ANTENATAL CARE

General Objective

To enhance the knowledge, attitude and practice of midwives on FOCUSED ANTENATAL CARE

Specific Objectives

• To demonstrate how to make an immediate general

assessment of the pregnant woman

• To apply the process flow of providing antenatal

care.

• To discuss the importance of a birth and

emergency plan

Objectives of Prenatal Care

To detect diseases which

may complicate

pregnancy

Educate women on

danger and emergency

signs & symptoms

Prepare the woman and

her family for childbirth

Steps to Follow in Prenatal Care

1) IMMEDIATE ASSESSMENT for emergency signs.

Unconscious/Convulsing

Vaginal bleeding

Severe abdominal pain

Looks very ill

Severe headache with visual disturbance

Severe difficulty in breathing

Dangerous Fever

Severe vomiting* Attend to sick woman quickly.

Steps to Follow in Prenatal CareSteps to Follow in Prenatal Care

2) Make the woman

comfortable.Greet her, make sure she is comfortable and

ask how she is feeling.

If first visit, register the woman and issue a

Mother and Child Book (antenatal record

form)

Steps to Follow in Prenatal Care 3) Assess the pregnant womanFIRST visit:

How old is patient? Past Medical HistoryObstetric History: Gravidity? LMP? AOG? Alcohol/Drug/substance abuse?Ask about or check record for prior pregnancies:

ConvulsionsStillbirth or death in the first dayHeavy bleeding during or after deliveryPrior cesarean section, forceps or abortion

Steps to Follow in Prenatal Care3) Assess the pregnant woman

ON ALL VISITS:

Check duration of pregnancy (AOG).Ask for bleeding/danger signs during this pregnancyCheck record for previous treatments received during this pregnancyPrepare birth and emergency planAsk patient if she has other concernsGive education and counseling on family planning and breastfeeding

Steps to Follow in Prenatal Care 3) Assess the pregnant woman

THIRD TRIMESTER1. Leopold’s exam, fetal heart beat2. Give education & counseling on

family planning

Do not perform vaginal exam as a routine prenatal care procedure. Always record findings. All pregnancies are at risk. Encourage all pregnant

women to deliver in the health facility.Refer patients with abnormal findings to higher facility.

4) Get baseline laboratory information of the woman on the first or following the first visit.

Hemoglobin, blood typeUrinalysisVDRL or RPR to screen for syphilis

If not available, refer to the nearest RHU or hospital for the tests.

Steps to Follow in Prenatal Care

5) Check for pallor or anemia.

Ask about getting tired easily or shortness of breath during routine work.

On 1st visit, check hemoglobin & blood type. The normal hemoglobin cut-off level for a pregnant woman is 11g/dl.

On subsequent visits: Look for conjunctival pallor. Look for palmar pallor. Count number of breaths in one

minute.

Steps to Follow in Prenatal Care

6) Check for hypertension/ pre-eclampsia.

Measure BP in sitting position.

If diastolic BP is 90 mm Hg or higher repeat measurement after 1 hour rest.

If diastolic BP is still 90 mm Hg or higher ask the woman if she has:

• Severe headache• Blurred vison • Epigastric pain

Check urine for protein.

Steps to Follow in Prenatal Care

7) Check for gestational diabetes.

ASK ABOUT Family history of diabetes

& history of obesity. Past pregnancy for difficult

labor, large babies, congenital malformations and previous unexplained fetal death.

LOOK FOR signs of maternal

overweight or obesity Polyhydramnios Signs of large baby or fetal

abnormality Vaginal infection.

Low Risk: 24-28 wksHigh Risk: Immediately, any AOG

Steps to Follow in Prenatal Care

8) Check for fever, burning sensation on urination and abnormal vaginal

discharge.

Ask about episodes of fever or chills and take temperature.

Ask about pain or burning sensation on urination.

Ask about presence of abnormal vaginal discharge, itching at the vulva or if partner has a urinary problem.

Steps to Follow in Prenatal Care

9) Immunize against tetanus.Tetanus Toxoid Immunization Schedule

Vaccine Minimum Interval Duration of Protection

TT1 at first contact with woman 15-49 yrs or at first ANC visit NIL – no protection

TT2 at least 4 weeks after TT1 •Infants born to the mother will be protected from neonatal tetanus•3 years of protection for the mother

TT3 at least 6 months after TT2 •Infants born to the mother will be protected from neonatal tetanus•5 years of protection for the mother

TT4 at least 1 year after TT3 •Infants born to the mother will be protected from neonatal tetanus•10 years of protection for the mother

TT5 at least 1 year after TT4 •Infants born to the mother will be protected from neonatal tetanus•Lifetime protection for the mother

Steps to Follow in Prenatal Care

Steps to Follow in Prenatal Care

10) Give MEBENDAZOLE to treat for intestinal parasites.

500 mg single dose once in six months (after the 1st trimester)

11) Give iron and folate supplementation to prevent anemia and neural tube defects:

60 mg Fe & 250 mcg Folate If Hgb <80 gm/dl→ double the dose

12) Refer for preventive intermittent treatment for falcifarum malaria (if area is endemic)

Steps to Follow in Prenatal Care

13) Provide health information, advice

HEALTH INFORMATION:1.Nutrition2.Self-care during pregnancy3.Effect of tobacco, alcohol &

drugs4.Breastfeeding5.Birth & Emergency situations 6.Schedule of appointment

Steps to Follow in Prenatal Care14) Advise on Danger Signs

1. Vaginal bleeding2. Convulsions3. Severe headache4. Severe abdominal pain5. Fast or difficult breathing6. Fever or burning urination

Steps to Follow in Prenatal Care

15) Encourage the woman to come

back for return visits.

At least 4 routine antenatal visits

1st visit: before 4 months

2nd visit: 6 months

3rd visit: 8 months

4th visit: 9 months – return if

undelivered within 2 weeks after the

EDC.

Pregnant women who do not come for

prenatal care should be visited at home.

The Birth Plan

A written document prepared during the first prenatal consultation

Discussed with the patient and her family

May change anytime during pregnancy if a problem is detected.

The Birth Plan

Contains information on:

the woman’s condition during pregnancy preferences for her place of delivery and

choice of birth attendant available resources for her childbirth and

newborn baby preparations needed should an emergency

situation arise during pregnancy, childbirth and postpartum.

Emergency Plan

Advise on danger signsWhere to go? How to go?Who will go with you to health center?How much will it cost? Who will pay? How will you pay? Start saving for these possible costs now. Who will care for your home and other children when you are away?

BIRTH

and

EMERGENCY

PLAN

ANTENATAL CARE: Key Messages

Reduced number of visits Provided by skilled birth attendantScreening and prevention of diseases that

may complicate pregnancyPreventive Measures: Tetanus immunization,

iron and folic acid supplementationCounseling on family planning, nutrition,

breastfeeding, and danger signsBIRTH PLAN: Birth preparedness and

complication readiness

Because Giving birth should be about giving life not giving up a life.