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FOCUSED ANTENATAL CARE

BY DR A.K SULEIMAN

OUTLINE
INTRODUCTION

GOALS OF FOCUSED ANC SCHEDULE AND TIMING OF ANC

VISITS
CONCLUSION

INTRODUCTION
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
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

INTRODUCTION
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

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

INTRODUCTION
The new approach to ANC emphasizes

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

INTRODUCTION
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
Malaria Severe anaemia

Pre-eclampsia/eclampsia
HIV

STIS including Syphylis testing


TB-screening

Goal NO 2:Prevention
Malaria:

-IPT -ITNs TT immunization


Iron/folate supplement
Nutrition

Goal NO3: Birth preparedness and complication


readiness.
Develop individual birth plan:

Facility

or place of birth Skilled provider to attend birth Provider/facility contact information Transportation Funds Decision-Making

Family and community support Blood donor in case of emergency Needed items: for safe and clean

delivery and care of newborn

Danger signs/signs of advanced

labour

Danger signs during pregnancy


Vaginal bleeding Difficulty in breathing Fever Severe abdominal pain Severe headache/blurred vision

Convulsions/Loss of consciousness

Labour pains before 37 weeks

Goal No 4: Health education


Prevention of malaria

Nutrition Avoid potentially harmful substances


Rest and activity

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

Early and exclusive breastfeeding

Child spacing Post-natal care

Schedule and timing of ANC visits


First visit: Within 16 weeks Second visit: At 20-24 weeks Third visit: At 28-32 weeks Fourth visit: At 36 weeks or later Post-natal visit: 2 weeks after delivery

First ANC visit(within 16 weeks)


Use classifying form to obtain:
Obstetric

& medical history.

Senior registrars to classify patients.


High risk patients should be seen frequently If at anytime patient becomes high risk visits should be frequent

Contents of first visit


Demographic data Medical history Obstetric history Obstetric operations

Perinatal complications History of present pregnancy Examination


Signs

of anaemia Weight and height Blood pressure Chest and heart auscultation SFH

Investigations
Urinalysis

patients

for bacteriuria &protenuria. All

VDRL Blood

group typing (ABO and Rh)

HB

if signs of severe anaemia


screening

HIV

Interventions
FE /Folate supplement. 60mg of fe and

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


If rapid test for syphylis is +ve treat Tetanus toxoid first injection SP once in 2nd and 3rd trimester

Counselling
Practice safe sex(faithfullness /condom use) Avoid tobacco, alcohol, and other harmful

substance
Advice on where to go in case of bleeding,

abdominal pain or other emergency.


Birth plan, use of ITNs and HIV testing

Give date of next ANC visit

Complete clinic record and ANC card

2nd visit(20-24weeks )
Personal history- any change since 1st visit or

complaints
Note intercurrent disease, injury or other

condition since 1st visit


Note intake of medicines other than haematinics
Note abnormal changes in body features or

physical capacity-oedema & dyspnoea

Check up on habits eg. Smoking and

alcohol
Examination:
Blood SFH Peripheral

pressure

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

Investigations
Urinalysis for evidence of bacteriuria.
Proteinuria

if nulliparous or has high BP, PE or Eclampsia in previous pregnancy All women with hypertension in index preg be tested for proteinuria Repeat HB if sign of severe anaemia

Intervention
Haematinics

Counselling
Practice safe sex(faithfullness /condom use) Avoid tobacco, alcohol, and other harmful

substance
Advice on where to go in case of bleeding,

abdominal pain or other emergency.


Birth plan, use of ITNs and HIV testing

Give date of next ANC visit

Complete clinic record and ANC card

3rd visit (28-32wks)


Personal history- any change since 2nd visit or

complaints
Note intercurrent disease, injury or other

condition since 2nd visit


Note intake of medicines other than haematinics
Note abnormal changes in body features or

physical capacity-oedema & dyspnoea

Symptoms & events since 2nd visit


Abdominal or back pain (? Preterm labour) Bleeding Vaginal discharge(?amniotic fluid) Oedema, dyspnoea Check up on habits eg smoking and alcohol

Examination: Blood pressure

SFH
Palpate abdomen for detection of multiple fetuses Auscultate for fetal heart sounds Peripheral oedema

Investigations
Urinalysis for evidence of bacteriuria.

Proteinuria

if nulliparous or has high BP, PE or Eclampsia in previous pregnancy All women with hypertension in index preg be tested for proteinuria HB for all women

Counselling
Practice safe sex(faithfullness /condom use) Avoid tobacco, alcohol, and other harmful

substance

Advice on where to go in case of bleeding,

abdominal pain or other emergency.

Birth plan

Provide recommendation on lactation,

contraception and importance of postpartum visit

Give date of next ANC visit

Complete clinic record and ANC card

4th visit (36wks)


Personal history- any change since 3rd visit or

complaints
Note intercurrent disease, injury or other

condition since 3rd visit


Note intake of medicines other than haematinics
Note abnormal changes in body features or

physical capacity-oedema & dyspnoea

Obtain history of previous delivery

complications

Examination:

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

Investigations
Urinalysis for evidence of bacteriuria.
Proteinuria

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

All women with hypertension in index preg be tested for proteinuria

Women with breech presentation should be

evaluated for ECV


Offer information on where to go when

labour start or if there are other symptoms Birth plan


Advice if undelivered by the end of 41 wk for

hospital evaluation Ind. Of labour

Complete clinic record and

ANC card

Post partum visit


The committee recommend that this should take

place 2 weeks after delivery 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
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

The new model is not associated with increase

risk for either the woman or the fetus

It reduces the time and resources

necessary for ANC by limiting the number of visits

Thank you