GOLDEN LIGHT HEALTH INSTITUTE

PRESENTED BY SARAH MWENYA

INTRODUCTTION

 Pregnancy is one of the most important

periods in the life of a:
 woman
 family
 society.
 Extraordinary attention is therefore given
to antenatal care by the health care
systems of most countries.
 …..
 The goal of antenatal care is to:
 prevent health problems in both
 infant
 mother
 to see that each newborn child has a
good start.
 ……
 The care provided needs to be;
 appropriate
 not excessive.
 New technologies need to be:
 implemented continually
 while older services need to be
reconsidered.
 ……
 The care for each pregnant woman
needs to be:
 individualized based on her own
needs and wishes.
 …..
 GENERAL OBJECTIVE
 At the end of the lecture, students
should be able to gain knowledge
and understanding on antenatal
care.
 ……
 SPECIFIC OBJECTIVES
 At the end of the lecture, students
should be able to:
 Define antenatal care
 Outline the aims of antenatal care.
 Explain the 2016 WHO ANC model.
 Discuss the activities during antenatal
care.
 …….
 DEFINITION OF ANTENATAL CARE
 Antenatal care is:
 the supervision and management
offered to a pregnant woman from
conception upto the onset of labour
(Henderson and Macdonald, 2004).
AIMS OF ANTENATAL CARE

 Early detection of complications

and prompt treatment
 Although most pregnancies are
normal, early detection and
treatment of problems that can
complicate pregnancy is important.
 …..
 ANC promotes targeted assessment
during which the skilled provider:
 interviews
 Examines
 tests the woman
 to detect signs and symptoms of
pregnancy as well as any complications.
 ……
 Prevention of diseases and
complications
 Provision of safe, simple and cost-
effective interventions such as:
 Tetanus Toxoid immunization to
prevent tetanus.
 ….
 Prevention of diseases and
complications
 Provision of safe, simple and cost-
effective interventions such as:
 Tetanus Toxoid immunization to
prevent tetanus.
 …..
 Intermittent preventive treatment with Fansidar
and insecticide-treated bed nets for malaria
prevention.
 Intermittent Presumptive Treatment (IPT) for
hookworm infection through provision of either
albendazole or mebendazole doses.
 …..
 Birth preparedness and
complication readiness
 If a woman is well prepared for a
normal childbirth and possible
complications, she is more likely to
receive the skilled and timely care she
needs.
 …..
 This can protect the mother and the
newborn’s life.
 It allows for time to develop a birth
plan which includes making
arrangements for normal childbirth.
 …..
 Developing a birth plan
 It includes:
 The skilled provider to attend to
the woman.
 Place of birth
 …..
 Transportation of the pregnant woman
to the skilled provider.
 Funds
 Support person or birth companion.
 Items needed for a clean and safe birth
and for the newborn.
 …..
 Some arrangements in case of
complications
 Recognition and response to danger signs
 Decision-making in an emergency
situation
 Emergency funds.
 Emergency transportation.
 ……
 Health promotion 
 Throughout Antenatal care health
education and counseling are done
to make sure women are able to
take care of themselves.
 …..
 It is the duty of the skilled provider
to ensure that adequate information
is given to these mothers.
 …….
 Messages given include:
 Preparing a birth plan.
 Recognizing danger signs in
pregnancy and during childbirth.
 HIV and pregnancy
 Malaria in pregnancy
 ……
 Nutrition during pregnancy
 Activity and exercise
 Childbirth and infant nutrition
including breastfeeding and
replacement feeding
 Postnatal care and family planning
services.
2016 WHO ANC Model

 2016 WHO ANC Model is antenatal

care model with a minimum of eight
contacts recommended to reduce
perinatal mortality and improve
women’s experience of care.
 ……
 2016 WHO ANC model replaced the
WHO FOCUSED ANTENATAL CARE
(FANC) model.
 ……
 2016 WHO ANC Model was formed
based on the following reasons
 Evidence:
 suggesting increased perinatal deaths in 4-
visit ANC model
 …..
 supporting improved safety during
pregnancy through increased
frequency of maternal and fetal
assessment to detect complications
 …..
 supporting improved health system
communication and support around
pregnancy for women and families
 ……
 indicating that more contacts between
pregnant women and respectful,
knowledgeable health care workers is
more likely to lead to a positive
pregnancy experience
 ….
 from studies indicating no important
differences in maternal and perinatal
health outcomes between ANC models
that included at least eight contacts
and ANC models that included 11 to 15
contacts.
Differences between WHO focused antenatal care and 2016 WHO ANC
model

WHO FANC model 2016 WHO ANC model

 First trimester  First trimester
 Visit 1: 8-12 weeks  Contact 1: up to
12 weeks
 Second trimester  Second trimester
 Visit 2: 24-26  Contact 2: 20
weeks weeks
 Contact 3: 26
weeks
 Third trimester  Third trimester
 Visit 3: 32 weeks  Contact 4: 30 weeks
 Visit 4: 36-38 weeks  Contact 5: 34 weeks
 Contact 6: 36 weeks
 Contact 7: 38 weeks
 Contact 8: 40 weeks
 ACTIVITIES DURING ANTENATAL CARE
REGISTRATION AND BOOKING

 When the woman reports for Antenatal

Care booking, she has to be registered
for the purpose of record keeping and
documentation.
 …
 HISTORY TAKING
 The following are the preliminary points
to note during History taking:
 Prepare the necessary equipment.
 Greet the woman respectfully and introduce
yourself.
 Offer the woman a seat and ensure privacy.
 ……..
 Explain the procedure and encourage
her to ask questions.
 Get her permission before you begin
the procedure.
 Listen to what the woman has to say.
 ……
 History taking is cardinal during ANC
booking for a Nurse/Midwife to get to
know the client well.
 It is a means of assessing the health of
the woman to find out any condition
which may affect child bearing.
 ….
 The history has to be comprehensive.
 Key issues to consider in history
taking include the following;
 Biological data
 Name
 Age
 Address
 Marital status
 …
 Educational level
 Occupation
 Religion
 Contact number
 Next of kin
 …..
 Family History
 This kind of history is taken to know the genetic
predisposition to certain diseases.
 Ask the woman if there is any history of the following in
the family;
 Diabetes mellitus
 Hypertension
 Asthma
 Epilepsy
  sickle cell disease
 mental illness
 since they tend to run in families.
 Include history of pulmonary tuberculosis
contact and history of multiple pregnancies.
 ….
 Personal Medical History
 Ask the woman if she has ever suffered
from any medical condition
 Diabetes mellitus
 Hypertension
 Asthma
 Epilepsy
 …..
 In addition ask about history of
 sexually transmitted infections
 urinary tract infection
 hepatitis e.t.c.
 ….
 Former illnesses may have damaged
certain structures or organs which could
give rise to complications during
pregnancy and labour
 ….
 Surgical History:
 Ask the woman whether she has had injuries
or operations involving the
 pelvic bones
 Spine
 lower limbs.
 These could alter the pelvic diameters and
angle of inclination that may lead to cephalo-
pelvic disproportion.
 …..
 Remember to ask about history of blood
transfusion to exclude:
 iso-immunisation if the woman is rhesus negative
 ….
 Past Obstetrical History:
 Ask about:
 Parity and gravid
 Record of previous pregnancies and labour.
 Premature or post mature labour
 Spontaneous or induced
 …..
 history of instrumental deliveries
 previous obstetric Complications
 previous still births.
 …..
 Menstrual and contraceptive history
 Ask about:
 Age at menarche
 menstrual interval
 bleeding pattern
 method of contraception
 when and how long and reasons for stopping fp.
 ……
 Present obstetric History
 Ask the woman about:
 First day of the last normal menstrual period and
then calculate the gestational age of the
pregnancy and expected date of delivery.
 Fatigue
 drowsiness,
 Headaches
 ….
 sore tongue
 loss of appetite
 nausea and vomiting
 oedema.
 …
 PHYSICAL EXAMINATION
 This should be done under strict privacy.
 Tell the woman what is going to be done
and encourage her to ask questions.
 Listen to what the woman has to say.
 Prior to the physical examination as a
nurse note the following;
 …..
 Stature – If a woman has a small built she is likely
to have a small pelvis.
 Gait - As the woman walks in, observe any
deformity, stunted growth, limp e.t.c., such may
indicate disproportion in the pelvic diameters.
 ….
 A pregnant woman tilting backwards with a large
abdomen may make one suspect multiple
pregnancies or a very large foetus e.t.c.
 ..
 Height; - 150 cm or less needs special care.
 Weight:-The average weight gain during
pregnancy is about 12-14 kg in the first trimester a
woman should gain 0.4 kg per month and in the
second and third trimester she should gain 0.4 kg
per week.
 ….
 Vital signs: Blood pressure, temperature, pulse
and respiration: - Checked and recorded at each
visit,
 Urinalysis – ask the woman to pass urine and you
should perform Urinalysis.
 This should be done at every visit to rule out
proteins, sugar and acetone in urine.
 ….
 Actual examination
 It has to be done from head to toe
 Assist the woman to get onto the couch
 …..
 Wash your hands thoroughly with soap and
water and dry them, then start the
examination.
 Head – look for
 Under nourished hair
 General cleanliness
 Eyes – examine for:
 Pallor
 Jaundice on the conjunctiva by asking the woman
to look up.
 ….
 Nose – examine the nose for:
 polyps.
 Ears – examine the ears for:
 polyps
 any discharge.
 ….
 Mouth – ask the woman to open the mouth. Check for:
 signs of anaemia on the
 Lips
 mucus membranes of the mouth
 gums
 tongue.
 fissures on the tongue
 oral thrush
 sores on the tongue.
 Take note of dental caries
 …
 Glands
 palpate for enlargement of the
 peri-auricular lymph glands
 submandibular lymph glands
 cervical glands around the neck.
 Palpate the thyroid gland too.
 Ask the woman to swallow while your fingers
are lightly placed just below the larynx.
 ….
 Enlargement of gland suggest
 infections
 chronic illness
 may be to the effect of estrogen on the glands
 ….
 Hands – starting with the furthest arm,
examine the arms for
 signs of anaemia on the palms
 poor venous return on pressure of the nail beds.
 Examine for signs of oedema.
 Ask the woman to make a fist with each hand;
 a feeling of tightness in the knuckles in the absence of
pitting oedema would be suggestive of occult oedema.
 ….
 Check for any physical disability and symmetry
of the arms.
 Lastly palpate the axilla for any enlarged
lymph nodes.
 …
 Breast- examine the breast for;
 Presumptive signs of pregnancy i.e.
 Montgomery’s tubercles
 darkening of primary areola and secondary areola.
 ……
 Suitability for breast feeding – this is more
significant in primigravidae.
 Expression of fluid shows that the ducts are
patent.
 Presences of clear fluid, milky fluid, colostrum, are
presumptive signs of pregnancy.
 Lumps or swelling in the breast.
 ….
 Lower limbs - starting with the furthest leg:
 Examine the legs for:
 signs of anaemia on the soles
 poor venous return on pressure of the nail beds.
 …
 Examine for signs of tibial, pedal and ankle
oedema.
 Check for any physical disability and symmetry of
the arms.
 Also check for varicose veins and calf pain.
 …..
 Abdominal examination
 Inspection
 Shape:-Note the contour of the abdomen -is it
round, oval, irregular or pendulous?
 Size:- Should correspond with the supposed
period of gestation
 Skin: - check for dark line of pigmentation (linea
nigra), Straegravidarum, Scar - Any operation
scar(c/s) and any skin lesions.
 …..
 Palpation
 Height of Fundus to determine the how old the
pregnancy is.
 Fundal Palpation to determine lie and
presentation.
 ...
 Lateral Palpation to determine the lie, attitude and
position
 deep pelvic Palpation to determine the
Presentation.
 Auscultation:
 Listen to the Foetal heart rate and rhythm
 count for one complete minute to ascertain
regularity.
 …
 LABORATORY TESTS
 Urine; Midstream urine culture is the
recommended method for diagnosing
asymptomatic bacteriuria (ASB) in pregnancy.
 Urine can also be used to assess for presence of
proteins in urine
 ….
 Blood Tests: Collect blood samples for
 RPR
 HIV
 Haemoglobin
 Rhesus
 blood grouping.
 An ultrasound scan before 24 weeks’ gestation is
recommended for all pregnant women to:
 estimate gestational age
 detect fetal anomalies and multiple pregnancies
 enhance the maternal pregnancy experience
 ….
 Malaria parasite to rule malaria if patient
presents with signs and symptoms of malaria
 ….
 TREATMENT
 The following are the drugs given to the
pregnant woman;
 Intermittent Presumptive Treatment:
 Three doses of Fansidar (SP) to be given at 1st,
2nd, and 3rd visit to prevent malaria in pregnancy
and/or treat asymptomatic malaria.
 The SP is to be taken by the woman under direct
observation by the Nurse.
 ….
 Tetanus toxoid injection to be given up to 4th
dose to prevent adult/neonatal tetanus.
 Mebendazole 500 mg per oral stat is given for
deworming.
 This is given as a single dose with a minimum
gestational age of 20 weeks.
 ….
 Daily doses of ferrous sulphate 200mg and
Folic acid 5 mg to prevent and correct iron
deficiency anaemia and folic acid deficiency
anaemia.
INFORMATION EDUCATION AND COMMUNICATION (IEC)

 Give IEC on;

 Nutrition in pregnancy
 Hygiene in pregnancy
 Danger signs in pregnancy
 Minor disorders in pregnancy
 Birth preparedness and complication readiness,
 …
 Malaria in pregnancy
 PPTCT
 Importance of ANC
 Signs of true labour
 Family planning
 Birth registration
 Child immunization
 …
 RECORDING OF FINDINGS
 Record or enter all the information gathered
and the care provided on
 the Antenatal Card
 Safe Motherhood Register.
 …..
 SUMMARY
 Antenatal care, also known as prenatal care, is the
complex of interventions that a pregnant woman
receives from organized health care services.
 The number of different interventions in antenatal
care is large.
 These interventions may be provided in
approximately 8 antenatal care contacts during a
pregnancy.
 ….
 The purpose of antenatal care is to prevent or
identify and treat conditions that may
threaten the health of the fetus/newborn
and/or the mother, and to help a woman
approach pregnancy and birth as positive
experiences.
 …
 To a large extent antenatal care can contribute
greatly to this purpose and can in particular
help provide a good start for the newborn
child.
 ……
• REFERENCES
• The Society of Obstetricians and Gynaecologists of Canada. The Menopause Handbook.
February 2006. Available at www.sogc.org
• MayoClinic.com. Menopause: Definition. Accessed August 2, 2010. Available at
www.mayoclinic.com/health/ menopause/DS00119
• MayoClinic.com. Menopause: Causes. Accessed August 2, 2010. Available at
www.mayoclinic.com/health/ menopause/DS00119/DSECTION=causes
• MayoClinic.com. Menopause: Complications. Accessed August 2, 2010. Available at
www.mayoclinic.com/ health/menopause/DS00119/DSECTION=complications
• MayoClinic.com. Menopause: Treatments and Drugs. Accessed August 2, 2010. Available at
www.mayoclinic. com/health/menopause/DS00119/DSECTION=treatments and drugs
• U.S. Department of Health and Human Services, Office on Women’s Health. Understanding
Menopause. Accessed August 2, 2010. Available at www.womenshealth.gov/menopause/
• MayoClinic.com. Menopause: Lifestyle and Home Remedies. Accessed August 2, 2010.
Available at www. mayoclinic.com/health/menopause/DS00119/DSECTION=lifestyle and
home remedies
 ….

• End of lecture