TECHNICAL NOTES

Keyword : antenatal care, pregnancy, grup care, model of care, connecting pregnancy,
perinatal outcomes, health services, pregnancy outcome, prenatanal care

Bagaimana pelaksanaan 1. Routine antenatal care in later pregnancy is

Antenatal Care di negara – geared towards the detection of problems
negara berkembang requiring specialist input and the reassurance
that pregnancy is progressing well when no
problems are identified. This review follows on
from ‘routine antenatal management at the
booking clinic’, and assesses the specific tasks
and investigations that are routine for all women
in later pregnancy. (Shaw & Kean, 2016)
2. Antenatal care can play an important role in
preparing women for birth. This study shows
that information about birth provided during
pregnancy is insufficient from women's
perspective, although some groups of women do
report being more satisfied with this
information. The way that this segment of
antenatal care is provided leaves room for
improvement. (Gottfredsdottir, Steingrímsdóttir,
Björnsdóttir, Gudmundsdóttir, & Kristjánsdóttir,
2016)
3. There is need for the Nigerian government to
prioritize its activities to encourage and ensure
that women within the childbearing age are fully
vaccinated with the tetanus toxoid, that pregnant
women receive quality ANC services and
deliver in functional hospitals. (Saleh, Nemecek,
& Jones, 2015)
Bagaimana model pelaksanaan 4. Group antenatal care, in the form of Pregnancy
Antenatal Care yang Circles, is acceptable to women and appears to
enhance their experiences of pregnancy. Further
direkomendasikan work needs to be done both to test the findings
in larger, quantitative studies and to find a
model of care that is acceptable to women and
their partners. (Hunter et al., 2018)
5. Application of the Betty Neuman systems model
in the nursing care of patients/clients with
multiple sclerosis. (Zakieh Ahmadi and
Tabandeh Sadeghi.,2017)
6. In Journal of Midwifery, group antenatal care
model (Pregnancy Circles) has a significant
change in antenatal care, it requires adequate
managerial support in increasing capacity which
is essential for success. This finding has been
used to inform the development of the
upcoming pilot experiment. Overall, midwives
gain a sense of accomplishment and job
satisfaction when providing gANC, and assume
that it empowers women and improves care.
(Hunter et al., 2018)
7. Individual midwives adopted practices
according to their own perceptions of actions
and behaviors that were considered to be in
accordance with the philosophy of woman-
centred care. Information arising from this study
has shown ways midwives may arrange
antenatal care consultations to maximize
women’s participation. (Wright, Pincombe, &
McKellar, 2018)
8. In Journal BMC Pregnancy and Childbirth,
Antenatal care trial interventions: a systematic
scoping review and taxonomy development of
care models. (Symon et al., 2017)
9. Description of implementation activities of the
multicomponent, community-wide initiatives of
 the Teenage Pregnancy Prevention Program
initiated in 2010 by the Office of Adolescent
Health and the Centers for Disease Control and
Prevention. (Approach et al., 2017) (Hindin et
al., 2016)
Bagaimana screening penyakit 10. Several risk factors identified in this review are
penyerta kehamilan detectable in routine prenatal care visits (e.g.
previous pregnancy loss, pregnancy
complications), potentially modifiable (e.g.
coping styles, social support, partner factors)
and can be identified prior to pregnancy (e.g.
psychosocial factors), underlining the
significance of pre-conception mental health
screening. (Bayrampour et al., 2018)
11. Appropriate health technology should be
effective, safe and feasible. Interventions of
proven benefits in eliminating or alleviating
adverse maternal outcomes include routine iron
and folate supplementation in areas of high
anemia prevalence, hemoglobin determination
late in pregnancy, screening for asymptomatic
bacteriuria by urine culture or dipstick,
serologic screening and treatment of syphilis,
obtaining a history of difficult labor in multipara
or height in nullipara and external cephalic
version at term. Interventions of proven benefits
in eliminating or alleviating adverse newborn
outcomes include routine measurement of
fundal height, reduction of maternal physical
strain, diagnosis and treatment of tuberculosis,
malaria prophylaxis, adequate tetanus
immunization, antenatal and perinatal
Zidovudine in HIV-positive mothers and one
 vaginal examination during pregnancy. Only
these interventions of proven benefits should be
implemented. Q 1998 International Federation
of Gynecology and Obstetrics. (Gruden, Webb,
& Warnock, 1994)
12. Most women (96%) perceived they should be
asked about each of the risk factors at least
once. Women are willing to be asked about risk
factors; however this process is time-
consuming. Strategies to streamline visits and
prioritise recommendations so time-efficient yet
comprehensive care can be delivered are
needed, particularly when factors require
monitoring over time and for those who may be
‘at-risk’ for multiple factors. (Waller et al.,
2018)
13. Routine antenatal care in later pregnancy is
geared towards the detection of problems
requiring specialist input and the reassurance
that pregnancy is progressing well when no
problems are identified. This review follows on
from ‘routine antenatal management at the
booking clinic’, and assesses the specific tasks
and investigations that are routine for all women
in later pregnancy.(Shaw & Kean, 2016)

Apakah hambatan pelaksanaan 14. Vulnerable clients, specifically those with

Antenatal Care psychosocial problems, present a challenge in
111 perinatal healthcare. Negative appraisal of
care might be an unavoidable drawback of 112
adhering to sARM. It also stresses the need for
improving caregiver-client expectations and 113
system side improvements. (de Groot, Bijma,
 Bonsel, & Lambregtse-van den Berg, 2018)
15. Infant mortality has shown a steady decline in
recent years but a marked socioeconomic
gradient persists. Antenatal care is generally
thought to be an effective method of improving
pregnancy outcomes. (Hollowell, Oakley,
Kurinczuk, Brocklehurst, & Gray, 2011)
16. In Journal Social Science and Medicine,
Cultural practices and social norms will
influence antenatal care visits. (Adjiwanou &
LeGrand, 2013).
17. Adolescent pregnancy, particularly unintended
pregnancy, can have lasting social, economic,
and health outcomes. The objective of this
review is to identify high-quality interventions
and evaluations to decrease unintended and
repeat pregnancy among young people in low-
and middle-income countries. (Hindin et al.,
2016)

Bagaimana evaluasi Pelaksanaan 18. Insufficient evidence of adequate quality to

Antenatal Care recommend routine implementation of any of
the programmes as a means of reducing infant
mortality in disadvantaged/vulnerable women.
Several interventions merit further more
rigorous evaluation. (Hollowell et al., 2011)
19. Governments and NGOs should place more
importance on the role of antenatal care
providers and on the services they offer, in
efforts to promote skilled birth attendance.
(Adjiwanou & LeGrand, 2013)
20. Antenatal education that needs to be improved
is information about labor, breastfeeding,
depression and emotional well-being, and caring
 for the baby. (Thomson, Dykes, Singh, Cawley,
& Dey, 2013)
21. The risk of neonatal early-onset neonatal
healthcare associated infection was significantly
associated with insufficient number of antenatal
care visits. Further studies assessing the quality
of antenatal care and targeting its improvement
are warranted. (Mizumoto et al., 2015)
22. Saunders's seven-step method was used for the
development of a programme implementation
monitoring plan, with specific attention to the
setting and context of the programme. Data
were triangulated from multiple sources, and
prespecified criteria were applied to examine the
evidence for implementation. A process
evaluation of implementation of a complex
intervention is possible. The results can be used
to improve understanding of the associations
between specific programme elements and
programme outcomes on effectiveness of the
intervention.(Vos et al., 2017)

Adjiwanou, V., & LeGrand, T. (2013). Does antenatal care matter in the use of skilled birth
attendance in rural Africa: A multi-country analysis. Social Science and Medicine, 86,
26–34. https://doi.org/10.1016/j.socscimed.2013.02.047

Approach, C., Mueller, T., H, M. P., Tevendale, H. D., Ph, D., Fuller, T. R., … H, M. P.
(2017). Teen Pregnancy Prevention : Implementation of a. Journal of Adolescent Health,
60(3), S9–S17. https://doi.org/10.1016/j.jadohealth.2016.11.002

Bayrampour, H., Vinturache, A., Hetherington, E., Diane, L., Tough, S., Bayrampour, H., …
Diane, L. (2018). Risk factors for antenatal anxiety : A systematic review of the
literature literature. Journal of Reproductive and Infant Psychology, 00(00), 1–28.
https://doi.org/10.1080/02646838.2018.1492097
de Groot, N., Bijma, H. H., Bonsel, G. J., & Lambregtse-van den Berg, M. P. (2018). The
role of structured Antenatal Risk Management (sARM) on experiences with antenatal
care by vulnerable clients. Midwifery, 67, 39–45.
https://doi.org/10.1016/j.midw.2018.09.003

Gottfredsdottir, H., Steingrímsdóttir, P., Björnsdóttir, A., Gudmundsdóttir, E. Ý., &

Kristjánsdóttir, H. (2016). Content of antenatal care: Does it prepare women for birth?
Midwifery, 39, 71–77. https://doi.org/10.1016/j.midw.2016.05.002

Gruden, J. F., Webb, W. R., & Warnock, M. (1994). Centrilobular opacities in the lung on
high-resolution CT: Diagnostic considerations and pathologic correlation. Appropriate
Technology: Antenatal Care, 162(3), 569–574.
https://doi.org/10.2214/ajr.162.3.8109498

Hindin, M. I. to P. U. and R. P. A. Y. P. in L. M.-I. C. : A. S. R. of the P. and G. L., Ph, D.,

Kalamar, A. M., Ph, D., Thompson, T., Ph, D., … Ph, D. (2016). Interventions to
Prevent Unintended and Repeat Pregnancy Among Young People in Low- and Middle-
Income Countries: Journal of Adolescent Health, 59(3), S8–S15.
https://doi.org/10.1016/j.jadohealth.2016.04.021

Hollowell, J., Oakley, L., Kurinczuk, J. J., Brocklehurst, P., & Gray, R. (2011). The
effectiveness of antenatal care programmes to reduce infant mortality and preterm birth
in socially disadvantaged and vulnerable women in high-income countries : a systematic
review. BMC Pregnancy and Childbirth, 11(1), 13. https://doi.org/10.1186/1471-2393-
11-13

Hunter, L. J., Da Motta, G., McCourt, C., Wiseman, O., Rayment, J. L., Haora, P., …
Harden, A. (2018). Better together: A qualitative exploration of women’s perceptions
and experiences of group antenatal care. Women and Birth, 1–10.
https://doi.org/10.1016/j.wombi.2018.09.001

Mizumoto, B. R., Moreira, B. M., Santoro-Lopes, G., Cunha, A. J., dos Santos, R. M. R.,
Pessoa-Silva, C. L., … Hofer, C. B. (2015). Quality of antenatal care as a risk factor for
early onset neonatal infections in Rio de Janeiro, Brazil. Brazilian Journal of Infectious
Diseases, 19(3), 272–277. https://doi.org/10.1016/j.bjid.2015.02.003

Saleh, J.-E. A., Nemecek, J., & Jones, C. (2015). Antenatal care services and neonatal
tetanus: An outlook at the northeastern Nigeria. Pediatric Infectious Disease, 7(1), 3–7.
 https://doi.org/10.1007/s10750-010-0171-5

Shaw, L. E., & Kean, L. H. (2016). Routine antenatal management later in pregnancy.
Obstetrics, Gynaecology and Reproductive Medicine, 26(9), 265–270.
https://doi.org/10.1016/j.ogrm.2016.06.004

Symon, A., Pringle, J., Downe, S., Hundley, V., Lee, E., Lynn, F., … Alderdice, F. (2017).
Antenatal care trial interventions : a systematic scoping review and taxonomy
development of care models. BMC Pregnancy and Childbirth, 1–16.
https://doi.org/10.1186/s12884-016-1186-3

Thomson, G., Dykes, F., Singh, G., Cawley, L., & Dey, P. (2013). A public health
perspective of women’s experiences of antenatal care: An exploration of insights from a
community consultation. Midwifery, 29(3), 211–216.
https://doi.org/10.1016/j.midw.2012.01.002

Vos, A. A., van Voorst, S. F., Posthumus, A. G., Waelput, A. J. M., Denktaş, S., & Steegers,
E. A. P. (2017). Process evaluation of the implementation of scorecard-based antenatal
risk assessment, care pathways and interdisciplinary consultation: the Healthy
Pregnancy 4 All study. Public Health, 150, 112–120.
https://doi.org/10.1016/j.puhe.2017.05.010

Waller, A., Bryant, J., Cameron, E., Galal, M., Symonds, I., & Sanson-Fisher, R. (2018).
Screening for recommended antenatal risk factors: How long does it take? Women and
Birth, (2017), 1–7. https://doi.org/10.1016/j.wombi.2018.01.005

Wright, D., Pincombe, J., & McKellar, L. (2018). Exploring routine hospital antenatal care
consultations — An ethnographic study. Women and Birth, 31(3), e162–e169.
https://doi.org/10.1016/j.wombi.2017.09.010