ANTENATAL CARE

General Objective
To enhance the knowledge, attitude and practice

of midwives on FOCUSED ANTENATAL CARE Specific Objectives

To demonstrate how to make an immediate general

assessment of the pregnant woman

To apply the process flow of providing antenatal care.

To discuss the importance of a birth and emergency

plan

Objectives of Prenatal Care

To detect diseases which

may complicate pregnancy

Educate women on danger and emergency signs & symptoms Prepare the woman and

her family for childbirth

Steps to Follow in Prenatal Care

1) IMMEDIATE ASSESSMENT for emergency
signs.

Unconscious/Convulsing
Vaginal bleeding Severe abdominal pain

Looks very ill

Severe headache with visual disturbance Severe difficulty in breathing

Dangerous Fever
Severe vomiting * Attend to sick woman quickly.

Steps to Follow in Prenatal Care

2) Make the woman comfortable.

Greet her, make sure she is comfortable and ask
how she is feeling.

If first visit, register the woman and issue a

Mother and Child Book (antenatal record form)

Steps to Follow in Prenatal Care

3) Assess the pregnant woman FIRST visit: How old is patient? Past Medical History Obstetric History: Gravidity? LMP? AOG? Alcohol/Drug/substance abuse? Ask about or check record for prior pregnancies:
Convulsions Stillbirth or death in the first day Heavy bleeding during or after delivery Prior cesarean section, forceps or abortion

Steps to Follow in Prenatal Care

3) Assess the pregnant woman

ON ALL VISITS:

Check duration of pregnancy (AOG). Ask for bleeding/danger signs during this pregnancy Check record for previous treatments received during this pregnancy Prepare birth and emergency plan Ask patient if she has other concerns Give education and counseling on family planning and breastfeeding

Steps to Follow in Prenatal Care

3) Assess the pregnant woman

THIRD TRIMESTER 1. Leopolds exam, fetal heart beat 2. Give education & counseling on family planning

Do not perform vaginal exam as a routine prenatal care procedure. Always record findings. All pregnancies are at risk. Encourage all pregnant women to deliver in the health facility. Refer patients with abnormal findings to higher facility.

Steps to Follow in Prenatal Care

4)

Get baseline laboratory information of the woman on the first or following the first visit.

Hemoglobin, blood type Urinalysis VDRL or RPR to screen for syphilis

If not available, refer to the nearest RHU or hospital for the tests.

Steps to Follow in Prenatal Care

5) Check for pallor or anemia.

Ask about getting tired easily or shortness of breath during routine work. On 1st visit, check hemoglobin & blood type. The normal hemoglobin cut-off level for a pregnant woman is 11g/dl. On subsequent visits:

Look for conjunctival pallor. Look for palmar pallor. Count number of breaths in one minute.

Steps to Follow in Prenatal Care

6) Check for hypertension/ pre-eclampsia.

Measure BP in sitting position. If diastolic BP is 90 mm Hg or higher repeat measurement after 1 hour rest.

If diastolic BP is still 90 mm Hg or higher ask the woman if she has: Severe headache Blurred vison Epigastric pain
Check urine for protein.

Steps to Follow in Prenatal Care

7) Check for gestational diabetes.

ASK ABOUT Family history of diabetes & history of obesity. Past pregnancy for difficult labor, large babies, congenital malformations and previous unexplained fetal death. LOOK FOR signs of maternal overweight or obesity Polyhydramnios Signs of large baby or fetal abnormality Vaginal infection.

Low Risk: 24-28 wks High Risk: Immediately, any AOG

Steps to Follow in Prenatal Care

8) Check for fever, burning sensation on urination and abnormal vaginal discharge.

Ask about episodes of fever or chills and take temperature. Ask about pain or burning sensation on urination.
Ask about presence of abnormal vaginal discharge, itching at the vulva or if partner has a urinary problem.

Steps to Follow in Prenatal Care

9) Immunize against tetanus.

Tetanus Toxoid Immunization Schedule
Vaccine Minimum Interval Duration of Protection

TT1

at first contact with woman 15-49 yrs or at first ANC visit at least 4 weeks after TT1

NIL no protection Infants born to the mother will be protected from neonatal tetanus 3 years of protection for the mother Infants born to the mother will be protected from neonatal tetanus 5 years of protection for the mother Infants born to the mother will be protected from neonatal tetanus 10 years of protection for the mother Infants born to the mother will be protected from neonatal tetanus Lifetime protection for the mother

TT2

TT3

at least 6 months after TT2

TT4

at least 1 year after TT3

TT5

at least 1 year after TT4

Steps to Follow in Prenatal Care

10) Give MEBENDAZOLE to treat for intestinal parasites.

500 mg single dose once in six months (after the 1st trimester)

11) Give iron and folate supplementation to prevent anemia and neural tube defects:
60 mg Fe & 250 mcg Folate If Hgb <80 gm/dl double the dose

12) Refer for preventive intermittent treatment for falcifarum malaria (if area is endemic)

Steps to Follow in Prenatal Care

13) Provide health information, advice

HEALTH INFORMATION: 1. Nutrition 2. Self-care during pregnancy 3. Effect of tobacco, alcohol & drugs 4. Breastfeeding 5. Birth & Emergency situations 6. Schedule of appointment

Steps to Follow in Prenatal Care

14) Advise on Danger Signs

1. Vaginal bleeding

2. Convulsions
3. Severe headache 4. Severe abdominal pain

5. Fast or difficult breathing

6. Fever or burning urination

Steps to Follow in Prenatal Care

15) Encourage the woman to come back for return visits.

At least 4 routine antenatal visits
1st visit: before 4 months 2nd visit: 6 months 3rd visit: 8 months 4th visit: 9 months return if undelivered within 2 weeks after the EDC. Pregnant women who do not come for prenatal care should be visited at home.

The Birth Plan

A written document prepared during the first prenatal consultation Discussed with the patient and her family May change anytime during pregnancy if a problem is detected.

The Birth Plan

Contains information on:

the womans condition during pregnancy preferences for her place of delivery and choice of birth attendant available resources for her childbirth and newborn baby preparations needed should an emergency situation arise during pregnancy, childbirth and postpartum.

Emergency Plan
Advise on danger signs Where to go? How to go? Who will go with you to health center? How much will it cost? Who will pay? How will you pay? Start saving for these possible costs now. Who will care for your home and other children when you are away?

B I R T H and E M E R G E N C Y P L A N

ANTENATAL CARE: Key Messages

Reduced number of visits Provided by skilled birth attendant Screening and prevention of diseases that may

complicate pregnancy Preventive Measures: Tetanus immunization, iron and folic acid supplementation Counseling on family planning, nutrition, breastfeeding, and danger signs BIRTH PLAN: Birth preparedness and complication readiness

Because Giving birth should be about giving life not giving up a life.