FOCUSED ANTENATAL CARE

BY DR A.K SULEIMAN

OUTLINE
y INTRODUCTION y GOALS OF FOCUSED ANC y SCHEDULE AND TIMING OF ANC

VISITS
y CONCLUSION

INTRODUCTION
y Antenatal care, the care a woman

receives throughout her pregnancy, is important in helping to ensure that women and newborns survive pregnancy and childbirth

INTRODUCTION
y The traditional approach to antenatal

care, which is based on European models developed in the early 1900s, assumes that more is better in care for pregnant women. Frequent routine visits are the norm, and women are classified by risk category to determine their chances of complications and the level of care they need

programs are poorly implemented and do little to promote the health of mothers and newborns y Until recently. Too often. many of the components of antenatal care had not been rigorously evaluated. examinations.INTRODUCTION y Traditionally. Now the World Health Organization (WHO) has developed a focused ANC package that includes only counseling. and tests that serve immediate purposes and have proven health benefit . antenatal care (ANC) programs have mirrored those in developed countries.

INTRODUCTION y The new approach to ANC emphasizes the quality of care rather than the quantity. For normal pregnancies WHO recommends only four antenatal visits .

goal-directed actions Family ±centered care Quality. rather than quantity of visits & Care by skilled providers. .INTRODUCTION Focused ANC is an approach to ANC that emphasizes: Evidence ±based .

Goals of Focus ANC To promote maternal and newborn health and survival through:  Early detection and treatment of problems and complication  Prevention of complications and diseases  Birth preparedness and complication readiness  Health promotion .

Goal NO 1:Early detection and treatment of conditions y Malaria y Severe anaemia y Pre-eclampsia/eclampsia y HIV y STI¶S including Syphylis ±testing y TB-screening .

Goal NO 2:Prevention y Malaria: -IPT -ITNs y TT immunization y Iron/folate supplement y Nutrition .

y Develop individual birth plan: Facility or place of birth Skilled provider to attend birth Provider/facility contact information Transportation Funds Decision-Making .Goal NO3: Birth preparedness and complication readiness.

y Family and community support y Blood donor in case of emergency y Needed items: for safe and clean delivery and care of newborn y Danger signs/signs of advanced labour .

Danger signs during pregnancy y Vaginal bleeding y Difficulty in breathing y Fever y Severe abdominal pain y Severe headache/blurred vision .

y Convulsions/Loss of consciousness y Labour pains before 37 weeks .

Goal No 4: Health education y Prevention of malaria y Nutrition y Avoid potentially harmful substances y Rest and activity .

y Prevention of tetanus and anaemia y HIV/AIDS prevention and care y Sexual relations and safer sex y Importance of delivery by skilled attendant .

y Early and exclusive breastfeeding y Child spacing y Post-natal care .

Schedule and timing of ANC visits y First visit: Within 16 weeks y Second visit: At 20-24 weeks y Third visit: At 28-32 weeks y Fourth visit: At 36 weeks or later y Post-natal visit: 2 weeks after delivery .

High risk patients should be seen frequently If at anytime patient becomes high risk visits should be frequent - - . Senior registrars to classify patients.First ANC visit(within 16 weeks) y Use classifying form to obtain: Obstetric - & medical history.

Contents of first visit y Demographic data y Medical history y Obstetric history y Obstetric operations .

y Perinatal complications y History of present pregnancy y Examination  Signs of anaemia  Weight and height  Blood pressure  Chest and heart auscultation  SFH .

y Investigations  Urinalysis for bacteriuria &protenuria. All patients  VDRL  Blood  HB group typing (ABO and Rh) if signs of severe anaemia screening  HIV .

60mg of fe and 250mcg folate.Interventions y FE /Folate supplement. HB <7gm/dl double dose y If rapid test for syphylis is +ve treat y Tetanus toxoid first injection y SP once in 2nd and 3rd trimester .

alcohol. abdominal pain or other emergency.Counselling y Practice safe sex(faithfullness /condom use) y Avoid tobacco. use of ITNs and HIV testing . and other harmful substance y Advice on where to go in case of bleeding. y Birth plan.

y Give date of next ANC visit y Complete clinic record and ANC card .

2nd visit(20-24weeks ) y Personal history.any change since 1st visit or complaints y Note intercurrent disease. injury or other condition since 1st visit y Note intake of medicines other than haematinics y Note abnormal changes in body features or physical capacity-oedema & dyspnoea .

y Check up on habits eg. Smoking and alcohol y Examination: Blood SFH Peripheral pressure oedema V/E only if not done at 1st visit .

PE or Eclampsia in previous pregnancy All women with hypertension in index preg be tested for proteinuria Repeat HB if sign of severe anaemia ‡ ‡ .  Proteinuria if nulliparous or has high BP.Investigations y Urinalysis for evidence of bacteriuria.

Intervention y Haematinics .

y Birth plan. abdominal pain or other emergency. and other harmful substance y Advice on where to go in case of bleeding. alcohol. use of ITNs and HIV testing .Counselling y Practice safe sex(faithfullness /condom use) y Avoid tobacco.

y Give date of next ANC visit y Complete clinic record and ANC card .

3rd visit (28-32wks) y Personal history.any change since 2nd visit or complaints y Note intercurrent disease. injury or other condition since 2nd visit y Note intake of medicines other than haematinics y Note abnormal changes in body features or physical capacity-oedema & dyspnoea .

Symptoms & events since 2nd visit y Abdominal or back pain (? Preterm labour) y Bleeding y Vaginal discharge(?amniotic fluid) y Oedema. dyspnoea y Check up on habits eg smoking and alcohol .

y Examination:  Blood pressure  SFH Palpate abdomen for detection of multiple fetuses Auscultate for fetal heart sounds Peripheral oedema    .

PE or Eclampsia in previous pregnancy All women with hypertension in index preg be tested for proteinuria HB for all women ‡ ‡ .Investigations y Urinalysis for evidence of bacteriuria.  Proteinuria if nulliparous or has high BP.

Counselling y Practice safe sex(faithfullness /condom use) y Avoid tobacco. and other harmful substance y Advice on where to go in case of bleeding. abdominal pain or other emergency. y Birth plan . alcohol.

y Provide recommendation on lactation. contraception and importance of postpartum visit .

y Give date of next ANC visit y Complete clinic record and ANC card .

injury or other condition since 3rd visit y Note intake of medicines other than haematinics y Note abnormal changes in body features or physical capacity-oedema & dyspnoea .4th visit (36wks) y Personal history.any change since 3rd visit or complaints y Note intercurrent disease.

y Obtain history of previous delivery complications .

y Examination:       Blood pressure SFH Palpate abdomen for detection of multiple fetuses Fetal lie and presentation Aucultate for fetal heart sounds Peripheral oedema .

 Proteinuria if nulliparous or has high BP.Investigations y Urinalysis for evidence of bacteriuria. PE or Eclampsia in previous pregnancy ‡ All women with hypertension in index preg be tested for proteinuria .

Of labour .y Women with breech presentation should be evaluated for ECV y Offer information on where to go when labour start or if there are other symptoms y Birth plan y Advice if undelivered by the end of 41 wk for hospital evaluation ± Ind.

yComplete clinic record and ANC card .

Post partum visit y The committee recommend that this should take place 2 weeks after delivery y Activities:  Advice on prevention of unplanned pregnancy  Reinforcement of breast feeding  Complete TT immunization for late attendants to ANC .

Continue iron & folate supplement Planned any continued surveillance if required .

Conclusion y The result of the WHO randomized trial & review of scientific evidence on ANC models with reduced number of visits justifies the introduction of the new WHO model for general use. including in Family Medicine y The new model is not associated with increase risk for either the woman or the fetus .

y It reduces the time and resources necessary for ANC by limiting the number of visits .

Thank you .