ANTENATAL

CARE

MTHETHIWA
Comprehensive maternity care
Comprehensive maternity care comprises of
1. Preconception care
2. Antenatal care
3. Intrapartum care
4. Postnatal care
Antenatal care comprises of: Careful history taking, examination,
investigations, prophylaxis and treatments, Counseling given to the
pregnant woman at different stages of the pregnancy
Systemic supervision (examination and advice) of a
woman during pregnancy is called Antenatal care /
prenatal care.

Antenatal care refers to the care given to an expectant

mother from the time of conception until the beginning
of labour.
OBJECTIVE

To ensure a normal pregnancy with

delivery of a healthy baby from a healthy
mother
GOALS
• To reduce maternal mortality and morbidity rates
• To improve the physical and mental health of women and indeed the
entire family
• To prevent and identify maternal and fetal abnormities that can affect
pregnancy outcome
• To decrease financial burden for care of mothers especially in
developing countries
• To remove the fear about the delivery and to gain confidence before
labour
AIMS
• To screen the high risk cases
• To prevent or detect or treat any earliest complication
• To ensure continued medical surveillance and prophylaxis
• To educate the mother about the physiology of pregnancy and labour
by demonstrations, charts and diagrams so that fear is removed and
psychology is improved.
• To discuss with the couple about the place, time and mode of the
delivery, provisionally and care of the newborn
• To motivate the couple about the need of family planning
• To advice the mother about breast-feeding, postnatal care and
immunization
MODELS OF ANC
Contact vs Visit
Contact - it implies an active connection between a pregnant woman
and a health care provider that is not applied with the word ‘visit’.
Quality care including medical care, support and timely and relevant
information
In terms of the operationalization of this recommendation, ‘contact’
can take place at the facility or at community level
Contact helps to facilitate context-specific recommendations
• Interventions (such as malaria, tuberculosis)
• Health system (such as task shifting)
 Focused ANC
FANC is providing goal-oriented care that is timely, friendly,
simple, beneficial and safe to pregnant women in order to
achieve a good outcome for the mother and baby and prevent
any complications that may occur in pregnancy, labour, delivery
and postpartum
Suggested four routine visits only at different gestations with a
few evidence based diagnostic and intervention modalities
performed at each of the 4 visits
Additional visits were individualized depending on patients need
 2016 WHO ANC model

A minimum of eight contacts Is now been recommended

• Increased perinatal deaths in 4-visit ANC model
• Improved safety during pregnancy through increased frequency of maternal and fetal
assessment to detect complications
• Improved health system communication and support around pregnancy for women and
families
• More contact between pregnant women and doctor is more likely to lead to a positive
pregnancy experience
• Evidence indicates no significant differences in maternal and perinatal health outcomes
between ANC models that included at least eight contacts and ANC models that included 11
to 15 contacts.
Visit First
Up to 12 wks
Second
16 wks 20-40 wks

Activities Classification to either the basic or

Clinical exam for Hb test
specialized
Drug and substance abuse anemia Iron/FA, SP, Albendazole
Clinical exam
Gestational age; FH TT second dose
Hb test
Gestational age determination exam Instructions for birth
Blood pressure
Blood pressure planned
Weight/Height
Syphilis/STIs/HIV, Hep B Iron / FA Recommendations for
Urinalysis
supplementation lactation + contraception
ABO/RH
TTV Complete on ANC card Examine for
Iron /FA supplementation, Ca –high risk
GBV presentation(breech)
GBV
Document on ANC card SP Document on ANC card
Sp 13-16 wks
ITN
Risk factors
• Age <18 >35
• Parity >4
• Previous NND
• Height < 150cm
• Previous C/S
• Malnutrition
• Other BOH
Booking visit
Detailed evaluation through history, physical exam and
laboratory work-up as required – Based on the results further
work up and a program of care is planned on individual basis
Maternal or fetal factors that may require special care for the
specific mother are identified and noted
Subsequent visits
Are conducted based on the plans made at initial visit
Newly developing situations during follow up are also noted
and management plans modified accordingly
Approach
Booking visit
Confirm pregnancy
Discuss birth plan
Take history and do physical exam
Height and weight, MUAC, vital(BP)
Assess for anaemia
Screen for syphilis
Give tetanus toxoid vaccine, iron, folate
and albendazole
Give SP (13-16wks)
Tell her about danger signs
Counsel and educate
Investigations
FBC,
Blood group, Rhesus factor
HIV
VDRL
Hepatitis B,
Diabetes……
Urinalysis – Protein, glucose, ?infection, ?renal disease
Pelvic ultrasound scan
 Early USS
• Recommended for all pregnant women before 24 weeks
Estimates gestational age
Detects fetal anomalies
Detects multiple gestation
Enhance maternal pregnancy experience
SP -3 tabs once
TIMING OF CONTACT DOSE
1. Up to 12 wks
1a. 13-16 wks DOSE 1, additional contact
2. 20 W DOSE 2
3. 26 W DOSE 3
4. 30 W DOSE 4
5. 34 W DOSE 5
6. 36 W NO SP, if last dose less than 4
wks ago
7. 38 W DOSE 6
8. 40 W
ANC Package in Malawi
1.History taking
2.Full physical examination (on 1st visit)
3.Standard investigations:
Blood tests: FBC, syphilis & HIV
Urine tests: glucose, protein, microscopy
USS
4.Prophylaxis and treatment
– Malaria : SP, ITN
– Intestinal worms: albendazole
– Anaemia : ferrous sulphate & folate (FeFo)
– Tetanus toxoid vaccine (TTV)
 Education and counselling
Danger signs Lifestyle
Vaginal bleeding Diet and nutrition
Sleep and rest
Severe headache/blurred Exercise in pregnancy
vision/swelling/dizziness Harmful habits (e.g., smoking, drug
Convulsions abuse, alcoholism)
Effects of STIs/HIV
Labour pains before 37 weeks
Coitus
Fever in pregnancy Travelling
Early rupture of membranes Medications
All signs of labour
Barriers ANC
• Inadequate accessibility to health care facilities
• Poor female education
• Economic factors
• Lack of adequate facilities in our health institutions
• Inadequate public awareness
• Cultural practices e.g. early marriage, use of local
untrained birth attendants