1 Antenatal Care
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Transcript of 1 Antenatal Care
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