woman's food intake should be especially rich in proteins, iron, vitamin A and other essential micronutrients
    • Some of the recommended dietary items are
  • cereals, milk and milk products such as curd,
  • Green leafy vegetables and other vegetables,
  • pulses, eggs and meat, including fish and poultry (if the woman is a non-vegetarian),
  • nuts (especially groundnuts),
  • Jaggery,
  • fruits, etc.
    • Food taboos must be looked into while counselling regarding her dietary intake
  • Advised to sleep for
    • 8 hours at night and
    • rest for another 2 hours during the day.
  • Advised to refrain from doing heavy work, such as construction work and full-time farm labour work, as it can adversely affect the birth weight of the baby
  • All pregnant women should be told to avoid the supine position, especially in late pregnancy,
    • as it affects both the maternal and the foetal physiology.
    • During pregnancy, the uterus exerts pressure on the main pelvic veins
    • This results in a reduced quantity of circulating blood reaching the right side of the heart.
    • This causes reduced oxygenation to the brain and can therefore lead to a fainting attack, a condition referred to as the supine hypotension syndrome

Personal hygiene

  • Personal cleanliness, bathing and clean clothes daily
  • Rest and sleep: 8 hours of sleep + at least 2 hours of rest after mid-day meal
  • Bowels: avoid constipation by regular intake of green leafy vegetables, fruit and extra fluids. Avoid purgatives like castor oil
  • Exercise: light household work is advised
  • Manual physical labour during late pregnancy may adversely affect the fetus
  • Smoking: cut down to a minimum.
    • Expectant mothers who smoke heavily produce babies much smaller than the average
  • The reason is that nicotine has a vasoconstrictor influence in the uterus and induces a degree of placental insufficiency
    • Adverse effects of smoking range from LBW to an increased risk of perinatal death
  • Women who smoke during pregnancy give birth to babies which weigh on average 170 g less at term than the babies of non-smokers
  • The perinatal mortality amongst babies whose mothers smoked during pregnancy is between 10 – 40 percent higher than in non-smokers
  • Alcohol: can cause fertility problems in women
    • Moderate to heavy drinkers who became pregnant have greater risk of pregnancy loss
    • If they do not abort, their children may have various physical and mental problems
    • Heavy drinking has been associated with Fetal Alcohol Syndrome (FAS)
  • Dental care:
  • Sexual intercourse:
    • Safe during normal pregnancy
    • Sex should be avoided during pregnancy if there is a risk of abortion (h/o previous recurrent spontaneous abortions), or a risk of a preterm delivery (h/o previous preterm labour)

Drugs

  • Discourage the use of drugs that are not absolutely essential
  • Certain drugs may cause fetal malformations. E.g. thalidomide, a hypnotic drug which caused deformed hands and feet of the babies born, more so if taken between 4 to 8 weeks of pregnancy
    • Another example is LSD. It causes chromosomal abnormality
    • Streptomycin may cause 8th nerve damage and deafness in the fetus
    • Iodide containing preparations may cause congenital goiter in the fetus
    • Corticosteroids may impair fetal growth
    • Sex hormones may produce virilism
    • Tetracycline may affect the growth of bones and enamel formation of teeth
    • Anesthetic agents like pethidine administered during labour can have depressant effect on the baby and delay the onset of breathing
  • Later in puerperium, if the mother is breast feeding, there are certain drugs which are excreted in breast milk.

Radiation
Exposure to radiation is a danger to the developing fetus

  • The most common source of radiation abdominal X-ray during pregnancy
    • Studies have shown that mortality rate due to leukemia and other neoplasms were significantly greater among children exposed to intrauterine X-ray
    • Congenital malformations like microcephaly are also more common in such cases
    • Hence, an X-ray during pregnancy should be carried out only for definite indications and that too with the X-ray dose kept to minimum
  • Among women of child-bearing age, elective X-ray should be avoided in the two weeks preceding the menstrual period

Warning signs

  • The mother should be given clear-cut instructions that she should report immediately in case of the following warning signals:
    • Swelling of the feet
    • Fits
    • Headache
    • Blurring of vision
    • Bleeding or discharge per vagina and
    • Any other unusual symptom

Child care

  • advice regarding nutrition, childrearing, family planning education, family budgeting etc. should be given during antenatal visits

Antenatal Care
Components of Antenatal care
Prenatal Advice
Risk Approach in Antenatal Care
Ensuring Complete Registration of Antenatal Women in the Jurisdiction: Ensuring Complete Antenatal Registration
Specific Health Protection during Antenatal Visits
Lecture on Antenatal Care: Antenatal Care
5-Page ANC History Taking Format: 5-Page ANC History Taking Format: Essential Guide for Perfect Assessments
Pallor and its Grading
Why ANC History Taking Matters?

#Obstetric index (GPAL) in Antenatal Case History: Obstetric index (GPAL) in Antenatal Case History
#Decoding Gravida and Para: Terms in Antenatal History Taking: Decoding Gravida and Para: Terms in Antenatal History Taking
#Duration of Pregnancy: Understanding the Trimesters and Gestational Age Categories: Duration of Pregnancy: Understanding the Trimesters and Gestational Age Categories
#Calculation of Expected Date of Delivery (EDD) and Period of Gestation (POG): Calculation of Expected Date of Delivery (EDD) and Period of Gestation (POG)
#Antenatal Care and Case Booking: Antenatal Care and Case Booking
#Clinical Significance of Antenatal History Components (Socio-Demographic components): Clinical Significance of Antenatal History Components (Socio-Demographic components)
Antenatal History Taking: Significance of Clinical Components
Trimester-wise History Taking in Antenatal Care: FIRST Trimester
Trimester-wise History Taking in Antenatal Care: SECOND Trimester
Trimester-wise History Taking in Antenatal Care: THIRD Trimester
Trimester-wise History Taking in Antenatal Care: A Comprehensive Guide (all 3 trimesters))
Components of Birth Preparedness and Complication Readiness (BPCR)
BPCR in brief: ‘Birth Preparedness and Complication Readiness’ (BP/CR)
Specific Health Protection during Antenatal Visits