By: Yohannes A.

(BSc, ESPS)

ANTENATAL CARE
OUTLINE

 Definition
 Purpose
 Components
 Objectives
 Focused ANC
 Revised 2016 WHO ANC
ANC

 Defn

 The care provided by skilled health-

care professionals to pregnant women

and adolescent girls in order to ensure

the best health conditions for both

mother and baby during pregnancy.

ANC

 The Purpose of ANC is to:

 prevent
 identify and
 treat conditions
 help a woman approach pregnancy and birth as
a positive experieces
ANC
 A positive pregnancy experience is defined as:
 maintaining physical and sociocultural normality

 maintaining a healthy pregnancy for mother and

baby (including preventing and treating risks, illness

and death)
 having

 an effective transition to positive labour and birth,

and
 achieving positive motherhood (including maternal self-
esteem, competence and autonomy)
ANC

 The components of ANC include:

 risk identification;

 prevention and management of

pregnancy-related or concurrent
diseases; and
 health education and health promotion.
ANC

 ANC reduces maternal and perinatal morbidity

and mortality both directly and indirectly.

 Globally, during the period 2007–2014,

only 64% of pregnant women attended the
WHO-recommended minimum four contacts for
ANC.
ANC

 Focused Antenatal care (FANC)

(currently FMoH working protocol)

Vs

 Revised 2016 WHO ANC

FANC

 Objectives
 help women maintain normal pregnancies

through:
1. Health promotion and disease prevention
2. Early detection and treatment of
complications and existing diseases
3. Birth preparedness and complication
readiness planning
FANC Objectives

1. Health Promotion and Disease Prevention:

 Immunization against tetanus

 Iron and folate supplementation.

 How to recognize danger signs, what to do, and

where to get help

 Voluntary counseling and testing for HIV

 The benefit of skilled attendance at birth

FANC Objectives ctd..
1. Health Promotion and Disease
Prevention:
 Breastfeeding
 Establish access to family planning
 Protection against malaria with insecticide-
treated bed nets
 Good nutrition and the importance of rest
 Protection against iodine deficiency
 Risks of using tobacco, alcohol, local
stimulants, and traditional remedies
 Hygiene and infection prevention practices
FANC Objectives ctd..

2. Early detection and treatment of

complications and existing Diseases

 History (past and present)

 General Physical Examination

FANC Objectives ctd..

3. Birth Preparedness and

Complication Readiness
 Roughly 15% of women life-threatening
cxp
 A skilled attendant at birth
 The place of birth and how to get
there
 Items needed for the birth
 Money saved to pay for supplies that
may not be provided for free
 The FANC model categorizes
pregnant women into two
groups:
1. Those eligible to receive routine
ANC (The basic component)
2. Those who need specialized care
based on their specific health
conditions or risk factors
 Sets of criteria (checklists) are used to
determine the eligibility of women for the
basic component.
 If a woman has none of the conditions listed on the

classifying form (no single yes), she is eligible to

follow the basic component
 If a woman has any one condition (>= 1 yes), she

should follow a specialized care

 If the specialized service is not available in

the facility, refer her to the next level of
care
A woman who was initially

classified to follow the basic

component may be reclassified to

follow specialized care if she

develops any of the conditions at

anytime and vise versa.

The Focused ANC Model
Classifying form
The First Visit

 Ideally should occur at GA of 8–12 weeks

(generally preferable before 16 weeks)
 expected to take 30–40 minutes

 approximately 75% of women are expected to

follow the basic component
 Only one routine vaginal examination during
pregnancy is recommended
Practical Scenarios
 What if a woman comes at a
later gestational age (e.g. 20
wks) for the first time?

 Why is vaginal examination

needed during ANC?
The First Visit

 Objectives:
 To determine patients’ medical and

obstetric history
 To do pregnancy test to those women who

come early in pregnancy

 To determine gestational age

 To provide routine Iron supplementation

The First Visit

 Objectives:
 Provide advice on signs of pregnancy-related

emergencies and how to deal with them

 To give advice on malaria prevention and if

necessary provide ITN

 To provide routine PICT

 To provide PMTCT services

 To identify and treat symptomatic STI

The First Visit

 History
1. Personal Hx
Identification
LNMP (confirm reliability), EDD
Gravidity, Parity, no of children
alive, no of abortions
Socioeconomic status
History of Female Genital Cutting
The First Visit

 History
2. Medical Hx
Current use of medicines
Blood transfusions
Operations other than caesarean
section
Specific diseases and conditions
( DM, cardiac ds, Renal ds,
hypertension….)
The First Visit
 History
3. Obstetric Hx
 Previous stillbirth or neonatal loss
 Birth weight of last baby
 Last pregnancy: hospital admission for hypertension
or pre-eclampsia/eclampsia
 Periods of exclusive breast-feeding: When? For how
long?
 Previous surgery on reproductive tract (myomectomy,
removal of septum, fistula repair, CS, repaired
ruptured uterus, cervical circlage)
 Any unexpected event (pain, vaginal bleeding, others:
specify) .
The First Visit

 Physical Examination
 Do general physical examn
 ABD- measure fundal height in cm
and record the finding on the chart
 General Gyn examn
The First Visit

 Laboratory
 U/A
 VDRL
 BG & Rh
 Hg or Hct
 S/E
 PICT
 HBsAg
 U/S
 Others as necessary when indicated
The First Visit
 Preventive supplementation
 Iron and folate supplements to all women
 one tablet of 60-mg elemental iron and 400
micrograms folate per day
 If rapid test for syphilis is positive: treat,
provide counseling on safer sex, and arrange
for her partner’s treatment and counseling
 Tetanus toxoid: give first injection
 Provide ITN (malaria endemic)
 Refer clients that need specialized care,
according to diagnosis
The First Visit

 Advice, questions and answers

 Schedule the next appointment

 Maintain complete records

The Second Visit

 Scheduled at 24-26 Weeks

 Expected to take 20 minutes

The Second Visit

 Objectives
 Address complaints and concerns

 Perform pertinent examination and

laboratory investigation
 Assess fetal well being (e.g. FHB)

 Decide on the need for referral based on

updated risk assessment

The Second Visit

 History
 Physical examination
 Uterine height in centimeters
 Auscultate for fetal heart beat
 Laboratory tests
 U/A- for urinary-tract infection
(treat if +ve)
 Repeat test for proteinuria (Nullipara,
hx of HTN, pre-eclmpsia/ eclampsia)
The Second Visit

 Laboratory tests
 All women with hypertension in the present visit
should have urine test performed to detect
proteinuria
 Repeat Hb only if Hb at first visit was below 7 gm/dl
or signs of severe anemia is present
 Indirect Coomb’s test is done if the woman is Rh-ve
 Ensure compliance to iron and folate
supplement
 Schedule next appointment
 Maintain complete records
The Third Visit

 Takes place around 30 – 32 weeks

 Expected to take 20 minutes

The Third Visit

 Objectives:
 Address complaints and concerns
 Perform pertinent examination and
laboratory investigation
 Assess for multiple pregnancy, assess fetal
well being
 Review individualized birth plan and
complication readiness
 Advice on family planning, breastfeeding
The Third Visit

 Hx
 P/E
 Measure uterine height

 Palpate abdomen for possible detection of

multiple fetuses.
 Auscultate Fetal heart beat
The Third Visit

 Lab
 Hb to all women
 U/A (UTI, proteinuria)
 Ensure compliance of iron and folate
 Tetanus toxoid injection as needed.
 Anti–D is given if the woman’s blood
group is Rhesus negative and Coomb’s
test is negative
The Third Visit

 Give advice on measures to be taken in

case labor starts
 Schedule appointment: fourth visit, at
36-38 weeks
 Maintain complete records
The Fourth Visit

 Scheduled between weeks 36 and 38

 Should be the final visit of the basic

component
The Fourth Visit

 Objectives
 Prepare women and their families for
childbirth
 Complication readiness
 Develop an emergency plan which
includes transportation, money, blood
donors, designation of a person to
make a decision on the woman’s
behalf and person to care for her
family while she is away.
The Fourth Visit

 Re-inform women and their families on

the benefits of breastfeeding and
contraception
 Perform relevant examination and
investigations
 Review special care and treatment for
HIV positive women
The Fourth Visit

 It is extremely important that women

with fetuses in breech presentation
should be discovered and external
cephalic version be considered at this
visit.
The Fourth Visit

 Hx
 P/E
 Uterine height

 Check for multiple fetuses.

 Fetal lie, presentation (head, breech,

transverse).
 Fetal heart sound(s)
The Fourth Visit

 Laboratory
 U/A (UTI, Proteinuria)
 U/Sto exclude placenta previa
 Continue Iron
 Advise
 Schedule appointment, if the woman
does not deliver by end of week 41
The Fourth Visit

 Schedule appointment for postpartum

visit.
 Provide recommendations on lactation
and contraception
 Complete the registration log book
 Women who come late (e.g. after
32 weeks) should receive all
services for previous visits and
current one as well.
 For those women who missed any
of the appointments
 Tracing mechanism should be

established
REFERENCES

 WHO ANC guideline 2016

 Management protocol on selected
obstetrics topics (FMOH)
January, 2010
THE END!