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FOCUSED ANTENATAL CARE

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R ÔNTRODUCTÔON

R GOALS OF FOCUSED ANC

R SCHEDULE AND TÔ ÔNG OF ANC


VÔSÔTS

R CONCLUSÔON
ÔNTRODUCTÔON

R Antenatal care, the care a woman


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

R 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
ÔNTRODUCTÔON

R Traditionally, antenatal care (ANC) programs have


mirrored those in developed countries. Too often,
programs are poorly implemented and do little to
promote the health of mothers and newborns

R Until recently, many of the components of antenatal


care had not been rigorously evaluated. Now the
World Health Organization (WHO) has developed a
focused ANC package that includes only counseling,
examinations, and tests that serve immediate
purposes and have proven health benefit
ÔNTRODUCTÔON

R The new approach to ANC emphasizes


the quality of care rather than the
quantity. For normal pregnancies WHO
recommends only four antenatal visits
ÔNTRODUCTÔON

Focused ANC is an approach to ANC that emphasizes:

‰ Evidence ±based , goal-directed actions

‰ Family ±centered care

‰ Quality, rather than quantity of visits &

‰ Care by skilled providers.


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

R alaria
R Severe anaemia
R Pre-eclampsia/eclampsia
R HÔV
R STÔS including Syphylis ±testing
R TB-screening
Goal NO 2:Prevention

R alaria:
-ÔPT
-ÔTNs
R TT immunization

R Ôron/folate supplement

R Nutrition
Goal NO3: Birth preparedness and complication
readiness.

R Develop individual birth plan:

†Facilityor place of birth


†Skilled provider to attend birth

†Provider/facility contact information

†Transportation

†Funds

†Decision- aking
R Family and community support

R Blood donor in case of emergency

R Needed items: for safe and clean


delivery and care of newborn

R Danger signs/signs of advanced


labour
Danger signs during pregnancy

R Vaginal bleeding

R Difficulty in breathing

R Fever

R Severe abdominal pain

R Severe headache/blurred vision


R Convulsions/Loss of consciousness

R Labour pains before 37 weeks


Goal No 4: Health education

R Prevention of malaria

R Nutrition

R Avoid potentially harmful substances

R Rest and activity


R Prevention of tetanus and anaemia

R HÔV/AÔDS prevention and care

R Sexual relations and safer sex

R Ômportance of delivery by skilled attendant


R Early and exclusive breastfeeding

R Child spacing

R Post-natal care
Schedule and timing of ANC visits

R First visit: Within 16 weeks

R Second visit: At 20-24 weeks

R Third visit: At 28-32 weeks

R Fourth visit: At 36 weeks or later

R Post-natal visit: 2 weeks after delivery


First ANC visit(within 16 weeks)

R Use classifying form to obtain:


ùObstetric & medical history.

- Senior registrars to classify patients.

- High risk patients should be seen frequently

- Ôf at anytime patient becomes high risk visits


should be frequent
Contents of first visit

R Demographic data

R edical history

R Obstetric history

R Obstetric operations
R Perinatal complications

R History of present pregnancy

R Examination
† Signsof anaemia
† Weight and height

† Blood pressure

† Chest and heart auscultation

† SFH
R Ônvestigations
† Urinalysis for bacteriuria &protenuria. All
patients

† VDRL

† Blood group typing (ABO and Rh)

† HB if signs of severe anaemia

† HÔV screening
Ônterventions

R FE /Folate supplement. 60mg of fe and


250mcg folate. HB <7gm/dl double dose

R Ôf rapid test for syphylis is +ve treat

R Tetanus toxoid first injection

R SP once in 2nd and 3rd trimester


Counselling

R Practice safe sex(faithfullness /condom use)

R Avoid tobacco, alcohol, and other harmful


substance

R Advice on where to go in case of bleeding,


abdominal pain or other emergency.

R Birth plan, use of ÔTNs and HÔV testing


R Give date of next ANC visit

R Complete clinic record and ANC card


2nd visit(20-24weeks )

R Personal history- any change since 1st visit or


complaints

R Note intercurrent disease, injury or other


condition since 1st visit

R Note intake of medicines other than haematinics

R Note abnormal changes in body features or


physical capacity-oedema & dyspnoea
R Check up on habits eg. Smoking and
alcohol

R Examination:
†Blood pressure
†SFH

†Peripheral oedema
†V/E only if not done at 1st visit
Ônvestigations

R Urinalysis for evidence of bacteriuria.


† Proteinuria if nulliparous or has high BP,
PE or Eclampsia in previous pregnancy

ƒ All women with hypertension in index preg


be tested for proteinuria

ƒ Repeat HB if sign of severe anaemia


Ôntervention

R Haematinics
Counselling

R Practice safe sex(faithfullness /condom use)

R Avoid tobacco, alcohol, and other harmful


substance

R Advice on where to go in case of bleeding,


abdominal pain or other emergency.

R Birth plan, use of ÔTNs and HÔV testing


R Give date of next ANC visit

R Complete clinic record and ANC card


3rd visit (28-32wks)

R Personal history- any change since 2nd visit or


complaints

R Note intercurrent disease, injury or other


condition since 2nd visit

R Note intake of medicines other than haematinics

R Note abnormal changes in body features or


physical capacity-oedema & dyspnoea
Symptoms & events since 2nd visit

R Abdominal or back pain (? Preterm labour)

R Bleeding

R Vaginal discharge(?amniotic fluid)

R Oedema, dyspnoea
R Check up on habits eg smoking and alcohol
R Examination:
† Blood pressure

† SFH

† Palpate abdomen for detection of multiple fetuses

† Auscultate for fetal heart sounds

† Peripheral oedema
Ônvestigations

R Urinalysis for evidence of bacteriuria.


† Proteinuria if nulliparous or has high
BP, PE or Eclampsia in previous
pregnancy

ƒ All women with hypertension in index


preg be tested for proteinuria

ƒ HB for all women


Counselling

R Practice safe sex(faithfullness /condom use)

R Avoid tobacco, alcohol, and other harmful


substance

R Advice on where to go in case of bleeding,


abdominal pain or other emergency.

R Birth plan
R Provide recommendation on lactation,
contraception and importance of
postpartum visit
R Give date of next ANC visit

R Complete clinic record and ANC card


4th visit (36wks)

R Personal history- any change since 3rd visit or


complaints

R Note intercurrent disease, injury or other


condition since 3rd visit

R Note intake of medicines other than haematinics

R Note abnormal changes in body features or


physical capacity-oedema & dyspnoea
R Obtain history of previous delivery
complications
R Examination:
† Blood pressure

† SFH

† Palpate abdomen for detection of multiple fetuses

† Fetal lie and presentation

† Aucultate for fetal heart sounds

† Peripheral oedema
Ônvestigations

R Urinalysis for evidence of bacteriuria.


† Proteinuria if nulliparous or has high BP, PE
or Eclampsia in previous pregnancy

ƒ All women with hypertension in index preg be


tested for proteinuria
R Women with breech presentation should be
evaluated for ECV

R Offer information on where to go when


labour start or if there are other symptoms
R Birth plan

R Advice if undelivered by the end of 41 wk for


hospital evaluation ± Ônd. Of labour
RComplete clinic record and
ANC card
Post partum visit

R The committee recommend that this should take


place 2 weeks after delivery
R 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

R 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 edicine

R The new model is not associated with increase


risk for either the woman or the fetus
R Ôt reduces the time and resources
necessary for ANC by limiting the
number of visits
Thank you