Antenatal Care (ANC): Overview

Advances in Maternal and Neonatal Health

 Session Objectives

 Describe the purpose of antenatal care and its role in

relationship to Safe Motherhood initiatives
 Define current issues related to providing effective antenatal
care

Antenatal Care: Overview 2

Essential Health Sector Interventions for
Safe Motherhood
SAFE
MOTHERHOOD

Clean/safe Delivery

Essential Obstetric Care

Postpartum Care
Family Planning

Antenatal Care
Postabortion

BASIC HEALTH SERVICES

EQUITY

EMOTIONAL AND PSYCHOLOGICAL

SUPPORT
Antenatal Care: Overview 3
 Objectives of ANC

 Promote and maintain the physical, mental and social health of

mother and baby by providing education on nutrition, personal
hygiene and birthing process
 Detect and manage complications during pregnancy, whether
medical, surgical or obstetrical
 Develop birth preparedness and complication readiness plan
 Help prepare mother to breastfeed successfully, experience
normal puerperium, and take good care of the child physically,
psychologically and socially

Antenatal Care: Overview 4

 What is Effective ANC?

 Care from a skilled attendant and continuity of care

 Preparation for birth and potential complications
 Promoting health and preventing disease
 Tetanus toxoid, nutritional supplementation, tobacco and
alcohol use, etc
 Detection of existing diseases and treatment
 HIV, syphilis, tuberculosis, other co-existing medical
diseases (e.g., hypertension, diabetes)
 Early detection and management of complications

Antenatal Care: Overview 5

 Why Disease Detection and Not Risk
Assessment
 Risk approach is not an efficient or effective strategy for
maternal mortality reduction:
 “Risk factors” cannot predict complications: usually not
direct cause of complication
 What do you do once you identify risks? What about “low
risk?”
 Maternal mortality is relatively rare in population at risk (all
women of reproductive age); “risk factors” are relatively
common in same population, these “risk factors” do not
appear to be good indicators of which women will
experience complications
 Majority of women who experienced complication were
considered “low risk;” vast majority of women considered
to be “high risk” gave birth without experiencing a
complication
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Fortney 1995; Yuster 1995.
 Goal-Directed Interventions Give a
Framework for Effective ANC

 Disease detection
 Counseling and health promotion
 Birth preparedness
 Complication readiness

Antenatal Care: Overview 7

 Goal-Directed Components of ANC:
Disease Detection
 Look for problems requiring additional care
Parameter Condition
Skin, general appearance, night Malnutrition
blindness, goiter
Temperature, dysuria Signs of infection
Blood pressure, edema, proteinuria, Signs of pre-eclampsia
reflexes
Hemoglobin, conjunctiva/palms/ Signs of anemia
tongue pallor
Breast exam Breast disease
Baby’s movements, fundal height, Fetal distress/demise
baby’s heart beat
Pelvic and speculum exam Sexually transmitted diseases

Antenatal Care: Overview 8

 Goal-Directed Components of ANC:
Counseling and Health Promotion

 Client-centered and gestational age-specific counseling for

women and partners/ supporters on:
 Nutrition and micronutrients
 Rest and avoidance of heavy physical work
 Danger signals of complications and disease/illness
 Family planning
 Breastfeeding
 Malaria prophylaxis
 Tobacco and alcohol use

Antenatal Care: Overview 9

 Goal-Directed Components of ANC:
Birth Preparedness

 Make plans for the birth:

 Prepare the necessary items for birth
 Identify a skilled attendant and arrange for presence at
birth
 Identify appropriate site for birth, and how to get there
 Identify support people, including who will accompany the
woman and who will take care of the family
 Establish a financing plan/scheme

Antenatal Care: Overview 10

 Goal-Directed Components of ANC:
Complication Readiness
15% of all pregnant women develop a life-threatening complication
requiring obstetric care
 Establish a financing plan/scheme
 Make a plan for decision-making
 Arrange a system of transport
 Establish a plan for blood donation

Antenatal Care: Overview 11

 Goal-Directed ANC

 Goal-directed interventions
 Increasing use of systematic review of evidence to evaluate
effectiveness of interventions
 This effort is now underway and is ongoing

Antenatal Care: Overview 12

 Summary

Antenatal care includes goal-directed interventions

 Skilled attendant
 Preparation for birth and complications
 Health promotion
 Detection of complications

Antenatal Care: Overview 13

 References

Fortney J. 1995. Antenatal risk screening and scoring: a new look.

Int J Gynecol Obstet 50(Suppl 2): S53–S58.
Yuster EA. 1995. Rethinking the role of the risk approach and
antenatal care in maternal mortality reduction. Int J Gynecol
Obstet 50(Suppl 2): S59–S61.

Antenatal Care: Overview 14