Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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1

Evidence Based Practice: A new WHO Antenatal Care Model

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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2

Standard antenatal care model

• The recommended antenatal care programme in most developing countries is often the same as those practicing in developed countries.

• Departure from the standard programme is almost the rule, usually as the result of insufficient resources or lack of women’s compliance.

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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3

Activities included in the new basic ANC programme

1. Screening for health conditions likely to increase th

e risk of specific adverse outcomes

2. Therapeutic interventions known to be beneficial

3. Alerting women to emergencies and instructing the

m on appropriate response

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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4

1. The first visit (<12 weeks)

2. The second visit ( 26 weeks )3. The third visit ( 32 weeks )4. The fourth visit ( 38 weeks )

The basic component of the new WHO antenatal care model

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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5

Content of the first visit

a) Obtain information on

1. Personal history

2. Medical history

3. Obstetric history

4. Obstetrical operations

5. Special perinatal complications

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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6

Content of the first visit

b) Perform physical examination

1. Check for signs of severe anaemia

2. Record weight (kilograms) and height (metres).

3. Measure blood pressure.

4. Chest and heart auscultation.

5. Measure uterine height

6. Consider vaginal examination

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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7

Content of the first visit

c) Perform the following tests:

1. Urine: multiple dipstick test

2. Blood: syphilis (rapid test)

3. Blood-group typing (ABO and rhesus)

4. Haemoglobin (Hb): only if there are signs of severe anaemia.

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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8

Content of the first visit

d) Assess for referral

Determine whether the woman is eligible for

the basic component of the new WHO model

or if she is in need of special care and/or

referral to a specialised clinic or hospital (use

the classifying form)

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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9

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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10

• Obstetric exam

• Maternal weight (only women with low weight/height at first visit)

• Blood pressure and proteinuria

• Fe/folic acid supplementation

• Recommendations for emergencies

The Basic ProgrammeSecond visit (26 weeks) and subsequent visits

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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11

• Repeat Syphilis test for high-risk populations

• Haemoglobin levels

• Tetanus toxoid (second dose)

• Instructions for delivery

• Recommendations for lactation/contraception

Third visit (32 weeks) add to second visit

The Basic Programme

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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12

• Detection of breech and referral for external version

• Instructions for delivery

• Recommendations for lactation/contraception

Fourth visit (38 weeks) add to second visit

The Basic Programme

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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13

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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14

• Women initiating ANC after 12 weeks received all activities recommended for the previous visits up to the present gestational age.

• Activities relevant only to some populations (malaria, smoking, iodine, HIV, thalassemia, etc.) were to be added as needed.

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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Fokus ANC model baru

• Memberi pengertian pada ibu tentang pentingnya persalinan oleh tenaga terampil dan bagaimana mendapatkan pelayanan bila terjadi obstetri emergensi

• Lebih melibatkan suami dalam persiapan kehamilan dan persalinan

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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ANCmodel baru membantu mempersiapkan

persalinan yang aman• Sejak kunjungan I:• Mengenal tanda dan gejala komplikasi • Perencanaan pertolongan oleh tenaga terampil• Persiapan peralatan persalinan sederhana• Mengetahui ke mana bila ada komplikasi • Rencana transpor yang jelas • Rencana tabungan untuk persalinan • Penentuan kerabat yang menemani ke RS • Persiapan keluarga- donor darah • Penentuan pengambil keputusan dalam keluarga• Perencanaan siapa yang menjaga anak-anak di rumah, bila ibunya

bersalin.

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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17

Special Care

Women considered to require further assessment or special care received the protocols used in the study clinics for their condition

Department of reproductive health and research Département santé et recherche génésiques

UNDP / UNFPA / WHO / WORLD BANKHRPHRP

JV_F

IGO

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Standard ANC

Control clinics followed guidelines

formally recommended by the local

health authorities based on the

“traditional” Western ANC model.