Antenatal Care: Asheber Gaym M.D. January 2009

Antenatal
Care
Asheber Gaym M.D.

January 2009
Outline
•Describe the objectives of antenatal

care
•Discuss different models of antenatal
care
•Describe activities of antenatal care
•Detail essential diagnostic work-up
during antenatal care
•Outline ANC fetal well being
assessment strategies
Asheber Gaym, 2
2009
Objectives of Antenatal Care
• Antenatal care refers to the health care provided to a
pregnant woman throughout pregnancy until labor.
• Basically a screening program intended to detect
complications early; provide health education and
implement effective health promotive and preventive
interventions
• Objectives
– Overall- reduce maternal and perinatal morbidity and
mortality
– Timely detection and management of complications
– Ensure the birth of a healthy child
– Ensure the health of the mother
– Provide essential health education to the mother including
information on the danger signs of pregnancy
Asheber Gaym, 3
2009
Models of Antenatal Care Provision
• Traditional ANC model(s)

– Began two hundred years ago and instituted programs and
interventions that were traditionally thought to benefit the
mother and her fetus
– Activities were not scientifically tested as to their effectiveness
or benefit
– Followed a visit pattern of 4 weeks until 28th week; then every
2 weeks until 36th week and a weekly visit with many
interventions at each visit
– Led to upto 14 visits and cost incurred for many investigations
that were not necessarily warranted
– It has recently been suggested that the traditional ANC
practice
be replaced by new models of focused ANC programs
Asheber Gaym, 4
2009
Models of ANC – Continued
• Focused ANC- also Đalled ͞Ŷeǁ͟ or ͞WHO͟ ŵodels

– Followed large randomized multicenter trials between
the traditional and focused ANC programs that identified
evidence based interventions and visit patterns that
benefited mothers and their fetus and were cost
effective as well
– Suggested four routine visits only at different gestations
with a few evidence based diagnostic and intervention
modalities performed at each visit
– Visits were at 16,28,32 and 36 weeks
– Additional visits were individualized on an individual
basis
Asheber Gaym, 5
2009
Focused ANC Program
Visit First Visit Second visit Third visit Fourth visit
Gestational
Activities
<16 weeks 28 weeks 32 weeks 38 weeks
age
Activities •Classification to •Clinical exam for •Hgb test •Examine for
either the basic or anemia •TT second dose breech
specialized •Gestational age; FH; •Instructions for presentation
component FHB exam birth planned •Document on ANC
•Clinical exam •Blood pressure •Recommendation card
•Hgb test •Weight- only if s for
•Gestational age underweight at initial lactation/contrace
determination visit ption
•Blood pressure •Urinalysis- for •Document on ANC
•Weight/Height nullipara or previous card
•Syphilis/STIs preeclampsia
•Urinalysis •Iron supplement
•ABO/RH •Complete on ANC
•TT administration card
•Iron
supplementation
•Document on ANC
card
Asheber Gaym, 6
2009
Visits of Antenatal Care – Objectives
• Initial visit –
– Detailed evaluation through history, physical exam
and laboratory work-up as required
– Based on the results further work up and a program
of care is planned on individual basis
– Maternal or fetal factors that may require special
care
for the specific mother are identified and noted
• Subsequent visits-
– Are conducted based on the plans made at initial visit
– Newly developing situations during follow up are also
noted and management plans modified accordingly
Asheber Gaym, 7
2009
Initial visit- History
• Present pregnancy-
– Accurate dating of gestational age
– Any symptoms – minor or major complaints
– Fetal movement perception
– ANC details – investigations and interventions if the mother is referred from
other facilities
– Presence of any of the danger signs
• Past obstetric history
– Details of any obstetric complications in previous pregnancies
• Family history
– Any familial medical conditions
– Family history of congenital anomalies; multifetal gestations and
hypertensive disorders of pregnancy
• Personal history
– History of medical illnesses
– History of smoking, alcohol intake and habitual drugs use
Asheber Gaym, 8
2009
Initial visit- Physical Exam
• Vital signs and anthropometry (weight and height)
• Detailed physical exam for medical or surgical illnesses
• Abdominal exam –objectives
– Fundal height by symphysis-fundal height measurement by the tape
method
– Fetal heart auscultation after 10th week by doppler or 20th week by
fetal heart stethoscope
– Fetal presentation after the 28th week but malpresentations
abnormal
after the 34th week
• Pelvic examination - objectives
– For uterine size measurement if gestation is less than 12th week
– Adnexal abnormalities or masses
– Early evidence of pregnancy on physical exam- cervical softening;
ChadǁiĐk’s sigŶ; ďluish Đolor of ǀagiŶa, ĐerǀixͿ; VoŶ-FerŶǁald’s
sign( loĐalized softeŶiŶg of the fuŶdusͿ aŶd Hegar’s sigŶ
Asheber Gaym, 9
2009
Subsequent visits – Activities
• History
– Follow up on previous complaints
– Any new complaints since last visits
– Development of any of the danger symptoms
– Fetal movements history
• Physical examination
– Brief detailed exam including the vital signs,
anthropometry and general examination
– Adequacy of weight gain since last visit
– Adequacy of fundal growth since last visit
– Presence of fetal heart beat
– Presence of other findings such as generalized
edema
Asheber Gaym, 10
2009
Diagnostic work-up during antenatal
care
Diagnostic procedure Gestational age
Hemoglobin/hematocrit determination Initial visit; repeat at 28-32 weeks
ABO and RH typing Initial visit
VDRL Initial visit; repeat at 28 weeks if negative
Urinalysis At each visit to detect proteinuria
Urine culture and sensitivity Initial visit to detect asymptomatic
bacteriuria
IŶdireĐt Cooŵď’s test Initial visit
Serum alpha-fetoprotein test 16-18 weeks
Routine ultrasonography 16-18 weeks
Screening test for gestational diabetes 24-28 weeks
Pap smear Initial visit
Cervical smear gram stain and culture Initial visit
HBsAg; HIV tests I n it, i2a00l9visit
Asheber G a y m 11
Assurance of fetal well being at ANC-
Strategies
• Progressive increase in maternal weight
• Progressive fundal height growth as per expectations
• Adequate maternal perception of fetal movement
( at least 10 in 12 hours)
• Fetal well being tests – from 28 weeks onwards
(specific timing of follow up initiation depends on
the individual risk profile concerned)
– Non stress test
– Contraction stress test
– Fetal biophysical profile score
– Doppler ultrasound velocimetry
• Ultrasonographic fetal scan for anomalies
Asheber Gaym, 12
2009
Health Interventions during ANC
• Health education – topics

– Prompt reporting of danger signs of
pregnancy
– Balanced diet
– Labor and delivery preparation
– Basics of family planning, child rearing and
immunization
• Iron supplementation
• Psychological support
Asheber Gaym, 13
2009

Antenatal Care: Asheber Gaym M.D. January 2009

Uploaded by

Copyright:

Available Formats

Antenatal Care: Asheber Gaym M.D. January 2009

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Antenatal Care: Asheber Gaym M.D. January 2009

Uploaded by

Copyright:

Available Formats

Antenatal

Asheber Gaym M.D.

•Describe the objectives of antenatal

• Traditional ANC model(s)

• Focused ANC- also Đalled ͞Ŷeǁ͟ or ͞WHO͟ ŵodels

• Health education – topics

You might also like