ANTENATAL CARE

General Objective• To provide QUALITY 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

Session I Objectives of Prenatal Care

Specific Objective:

To know the importance of prenatal care.

Objectives of Prenatal Care

Detection of diseases

which may complicate

pregnancy

Education of women on

danger and emergency

signs & symptoms

Preparation of the

woman and her family

for childbirth

Session 2 Steps to Follow in Prenatal Care

Specific Objective:

To apply the process flow of providing antenatal care

Steps to Follow in Prenatal Care1) IMMEDIATE ASSESSMENT for emergency signs.

Unconscious/Convulsing

Vaginal bleeding

Severe abdominal pain

Looks very ill

Severe headache with visual disturbance

Severe difficulty in breathing

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.

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

FIRST visit:How old is patient? History of alcohol use? Drug/substance abuse?Past Medical HistoryObstetric History: Gravidity? LMP? AOG? 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 Care Steps to Follow in Prenatal Care 3) Assess the pregnant woman3) Assess the pregnant woman

ON ALL VISITS:

Check duration of pregnancy.

Ask for bleeding/danger signs during this pregnancy

Check record for previous treatments received during this pregnancy

Prepare birth and emergency plan

Ask patient if she has other concerns

Give education and counseling on family planning

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

THIRD TRIMESTER

1. Leopold’s exam, fetal heart beat

2. 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 type

Urinalysis

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

Steps to Follow in Prenatal Care

5) Check for gestational diabetes.ASK ABOUT

– Family history (first degree) 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

6) 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. If pallor: Is it

severe pallor? Some pallor?• Count number of breaths in one

minute.

Steps to Follow in Prenatal Care

7) 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

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.

11) Give iron and folate supplementation to

prevent anemia and neural tube defects:

60 mg Fe & 250 mcg Folate If Hgb <70 gm/dl→ double the dose

12) Give preventive intermittent treatment for

falcifarum malaria (if area is endemic)

13) Give Vitamin A.

Steps to Follow in Prenatal Care

14) Provide health information, advice. Counsel on danger signals

DANGER SIGNS1. Vaginal bleeding2. Convulsions3. Severe headache4. Severe abdominal pain5. Fast or difficult breathing6. Fever or burning urination

HEALTH INFORMATION:HEALTH INFORMATION:1.1. NutritionNutrition2.2. Self-care during Self-care during

pregnancypregnancy3.3. Effect of tobacco, alcohol Effect of tobacco, alcohol

& drugs& drugs4.4. BreastfeedingBreastfeeding5.5. Birth & Emergency Birth & Emergency

situations situations 6.6. Schedule of appointmentSchedule of appointment

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.

Session 3Birth and Emergency Plan

Specific Objective:

To discuss the importance of a birth and emergency plan

What is a Birth Plan

• A document prepared during prenatal care

– 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 PlanAdvise 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?

Specific Objectives

To demonstrate how to make an immediate general

assessment of the pregnant woman

To explain the process flow of providing antenatal

care.

To apply procedures and skills necessary during

antenatal care correctly

To provide QUALITY ANTENATAL CARE