Professional Documents
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Doh - 2016-0035
Doh - 2016-0035
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SEP 19 2016
ADMINISTRATIVE ORDER
No. :lotftJ- oo-o.r
II. Objectives
This Order seeks to improve the quality of antenatal care through the provision
of technical guidance in the shift in ANC concept from the high risk approach to the
four-visit model of focused ANC and the consequent service delivery scheme of the
ANC package.
This Order shall apply to all providers of maternal and newborn care services
in the public and private sector and at all levels of the health care delivery system.
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2. High Risk ANC is a method of providing antenatal care with the objective of
classifying pregnant women as low risk or high risk based on pre-determined
criteria. This approach is hard to implement effectively since a woman may have
more than 1 risk factors and not all high risk develop complications in like manner
that some low risk women develop complications particularly during childbirth.
4. Birthing Center is a healthcare facility also known as birthing home, lying -in and
puericulture center. It can be a Rural Health Unit, Health Center, City/
Municipal/ Community/Medicare/District Hospitals that provide birthing services.
It can also be the unit in secondary and tertiary hospitals where maternity care
services are provided such as the out-patient obstetrics department, delivery room
and maternity ward. It provides antenatal care, birthing care and postnatal care. It
is staffed by doctors who are general practitioners or with specialization in
obstetrics, nurses or nurse-midwives and midwives trained on basic emergency
obstetrics and newborn care.
5. Maternal Health Services refer to a range of services that covers care during the
periods that include, but are not limited to, antenatal, delivery, and postpartum
periods. (RPRH Law IRR).
V. Guiding Principles
All health workers in Birthing Centers shall be guided by the following principles
in the provision of ANC:
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3. ANC visits provide opportunities to promote lasting health, offering benefits that
continue beyond the pregnancy period, This includes birth preparedness and
extends to cover health information and counselling for pregnant women, their
families and communities.
ANC presents the first opportunity for a woman to connect with the health
system and thus an entry point for integrated care. To ensure that women and
newborns benefit from ANC the following shall guide skilled health professionals in
the provision of antenatal care:
a. The first ANC visit shall be considered crucial for early identification of
underlying conditions such as chronic hypertension, diabetes, anemia and
the like and shall be done as early as possible preferably during the first
trimester. Likewise, this visit shall distinguish women who require the
standard 4-visit model from those requiring special attention and more
visits.
b. The last visit shall be at around the 37 weeks or near the expected date of
delivery to ensure that appropriate advice and care have been provided to
prevent and manage difficult labor and problems such as multiple births,
post-maturity and mal-presentation.
4. All pregnant women shall be required to have a written Birth Plan (contained in
Mother-Baby Book, Mother and Child Book, Rekord ni Nanay, Nanay and Baby
Book, other similar health records) at the first ANC visit. The women should
discuss and review this plan with a health worker at every ANC visit and 1 month
before the expected date of delivery. The birth center nurse or midwife shall
ensure the identification of the following elements in the plan:
5. Health professionals in birthing centers shall effectively use each visit to provide
opportunities to promote lasting health and offer benefits that continue beyond
pregnancy and delivery. Thus, each woman accessing antenatal care shall be given~
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a Mother and Child Book. The Mother and Child Book shall be used not only as a
tool to prepare for birth but also to provide information and learning about
pregnancy and child care. With the aid of the Mother and Child Book health
workers should be able to infonn, educate and give advice about-
Likewise, all essential information and birth center visit findings shall be
accurately recorded in the Mother and Child Book. The coverage of 4 or more
ANC visits disaggregated by trimester is important because the effectiveness of
certain interventions such as iron with folic acid and calcium carbonate
supplementation, tetanus toxoid vaccination and provider initiated counselling and
testing (PICT) for HIV, syphilis and hepatitis B depend on repeated visits and the
trimester in which they occur. This guides the woman and health providers as well
on actions to take.and make referrals efficient.
The Mother and Child Book is a record that should be held by the woman. The
Birthing Center nurse or midwife should instruct the woman to bring the Book
during every health center visit and at the time of delivery.
6. All birthing centers shall guarantee the provision of focused ANC by establishing
and maintaining a network of service providers (service delivery network) as
necessary to ensure that all the essential services are delivered to every pregnant
woman. The network of service providers may include hospitals, specialized
clinics such as the Social Hygiene Clinic and laboratories both in the public and
private sector.
7. All birthing center staff at each level of the health care delivery system shall
comply with the ANC goals and activities at each visit based on the 4-visit model
as applied in focused ANC:
and management for emergency signs and symptoms, give appropriate treatment
and refer to if needed.
History Assess significant Assess significant Assess significant Assess significant
(ask, check signs and symptoms signs and symptoms signs and symptoms signs and
records)
Take psychosocial, Check records for Check records for
medical and previous previous previous
obstetric history complications & complications & complications &
treatments during treatments during treatments during
the the the
Confirm pregnancy
and calculate EDD
Classify women for
basic ANC (4 visits)
or more specialized
care (in some cases,
this may come after
the tests results are
made
Examination Complete general Check for anemia Check for anemia Check for anemia
(look, listen, feel) and obstetrical and thyroid and thyroid and thyroid
examination enlargement enlargement enlargement
including nutritional
assessment:
compute for body
mass index (BMI)
and monitor weight
gain based on pre-
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~ STis using glucose
syndromic challenge test)
approach as necessary
~ Syphillis ~ Bacteriuria as
~ HIV necessary
~ Hepatitis B
(HBsAG)
~ Urinalysis for
proteinuria,
albuminuria
~ Stool
examination
~ Acetic Acid
Wash
Treatments If indicated: ~ Deworming If indicated: If indicated:
~ Syphillis If indicated: ~ ARV ~ ARV
~ ARV ~ ARV ~ Bacteriuria ~ Bacteriuria
(anteretroviral) ~ Bacteriuria ~ Anemia ~ Anemia
~ Bacteriuria ~ Anemia
};> Anemia
If indicated: If breech, do an
};> Oral curative external cephalic
services: version (ECV) or
permanent refer for ECV
filling and gum
treatment
Preventive Tetanus Toxoid Tetanus Toxoid
Measures immunization immunization
Iron with folic acid Iron with folic acid Iron with folic acid Iron with folic acid
supplementation supplementation supplementation supplementation
Calcium carbonate Calcium carbonate Calcium carbonate
Oral health check- Oral health check- Oral health check- Oral health check-
up and prophylaxis up and prophylaxis up and prophylaxis up and prophylaxis
IPTp (intermittent IPTp (intermittent IPTp (intermittent
treatment for treatment for treatment for
malaria) in endemic malaria) in endemic malaria) in endemic
areas areas areas
Health Education, Self-care Birth Plan Birth Plan Birth Plan
Advice and
Counselling
Alcohol and Reinforcement of Breastfeeding Breastfeeding
tobacco use previous advice
Nutrition Postpartum and Postpartum and
counseling and postnatal care postnatal care
supplemental including follow-up
feeding program if tetanus
appropriate immunization for
TT3 after 6 months;
after 1 year for TT4
and TT5 after
another year
Safe sex Pregnancy spacing Pregnancy spacing
Rest and sleep Reinforcement of Reinforcement of
(under ITN- previous advice previous advice
insecticide treated
bed nets in endemic
areas)
Birth Plan
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8. Where the required services are not available at the Birthing Center, e.g., HIV
testing, syphilis testing, etc., the Birthing Center head shall be responsible for
referring the woman to an appropriate facility for the tests and/or treatment and
ensure that the referral and the services required has been adequately served.
9. The result of the tests as well as the recommended medical management and
treatment shall be appropriately compiled in the Individual Record at the Birthing
Center. Relevant information shall be recorded in the Mother and Child Book for
future reference.
10. Antenatal care services as provided for in this Guideline shall be part of the
Maternity Care Package and shall be reimbursed by PhilHealth to appropriate
facility providing specific service(s).
U. The following indicators shall be the indicators for quality antenatal care and shall
be reported as part of the National Safe Motherhood Program Results Matrix
starting 2017 (Please refer to the ANC Utilization Report matrix in the attached
annex of this policy):
VII. Effectivity
J_ .
PAULYN JE~~, Secretary of Health
MPH, CESO II
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ANNEX 1
National Safe Motherhood Program
Antenatal Care (ANC) Utilization Report
Regional Health Office _ __ _
Year
PROVINCES/CHARTERED CITIES (please indicate names in the columns below)
INDICATORS Regional Average
0
Number % Number % Number % Number % Number % Number % Number /o
Total Deliveries ..
I . With written birth plan
2. With at least 4 ANC visits
3. With at least 2 tetanus toxoid
vaccination during pregnancy
4. Received IPTp (intermittent
preventive treatment) malaria during
pregnancy (jor women living in
endemic areas on~v )
5. Tested positive for HIV during
pregnancy
6. Tested positive for syphilis during
pregnancy
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?.Received treatment at: .
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a) treatment hub
b) birthing center
Submitted by:
MNCHN Coordinator
Date: _ __ __ _ _ _ _ _ _ __