PRENATAL CARE AND ROLE

OF PEDIATRIC NURSE

REMYA S. R
First Year Msc Nursing
TVM Govt:Nursing College
INTRODUCTION

Pregnancy is a period from conception to

birth, having a healthy pregnancy is one of
the best ways to promote a healthy birth.
Getting early and regular prenatal care
improves the chances of a healthy pregnancy
Prenatal visits to a health care provider
usually include a physical exam, weight
checks, and providing a urine sample
depending on the stage of the pregnancy
PRENATAL CARE
DEFINITION
Prenatal care (also known as antenatal care ) refers to the
regular medical and nursing care recommended for women
during pregnancy.

“Periodic and regular supervision including examination and

advice of a woman during pregnancy is called Prenatal care”.

Prenatal care can be defined as the care provided by skilled

health care professionals to pregnant women and pregnant
adolescent girls in order to ensure the best health conditions
for both mother and baby during pregnancy.
 AIMS AND OBJECTIVES OF PRENATAL
CARE
The aims are-

• To screen the high risk cases and give them special attention.
• To promote, protect and maintain health of the mother during
pregnancy
• To ensure continued medical surveillance and prophylaxis
• To educate the mother about the physiology of pregnancy and labor by
demonstrations, charts and diagrams so that fear is removed and
psychology is improved
• To discuss with the couple about the place, time and mode of the
delivery, provisionally and care of the newborn
• To advice the mother about breast-feeding, post-natal care and
immunization
The objective is:

• To ensure a normal pregnancy with

delivery of a healthy baby from a healthy
mother. The criteria of a normal
pregnancy are – delivery of a single baby
in good condition at term(between 38-42
weeks by dates), with a fetal weight of
2.5kg or more and with no maternal
complications.
 STEPS TOWARDS A HEALTHY PREGNANCY
Promote a healthy pregnancy before getting pregnant

Develop a plan for their reproductive life.

Adopt a healthy diet and lifestyle.

Make sure their immunizations are up to date.

Control diabetes and other medical conditions.

Avoid smoking, drinking alcohol, and using drugs.

Avoid exposure to toxic substances.

Attain a healthy weight.

Learn about their family health history and that of their partner.

Seek help for depression, anxiety, or other mental health issues.

Promote a healthy pregnancy before getting pregnant

• For women who are thinking about getting

pregnant, following a health care provider's
advice can reduce the risk of problems
during pregnancy and after birth.

• For example, taking a supplement

containing at least 400 micrograms of folic
acid before getting pregnant can reduce the
risk of complications such as 
neural tube defects (NTDs)—abnormalities
that can occur in the brain, spine, or spinal
column of a developing fetus and are
present at birth.
Develop a plan for the reproductive life.
• This includes the plan for the number and timing of
pregnancies based on your values and life goals.
Sharing the life plan with the health care provider can
help address any potential problems before getting
conceive.

Adopt a healthy diet and lifestyle.

• Follow a healthy diet: Choose a variety of fruits, vegetables,
whole grains, and low-fat dairy products to help ensure the
developing fetus gets all the nutrients it needs. Make sure to
drink plenty of water.
• Eat a safe diet: Avoid certain foods such as raw fish,
undercooked meat, and unpasteurized cheeses
.Always check the label to make sure the cheese is
pasteurized.
•  Limit caffeine intake: Some studies suggest that
too much caffeine can increase the risk of
miscarriage. It should be limited to 200 milligrams
(the amount in about one 12-ounce cup of coffee) per
day.
• Take folic acid: Begin or continue to get at least
400 micrograms of folic acid by taking vitamin
supplements every day to reduce the child's risk
of neural tube defects.
 Dietary
Sl no Non Pregnant Pregnancy Lactation Sources
components

1 Energy(kcal) 2,200kcal 2,500 kcal 2,600 kcal Protein, fat, carbohydrate

2 Protein(g) 50g 60g 65g Meat, fish, poultry, diary product

Meat, egg,
3 Iron(mg) 18mg 40mg 30mg*
grains

4 Calcium(mg) 500mg 1,000mg 1,500mg Dairy products

Meat, egg,
5 Zinc(mg) 12mg 15mg 19mg
seafood
Iodized salt,
6 Iodine(µg) 150 µg 175 µg 200 µg
seafood

Vegetables, liver,
7 Vitamin A(IU) 5,000IU 6,000IU 8,000IU
fruits

8 Vitamin D(IU) 200IU 400IU 400IU Dairy products

Grains,
9 Thiamine(mg) 1.1mg 1.5mg 1.5mg
cereals
Meat, liver,
10 Riboflavin(mg) 1.1mg 1.6mg 1.6mg
grains

Nicotinic Meat, nuts,

11 15mg 17mg 17mg
acid(mg) cereals

Ascorbic Citrus fruits,

12 60mg 70mg 70mg
acid(mg) tomato

Leafy vegetables,
13 Folic acid(µg) 200 µg 400 µg 400 µg
liver

14 Vitamin B12(µg) 2 µg 2.2 µg 2.2 µg Animal proteins

Get regular dental checkups.
• Gums are more likely to become inflamed or
infected because of hormonal changes and
increased blood flow during pregnancy.
Regularly scheduled checkups is important.
 
Get up to date on vaccines.
• Enquire health care provider if there is a
need for booster vaccines.
Control diabetes or other medical conditions .
Many health problems affect not only the pregnant woman
but also the developing infant. Here are some specific dietary
suggestions for women who are planning for a pregnancy:

• Increase your intake of fiber. Eating 10 more grams of fiber in the form of
cereals, fruits, and vegetables is associated with 26% lower risk of
gestational diabetes.
• Reduce consumption of sugar-sweetened cola. greater risk of gestational
diabetes.
• Eat less red meat, processed meats, and animal fats and cholesterol.
Eating less of these foods before pregnancy can decrease the chances of
developing diabetes when you are pregnant.
• Replace animal protein with protein from nuts to lower your risk of
gestational diabetes. Increase the intake of folic acid
Avoid smoking, drinking alcohol, and taking drugs.

During pregnancy, these behaviors can increase the risk for 

sudden infant death syndrome (SIDS) , preterm birth, fetal alcohol spectrum
disorders, and NTDs.

Avoid exposure to toxic substances.

• During pregnancy, exposure to radiation, pesticides, some metals, and

certain chemicals can cause birth defects, premature birth, and
miscarriage.  A few examples of exposures that are known to be toxic
to the developing fetus are:
• Lead: Lead is a metal that may be present in house paint, dust, and
garden soil..
• Radiation: Radiation is in the form of X-rays, radio waves, heat, or
light, or it can come from "radioactive" materials
• Solvents: Solvents are chemicals that dissolve other substances.
Solvents include alcohols, and paint thinners
Strive to reach a healthy weight before trying to get
pregnant.
Obesity may make it more difficult to become
pregnant. Being overweight or obese also puts at risk for
complications during pregnancy
Maintain a healthy weight.
• Women who are underweight (BMI less than 18.5) should gain
between 28 and 40 pounds.
• Women at a normal weight (BMI between 18.5 and 24.9)
should gain between 25 and 35 pounds.
• Overweight women (BMI 25 to 29.9) should gain between 15
and 25 pounds.
• Obese women (BMI more than 30) should gain between 11 and
20 pounds.
• Excessive weight gain during pregnancy increases the risk for
gestational high blood pressure, cesarean section, and large-
for-gestational-age infants.
Physical activity.
• Most women can continue regular levels of physical activity
throughout pregnancy. Regular physical activity can help
you feel better, sleep better, and prepare your body for
birth.  

• Learn family’s health history.

Health care provider will ask for information about your
family’s genetic and health history. Mother may be referred for genetic
counseling if certain conditions run in your family or if a family
member was born with a physical abnormality .  
• Get mentally healthy.
It’s natural to worry or feel sad, anxious, or stressed at
times. However, if these feelings do not go away and they interfere
with daily life, it’s important to seek help before get pregnant.
 Hormonal changes and other situations during pregnancy can worsen
depression.
TESTS DURING PREGNANCY
Pre-pregnancy test includes the following:
• Rubella
• Sexually transmitted infections (STIs)
• Genetic disorders
The types of tests you may have during pregnancy include:
• Routine Tests
• Glucose challenge screening: Usually given between 24 and
28 weeks of pregnancy
• Group B streptococcus infection screening: This test is
performed between 35 and 37 weeks of pregnancy to look
for bacteria (GBS) that can cause pneumonia or other
serious infections in your infant.
• Ultrasound exam: 
▫ Ultrasound exam between 18 and 20 weeks of pregnancy to check for
any problems with the developing fetus.
▫ Obstetric ultrasounds are most commonly performed during the
second trimester at approximately week 20. Among other things,
ultrasounds are used to:
▫ Check for multiple fetuses
▫ Assess possible risks to the mother
▫ Check for fetal malformations
▫ Determine if an intrauterine growth retardation condition exists
▫ Note the development of fetal body
▫ Check the amniotic fluid and umbilical cord for possible problems.
▫ Determine due date
• Generally an ultrasound is ordered whenever an abnormality is
suspected or along a schedule similar to the following:
▫ 7 weeks – confirm pregnancy, ensure that it’s neither molar or
ectopic, determine due date.
▫ 13-14 weeks – evaluate the possibility of down syndrome.
▫ 18-20 weeks
▫ 34 weeks- evaluate size, verify placental position
 Nuchal transduce screening:. 
(NTDs) and Other Conditions
Screening for Chromosomal
and Neural Tube Defects
First trimester screen. 

Chorionic villus sampling (CVS):

Amniocentesis :

Cell-free fetal DNA:  

Carrier screening for cystic fibrosis (CF): 

Glucose tolerance test: 

Non-stress test. Biophysical profile (BPP). 

HEALTH PROBLEMS DURING PREGNANCY
Regular prenatal visits help the health care provider identify
potential health problems early and take steps to manage them, to
protect the health of the mother and the developing fetus.

Iron Anemia occurs when your red blood cell count (hemoglobin or
Deficiency hematocrit) is low. Health care provider may recommend iron
Anemia and folic acid supplements.

Gestational Gestational diabetes occurs when blood sugar levels are found

Diabetes to be too high during pregnancy. Treatment includes
controlling blood sugar levels through a healthy diet and
exercise, and through medication if blood sugar values remain
high.

Depression Many people are familiar with the phrase "postpartum

and Anxiety depression," meaning depression that occurs after the birth of
a baby
 Possible problems in the fetus include decreased movement after 28
Fetal weeks of pregnancy and being measured as smaller than normal.
These pregnancies often require closer follow-up including more
Problems testing such as ultrasound exams, non-stress testing and biophysical
profiles as well as possible early delivery.

High Blood Pregnant women who develop high blood pressure will need to be
Pressure monitored closed for  preeclampsia.
Related to
Pregnancy
Infections, including some sexually transmitted infections (STIs),
may occur during pregnancy and/or delivery and may lead to
Infections complications for the pregnant woman, the pregnancy, and the baby
after delivery.

Some women experience severe, persistent nausea and vomiting

Hyperemesis during pregnancy beyond the typical "morning sickness." Medication
may be prescribed to help with the nausea.
Gravid arum

Pregnancy loss from natural causes before the 20th week is

considered a miscarriage. The most common cause of first trimester
Miscarriage miscarriage is chromosomal problems. Symptoms can include
cramping or bleeding. Spotting early in pregnancy is common and
does not mean that a miscarriage will occur.
 This condition occurs when the
Placenta
Previa
placenta covers part of the opening
of the cervix inside the uterus..

In some women, the placenta

Placental
Abruption separates from the inner uterine
wall.

Preeclampsia is a quick or sudden

Preeclam
psia
onset of high blood pressure after
the 20th week of pregnancy.

Infants do best if they are born

Preterm
Labor
after 39 or 40 weeks of pregnancy
(full term).
 HIGH RISK GROUPS
Some women are at increased risk for health problems during
pregnancy. Important risk factors include the following:

Overweight and obesity.

Young or old maternal age. 

Problems in previous pregnancies. 

Existing health conditions. 

Pregnancy with twins or other multiples. Post-Traumatic Stress

Disorder (PTSD) and Pregnancy
Prenatal care includes
• Monthly visit to doctor during the first two
trimesters (from week 1-28)
• Fortnightly visit to doctors from 28th week to
36th week of pregnancy.
• Weekly visit to the doctor after 36 week
(delivery at week 38-40).
As per government of India norms:
• 1st visit within 12 weeks or preferably as soon
as pregnancy is suspected.
• 2nd visit between 14 and 26 weeks
• 3rd visit between 36 weeks and term.
• 4th visit between 36 weeks and term.
ANTENATAL VISITS
• Ideally 13 visits, 7 in first 7 months , 2 in 8th
month , 4 in 9th month
• Minimum 4 visits
• I : As soon as the pregnancy is suspected (For
registration & first check-up) 
• II : 26 weeks
• III : 32 weeks
• IV : 36 weeks (At least one visit at home by
health worker)
IMPORTANCE OF PRENATAL CARE

• To confirm pregnancy & assess the period of

gestation.
• To prevent maternal & neo natal tetanus.
• To facilitate health education regarding diet,
rest, avoidance of unnecessary travel &
preparation for delivery.

COMPONENTS OF PRENATAL CARE

• Identification of pregnant women’s &

importance of early registration.
• Diagnosis of pregnancy.
• Clinical assessment.
ADVICE DURING ANTENATAL VISIT.
 Nutrition.
 Management of minor ailments.
 Risk assessment & appropriate management.
 Complications & management.
 Complications of late pregnancy.
 Management of medical disorders during
pregnancy.
 Screening for congenital malformations
during pregnancy.
 Management of Anemia during pregnancy.
IDENTIFICATION / REGISTRATION
▫ Early identification helps,
▫ Assessing the health status of the mother.
▫ Obtain baseline information of the mother.
▫ Screen for factors, referral to FRU.
▫ Recall LMP easily.
▫ Do MTP if required (< 10 wks.)
▫ Counsel on hygiene diet , rest.
▫ Build up rapport with pregnant women 12 wks
WITHIN 20 WKS
▫ Screen & treat anemia.
▫ Initiate prophylaxis against anemia.
▫ Screen risk factors & medical conditions.
▫ Develop individualized birth plan.
▫ Immunize with tetanus toxoid.
▫ Investigate – Hb, blood group, urine examination, VDRL,
Blood grouping.
 28-32 Weeks
Aimed at the following. To detect
• PIH.
• Multiple gestation.
• Anemia.
• Develop individualized birth plan.
• Give TT.
• Assess IUGR.
• Repeat HB estimation.
 

36 Weeks.
• PIH.
• Detect the following.
• Identify foetal & presentation.
• Rule out CPD in primi gravida.
ROLE OF NURSE IN PRENATAL CARE

REGISTRATION- The nurse has to do registration of

the antenatal mother so that to assess the following
condition-
• To assess the health status
• To identify and manage high risk cases
• To estimate EDD more accurately
• To give the first dose of TT (after 12 weeks)
• To help the woman for an early and safe abortion
(MTP) if it is required
• To start the regular dose of folic acid during the
first trimester
 
2. PRENATAL SERVICES FOR MOTHERS

• Health history
• Physical examination
• Laboratory Examination
• Urine/ Stool/ Blood(Count)/ Hb/ Serological/ Blood
group(Rh also)
• Pap test(if facilities are available)/ Chest X-Ray and
Gonorrhea test(if needed)
• TT Immunization
• Health education
• Home visit
• Referral(if needed)

MAINTENANCE OF RECORDS

• Antenatal Card
• Antenatal register
ANTENATAL CHECKUP HISTORY

• (I) To diagnose pregnancy

• (ii) To identify any complications during previous
pregnancies
• (Iii) To identify any medical/ obstetric
condition(s) that may complicate this pregnancy

Age of the woman

• Complications when <16 years/>40 year order of

the pregnancy

SYMPTOMS DURING THE PRESENT

PREGNANCY
• Symptoms indicating discomfort (nausea and
vomiting, heartburn, constipation, frequency of
urination)
Previous pregnancies/Obstetric history

• Number of earlier pregnancies / abortions / deliveries

• Number of premature birth(s) / stillbirth(s) / neonatal
deaths
• Hypertensive disorders of pregnancy (history of
convulsions)

History of any systemic illness

• Hypertension , Diabetes ,Heart Disease

,Tuberculosis ,Renal Disease ,Convulsions ,Asthma
,Rashes, Jaundice
• Family history of systemic illness: Above illnesses ,
Thalassemia , Delivery of twins or delivery of an infant
with congenital malformation
• History of drug intake or allergies
• History of intake of habit-forming substances
(tobacco, alcohol)
 Investigation The nurse should undergo
following investigation-
• CBC
• Blood grouping & Rh typing
• Urine R/E
• RBS
• VDRL
• HBS Ag
• Ultrasound

9. Ultrasound

• At 11-14 weeks: offer nuchal translucency screening

for Down's syndrome, with other tests if available.
• At 18-20 weeks: offer screening with ultrasound for
congenital anomalies.
• At 36 weeks: for fetal maturity, placenta praevia.
10. Antenatal Advice
• DIET Diet should be:
• Nutritious , balanced , light , easily digestible , rich in
protein, mineral and vitamin with women’s choice
• Iron & folic acid supplementation.

11.REST & SLEEP :

• Night 8 hours ,Day 2 hours (lie on left side )

Contraindications of exercise and to limit

physical activity in :
• Fetal growth restriction
• Cardiac or pulmonary disease.
• Vaginal bleeding(APH)
• Cervical insufficiency
• Hypertension in pregnancy
• Risk for preterm labour.
12. BOWEL
• Regular bowel movement may be facilitated by regulation of diet, taking plenty fluid, vegetable
and milk
13. ABSISTENCE :
• Should be avoided in 1st trimester and last 6 weeks
• Generally coitus is not restricted during pregnancy.
14 . TRAVELLING
• Should be avoided in 1st trimester and last 6 weeks .

15. IMMUNIZATION
• Indicated : TT , HAV , HBV , Rabies
• Contraindicated : Live virus vaccine (rubella measles, mumps, Varicella)
16. PERSONAL HYGIENE
• The nurse should advice the mother regarding the personal hygiene and its importance.

17. RADIATION
• The nurse should advice the mother to avoid the X-rays.

18. DRUGS
• Sedative , Anticoagulant, Antithyrodism, Hormones& Antibiotics should be avoided

19. OCCUPATIONAL HAZARDS

• Lead, mercury, X ray s& ethylene oxide.
 • High fever with/without abdominal pain, feels too weak to get
out of bed
• Fast/difficult breathing

• Decreased or absent fetal movements

• Excessive vomiting (woman is unable to take food/fluids)

• Any bleeding P/V during pregnancy

20. • Heavy (>500 ml) vaginal bleeding during and following delivery

DANGER/ • Severe headache with blurred vision

WARNIN
• Convulsions or loss of consciousness
G SIGNS
• Labor lasting longer than 12 hours

• Failure of the placenta to come out within 30 minutes of delivery

• Preterm labour

• Premature or prelabour rupture of membranes (PROM)

• Continuous severe abdominal pain

 21. Health education
Breast feeding
Nutrition •
Family planning •
Postnatal exercises •
Child care • Dental care
Clothing, shoes and belt •
The nurse
advise the Care of breast •
mother Smoking and alcohol
regarding-
Birth plan
Mental preparation
Diet •
Sleep and rest •
To avoid stressor •
Minor ailments.
PROGRAMMES IN THE ANTENATAL PERIOD

Maternity Benefit Programme (MBP)

• The scheme will be implemented using the platform of
Integrated Child Development Services (ICDS) under
Women and Child Development/Social Justice
Department.
Cash Transfer Conditions Amount in Rupees
 Early Registration of
First Installment 1,000/-
Pregnancy
 Received atleast one
Second Installment Antenatal checkup (after 6 2,000/-
months of pregnancy)

 Child birth is registered

 Child has received first cycle

Third Installment of BCG, OPV, DPT and 2,000/-
Hepatitis-B or its
equivalent/substitute
 Pradhan Mantri Matru Vandana Yojana’
(PMMVY).
• From 01.01.2017, the Maternity Benefit
Programme would be implemented in all the
districts of the country in accordance with the
provision of the National Food Security Act, 2013.
The programme is named as ‘Pradhan Mantri
Matru Vandana Yojana’ (PMMVY).
• Under PMMVY, a cash incentive of ` 5000/- would
be provided directly in the account of Pregnant
Women and Lactating Mothers (PW&LM) for first
living child of the family subject to their fulfilling
specific conditions relating to Maternal and Child
Health.
Thanks
all