ANTENATAL CARE

General Objective
• To provide QUALITY ANTENATAL CARE.

Specific Objectives
To demonstrate how to make an immediate
general assessment of the pregnant woman

To apply the process flow of providing

antenatal care.

To discuss the importance of a birth and

emergency plan
Session I
Objectives of Prenatal Care

Specific Objective:
To know the importance of
prenatal care.
Objectives of Prenatal Care
Detection of diseases
which may complicate
pregnancy

Education of women on
danger and emergency
signs & symptoms

Preparation of the
woman and her family
for childbirth
Session 2
Steps to Follow in Prenatal Care
Specific Objective:
To apply the process flow of providing
antenatal care
 Steps to Follow in Prenatal Care
1) IMMEDIATE ASSESSMENT for emergency signs.
Unconscious/Convulsing
Vaginal bleeding
Severe abdominal pain
Looks very ill
Severe headache with visual disturbance
Severe difficulty in breathing
Fever
Severe vomiting
* Attend to sick woman quickly.
Steps to Follow in Prenatal Care

2) Make the woman comfortable.

Greet her, make sure she is comfortable
and ask how she is feeling.

If first visit, register the woman and issue

a Mother and Child Book.
Steps to Follow in Prenatal Care
3) Assess the pregnant woman
FIRST visit:
How old is patient? History of alcohol use?
Drug/substance abuse?
Past Medical History
Obstetric History: Gravidity? LMP? AOG?
Ask about or check record for prior
pregnancies:
Convulsions
Stillbirth or death in the first day
Heavy bleeding during or after delivery
Prior cesarean section, forceps or abortion
Steps to Follow in Prenatal Care
3) Assess the pregnant woman
ON ALL VISITS:
Check duration of pregnancy.
Ask for bleeding/danger signs during this
pregnancy
Check record for previous treatments received
during this pregnancy
Prepare birth and emergency plan
Ask patient if she has other concerns
Give education and counseling on family
planning
Steps to Follow in Prenatal Care
3) Assess the pregnant woman
THIRD TRIMESTER
1. Leopold’s exam, fetal heart beat
2. Give education & counseling on
family planning

Do not perform vaginal exam as a routine

prenatal care procedure.
Always record findings.
All pregnancies are at risk. Encourage all pregnant
women to deliver in the health facility.
Refer patients with abnormal findings to higher facility.
Steps to Follow in Prenatal Care

4) Get baseline laboratory information of

the woman on the first or following
the first visit.

Hemoglobin, blood type

Urinalysis

 If not available, refer to the nearest

RHU or hospital for the tests.
 Steps to Follow in Prenatal Care
5) Check for gestational diabetes.
ASK ABOUT
– Family history (first degree) of
diabetes & history of obesity.
– Past pregnancy for difficult
labor, large babies, congenital
malformations and previous
unexplained fetal death.

LOOK FOR
– signs of maternal overweight
or obesity
– Polyhydramnios Low Risk:
– Signs of large baby or fetal 24-28 wks
abnormality High Risk:
– Vaginal infection. Immediately,
any AOG
Steps to Follow in Prenatal Care

6) Check for pallor or anemia.

Ask about getting tired easily or

shortness of breath during routine
work.

On 1st visit, check hemoglobin &

blood type. The normal
hemoglobin cut-off level for a
pregnant woman is 11g/dl.

On subsequent visits;
• Look for conjunctival pallor.
• Look for palmar pallor. If pallor: Is it
severe pallor? Some pallor?
• Count number of breaths in one
minute.
Steps to Follow in Prenatal Care

7) Check for hypertension/ pre-eclampsia.

Measure BP in sitting position.

If diastolic BP is 90 mm Hg or higher
repeat measurement after 1 hour
rest.

If diastolic BP is still 90 mm Hg or
higher ask the woman if she has:
• Severe headache
• Blurred vison
• Epigastric pain

Check urine for protein.

Steps to Follow in Prenatal Care

8) Check for fever, burning sensation on

urination and abnormal vaginal discharge.
• Ask about episodes of fever or chills and
take temperature.

• Ask about pain or burning sensation on

urination.

• Ask about presence of abnormal vaginal

discharge, itching at the vulva or if
partner has a urinary problem.
Steps to Follow in Prenatal Care

9) Immunize against tetanus.

Tetanus Toxoid Immunization Schedule

Vaccine Minimum Interval Duration of Protection

TT1 at first contact with woman

15-49 yrs or at first ANC NIL – no protection
visit

TT2 at least 4 weeks after TT1 •Infants born to the mother will be
protected from neonatal tetanus
•3 years of protection for the mother
TT3 at least 6 months after TT2 •Infants born to the mother will be
protected from neonatal tetanus
•5 years of protection for the mother
TT4 at least 1 year after TT3 •Infants born to the mother will be
protected from neonatal tetanus
•10 years of protection for the mother
TT5 at least 1 year after TT4 •Infants born to the mother will be
protected from neonatal tetanus
•Lifetime protection for the mother
Steps to Follow in Prenatal Care

10) Give MEBENDAZOLE to treat for intestinal

parasites.
11) Give iron and folate supplementation to
prevent anemia and neural tube defects:
60 mg Fe & 250 mcg Folate
If Hgb <70 gm/dl→ double the dose
12) Give preventive intermittent treatment for
falcifarum malaria (if area is endemic)
13) Give Vitamin A.
Steps to Follow in Prenatal Care
14) Provide health information, advice.
Counsel on danger signals
HEALTH INFORMATION:
1. Nutrition
2. Self-care during
pregnancy
3. Effect of tobacco, alcohol
& drugs
4. Breastfeeding
5. Birth & Emergency
situations
6. Schedule of appointment
DANGER SIGNS
1. Vaginal bleeding
2. Convulsions
3. Severe headache
4. Severe abdominal pain
5. Fast or difficult breathing
6. Fever or burning
urination
Steps to Follow in Prenatal Care

15) Encourage the woman to come back for

return visits.
At least 4 routine antenatal visits
1st visit: before 4 months
2nd visit: 6 months
3rd visit: 8 months
4th visit: 9 months – return if undelivered within
2 weeks after the EDC.
Pregnant women who do not come for prenatal care
should be visited at home.
Session 3
Birth and Emergency Plan

Specific Objective:
To discuss the importance of a
birth and emergency plan
 What is a Birth Plan
• A document prepared during prenatal
care
– the woman’s condition during pregnancy
– preferences for her place of delivery and
choice of birth attendant
– available resources for her childbirth and
newborn baby
– preparations needed should an emergency
situation arise during pregnancy, childbirth
and postpartum.
 Emergency Plan
Advise on danger signs
Where to go?
How to go?
Who will go with you to health center?
How much will it cost? Who will pay?
How will you pay?
Start saving for these possible costs
now.
Who will care for your home and other
children when you are away?
Specific Objectives
To demonstrate how to make an immediate general
assessment of the pregnant woman

To explain the process flow of providing antenatal

care.

To apply procedures and skills necessary during

antenatal care correctly

To provide QUALITY ANTENATAL CARE