Antenatal Health Talk

Get the best care from our health professionals during your pregnancy

Antenatal Health Talk

We provide advice, education, reassure and support. We also address and treat the minor problems of pregnancy, and to provide effective screening during the pregnancy. See some tips below to help you during pregnancy:

Diabetes in pregnancy also known as diabetes during pregnancy is a condition where your blood sugar level becomes higher than normal. It is referred to as gestational diabetes if it was first noticed during pregnancy.
Diabetes in pregnancy usually occurs when your body can not control the amount of sugar produced due to inadequate insulin in the body.

• Being over weight before getting pregnant.
• Having a family member who is diabetic.
• If a person has had gestational diabetes before.
• If a person is an African – American, native America, Asian or Hispanic.
• Person has given birth to a big baby before > 3kg
• Person is above 25 years.

• You become more thirsty than normal.
• You become hungrier and eat more frequent than normal.
• You urinate more frequent than normal

• Macrosomia- which is a condition in which your baby grow so large above 4kg.
• Hypoglyceamia- which is also known as blood sugar lower than normal. this can occur to your baby shortly after birth.
• Jaundice which is yellowish discolouration of the eye or skin of the baby can also occur.

Lifestyle modifications- this are measure taken by mothers to prevent and control diabetes in pregnancy and they include
• Exercising in which walking is preferable
• Weight reduction
• Reduction in carbohydrate foods and increase intake of vegetables
• Avoid late night intake of food
• Monitoring of blood glucose level at home
• Stoppage of alcohol intake

However if lifestyle modifications fails to control blood sugar level then treatment in the hospital is recommended which involve the use of insulin injections and Metformin Tablets.

Episiotomy is a surgical procedure done to widen the vagina opening during childbirth. It is a small straight incision done on the perineum which is the skin and muscle in between your anus and vagina. Alternately, the incision may be done at an angle.

• Your baby head and shoulder are too large to fit through your vagina opening
• You or your baby is in distress and delivery needs to be sped up
• You are unable to stop or slow your pushing
• Instrument needs to be use for your delivery

• Infections
• Bleeding and perineal hematoma( which is a large collections of blood in the tissue)
• Painfull intercourse
• Perineal pain

• After your procedure, wait for about six weeks before engaging in any activity that might rupture your stitches including using tampons, having sex and douching
• to reduce pain,
* Use pain relievers such as ibuprofen, medicated creams and local anaesthetic sprays
* Take warm cean birth at least 24hrs after giving birth
* Apply ice packs immediately after birth
• To avoid painful bowel movement, take stool softeners, drink lots of water and eat a lot of fiber
• Always wipe front to back
• Use antibacterial sanitizers on your hand before cleaning the perineal area
• Change your pad every 2 to 4hrs
• Frequent sitz baths or shallow baths that cover your vulva may help speed healing and be sure you dry off carefully when you are done. this should be done at least 24hrs after birth
• Make sure you keep the area clean and dry and avoid using toilet paper( use baby wipes as options)
• You will have your stitches check at your six weeks visit after birth and at this point your doctor or mid wife will tell you when to resume activities and can provide guidance on how to deal with incontinence.

Whenever there is any bleeding in pregnancy, you have to know where the source is.
In early pregnancy,
• spotting is usually a normal sign of pregnancy development
• If you have spotting and pain, it might mean you have an ectopic pregnancy
• . spoting or bleeding with abdominal pain could also mean you are having a miscarriage
In late pregnancy,
• Bleeding could mean that your placenta is not in the proper position
• Bleeding could also mean that your placenta has separated from your womb

Contractions during late pregnancy mean labour has started and if it occurs before your delivery date it could mean preterm contractions

Between 17 and 18 weeks of pregnancy, you will start to feel your baby move. Sometimes you might notice that the baby is quiet during the day and more active at night. IF you notice such symptom, inform your doctor.

Swelling of the feet, face and hands during the pregnancy is normal however if . If you have a high blood pressure or headache, it could lead to convulsions

It is normal to have an increase in clear discharge during pregnancy but if there is blood stain or you have pressure or pain, tell your doctor.
During the late pregnancy, vaginal discharge could mean that your cervix is opening up early which could cause a miscarriage. Or premature delivery

Any kind of fever with pain has to be taken seriously especially during pregnancy.

Headaches are a very common complaint during pregnancy\Causes include: Lack of sleep, Stress, Hypertension and malaria etc

85% of the populations have an additional blood group factor called Rhesus D. They are RH positive. The remaining 15% of the population lack the factor and are therefore RH negative. If a Rhesus negative mother becomes pregnant to a Rhesus positive man, their baby may be Rhesus positive or negative. If the baby is also Rhesus negative, there will be no Rhesus problem but if the baby is Rhesus positive, there is a risk that some of its rhesus blood cells may enter the mother’s blood stream during the pregnancy or birth. If left untreated, the mother will develop antibodies to the baby’s rhesus positive blood which will cross the placenta and may destroy the baby’s red blood cells or in future pregnancies.

An injection of Anti D can be given to a RH negative mother which helps stop her immune system making antibodies to the baby’s rhesus positive cells. You will be given the Anti D injection within 72 hours of your birth if your baby is rhesus positive.

Hemoglobin is the substance that carries oxygen to every cell in the body. Our bodies use iron to produce hemoglobin. When you are pregnant, you need much more iron than usual to produce enough hemoglobin for your baby. If a blood test shows that your hemoglobin is low, this is called anemia. It is usually treated by eating more iron rich foods and taking antenatal drugs regularly etc.

Syphilis is a sexually transmitted disease that is quite uncommon today but it is still vital to detect and treat women who have this infection. Early treatment can prevent the unborn baby from being infected. A VDRL test is done during pregnancy to diagnose syphilis

Hepatitis B is a virus that is usually spread through blood to blood contact with an infected person, through sexual contact or from mother to child at birth. If your blood test shows that you have hepatitis B or you already know that you have it, your baby can be given a special injection called immunoglobulin as well as the hepatitis B vaccine to increase the protection. To protect against hepatitis B, all babies born are given hepatitis B immunization

AIDS is caused by the human immunodeficiency virus (HIV). It can cause serious illness to the affected people. Most infections have resulted from unprotected sex, sharing injecting equipment, receiving unscreened blood transfusion, mother to baby transmission during pregnancy, child birth or breastfeeding. HIV testing is very important during pregnancy so that proper treatment can be effected

Urine test is done to check for bladder or urinary tract infection. Sometimes, you can have this type of infection without having any symptoms. If you have an infection, it should be treated to avoid complications like kidney disease and miscarriage

Blood sugar test is very important during pregnancy which is use to diagnose diabetes . If diabetes is not discovered and treated, it may cause problems to the mother and baby. Treatment is usually by a special diet and insulin injection.

A Pregnancy ultrasound is a test used to image the developing baby as well as the mothers reproductive organs.
• It is also used to confirm pregnancy.
• To check fetal heart beat.
• To determine the sex of the baby.
• To check for miscarriages.
• To check for congenital abnormalities or birth defects.
• To confirm intra uterine fetal deaths.
• To monitor fetal growth and position.
• To determine the gestational age of the baby and estimate a due date.
• To diagnose an ectopic pregnancy (pregnancy outside the uterus).

Drinking alcohol and smoking during pregnancy affect the developing baby. As the general principle, use of alcohol and smoking during pregnancy imposes health hazards to both mother and fetus.

• Reduction in babies’ growth.
• Pre mature birth ,
• low birth weight
• Abnormality of the mouth and lips.
• sudden infant death
• miscarriage and still birth,

Second hand smoke [also called passive smoke or environmental tobacco smoke] is the combination of smoke from a burning cigarette and smoke exhaled by a smoker. Babies and children exposed to second hand smoke may also develop:

• Asthma,
• allergies, more frequent
• lung and ear infections
• Sudden infant death.

• miscarriage ,
• still birth and a range of life long physical,
• mental problems
• babies with small head,
• babies with flat face
• babies with ,narrow eye opening,
• feeding as a new born, developmental disability,
• Delay in developmental ,
• hearing defect,
• speech defect
• Visual defect.

Some important ways to stop Alcohol intake before or during pregnancy include:
• refusal to accept drinking,
• hanging out with those who don’t drink Alcohol,
• avoiding bars and clubs,
• taking other non Alcoholic drinks instead of Alcohol.

Sex during pregnancy is safe unless the doctor or midwife advice to avoid it. Having sex during pregnancy will not hurt the baby.  If pregnancy is normal and there is no complication, having sex and orgasm will not increase the risk of going into labour early or cause miscarriage. Later in pregnancy, an orgasm or even sex itself set off mild contractions .This is overcome by relaxation and lying down.

Sex should be avoided in pregnancy under the following condition:

• bleeding during pregnancy,
• draining of liquor (colorless fluid from the vagina)
• problem of Cervix ,
• when you are having twin pregnancy
• When you have had previous early labour.

Good sexual intercourse position during pregnancy is lying on the side either facing ones partner or with the partner behind.
Bad sex position is lying on top of your partner especially early in pregnancy.

In summary, planned and controlled sexual intercourse in pregnancy is safe; but ingestion of Alcohol and smoking in pregnancy poses a high risk and fatality to both mother and baby.

Normal labor is uterine (womb) contractions that results in progressive dilatation and shortening (effacement) of the cervix. That means from the time you start to have frequent contractions to the time your cervix is full and ready to give way to your baby to pass. Abnormal labour refers to a situation where there is slow or no progress in labour or simply put as difficult labor. Abnormal In simple terms abnormal labour can cause serious harm to both the mother and the baby. Abnormal labour is also refers to as prolonged labour and has an underlying cause in most cases. It should be noted that NO WOMAN SHOULD BE ALLOW TO SEE SUN RISE OR SET TWICE IN LABOUR

(1) STAGE 1: Begins when contractions start to open the cervix and ends when the cervix is fully dilated. For first timer-this stage last for 10-20hrs and for others this stage last for 7-10hrs
(2) STAGE 2: This starts when the cervix is fully dilated and ends when the baby is born. This is usually less than 2hrs in first timer and less than 1hr in others
(3) STAGE 3: Begins when the baby is born and ends when the placenta is out completely. This stage is usually less than 30mins

Generally, when labour last longer than the above ranges it is said to be prolonged/abnormal


Stages of labour Nullipara (first timer) Multipara (not first delivery)
1st stage duration <14hrs <10hrs
2nd stage Approx 1 hour About 30 mins
3rd stage <30mins <30mins

(1) CEPHALOPELVIC DISPROPORTION (CPD): The head of the baby is too large to fit through pelvis (birth canal). Pelvimetry (assessment of the birth canal) may be requested before your expected date of delivery by your Doctor.

(2) MACROSOMIA (BIG BABY): This is when the baby is >= 4.0kg and can cause problem in birth canal and even for the baby after birth.

(3) MALPRESENTATION: When the baby is not presenting with head it can slow the process of labour or cause problem for both baby and mother.

(4) UTERINE HYPERCONTRACTILITY: This is when the uterus (womb) contract too frequently i.e for more than 5 times with 10 mins.

(5) OTHERS include: Shoulder dystocia ( difficulty in delivering of the shoulders), Precipitate labour (labour is too rapid lasting 3-5 hours), Uterine rupture (tears in the wall of the womb), Umbilical cord prolapsed(the umbilicus present into the vaginal ahead of the baby), Retained placenta e.t.c

Process of child birth is a very complex process and complications can occur at any point in time. Ensure that your labour is monitored by qualified/trained health personnel in a well equipped facility where prompt intervention can be given when necessary.

In other for a child to be healthy and survive infancy, breastfeeding is important. It is cheap to practice and is of the highest quality for the babies
The fact that it clean, safe and contains substance which protects the child from common childhood illnesses makes breast milk the best for infants

Exclusive breastfeeding means that the neonate/infant receives only breast milk for 6months, no addition of water, solids or sweetener during this period. Only necessary drugs and ors can be administer during this period.

• Reduce frequent hospitalization of neonate/infants
• Reduce incidence of neonate with low intelligence score
• To have healthy babies with reduced risk of obesity and diabetes

• Reduced cost of feeding the babies
• Bring about children with high IQ
• Reduces risk of breast and ovarian cancer in mothers
• Breastfeeding

W.H.O has come up with a way to enable hospital help new mothers to initiate and practice exclusive breastfeeding
1. All staffs are informed regularly about the hospital breastfeeding policy
2. Teach pregnant mothers during antenatal on the benefits of exclusive breastfeeding which is re-inforce in clinic until baby is 6months
3. Allow skin to skin contact between mother and baby to support the initiation of breastfeeding
4. Show mothers how to breastfeed and how to maintain lactation even when separated from infants
5. Ensure infants gets no fluid or drink except prescribed by doctor
6. Practice rooming–in
7. Support and encourage mothers to breastfeed on demand while on admission and even after discharge
8. Avoid teats band dummies while breastfeeding is being initiated
9. Counsel women with immunosuppressive disease (HIV, HEP. B, HEP. C) how to achieve breastfeeding
Every mother wants their child to be healthy, intelligent and achieve developmental milestone as at when due, exclusive breastfeeding increases the chances of achieving that.

It is the measure taken in order to improve the body’s ability to generate an immune response naturally, or through vaccines. These methods build immunity or resistance towards some diseases. Many of these diseases are deadly. Fortunately, they are preventable.

The following are schedules for immunization for different ages/sex. Childhood immunization schedule;

Age of Child Recommended Vaccines
At birth Hepatitis B/Oral Polio Vaccine(OPV)-0/BCG
6 weeks Pentavalent Vaccine-0/Oral Polio Vaccine(OPV)1/Pneumococcal Vaccine(PCV)-1/ Rotavirus
10 weeks Pentavalent Vaccine-1/Oral Polio Vaccine-

2/Pneumococcal Conjugate Vaccine-

1/Rotavirus/Meningococcal Conjugate

14 weeks Pentavalent Vaccine -2/Oral Polio Vaccine-

3/Pneumococcal Vaccine -2/Inactived Polio Vaccine(IPV)

18 weeks Pneumococcal Conjugate
6 months Vitamin A
9 months Measles/Yellow fever
12 months Measles/ Mumps Rubella/Chicken Pox/Vitamin A/Meningococcal Conjugate
13 months MMR
18 months Chicken Pox/ Hepatitis A & B
19 months Vitamin A/ Hepatitis A& B
24 months Typhoid / Hepatitis A & B
9 years Human Papilloma Vaccine

Family planning is the practice of controlling the number of children one has, and the interval between their births. This is achieved through the use of contraceptive methods.

1. To prevent unwanted pregnancy and pregnancy related to health risks in women such as under aged pregnancy and septic abortions.
2. Reduce infant mortality.
3. Prevents spread of sexually transmitted infections and HIV/AIDS i.e use of condom (male and female) prevents unwanted pregnancy and STI including HIV.
4. Slowing population growth.
5. The use of contraceptive/family planning helps slow down unsustainable population growth and the resulting negative impact on the economy.

1. Barrier Method:
Example of such methods includes the use of condom (male and females). The use of Diaphragms and cervical caps.Some contain spermicidal chemicals which kill sperm cells e.g vaginal sponge.
2. Hormonal methods:
These containhormones either progesterone only or combination of estrogen and progesterone.
The hormones can prevent the ovaries from releasing the eggs during ovulation or by thickening the cervical mucus thereby inhibiting sperm movement to the uterus.Examples of hormonal methods include:
– Birth control pills.
– Implant: these are small rods implanted subdermally (under the skin) and then continue to release small doses of hormones which prevent pregnancy for 3-5 years.
– Progesterone injection e.g Depoprovera: They are given intramuscularly into the buttocks and provide contraception for about 3 months.
– Skin patches.
– Intrauterine devices.
– Hormonal IUD (releases hormones)
– Copper containing IUD (copper is spermicidal)
3. Permanent method:
– Bilateral Tubal Ligation(BTL): In this situation the fallopian tubes are ligated and severed.
– Male vasectomy: the vas deferens is ligated and cut.

• This is the first six weeks following the delivery of the baby.
• During this period, there are significant changes in the levels of different pregnancy hormones in the body.
• The body organs return to their pre-pregnancy sizes.
• The mother adjusts to her new responsibility of caring for her newborn baby.
• Both mother and baby require support from family and healthcare providers to ensure smooth journey through this joyous but challenging process.
• In this lecture, we will be discussing some of the challenges that may emanate during the course of the puerperium.
• We shall look at how the challenges can be recognized at home by the mother and the roles of the mother and the hospital.

• Bleeding after delivery
• Abdominal pain
• Lochia abnormalities
• Breastfeeding issues
• Puerperal pyrexia
• Constipation
• Mood abnormalities
• Care of the newborn baby

• It is normal to expect some slight bleeding after the placenta has been delivered.
• However, bleeding becomes worrisome when it is heavy as to warrant changing 2 pieces of sanitary pad in the first 2 hours or when it leads to dizziness, fainting spells or headache.
• Some of the causes of bleeding in the early period following delivery include: inadequate contraction of the uterus or any tears in the delivery tract (vagina, cervix or uterus).
o Inadequately Contracted Uterus
• Contraction of the uterus is important in stopping bleeding after delivery and in aiding the return of the uterus to it pre-pregnant size.
• The service provider will massage the patient’s uterus to stimulate contractions. If this is not successful, she may administer drugs to help achieve this. This may include injections of oxytocin (as either drip, through the vein or into your muscles) or tablets of misoprostol inserted into the anus of the bleeding patient.
• The cause of the bleeding may be because a part of the placenta or membranes is still in the uterus and may require removal by inserting hand into the womb to remove the retained pieces.
o Genital Tract Tears
• This usually follows bleeding from a tear in the vaginal wall, cervix or uterus.
• The service provider will check the site for the suspected tear. If identified, such will be sutured – medicine (anaesthesia) will be given before the repair is done.

• After delivery, the mother may feel abdominal pain. This usually result from contraction of the uterus as it returns to its pre-pregnant size.
• It is usually mild. If it does become severe, The service provider will prescribe some pain relieve medicine for you.
• There are other causes of abdominal pain. This will be discussed in the course of this lecture.

• Lochia is the discharge that comes from the uterus after birth.
• For the first 2 hours following delivery, lochia should be about the quantity of heavy menstrual flow and it should then continue to decrease until it stops.
• It is red in the first 3-4 days, becomes pinkish by the 4th to 10th day. Thereafter, it is clear and may continue to flow for up to 6wks after delivery.
• Abnormalities of lochia include:
-Persistence of reddish vaginal flow for more than 4 days may indicate the possible presence of placental fragments. This will need to be treated in the hospital.
-Smelly vaginal discharge after delivery will indicate the presence of genital infection. This will need to be treated by the administration of antibiotics. This may present with abdominal pain and/or fever.

• Establishing and maintaining breastfeeding for the newborn is a very important task in the puerperium.
• Continuous suckling of the breast by the baby is the stimulus that ensures that breastmilk continues to flow.
• Sometimes and especially in the early period after delivery, the breast milk may not flow as much as expected. The mother will need to take a lot of fluids, get some rest and continue attaching the baby to the breast. If these do not address the insufficient milk production, care should be sought in the hospital.
Some breast problems that may be experienced include:
• Breast engorgement, mastitis and cracked nipple.
• Breast engorgement occur when the baby does not suckle the breast and milk accumulates, thus, distends the channels that conduct breast milk. It usually resolved when the baby suckles the breast or the milk is expressed. Note that the baby should continue to suckle milk from an engorged breast.
• Mastitis: This occurs when the breast ducts become inflammed. The predisposing factors include: prolonged breastmilk stasis, infection of the breast ducts, a cracked nipple and an abscess.
• Usually the breast will be painful, swollen and usually there will be fever.
• When this occurs, continue breast feeding and expressing the affected breast and immediately come to the hospital for administration of safe antibiotics and pain relief medication.
• Cracked nipples: In this case the nipple becomes very painful. It usually occurs because of poor attachment of the baby to the milk. The correct attachment is for the baby to grasp –with the mouth- the nipple and the areola when breastfeeding.
• When this occurs, it is important that the attention of healthcare provider is sought.

• This is the occurrence of fever after delivery.
• It is important to address the causes of fever in the puerperium because it can stem from very serious complications that can impede breastfeeding and quality of life of the mother.
• Commonest causes include: genital tract infection, urinary tract infection, mastitis or breast abscess, thrombophlebitis (superficial vein blockage and inflammation).
• Mastitis have been discussed earlier.
• Genital tract infection can result from too frequent vaginal examinations during labour, infection and breakdown of a sutured genital tract lacerations, or infected retain products of conception. As stated earlier, this will usually be a cause of passage of foul smelling lorchia/vaginal discharge after delivery. This will need to be identified by the provider of care and the cause addressed.
• Urinary tract infection: This cause of fever will present with symptoms of painful urination, loin pains, frequent urination or vulvovaginal itching. It may result from infection before delivery or may be a new occurrence in the puerperium.
-The doctor will request the patient to do a urine culture and antibiotics and pain relief medication will be administered.
-It is important that the patient maintain good perineal hygiene to prevent occurrence and recurrence.
• Thrombophlebitis: This usually presents with pains at the site of intravenous fluid (drip) administration. The vein gets blocked and inflammation sets in. When this occurs, warm compression of the site and presentation to the physician is key.

• Constipation occurs commonly during early puerperium. Some of the predisposing factors include dehydration from labour, perineal pain from genital tract tears/episiotomy and inadequate fibre and water consumption.
• This can be addressed by:
(1) Liberal oral intake of oral fluids.
(2) Intake of high fibre diets.
(3) Doing sitz bathe for sutured genital tract laceration.
(4) If these measures do not provide relief, consult the service provider.
(5) Sometimes, constipation may result in anal pain either from some slight tear or engorgement of the anal veins, sitz bathe will provide relief and speed up healing.

• Mood changes may occur in the puerperal period. This include: “puerperal blues”, temporary depression and puerperal psychosis.
• Puerperal blues is common in the first week after delivery. The patient feels miserable and cries easily. During this period, the patient has not fully recovered from the stress of labour and delivery. And family appear to focus attention on the baby and neglect the mother. It is usually transient and with emotional support from especially the husband, she will recover.
• Postnatal depression. This lasts longer than puerperal blues and may go on for months or even years. In this instance, the patient loses interest in the environment, feels sad, loses appetite, loses sleep and may have suicidal thoughts. If the patient feels any of these symptoms, it is important to seek medical help soon.

• It is a very uncommon condition.
• This presents as negative change in the patient such as talking irrationally, hearing voices or seeing things that are not audible or visible to others; or thoughts of possession of powers that are irrational.
• Patients who feel this way should be brought to the hospital immediately so as to access care.

• Beyond providing care for self, the mother of the newborn, plays an important role as a nurse to her baby. Routine roles include breastfeeding, care of the cord, changing diaper, care of circumcision site (for male children), and monitoring the newborn for any problems such as fever (hotness of the body), jaundice (yellowness of the body), eye discharge and any other problems that may be affecting the baby.
• If any problem such as these is/are noticed in the newborn, such should be immediately reported to the hospital – Avoid providing self-care because it may be dangerous!

• The puerperium is a period of excitement for the mother, family and the community. Yet, this period presents some changes that require close monitoring to unearth any deviations from normal. Thankfully, these problems can be prevented and treatments are easily administrable.
• The mother plays a leading role in providing care for herself and the newborn. This she does by monitoring any deviations from the normal and seeking appropriate and beneficial help.
• The family and community have a role in providing adequate support and understanding to the needs of the mother and her newborn during this time and subsequently.

• 300 million malaria cases occur each year worldwide
• 9 out of 10 cases occur in Africa
• An African dies of malaria every 10 seconds
• Affects 5 times as many as TB, AIDS, measles and leprosy combined
• Every minute About 12 Nigerian women become pregnant (WHO)
• All are predisposed to dangers of Malaria in Pregnancy.
• 11% of Maternal death is due to Malaria
• Malaria is caused by one of 4 protozoan parasites:
• Plasmodium falciparum
• Plasmodium vivax
• Plasmodium ovale
• Plasmodium malariae
• Malaria is transmitted through the bite of an infected female Anopheles mosquito

• Malaria is more common in pregnancy compared to the general population probably due to Immunosuppression and loss of acquired immunity to malaria.
• In pregnancy, malaria tends to be more atypical in presentation probably due to the hormonal , immunological and haematological changes of pregnancy.
• The parasitemia tends to be 10 times higher and as a result, all the complications of falciparum malaria are more common in pregnancy compared to the non-pregnant population.
• P. falciparum malaria in pregnancy is more severe, the mortality is also double compared to the non-pregnant population.
• Some anti-malarials are contraindicated in pregnancy and therefore the treatment may become difficult, particularly in cases of severe P. falciparum malaria.
• Management of complications of malaria may be difficult due to the various physiological changes of pregnancy.

• Abortion
• Anaemia
• Cerebral malaria
• Low birth weight (Prematurity, IUGR)
• Stillbirth
• Congenital infection
• Puerperal sepsis
• Maternal Mortality

• THICK FILM – Specie identification
• THIN FILM – Parasite count
• OTHER INVESTIGATIONS – as necessary/indicated

• Depends on severity of the disease
• Simple / Uncomplicated – Fever Shivering/chills Headaches Muscle/joint pains Nausea/vomiting (Can tolerate per os)
• 1st trimester = Quinine ( safe and evidence-based)
• 2nd and 3rd trimesters
– 1st Line = Arthemeter/Lumefantrine ( Coartem )
– 2nd Line = Artesunate + Amodiquine Artesunate + fansider
• Complicated – Signs of uncomplicated malaria + Dizziness Breathlessness Sleepy/drowsy, confusion/coma, sometimes fits, jaundice, severe dehydration
• All trimesters – Quinine Parenteral , then Orals ** N:B – (Hypoglycaemia)
• Gestational age
• First trimester
• Second trimester
• Third trimester
• Aims at bringing attack/pyrexia to an end.

• Available options are:
– Vector control
– Drug prophylaxis
– Insecticide Treated Nets ( ITNs )
– Residual house hold spraying
– Environmental management – Cleanliness is next to Godliness – Drainage and water flow control
– All pregnant women should receive at least two doses of IPT after quickening at ANC visits
– Intermittent preventive treatment (IPT) given 3 times during pregnancy is effective for women with HIV/AIDS
– Presently, the most effective drug for IPT is sulfadoxine-pyrimethamine (SP) combination
– A single dose is three tablets of sulfadoxine 500 mg + pyrimethamine 25 mg.
– (Daraprim, the ‘Sunday-Sunday tablet’ is no longer effective)

Antenatal care is a type of preventive health care whose aim is to provide regular check-ups which allows health care professionals to treat and prevent potential health problems and to promote healthy life styles that benefit both mother and baby.

They include:
1. Early identification and management of complications that may arise in pregnancy
2. Provision of appropriate information and advice on the changes in body function during pregnancy, diet, breast feeding, immunization, family planning and child care.
3. Early detection of abnormality in fetal development.

Antenatal care has so much benefits both to the mother and her baby.
They include:
1. To ensure that the pregnant woman and the fetus are in best possible health. This is done by educating mother on the need for personal hygiene, intake of good and balanced diet and also exercise.
2. Early detection and treatment of complications: Antenatal care provides an avenue for any disease that will complicate pregnancy to be detected and treated on time. For example: hypertension in pregnancy, diabetes in pregnancy, e.t.c.
3. It offers education on parenthood by preparing mothers on how to take care of their children.
4. To prepare the woman for labour, breastfeeding and care of her child.
5. It also provides an avenue for screening pregnant women to help detect those who have medical conditions early enough as to help control it and prevent the fetus from getting it. Example screening for HIV, Hepatitis B, Syphilis, e.t.c.
6. It also educates mothers on the need to complete their immunization schedule. Thus: first tetanus toxoid is taken on the first day of antenatal care. Second one is taken 4 weeks after the first one. Third one is taken 6 months after the second one. Fourth one is taken 1 year after the third one. Fifth one is taken 1 year after the 4th one. With this,you can enjoy lifetime immunity.
7. Antenatal care provides an avenue to teach mothers on healthy lifestyle such as avoidance of alcohol,smoking,caffeine and unprescribed drugs.
8. It also educates mothers on personal hygiene,and dental hygiene as well.

Immediate care for the newborn and health assessment of the newborn starts right away. One of the first check is the Apgar score done at 1 minute and 5 minutes. The success or failure in its relation to newborn mortality (death) poses a problem to Doctor.


a) Cleaning of the nose and eyes of the baby with sterile gauze.
b) Gently suction of the mouth first, then nostrils of the child with a mucus extractor to remove mucus, blood and amniotic fluid from the airways.
c) Use a sterile towel to dry the baby so as to prevent hypothermia (low temperature).
d) If the baby has not cried, then gentle tactile stimulation of the baby (like rubbing its back and tapping the foot) must be done.
e) APGAR score evaluation should also be done to determine the wellbeing of the baby and need for resuscitation
f) Keep the baby warm by wrapping with a clean towel
The baby that is active and stable is then transferred to the mother for rooming-in and bedding in and further routine care.

• Vitamin K to prevent haemorrhagic(bleeding) disease of the newborn. 1mg of vitamin K is given intramuscularly or subcutaneously within 4 hours of birth.
• Rapid glucose testing should be performed in infants at risk for low sugar e.g. infants of diabetic mothers (IDMs), preterm small or large for gestational age(SGA, LGA)or stressed infant. Values less than 40mg/dl should be treated.
• Eye prophylaxis to prevent gonococcal ophthalmia (eye infection). This is routinely done within one hour of birth using erythromycin ointment.
• Hepatitis B vaccine (HBV) And Hepatitis B immune globulin (HBIG). HBIG is given at less than 7 days of infant’s age if the mother is HBSAg+. HBV is given to all infants irrespective of mothers’ status of HBSAg+ as it is part of National Immunization schedule.
• Cord blood is collected on all infants at birth and used for blood grouping and coomb’s testing to determine the rhesus status, if the mother is rhesus negative and blood group O.
• Infants should be positioned supine(lying on back) or lying on the right side with the dependent arm forward to minimize the risk of Sudden Infant Death Syndrome(SIDS).
• Care for the baby umbilical cord; the baby’s umbilical cord should cut to about 5-6cm long and tie tightly with umbilical clip and rope, to prevent bleeding. Subsequently, using cotton-soaked in 70% alcohol for cleaning cord 8-12 times a day and leave it open.

As soon as the delivery is completed, the baby should be quickly assessed for the state of its heart, lungs and brain function as well as the general wellbeing-And for this assessment, APGAR score is used and done at 1 minute and 5 minutes.

Score 0 1 2
A– Appearance of  skin colour Baby is completely blue Pink body blue extremities Baby is pink all over
P-Pulse or Heart rate 0 <100bpm >100bpm
G-Grimace or Reflex Irritability No response when catheter is inserted into nostrils Grimace i.e. some response to stimulation Crying, coughing and sneezing
A– Activity of Muscle  tone No movement of legs, arms, palms -Flaccid Some response to stimulation-partial flex on Active movement, waving arms or legs well flexed.
R-Respiration No cry or breathing Weak cry or irregular breathing Strong cry and regular breathing

APGAR Score 7-10 = Normal, good oxygenation with no need for resuscitation
APGAR score 4-6 = Moderate Asphyxia; Needs some stimulation and supplemental oxygen
APGAR score 0-3 = Severe Asphyxia requires positive pressure, ventilation and possibly cardiac support.
In establishing respiration at APGAR score 7-10 = Baby cries immediately by self (spontaneously). It follows with routine care earlier stated.
At APGAR score 4-6 and 0-3, a well trained doctor should be employed.

The baby first bath should be given at least 13 hours after birth, when the baby ha warmed up to auxiliary temperature of 36.50C. The bath aims at removing blood and other secretions from the baby. The bath should be performed from head to toe using warm water and gentle soap. Female genitalia should be cleaned in a front to back manner to prevent infections.

Exclusive breastfeeding is always encouraged within 30 minutes of birth and continued till first six months of birth without water or breast milk substitutes.

It is very important, the basic rules of care of newborn baby are known as it goes a long way in determining the survival and quality of life given to the newborn. A good antenatal care precedes a very vibrant newborn.

1.1    Introduction:

Management of labour involves all the activities put in place after the onset of labour by qualified health personnel in an enabling (standard) facility in order to have a healthy baby to a healthy mother and to avert feto-maternal jeopardy.

Proper, effective and timely labour management is the key to preventing and correcting all the problems of labour.

Essentials of labour management include qualified personnel and facility with at least basic emergency obstetric care.


  • Anticipation of problems in labour
  • Prevention of labour problems
  • Correction of labour problems
  • Delivery of a healthy baby with very good APGAR SCORES
  • Maternal safety


There are 3 stages of labour;

STAGE1: From onset of labour to full cervical dilatation. It consists of latent and active phases.

STAGE 2: From full cervical dilatation to delivery of fetus(es).

STAGE 3: From delivery of fetus(es) to delivery of placenta(e) 


  • Passage of show (mucus-like material).
  • Lower abdominal pain
  • Waist pain
  • Abdomen (tummy) becoming hard and relaxing
  • Drainage of liquor.


  • Painful distress
  • Palpable contractions
  • Cervical dilatation
  • Cervical effacement
  • Membrane rupture
  • Descent of presenting part.


The choice and number of investigations to be done in labour is dependent on the case at hand.

These include:

  • PCV
  • Grouping and cross matching of blood
  • Urinalysis
  • Obstetric scan
  • E/U/CR + Uric acid
  • LFT
  • Platelet count
  • Routine ANC tests


To manage labour, the diagnosis must be established. Labour is said to have started when a pregnant woman after the age of viability begins to experience lower abdominal and/or waist pain of increasing frequency, intensity and duration with at least one palpable contraction in 10 minutes lasting 20-30 seconds.Vaginal examination is then carried out to determine the stage of labour.

  • Admit patient
  • Educate her about the diagnosis and the intention to monitor her
  • If she is booked, review her ANC records for any special instructions
  • Carry out necessary investigation based on the case at hand
  • Provide emotional and psychological support
  • Do vaginal examination every 4 hours.
  • Fluids, analgesia and antiemetics when necessary
  • Monitor and record feto-maternal vital signs hourly


  • Commence partographic monitoring
  • Fetal heart rate be monitored and recorded every 30 minutes
  • Maternal vital signs be monitored and recorded regularly
  • Artificial rupture of membrane
  • Use of oxytocics
  • Use of analgesia
  • Companionship
  • Vaginal examination every 4 hours


  • At full cervical dilatation and with the urge to bear down the woman is encouraged to do so.
  • Episiotomy at crowning, if deemed necessary


  • Administration of oxytocic agent
  • Controlled cord traction
  • Cord clamping and cutting
  • Repair of lacerations and episiotomy


  • It may end up in C- section
  • Fetal distress
  • Maternal exhaustion
  • Worsening of pre-existing medical condition
  • PIH/ Pre-eclempsia /Eclempsia
  • Bleeding
  • Fetal demise
  • Maternal demise

1.8       CONCLUSION

Problems, complications and undesired events can happen in labour. Sensible anticipation, early recognition, timely intervention, cooperation and trust are the essentials and ingredients for the remedy.

Labour is a process in which your baby(fetus) comes out from your womb(uterus) through your reproductive opening(birth canal). Labour usually involves regular pain that comes and goes (contraction) which forces your womb to gradually push the baby down, leading to the gradual opening(dilatation) of your cervix until it is wide enough to allow the baby(fetus) to come out.

– In most cases, labour usually starts on its own (spontaneously)without any artificial cause. This usually happens when your pregnancy is due.
– In some cases, you may have to be induced in the hospital if you do not go into labour yourself and your pregnancy has passed its due date.

– You may start having regular pain that comes and goes, which usually gradually becomes more severe with time.
– You may see something like mucous(which looks like catarrh) sometimes mixed with blood come out from your vagina. This is called “show”.
– You may see water come out of your body or you will wake up one morning and see that your clothes are wet/soaked. Just know that your membranes may have ruptured.
– When you see any of these signs please just come to the hospital to see the doctor.

We have
– False Labour: In this case the woman is not actually in labour but is having slight discomfort.
– Latent Phase Labour: In this phase that labour is just beginning and not yet serious. The opening (dilatation) of the birth canal(cervix) is still less than 3cm.
– Active Phase Labour: The labour has started properly. In this phase the pain is more regular and severe. It is in this phase that the cervix gradually opens from 3cm to 10cm (full dilatation), leading to the delivery of the baby.

Below are some of the reasons why you may be induced into labour;
– When your pregnancy has passed its due date of delivery (prolonged pregnancy) and you did not go into labour by yourself(spontaneously).
– When the pregnancy is making your blood pressure go up(pregnancy induced hypertension).
– When a baby (fetus) of 8 months to 9 months old have died in your womb in the past (previous intra-uterine death at term).
– When a baby (fetus) of a mother with rhesus negative blood group is at risk of dying or having complications because the baby’s blood and the mother’s blood do not match or is not compatible(rhesus isoimmunisation).
– When the mother have some health conditions or challenges like diabetes, liver disease, chronic kidney disease, hypertension, which may harm or kill her baby if the baby continues to stay in her womb.
– When a baby (fetus) in the womb starts having reduced growth or is no longer growing as expected (IUGR) due to some problem in the pregnancy.
– When a baby have already died in the womb before the mother goes into labour (Intra-Uterine Fetal Death: IUFD)

There are some situations where a pregnant woman is not allowed to go into labour at all because it is too risky either to the mother, or to the baby or both. This situation can lead to death of the mother or the baby or even both of them if caesarian section (C/S) or proper management is not carried out.
These situations or conditions include:
– When a woman has done C/S surgery (Caesarian Sections) two or more times, she is not allowed to go into labour. She has to deliver through C/S surgery.
– If a woman has ever had tear of the womb (Uterine Rupture) in the past.
– If a woman is pregnant with twins or triplet and the 1st or leading twins is lying horizontally from left to right(transverse lie).
– If a woman had done one classical C/S surgery where the womb was cut vertically from up to down, sheis not allowed to go into labour in her next pregnancy.
– If a baby in the womb is so big (Macrosomic baby), and the doctor suspects you may not be able to deliver the baby safely.

– When labour becomes obstructed and cannot progress further.
– When the baby becomes too stressed up (fetal distress) that the heart beat begins moving fast or slowing down. This means the baby may not survive the stress of labour.
– When the pregnant mother have a small hip(Contracted Pelvis) that the baby cannot pass through.
– When labour becomes too prolongedthis can lead to distress of the mother and baby.
– When the cord of the baby comes out ahead of the baby’s head (Cord Prolapse) or the baby is coming out with the hand(hand presentation)
– When a pregnant woman comes in labour with a baby that is big (Macrosomic baby) and the baby is lying with the buttocks down (breech presentation).


Pregnancy starts with conception and goes through the period of nine months (about 37-42 wks) before delivery. As pregnant women, it is important you have some little knowledge of what is going on in your womb in terms of baby’s development. For the purpose of clarity, it is divided into trimesters after conception.

  • 1st trimester (1st 3months) from conception to 12 wks
  • 2nd trimester (4-6months) 13wks – 24wks
  • 3rd trimester (7-9months) 25wks – delivery


This is when the sperm meets with the ovary. It can also be called fertilization and it is at this point that the gender of the baby is determined. A boy is formed when ychromosome fertilizes the egg while a female is formed when x chromosome fertilizes the egg. After fertilization, the fertilized egg, now known as the zygote moves to the uterus where it gets attached to the uterine wall. At this point, the placenta which is used to nourish the baby starts forming and developing rapidly.

1ST TRIMESTER (Conception to 12wks)

The body structure starts forming, the heart, stomach, liver etc within the first four weeks.By the end of 12wks, the baby will be about 2 meters in length and start making some movement. The sex organ becomes clearer and the uterus will start rising above the pelvis.

2ND TRIMESTER (13weeks – 24weeks)

The fetus continues in its development and can weigh up to 0.6kg (averagely) by the end of 24wks. The uterus will rise a little above the belly button. The fetal movements most people starts feeling is by 18wks and is called quickening. The sex organs becomes clearer and can be seen on scan.

3RD TRIMESTER (25weeks – till birth)

The baby’s weight and size continues to increase. At 32weeks, the average weight of the baby will be around 1.8kg and moves around more often. The mother may start seeing thick yellowish discharge from her breast called colostrum and it prepares the breast for milk production. By 36 wks the average weight of the babyranges from 2.5kg-3.5kg. The baby’s head will start moving into the pelvis and at 37 weeks the baby is said to be at term and can safely be delivered at this point.


The development of a baby is a delicate process. It can be affected by substances and drugs pregnant women take within this period. Hence it is important you regularly seek the advice of your doctor before taking any medicines or substances including supplements.

Substances like cigarette and, alcohol and herbal concoctions can reduce the growth of the baby. They can also induce preterm labour, leading to preterm delivery. Drugs like tetracycline can lead to permanent discoloration and underdevelopment of the baby’s teeth. Others like Indomethacine can cause abnormal development of the heart; Septrin taken in early pregnancy can affect the development of the spinal cord.


Pregnancy goes through 3 trimesters (1st-3rd) starting from conception. Each of these periods is a delicately important and eventful period for the baby’s development. It can be affected by substances and drugs taken. While some medication are usually prescribed to support the baby’s development and the mother’s general health, a large number of other medication are dangerous to the baby. Solving this jig-saw puzzle lies in regular attendance at antenatal clinic visits and asking the doctor before taking any medicine – including that medicine your neighbor told you was prescribed for her in her own pregnancy.

Hypertension means having a blood pressure higher than normal. Ordinarily, blood pressure means the force with which blood moves through the body from the heart to all body tissues. A normal blood pressure (usually less than 140/90mmHg as taken by your attending physician) is essential to maintain blood and nutrient/oxygen flow for the pregnant woman and her baby.

When a pregnant woman’s blood pressure goes higher than normal, it has ominous implication for both her and her unborn baby. It is therefore one of the important examinations offered to women when they present for antenatal care.

• Decreases during the first trimester,
• Reaching its lowest point at 20 weeks
• Returns to pre-pregnancy level during the third trimester

• Gestational hypertension
• Pre-eclampsia
• Eclampsia
• Chronic hypertension with pregnancy
• Preeclampsia superimposed on chronic hypertension

[A] Gestational Hypertension
Blood pressure > 140/90mmHg on two or more occasions
• In a woman whose blood pressure was normal before pregnancy
• After 20 weeks gestation
• Without proteinuria (no protein detected on urinalysis – urine testing)
• Returning to normal 12 weeks after delivery
• Almost half of this develop preeclampsia syndrome

[B] Pre-Eclampsia
Pre-eclampsia =gestational hypertension + proteinuria (protein detected on urine testing)
• It is defined as hypertension of at least 140/90mmHg recorded on two separate occasions at least 4 hours apart and in the presence of at least 300mg protein in a 24 hour collection of urine, arising after the 20th week of gestation in a woman whose BP as normal before pregnancy and resolves completely by the 12th post-partum week.

Risk Factors of Preeclampsia

Demographic Nullipara
Extremes of age (<20yrs, >35yrs)
Obstetrics Multiple gestation
Molar pregnancy
Non- immune eye drops
Medical Diabetes mellitus
Chronic HTN
Renal disease
Maternal related
• History of preeclampsia in previous pregnancy
• Advanced maternal age
• Family history of preeclampsia
• History of placental abruption, IUGR, fetal death
• Obesity, BMI>35 doubles the risk
• Hypertension
• Diabetes
• Thrombotic vascular diseases
• Multiple gestation
• Molar pregnancy
• Smoking.

[C] Eclampsia
Eclampsia =preeclampsia + seizure/convulsion/coma

• Addition of convulsions in a woman with preeclampsia
• Occurs in 0.5 %- 4% of deliveries
• 25% have eclamptic seizure before labour, 50% during labour and 25% after delivery

[4] Chronic Hypertension

• Gestation<20 weeks or pregnancy • Sustained hypertension (>140/90)
• +/-proteinuria

[5] Superimposed Preeclampsia (on chronic hypertension)
• New onset proteinuria>300mg/24hrs in hypertensive women but no proteinuria before 20 weeksks gestation
• A sudden increase in proteinuria or blood pressure or platelet count< 100,000/mm^3 in women with hypertension and proteinuria before 20 weeks gestation.

Consequences of Hypertension in Pregnancy

• Convulsions and coma (eclampsia)
• Cerebral haemorrhage
• Renal failure
• Heart failure
• Liver failure
• Disseminated intravascular coagulation
• Abruption placentae
• Residual chronic hypertension in about 1/3 of cases
• Recurrent pre-eclampsia in next pregnancies

• Intrauterine Growth Restriction
• Premature birth
• Intrauterine fetal death
• Perinatal mortality

• Urine: 24 hour urine, proteinuria.
• Kidney functions: serum creatinine, urea, creatinine clearance and uric acid
• Liver functions: bilirubin, enzymes
• Blood: CBC,HCt, hemolysis and platelet count (thrombocytopenia)
• Coagulation profile: bleeding and clotting time

Treatment of hypertension in pregnancy
Antihypertensive drugs used in pregnancy are
• Methyldopa
• Nifedipine
• Hydralazine
• Labetalol

Those who develop seizure (or other conditions as will be determined by the doctor) will usually be given injections of magnesium sulphate based on the institutional protocol.

It is important to state that the patient has an important role to play in the treatment of hypertension in pregnancy. This will include (i) adhering to all medications prescribed to her (ii) adhering to all follow up as agreed with her service provider (iii) doing all requested investigations that will help in providing care.

Ensuring optimal blood pressure during pregnancy is key for a safe mother and child at the end of pregnancy. This can be achieved by optimal compliance with the antenatal care delivery system.


Substance abuse means that use of harmful or hazardous use of psychoactive substances. It is also when you use alcohol, prescription medicine, and other legal substances too much or in the wrong way.

  • 4% of pregnant women use illicit substances
  • Half of substance abusing women continue using during pregnancy
  • An even larger proportion abuse tobacco or alcohol
  • Many use more than one substance
  • Pregnant women typically highly motivated to modify behavior to help their unborn child
  • Many resume substance use postpartum


  1. Alcohol
  2. Tobacco
  3. Marijuana
  4. Cocaine
  5. Heroine


  • No level is safe in pregnancy.
  • Spontaneous abortions or stillbirth due to fetoplacental dysfunction (reduced blood blood flow from mother to baby).
  • It can slow down baby’s growth.
  • When the babies are born, they are at risk of having difficulty concentrating on assigned tasks and may have learning difficulty.
  • Future drinking problems in adult offspring
  • Fetal alcohol syndrome which include such features as: (i) Growth Problems (ii) Facial defects such as smooth philtrum, thin vermillion border, short palpebral fissures and other problems of the brain, spinal cord and nerves.


  • Reduces oxygen delivery to the baby.
  • Delivers harmful chemical (such as nicotine and carbon monoxide) to the baby.
  • Preterm delivery, low birth weight (<2500g), low birth weight, placenta previa, placenta abruption, death of the baby in the womb.
  • Sudden infant death, asthma, otitis media
  • Mental retardation, difficulty concentrating on assigned tasks.
  • Obesity and diabetes in adult offspring.
  • Smoking and use of nicotine substitutes in first 12 weeks, high risk of congenital malformations.


  • Crosses the placenta and can gain access to the fetal brain.
  • Can raise blood pressure in pregnancy.
  • Spontaneous Abortion, prematurity, placental abruption, fetal death, decreased growth (birth weight, length, head circumference), and reduced blood flow to the brain.
  • “crack babies” – jittery / tremors, high pitched cry, irritability, excessive suck, hyper-alertness, autonomic instability
  • Associated with delayed cognitive and language development.


  • Most common illicit substance used in pregnancy.
  • Detectable in urine for weeks.
  • Adverse effects inconclusive: association with sleep disturbance, hyperactivity, inattention, poorer visual problem-solving skills and delinquency.
  • May cause small head circumference.
  • Strongly associated with concomitant use of cigarettes and alcohol
  • Decreased intelligence testing scores
  • Can cause other diseases such as cancers of the blood (leukemia), muscle (rhabdomyosarcoma) and brain/spinal cord (astrocytoma).


Heroin use is deadly to the developing fetus or the newborn baby. Aside from increased miscarriage risk due to complications like placental abruption, illicit drug use during pregnancy increases the risk of stillbirth by 2 to 3 times.

  • Increases the risk of preeclampsia (hypertension in pregnancy), 3rd trimester bleeding, mal-presentation, poor fetal status, low birth weight and premature birth.
  • Neonatal abstinence syndrome (NAS)- increased autonomic reactivity.
  • Psychomotor and neurologic abnormalities.
  • Sudden Infant Death Syndrome.
  • May cause adverse developmental outcomes.

Interventions at Antenatal Clinic

  • Ask- at each visit

Your doctor will ask you about your exposure to any substance. You can also volunteer this information to your attending doctor.

  • Advise – cessation

Your doctor will advise you on what to do in order to stay off substances. This may require referring you to an addiction management programme.

  • Assess – willingness

Your doctor will assess your willingness to change this habit. This may take several office visits to move individuals to a stage where they become willing to change.

  • Assist – establish a plan

Your doctor beyond just counseling you on the need to stop using harmful substances will help you with links in the community where you can get help with beginning a new and beneficial life.

  • Arrange- follow up, referrals support

Your doctor will provide support for you as you go through the entire process of detoxification, continuation of antenatal and support for delivery and care of your new born bay


  • Counselling
  • Social Services
  • Testing for STDs
  • Frequent Prenatal visits, education
  • Early ultrasound
  • Antepartum fetal surveillance
  • Informing pediatrics of possible neonatal withdrawals


Bleeding in pregnancy remains a significant cause of morbidity and mortality for both mothers and baby during pregnancy. It occurs in 2-5% of pregnancies.


Bleeding in late pregnancy also known as antepartum hemorrhage is defined as bleeding from the genital tract after 28wks of pregnancy up to the time of delivery.


  • Spotting – stain of blood or spotting of blood
  • Minor hemorrhage – less than 50ml
  • Major hemorrhage – 50-1000ml without signs of circulatory decomposition
  • Massive hemorrhage – greater than 1000ml with or without signs of circulatory shock


  • Placenta previa: Placenta previa refers to when the placenta is abnormally located at the lower segment of the uterus. There are four types of placenta previa depending on how much of the cervix is covered by the placenta.

TYPE 1 – The placenta reaches the lower segment of the uterus but does not touch the cervix

TYPE 2 –The placenta touches the internal os of the cervix but does not cover it

TYPE 3 – The placenta partially covers the internal os of the cervix

TYPE 4 – The placenta completely covers the internal os


The management of major placenta previa is usually stabilization and urgent deliver. Delivery is commonly through emergency cesarean section.Attempt at vagina delivery with a major placenta previa can lead to catastrophic consequences, putting the lives of the baby and mother on the line.

  • Abruptio placenta: This is the abnormal detachment of the placenta from the endometrium before the fetus is delivered.


The management of abruptio placenta depends on whether the baby is alive or not. Premature placenta separation with a life baby is an indication for emergency cesarean delivery. However, with a dead fetus and a stable enough mother, delivery can be vagina if the cervical parameters a favorable.

  • Vasopraevia: This is the presence of unprotected foetal blood vessels running along the placenta and over the cervical opening.
  • Cervical ectropion: This is usually minor bleeding from the cervix as a result of translocation of epithelial cells along the cervical canal. Cervical ectropion does not require operative delivery. It is a minor cause of bleeding in pregnancy that is usually self limiting.


  • Trauma
  • Multiple gestation
  • Polyhydramnious
  • Multiparity
  • Smoking
  • Hypertensive diseases in pregnancy


Management of major APH is an emergency

  • Urgent admission
  • IV fluids (normal saline)
  • Blood transfusion
  • Urgent delivery through the fastest route commonly CS
  • Monitoring of vital signs (PR, BP,FHR)
  • Oxygen supplementation
  • Corticosteroid like Dexamethasone


Symptoms of antepartum hemorrhage includes

  • Bleeding pervagina
  • Abdominal pain
  • Fast pulse
  • Low blood pressure
  • Dizziness


Diagnosis of antepartum hemorrhage is made from patient’s history, physical examinations by the doctor, ultrasound scanning and lab tests.

Tests to be done will include:

  • PCV
  • Scan
  • Grouping and cross matching
  • Coagulation studies
  • E/U/Cr if bleeding is major.


In conclusion, antepartum hemorrhage can be very dangerous to both mother and baby, thus, patients with bleeding in late pregnancy must present to the hospital immediately. Depending on the severity of the bleeding, there will be need forvarying degrees of clinical interventions ranging from bed rest resuscitation/stabilization to even urgent delivery.


  • Pregnancy refers to a period of time during which oneor more offspring develop in a woman’s womb.It is also referred to with terms such as cyesis or gestation.


Pregnancy is diagnosed with a combination of the following:

  1. A missed period (Amenorrhea): When a woman misses her regular monthly flow, a pregnancy is SUSPECTED.
  2. Home or Hospital based pregnancy test: When a urine or blood pregnancy test is positive, a woman is MOST LIKELY PREGNANT
  3. A scan: A pregnancy scan is the ultimate confirmation of pregnancy. You are not pregnant, until a pregnancy scan shows a pregnancy in your womb.

Pregnancy Scan

  • An early pregnancy scan is very important for early pregnancy detection.
  • Other vital information to be found on a pregnancy scan are:
  1. Location: Where is the baby?

(i) A normal pregnancy is located inside the womb (Intrauterine)

(ii)Ectopic:  This is when a pregnancy is situated outside of the womb. This abnormal pregnancy occurs in about 1% of all pregnancies

(iii)Multiple: More than one baby in the same pregnancy, twins triplets etc

(iii)Heterotropic: It is a form of multiple gestation where an intrauterine gestation coexists with an ectopic in the same woman

  1. Gestational Age: How old is the pregnancy?


  • A normal Pregnancy lasts an average of 40 weeks
  • This duration is divided into three stages (trimesters) of three months each: first, second and third trimesters.
  • In pregnancy, women have several reasons for which they need to see a doctor, but some are more common than the others.
  • The focus of this lecture will be a concise discussion of the commonest complaints in pregnancy


First Trimester

  • Morning sickness: Nausea and vomiting
  • Fatigue
  • Abdominal cramps
  • Vaginal bleeding
  • Dizziness
  • Hyperacidity: Heartburn

Second Trimester

  • This stage of pregnancy is a relatively trouble-free for the pregnant woman
  • However, certain complaints related to pregnancy loss can happen here
    • Back/abdominal pain
    • Vaginal bleeding
  • Urinary Symptoms:Frequent urination, Nocturia, Feeling of incomplete voiding.

These are commonly a result of the weight of the developing fetus on the urinary bladder (pressure symptoms), and may or may not be associated with urinary tract Infection (UTI).

Third Trimester

  • The pressure symptoms described for second trimester tend to worsen in the third trimester as the weight of the fetus/womb increases:
  • Worsening frequency/nocturia (increased frequency of passing urine at night).
  • Constipation: Inability to pass stool for up to 3 days. Sometime it may simply be passage of stool with difficulty. This happens when stool is hard.
  • Haemorrhoid: This refers to the dilation of the veins in the anal canal. It is associated with pain during defaecation, and sometimes bleeding through the anus.
  • Venous varicosity: Dilation and tortuosity of the veins of the legs.
  • All these are results of the weight of the womb on the big veins of the pelvic region, causing damping of blood back into the veins in the lower regions: Anal canal and legs.


Worry will increase your anxiety, and you may lose sleep making you weak, and tired. Remember you need to be strong to carry your baby to viability and to have a safe delivery. So, no worries.

Let your doctors do the worrying for you.


  • Liberal fluid intake, especially water. This keeps you properly hydrated, and can help you relieve cramping, fatigue and dizziness, that are commonly the results of dehydration.
  • Fruits and vegetables are sources of vitamins and mineral essential for blood production and wellbeing of both you and your developing baby. They also help you prevent constipation.
  • Take your routine drugs daily and
  • Attend your antenatal meetings on schedule


Visit your doctor’s office for you scheduled antenatal care.

Also visit your doctor if you have any of the following:

  • Persistent abdominal pain
  • Vaginal bleeding
  • Fever (your body is hot)
  • Abnormal vaginal discharge
  • Urinary symptoms: painful urination or straining to urinate
  • If you can’t feel your baby’s kicks
  • If your water breaks


  • Pregnancy is long period of living with another human who depend on you for survival.
  • This relationship can put a strain on the body of a pregnant woman, increasing the need to see a doctor.
  • Pregnancy is not a disease, but can pose significant challenge to the expectant mother and the baby.
  • There is so much your doctor can do for you to deal with these challenges.
  • Therefore, regular ANC visits should not be taken for granted


This writeups is for educational purposes only. Please consult your doctor before making decisions about your care