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: Over

Essential Health Sector Interventions for

Safe Motherhood

Essential Obstetric Care

Postpartum Care

Clean/safe Delivery

Antenatal Care

Postabortion

Family Planning

SAFE
MOTHERHOOD

BASIC HEALTH SERVICES

EQUITY
EMOTIONAL AND PSYCHOLOGICAL
SUPPORT

Antenatal Care: Over

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: Over

What is Effective ANC?

Care from a skilled attendant and continuity of care

Preparation for birth and potential complications

Promoting health and preventing disease

Detection of existing diseases and treatment

Tetanus toxoid, nutritional supplementation, tobacco and

alcohol use, etc
HIV, syphilis, tuberculosis, other co-existing medical
diseases (e.g., hypertension, diabetes)

Early detection and management of complications

Antenatal Care: Over

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

Fortney 1995; Yuster 1995.

Antenatal Care: Over

Goal-Directed Interventions Give a

Framework for Effective ANC

Disease detection

Counseling and health promotion

Birth preparedness

Complication readiness

Antenatal Care: Over

Goal-Directed Components of ANC:

Disease Detection

Look for problems requiring additional care

Parameter
Skin, general appearance, night
blindness, goiter
Temperature, dysuria
Blood pressure, edema, proteinuria,
reflexes
Hemoglobin, conjunctiva/palms/
tongue pallor
Breast exam
Babys movements, fundal height,
babys heart beat
Pelvic and speculum exam

Condition
Malnutrition
Signs of infection
Signs of pre-eclampsia
Signs of anemia
Breast disease
Fetal distress/demise
Sexually transmitted diseases

Antenatal Care: Over

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: Over

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: Over

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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: Over

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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: Over

12

Summary
Antenatal care includes goal-directed interventions

Skilled attendant

Preparation for birth and complications

Health promotion

Detection of complications

Antenatal Care: Over

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References
Fortney J. 1995. Antenatal risk screening and scoring: a new look.
Int J Gynecol Obstet 50(Suppl 2): S53S58.
Yuster EA. 1995. Rethinking the role of the risk approach and
antenatal care in maternal mortality reduction. Int J Gynecol
Obstet 50(Suppl 2): S59S61.

Antenatal Care: Over

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