WRITE UPS - MISCELLANEOUS: (OB) - Managing Pregnancy In Family Practice


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.


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.


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.


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.


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.


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.


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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