ANTENATAL CARE

Fahad zakwan

IntroductionAntenatal Care (ANC) means “care before birth”, and

includes

1. Giving Health education,

2. Counseling,

3. Screening

4. Treatment to monitor and to promote the well-being of the mother and fetus.

Aim of ANCThe aim of Antenatal care (ANC) is to assist women to

remain healthy, finding and correcting adverse conditions when present, and thus aid the health of the

unborn.

ANC should also provide support and guidance to the woman and her partner or family, to help them in their

transition to parenthood.

Antenatal education• “birth preparedness” or “birth plans• aim at increasing awareness of danger signs, reducing the delays

in receiving skilled care and improving intra-family communications and relations with providers

• Birth and emergency preparedness: Identify place of birth, preparing essential items, identify at least two blood donors, prepare fund for transport,

• identify decision maker family members• Counseling on health promotion: Intermittent preventive

treatment for malaria in pregnancy, insecticide-treated nets, personal hygiene, diet and nutrition, danger signs

Lifestyle considerations

• Diet and supplementation

• Other lifestyle factors

Clinical examination of pregnant women

1. Abdominal palpation

2. Blood pressure measurement

3. Evaluation for edema

4. Fetal heart tones

5. Symphysis fundus height measurement

6. Weight measurement

Screening for hematological conditions

1. Blood group

2. Rhesus factor

3. Sickle cell anemia

Screening for common conditions in pregnancy

1. Pre-eclampsia

2. Anaemia

3. Malaria

4. Worm infestations

Screening for fetal anomalies

Common are the Neural tube defects and down syndromes:

• Ultrasound

• Amniocentesis

• Chorionic villi sampling

• CAT scan

• MRI

Screening for infections• Human Immunodeficiency Virus (HIV)

• Syphilis

• Rubella

• Toxoplasmosis

• Asymptomatic bacteriuria

• Hepatitis B virus

• Asymptomatic bacterial vaginosis

Foetal growth and well-being diagnosis

• Biophysical profile• Contraction stress test• Electronic fetal monitoring• Fetal blood sampling• Fetal movement test• Home uterine activity monitoring (HUAM)• L/S ratio and phosphatidyl glycerol (PG) testing• Nipple stimulation test• Nonstress test• Quantitative hCG test

Management of specific conditions

• Early detection and diagnosis of disease/abnormality ie quick check, history taking, physical examination, laboratory investigation a& decision making

• Prophylaxis, diagnosis and treatment of anaemia

Vaccination

•At least 2 doses of tetanus toxoid vaccination

•For prevention of tetanus in the newborn and the mother.

PMTCT•Prevention of mother-to-child transmission (PMTCT) of Human Immunodeficiency Virus (HIV).

Screening for diabetes in pregnancy

•Gestational diabetes (GDM)

•Non-gestational diabetes.

Quality of care• The current challenge is to find out which type of care

and in what quantity is considered sufficient to ensure good quality of care for low-risk pregnant women.

• Only interventions of proven effectiveness, for which benefits largely overcome possible harms, and those acceptable to pregnant women and their families, should be offered.

FOCUSED ATENATAL CARE (FANC)

• Antenatal care that emphasizes quality over quantity of visits.

• The approach, focused antenatal care, recognizes three key realities:

1. frequent visits do not necessarily improve pregnancy outcomes, and in developing countries they are often logistically and financially impossible for women to manage and a burden on the healthcare system

2. the majority of pregnancies progress without complication, so antenatal care providers must support women with normal pregnancies and help prevent complications.

3. many women who have risk factors never develop complications, while women without risk factors often do

FOCUSED ATENATAL CARE

• When antenatal care is planned using a risk approach, scarce healthcare resources may be devoted to unnecessary care for “high-risk” women who never develop complications, and “low-risk” women may be unprepared to recognize or respond to signs of complications

Principles underlying FANC

• The antenatal care model should include a simple form that can be used easily to identify women with special health conditions and/or those at risk of developing complications.

• The identification of women with special health conditins or risk factors should be done very carefully

Principles underlying FANC

• The opening hours of the clinics should be as convenient as possible.

• Only examinations and tests that serves an immediate purpose and that have been proven to be beneficial should be performed.

• Whenever possible, rapid and easy-to-perform tests should be used at the antenatal clinics or in facility as possible to the clinic.

Principles underlying FANC

• Women friendly: omens health and survival, basic human rights and comfort are given priority.

• Inclusive of partners or other family members

• Culturally appropriate

• Individualized care

• Part of household continuum of care

• Integrated service:HIV,STI,FP,emergency preparedness,birthpreparedness,malaria,micronutrients

Basic component of FANC

• In this category women attend ANC only four times

•Generally categorized as “low risk”

FIRST VISIT8-12 weeksActivities are:

Confirm pregnancy and EDD,

Classify women for basic ANC (four visits) or more specialized care.

Screen, treat and give preventive measures.

Develop a birth and emergency plan.

Advise and counsel.

SECOND VISIT

24-26 weeksActivities:

Assess maternal and fetal well-being.

Exclude PIH and anaemia.

Give preventive measures.

Review and modify birth and emergency plan

Advise and counsel

THIRD VISIT32 weeksActivities are:

Assess maternal and fetal well-being.

Exclude PIH, anaemia, multiple pregnancies.

Give preventive measures.

Review and modify birth and emergency plan

Advise and counsel

FOURTH VISIT36-38 weeks• Activities are:

Assess maternal and fetal well-being.

Exclude PIH, anaemia, multiple pregnancy, malpresentation.

Give preventive measures.

Review and modify birth and emergency plan.

Advise and counsel.