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.