ANC

(ANTENATAL CARE)
 INTRODUCTION
 ANC simply means care of the woman during
pregnancy
 Aim - healthy mother healthy child at the end of
pregnancy
 Ideally it begins with conception and continues
throughout pregnancy
 OBJECTIVES
 To promote, protect and maintain the health of
the mother during pregnancy
 To detect ‘high risk’ cases and give them special
attention
 To foresee complications and prevent them
 To remove anxiety and dread associated with
pregnancy
 To reduce maternal and infant mortality and morbidity

 To teach the mother elements of child care, nutrition,

personal hygiene and environmental sanitation

 To sensitize the mother to the need for family planning,

including advice to cases seeking medical termination of
pregnancy; and

 To attend to the under-fives accompanying the mother

These objectives are achieved
under the following:
 Antenatal visits
 Prenatal advice
 Specific health protection
 Mental preparation
 Family planning
 Paediatric component
 ANTENATAL VISITS
Ideally the antenatal clinic
attendance should be
Once a month during first
7 months
Twice during the next
month
Once a week thereafter (if
everything is normal)
 So, minimum of 4 visits
targeted
 1st visit as soon as the pregnancy is suspected,
(within 12 weeks) - registration & first antenatal
check up
 2nd visit between 14 and 26 weeks
 3rd visit between 28-34 weeks
 4th visit between 36 weeks and term
 Preventive services provided for
mother in these visits

 First visit: -History taking- past, present, EDD,

symptoms, Drug history etc

 Physical examination: weight (gain 2kg every month 9-

11kg in 9months), Height, BP (Pre eclampsia:

140mmHg or more for systolic, diastolic from 90mmHg

or more and urine albumin +2), Pallor for anaemia,

pulse, RR, Oedema (appears in evening and disappears

in morning is normal), breast examination- inverted or

flat
 Abdominal examination: Fundal height, 12 weeks- pubic
symphysis, 24 weeks at umbilicus, 36 weeks at
xiphisternum
 Fundal grip, lateral grip, 1st pelvic grip (4th leopold,
pawlicks grip, to see the engagement of the head), 2nd
pelvic grip
 foetal heart sound heard at 6th month (normal rate is 120-
140 per min), foetal movements felt at 18-22 weeks, foetal
parts felt at 22nd week. After 28th week it is possible to
distinguish the head and limbs, foetal lie and presentation
is relevant only after 32weeks of pregnancy.
 Assessment of the gestation age: USG, LMP and
EDD Naegles formula
Laboratory examinations:
1. ABO Blood grouping and Rh typing
2. Hb examination, RBS
3. Complete Urine Analysis (Sugar, Protein,
casts, pus)
4. VDRL/RPR
5. HIV testing
6. Rapid malaria test
7. Hepatitis B HBsAg
 On subsequent visits:
 Physical examination (e.g., weight gain, blood
pressure)
 Laboratory tests should include:
1. Urine examination
2. Haemoglobin estimation
3. VDRL
 Iron and folic acid supplementation and medication as
needed
 Immunization against tetanus
 Groups of individual instruction on nutrition, family
planning, self care, delivery and parenthood

 Home visiting by female health worker/trained dais

 Referral services wherever necessary

 Inform the women about JSY and other incentives

offered by the government
Iron supplementation tablet Pregnancy test kit
 ANC Visits
 Central purpose of ANC – to identify “high risk”
cases, as early as possible &
 To arrange for them skilled care, while continuing to
provide appropriate care for all other mothers
 High risk cases include:
1. Elderly primi (30 yrs & over)
2. Short statured (140 cm & below)
3. Malpresentations, viz breech, transverse lie, etc.
4. Ante partum haemorrhage, threatened abortion
5. Pre-eclampsia & eclampsia

6. Anaemia

7. Twins, hydramnios

8. Previous still-birth, intrauterine death, manual

removal of placenta

9. Elderly grandmultiparas ( above 4 full term

pregnancy bringing forth viable foetus though it
may be still birth child)
10. Prolonged pregnancy (14 days after EDD)

11. H/o previous CS or instrumental delivery

12. Pregnancy associated with general diseases, viz.

cardiovascular disease, kidney disease, diabetes,
TB, liver diseases, etc.
 Maintenance of records
 ‘Antenatal card’(Mother and child protection card)
is prepared at the first examination
 It contains : registration number
identifying data
previous health history
main health events
 Maintenance of records is essential for evaluation
and further improvement of MCH/FP services
Antenatal check up card
 Home visits
 Backbone of all MCH services
 At least one home visit by LHV or public health nurse
 More visits if delivery planned at home
 Why home visits?
 Mother is generally relaxed at home
 Home visit by health personnel will win her confidence
 Home visit provide an opportunity to observe the
environment and social conditions at home
 An opportunity to give prenatal advice
 PRENATAL ADVICE
 A major component of ANC

 Why now?- mother is more perceptive to advice

 ‘Talking points’ cover specific problems during

pregnancy as well as family and health care

 As such topics covered are - Diet, personal hygiene,

drugs, radiation, warning signs, child care
 Diet
 During pregnancy, an additional 350 kcal/day-
required and lactation- an additional of 600 kcal/day
required for 1st 6 months
 Proper diet required for -
 maintenance of maternal health
 need of the growing fetus
 strength and vitality required during labour
 successful lactation
 Ideally diet should be light, easily digestible,
nutritious- rich in proteins, vitamins, minerals
 Additional food- at least ½ liters of milk, plenty of
green leafy vegetables and fruits
 Salt to taste
 Majority of fat- animal origin rich in vitamin A and D
 Instruction about diet should be reasonable and
realistic to the women
 Adequate intake of nutrition – so that net gain during
whole pregnancy is 9-11 kg in total
 Personal Hygiene
 Personal cleanliness: bathe and clean clothes

 Rest and sleep: 8 hrs night sleep and 2 hrs during day
after lunch

 Avoid constipation by regular intake of green leafy

vegetables, fruits and plenty of fluids

 Exercise: only light household work advice

 Smoking and alcohol intake: should be avoided

 Dental care: oral hygiene

 Coital practices: should be restricted especially during

last trimester
 Drugs
 Drug use is discouraged unless absolutely
indicated
 Some drugs have teratogenic effects e.g.
thalidomide.
 During lactation precautions should be taken
 Radiation
 Exposure to radiation during pregnancy should be
avoided
 Most common source-X-rays
 Danger to developing fetus- leukaemia,
microcephaly, neoplasms
 X-ray done for specific indications; dose kept to
minimum
 In women expecting pregnancy, elective X-ray
Should be avoided two weeks before menstrual cycle
 Warning Signs
Mother to be given clear cut instructions to report
immediately in case of the following:
1. Swelling of the feet
2. Fits
3. Headache
4. Blurring of vision
5. Bleeding or discharge per vagina
6. Any other unusual symptom
 Child Care
 For these mother attending ANC clinics- special
classes are held

 Mother craft education- nutrition education, advice on

hygiene and child bearing, cooking demonstrations,
family planning education, etc.
SPECIFIC HEALTH PROTECTION

 Anaemia
 Nutritional deficiencies
 Toxaemias of pregnancy
 Tetanus
 Syphilis
 German measles
 HIV infection
 Rh status
 Prenatal genetic screening
 Hepatitis b infection
 Anaemia:
 major cause being iron and folic acid deficiency
 anaemia as such associated with high incidence of
premature births, peurpural sepsis, etc.
 IFA tabs-1 tab daily for 180 days containing 100mg
of elemental iron and 500mcg of folic acid-given free
of cost through ANCs, primary health centers and sub
centers, advised after food
 not given in first trimester especially
 Iron demand of foetus increased in 2nd trimester
 Food items inhibiting iron absorption: calcium,
tannins in tea, phytates, oxalates or tea after 3 hours
(gastric emptying time)
 Iron absorption enhanced by Vitamin C
 Other nutritional deficiencies:
 in some MCH centers- fresh milk given free of cost
 vitamin A and D capsules also given free of cost
 Toxaemias of pregnancy:
 indication - albumin presence in urine and increase
blood pressure
 early detection for early management and referrals
reduces the risk
 Tetanus:
 2 doses of TT: 1st dose and 2nd dose 4 weeks apart
 for an already immunized person-only booster dose is
given
 Syphilis:
 Cause spontaneous abortion, still birth, Perinatal
death, birth with congenital syphilis
 Vertical transmission seen → Neurological damage,
mental retardation
 So VDRL done to detect the case in ANC
 Congenital syphilis prevented by 10 injections of procaine penicillin
(600,000 units) in positive cases (given to mother)
 German measles:

 if contracted during first 16 weeks of pregnancy-foetal

death; survives, then congenital heart diseases, deafness
and cataract

 prevent infection- mass vaccination

 Rh Status:

 complication when mother is Rh-ve and foetus is

Rh+ve; can lead to foetal haemolysis

 routine procedure to test in early pregnancy

 HIV Infection:
• Prenatal testing of HIV infection is done to prevent
mother to child transmission
 Prenatal genetic screening:
• Screening for chromosomal abnormalities
• Universal genetic screening is generally not
indicated
• Performed in pregnancy for direct evidence of
structural abnormalities-to make the option of
abortion available
MENTAL PREPAREDNESS
 Sufficient time and opportunity must be given to the
expectant mothers to have free and frank talk on all
aspects of pregnancy and delivery

 Removes fear about confinement

 The ‘mothercraft’ classes at the MCH centers help a

great deal
 FAMILY PLANNING
Mother more receptive
to advice than other
times

Educational and
motivational efforts
must be initiated
Mother craft classes by health
workers
 PAEDIATRIC COMPONENT

 Suggested that a Pediatrician should be in

attendance at all antenatal clinics to pay
attention to the under-fives accompanying the
mothers
THANK
YOU