Focused Antenatal Care

BYDR A.K SULEIMAN

FOCUSED ANTENATAL CARE

OUTLINE

INTRODUCTION

GOALS OF FOCUSED ANC

SCHEDULE AND TIMING OF ANC VISITS

CONCLUSION

INTRODUCTION

Antenatal care, the care a woman receives throughout her pregnancy, is important in helping to ensure that women and newborns survive pregnancy and childbirth

INTRODUCTION

The traditional approach to antenatal care, which is based on European models developed in the early 1900s, assumes that more is better in care for pregnant women. Frequent routine visits are the norm, and women are classified by risk category to determine their chances of complications and the level of care they need

INTRODUCTION

Traditionally, antenatal care (ANC) programs have mirrored those in developed countries. Too often, programs are poorly implemented and do little to promote the health of mothers and newborns

Until recently, many of the components of antenatal care had not been rigorously evaluated. Now the World Health Organization (WHO) has developed a focused ANC package that includes only counseling, examinations, and tests that serve immediate purposes and have proven health benefit

INTRODUCTION

The new approach to ANC emphasizes the quality of care rather than the quantity. For normal pregnancies WHO recommends only four antenatal visits

INTRODUCTION

Focused ANC is an approach to ANC that emphasizes:

Evidence –based , goal-directed actions

Family –centered care

Quality, rather than quantity of visits &

Care by skilled providers.

Goals of Focus ANC

To promote maternal and newborn health and survival through:

Early detection and treatment of problems and complication

Prevention of complications and diseases

Birth preparedness and complication readiness

Health promotion

Goal NO 1:Early detection and treatment of conditions

Malaria Severe anaemiaPre-eclampsia/eclampsiaHIVSTI’S including Syphylis –testing

TB-screening

Goal NO 2:Prevention

Malaria: -IPT

-ITNs TT immunization

Iron/folate supplement

Nutrition

Goal NO3: Birth preparedness and complication readiness.

Develop individual birth plan:

Facility or place of birthSkilled provider to attend birthProvider/facility contact information

TransportationFunds Decision-Making

Family and community support

Blood donor in case of emergency

Needed items: for safe and clean delivery and care of newborn

Danger signs/signs of advanced labour

Danger signs during pregnancy

Vaginal bleeding

Difficulty in breathing

Fever

Severe abdominal pain

Severe headache/blurred vision

Convulsions/Loss of consciousness

Labour pains before 37 weeks

Goal No 4: Health education

Prevention of malaria

Nutrition

Avoid potentially harmful substances

Rest and activity

Prevention of tetanus and anaemia

HIV/AIDS prevention and care

Sexual relations and safer sex

Importance of delivery by skilled attendant

Early and exclusive breastfeeding

Child spacing

Post-natal care

Schedule and timing of ANC visits

First visit: Within 16 weeks

Second visit: At 20-24 weeks

Third visit: At 28-32 weeks

Fourth visit: At 36 weeks or later

Post-natal visit: 2 weeks after delivery

First ANC visit(within 16 weeks)

Use classifying form to obtain: Obstetric & medical history.

- Senior registrars to classify patients.

- High risk patients should be seen frequently

- If at anytime patient becomes high risk visits should be frequent

Contents of first visit

Demographic data

Medical history

Obstetric history

Obstetric operations

Perinatal complications

History of present pregnancy

Examination Signs of anaemiaWeight and heightBlood pressureChest and heart auscultationSFH

Investigations Urinalysis for bacteriuria &protenuria.

All patients

VDRL

Blood group typing (ABO and Rh)

HB if signs of severe anaemia

HIV screening

Interventions

FE /Folate supplement. 60mg of fe and 250mcg folate. HB <7gm/dl double dose

If rapid test for syphylis is +ve treat

Tetanus toxoid first injection

SP once in 2nd and 3rd trimester

Counselling

Practice safe sex(faithfullness /condom use)

Avoid tobacco, alcohol, and other harmful substance

Advice on where to go in case of bleeding, abdominal pain or other emergency.

Birth plan, use of ITNs and HIV testing

Give date of next ANC visit

Complete clinic record and ANC card

2nd visit(20-24weeks )

Personal history- any change since 1st visit or complaints

Note intercurrent disease, injury or other condition since 1st visit

Note intake of medicines other than haematinics

Note abnormal changes in body features or physical capacity-oedema & dyspnoea

Check up on habits eg. Smoking and alcohol

Examination:Blood pressureSFHPeripheral oedemaV/E only if not done at 1st visit

Investigations

Urinalysis for evidence of bacteriuria.Proteinuria if nulliparous or has high

BP, PE or Eclampsia in previous pregnancy

• All women with hypertension in index preg be tested for proteinuria

• Repeat HB if sign of severe anaemia

Intervention

Haematinics

Counselling




Birth plan, use of ITNs and HIV testing



3rd visit (28-32wks)

Personal history- any change since 2nd visit or complaints

Note intercurrent disease, injury or other condition since 2nd visit



Symptoms & events since 2nd visit

Abdominal or back pain (? Preterm labour)

Bleeding

Vaginal discharge(?amniotic fluid)

Oedema, dyspnoeaCheck up on habits eg smoking and alcohol

Examination: Blood pressure

SFH

Palpate abdomen for detection of multiple fetuses

Auscultate for fetal heart sounds

Peripheral oedema

Investigations

Urinalysis for evidence of bacteriuria.Proteinuria if nulliparous or has

high BP, PE or Eclampsia in previous pregnancy


• HB for all women

Counselling




Birth plan

Provide recommendation on lactation, contraception and importance of postpartum visit



4th visit (36wks)

Personal history- any change since 3rd visit or complaints

Note intercurrent disease, injury or other condition since 3rd visit



Obtain history of previous delivery complications

Examination: Blood pressure

SFH

Palpate abdomen for detection of multiple fetuses

Fetal lie and presentation

Aucultate for fetal heart sounds

Peripheral oedema

Investigations

Urinalysis for evidence of bacteriuria.Proteinuria if nulliparous or has high

BP, PE or Eclampsia in previous pregnancy


Women with breech presentation should be evaluated for ECV

Offer information on where to go when labour start or if there are other symptoms

Birth plan

Advice if undelivered by the end of 41 wk for hospital evaluation ± Ind. Of labour


Post partum visit

The committee recommend that this should take place 2 weeks after delivery

Activities: Advice on prevention of unplanned

pregnancy

Reinforcement of breast feeding

Complete TT immunization for late attendants to ANC

Continue iron & folate supplement

Planned any continued surveillance if required

Conclusion

The result of the WHO randomized trial & review of scientific evidence on ANC models with reduced number of visits justifies the introduction of the new WHO model for general use; including in Family Medicine

The new model is not associated with increase risk for either the woman or the fetus

It reduces the time and resources necessary for ANC by limiting the number of visits

Thank you

Documents

Focused Antenatal Care