ASK, CHECK RECORD LOOK, LISTEN, SIGNS CLASSIFY TREAT AND ADVISE

FEEL

 Blood  Measure  Diastolic SEVERE  Give magnesium

pressure at the blood blood PRE- sulphate B13.
last visit? pressure in pressure ECLAMPSIA  Give appropriate
 Eclampsia or sitting ≥110 mmHg anti-hypertensives 
pre-eclampsia position. and 3+ B14.
in previous  If diastolic proteinuria,  Revise the birth
pregnancies? blood or plan C2.
 Multiple pressure is  Diastolic  Refer urgently to
pregnancies? ≥90 blood hospital B17.
 Other diseases mmHg, pressure ≥90
(chronic repeat mmHg on
hypertension, after 1 two readings
kidney disease hour rest. and 2+
or  If diastolic proteinuria,
autoimmune blood and any of:
disease)? pressure is
still ≥90 →
mmHg, severe
ask the headache
woman if
she has: →
blurred
→ vision
severe
headache →
epigastric
→ pain.
blurred
vision

→
epigastric  Diastolic PRE-  Revise the birth
pain and blood ECLAMPSIA plan C2.
pressure 90-  Refer to hospital.
→ 110 mmHg
check on two
protein in readings and
urine. 2+
proteinuria.

✘
ASK, CHECK RECORD LOOK, LISTEN, FEEL SIGNS CLASSIFY TREAT AND ADVISE

IF NO FETAL MOVEMENT

 When did the  Feel for fetal  No fetal PROBABLY  Inform the
baby last movements. movement. DEAD woman and
move?  Listen for fetal  No fetal BABY partner about
 If no heart after 6 heart beat. the possibility
movement felt, months of of dead baby.
ask woman to pregnancy D2.  Refer to
move around  If no heart beat, hospital.
for some time, repeat after 1
reassess fetal hour.
movement.

 No fetal WELL  Inform the

movement BABY woman that
but fetal baby is fine
heart beat and likely to
present. be well but to
return if
problem
persists.

ASK, CHECK LOOK, LISTEN, FEEL SIGNS CLASSIFY TREAT AND ADVISE
RECORD

IF FEVER OR BURNING ON URINATION

 Have you  If history of  Fever VERY  Insert IV line and

had fever? fever or feels >38°C and SEVERE give fluids
 Do you hot: any of: FEBRILE slowly B9.
have  Give appropriate
DISEASE
burning on → → IM/IV
urination? Measure very fast antibiotics B15.
axillary breathing  Give
temperature. or artemether/quinine
IM B16.
→ →  Give glucose B16.
Look or feel stiff neck  Refer urgently to
for stiff neck. hospital B17.
→
ASK, CHECK RECORD LOOK, LISTEN, FEEL SIGNS CLASSIFY TREAT AND ADVISE

→ lethargy
Look for
lethargy. →
very
 Percuss weak/not
flanks for able to
tenderness. stand.

 Fever UPPER  Give appropriate

>38°C and URINARY IM/IV
any of: TRACT antibiotics B15.
 Give appropriate oral
INFECTION
→ antimalarial F4.
Flank pain  Refer urgently to
hospital B17.
→
Burning on
urination.

 Fever MALARIA  Confirm malaria

>38°C or with parasitological
history of diagnosis
fever (in  Give appropriate oral
last 48 antimalarial F4.
hours).  If no improvement in
2 days or condition is
worse, refer to
hospital.

 Burning on LOWER  Give appropriate oral

urination. URINARY antibiotics F5.
TRACT  Encourage her to
drink more fluids.
INFECTION
 If no improvement in
2 days or condition is
worse, refer to
hospital.
Next: If fever or burning on urination

Table
Have you had fever? Do you have burning on urination?

Next: If vaginal discharge

Table
Have you noticed changes in your vaginal discharge? Do you have itching at the vulva?

Next: If signs suggesting HIV infection

Table
Have you lost weight? Have you got diarrhoea (continuous or intermittent)?

Next: If cough or breathing difficulty

Table
How long have you been coughing? How long have you had difficulty in breathing?

Next: Give preventive measures

C12. GIVE PREVENTIVE MEASURES

Advise and counsel all pregnant women at every antenatal care visit.

Table
Check tetanus toxoid (TT) immunization status. Give tetanus toxoid if due F2.

Next: If cough or breathing difficulty

C13. ADVISE AND COUNSEL ON NUTRITION AND SELF-

CARE AND SUBSTANCE ABUSE
Use the information and counselling sheet to support your interaction with the
woman, her partner and family.

Counsel on nutrition
 Advise the woman to eat a greater amount and variety of healthy foods, such
as meat, fish, oils, nuts, seeds, cereals, beans, vegetables, cheese, milk, to
 help her feel well and strong (give examples of types of food and how much
to eat).

 Spend more time on nutrition counselling with very thin, adolescent and
HIV-infected woman.

 Determine if there are important taboos about foods which are nutritionally
important for good health. Advise the woman against these taboos.

 Talk to family members such as the partner and mother-in-law, to encourage

them to help ensure the woman eats enough and avoids hard physical work.

Advise on self-care during pregnancy

Advise the woman to:

 Take iron tablets F3.

 Rest and avoid lifting heavy objects.

 Sleep under an insecticide impregnated bednet.

 Counsel on safer sex including use of condoms, if at risk for STI or HIV G2.

 Avoid alcohol and smoking during pregnancy.

 NOT to take medication unless prescribed at the health centre/hospital.

Counsel on Substance Abuse:

 Avoid tobacco use during pregnancy.

 Avoid exposure to second-hand smoke.

 Do not take any drugs or Nicotine Replacement Therapy for tobacco

cessation.

Counsel on alcohol use:

 Avoid alcohol during pregnancy.

Counsel on drug use:

 Avoid use of drugs during pregnancy.