Primary Maternal Care: Skills workshop routine use of the antenatal card
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Primary Maternal Care: Skills workshop routine use of the antenatal card

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Primary Maternal Care addresses the needs of healthcare workers in level 1 district hospitals and clinics who provide antenatal and postnatal care, but do not conduct deliveries. It is adapted from ...

Primary Maternal Care addresses the needs of healthcare workers in level 1 district hospitals and clinics who provide antenatal and postnatal care, but do not conduct deliveries. It is adapted from theory chapters and skills workshops from Maternal Care. This book complements the national protocol of antenatal care in South Africa. It covers: booking for antenatal care, assessing fetal growth and well-being, hypertensive disorders of pregnancy, antepartum haemorrhage, preterm labour, important medical conditions

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    Primary Maternal Care: Skills workshop routine use of the antenatal card Primary Maternal Care: Skills workshop routine use of the antenatal card Document Transcript

    • 2A Skills workshop: Routine use of the antenatal card 5. Fetal movements from 28 weeks onwards. Objectives 6. Presenting part from 34 weeks onwards. 7. Haemoglobin concentration at 28 and 36 weeks. When you have completed this skills 8. The symphysis-fundus height from 18 workshop you should be able to: weeks. • Plot the symphysis-fundus height. 9. Any additional notes. • Use the symphysis-fundus height graph 10. Signature of the responsible midwife or doctor. to assess whether the fetus is growing adequately. The symphysis-fundus (SF) height and the patient’s weight are recorded on the antenatalA Recording information on graph while the other information is recordedthe antenatal card in the spaces provided.The front of the antenatal card is used B The significance of the lines on the graphto record details of the patient’s history,examination, special investigations, duration There are 3 oblique lines on the antenatal graph:of pregnancy, planned management and The 3 lines represent the normal increase infuture family planning at the first and second the symphysis-fundus height or SF height (i.e.antenatal visits. The back of the antenatal card a centile growth chart of fundal height). Theis used to record the observations made at solid line in the centre is the 50th centile oreach antenatal visit throughout pregnancy. average growth line. The dotted lines aboveThe following items should be recorded on and below this represent the 90th and 10ththe back of the antenatal card every time the centiles respectively (i.e. the upper and lowerpatient attends the antenatal clinic: limits of normal fundal growth).1. Date.2. Blood pressure.3. Proteinuria or glycosuria.4. Oedema.
    • 70 PRIMAR Y MATERNAL CARE Date PROBLEM LISTSIGNATURE: 1 2DATE: 3 4GESTATION 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 5 45 GESTATION EST. BY: 45 Date NOTES (essential facts only) Dates Sonar 40 40 Both SF-measurement 35 LW. 0. = Weight 35 x = measurement 30 30 25 25 20 20 15 15 10 10 Start SF measurement Repeat examination of breasts at 34 weeks 5 Uterine size using PRESENTING PART 5 anatomical landmarks HEAD ABOVE PELVIS (fifths)GESTATION 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43BLOOD- Syst.PRESSURE Diast. P PUrine S SOEDEMA RRT 2/01 Fetal movements Antenatal Haemoglobim (g/dl) card B ENGFigure 2-A: The back of the antenatal cardC Plotting the symphysis-fundus height 5. The method whereby the gestational agefor the first time when the patient is sure was determined must now be ticked inof the date of her last menstrual period the appropriate block at the top left-hand corner of the chart. In this case ‘Dates’1. Calculate the period of gestation in weeks. should be ticked. The gestational age is given along the top 6. Between 18 and 36 weeks the SF height and bottom of the graph (the horizontal in centimetre should be plotted on the SF axis). curve to determine the gestational age in2. Measure the SF height. The SF height in weeks. If the fundal height is at the level of centimetre is given both sides of the graph the umbilicus or higher, and the SF height (the vertical axis). The patient’s SF height differs from the gestational age by 4 weeks measures 21 cm. or more, the SF height should be plotted as3. Knowing the gestational age and the SF described in 2-G. height, the SF height for the gestational age can be plotted on the graph and should be recorded by making a dot. A small circle is D Plotting the SF height for the first drawn around the dot to make sure that it time when the patient does not know is clearly seen. the date of her last menstrual period4. The date of the antenatal visit should be 1. The patient’s SF height measures 27 cm. written at the top of the card in the square Plot the measurement on the 50th centile opposite the gestational age of the patient. opposite the 27 cm on the vertical axis. The person recording the observations on 2. By plotting the SF height measurement the antenatal card must also write her or on the 50th centile you are assuming that his name next to the date. the fetus is growing normally and that the measurement on the horisontal axis
    • SK ILLS WORKSHOP : ROUTINE USE OF THE ANTENATAL CARD 71 el SIGNATURE: N F. /7 DATE: 27 GESTATION 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 45 GESTATION EST. BY: 45 Dates Sonar 40 40 Both SF-measurement 35 LW. 0. = Weight 35 x = measurement 30 30 25 25 20 20 15 15 10 10 Start SF measurement Repeat examination of breasts at 34 weeks 5 Uterine size using PRESENTING PART 5 anatomical landmarks HEAD ABOVE PELVIS (fifths) GESTATION 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 BLOOD- Syst. PRESSURE Diast. P P Urine S S OEDEMA RRT 2/01 Fetal movements Antenatal Haemoglobim (g/dl) card B ENGFigure 2-B: A SF height measurement of 21 cm at a gestational age of 24 weeks is plotted on July 27th represents the approximate gestational E The first recording of the SF height age. In this case the approximate when the duration of pregnancy, as gestational age is 29 weeks. determined by her last normal menstrual3. The method whereby the gestational age period, differs from that determined was determined must now be ticked in by the SF height by 4 or more weeks. the appropriate block at the top left-hand 1. According to the patient’s last menstrual corner of the chart. In this case ‘SF- period, she is 31 weeks pregnant. The measurement’ should be ticked. SF height measurement is 25 cm which4. The fundal growth must be carefully indicates a gestational age of 26 weeks if recorded at the following visits. If little or plotted on the 50th centile of the SF curve. no growth occurs in the next 4 weeks, the 2. In this case the fundal height is above diagnosis of intra-uterine growth restriction the umbilicus, and the gestational age must be made. If excessive growth occurs, estimated from the mother’s last menstrual multiple pregnancy must be excluded. period and the SF height differ by 5 weeks. Normal growth with the SF-height between The SF height probably indicates the true the 90th and 10th centiles confirms a gestational age. Make a mark on the 50th normal growing singleton pregnancy. centile opposite 25 cm. This indicates an estimated gestational age of 26 weeks. 3. The method by which the gestational age is estimated must be recorded in the box at the top left-hand corner of the growth chart. In this case a tick should be made opposite ‘SF measurement’.
    • 72 PRIMAR Y MATERNAL CARE el SIGNATURE: N F. 10 DATE: 4/ GESTATION 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 45 GESTATION EST. BY: 45 Dates Sonar 40 40 Both SF-measurement 35 LW. 0. = Weight 35 x = measurement 30 30 25 25 20 20 15 15 10 10 Start SF measurement Repeat examination of breasts at 34 weeks 5 Uterine size using PRESENTING PART 5 anatomical landmarks HEAD ABOVE PELVIS (fifths) GESTATION 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 BLOOD- Syst. PRESSURE Diast. P P Urine S S OEDEMA RRT 2/01 Fetal movements Antenatal Haemoglobim (g/dl) card B ENGFigure 2-C: Recording the SF height of 27 cm on the 50th centile when a patient could not remember the dateof her last menstrual period. The patient attended the antenatal clinic on 4th October.4. The fundal growth must be carefully attended the antenatal clinic, the S-F height recorded at the following visits. If little measurement must be plotted 4 weeks later or no growth occurs in the next 4 weeks, on the graph. the diagnosis of intra-uterine growth restriction must be made. If excessive G Recording the presenting part and growth occurs, multiple pregnancy must the amount of fetal head palpable be excluded. Normal growth with the SF- above the brim of the pelvis height between the 90th and 10th centiles confirms a normal growing singleton From 34 weeks gestation onwards the lie and pregnancy. This information also confirms the presenting part must be determined at that using the SF-height to determine every visit (as described in Skills Workshop gestational age was correct. 1-2). The presenting part may be a vertex or breech. If the presenting part is a fetal head, then the amount of head above the pelvic brimF Plotting the symphysis-fundus height must be determined.at subsequent antenatal visitsThe symphysis-fundus height must be plotted H Writing notes on the antenatal record cardon the graph at every subsequent antenatalclinic visit. As before, the symphysis-fundus A space is provided on the antenatal cardheight measurement and the gestational age for brief notes. A block is also provided for aare used to determine where the dot should problem list. Few notes are needed and usuallybe made on the graph. For example, if the there are no notes in patients who are assessedpatient’s present visit is 4 weeks after she last as being low risk with normal pregnancies.
    • SK ILLS WORKSHOP : ROUTINE USE OF THE ANTENATAL CARD 73 el SIGNATURE: N F. /5 DATE: 20 GESTATION 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 45 GESTATION EST. BY: 45 Dates Sonar 40 40 Both SF-measurement 35 LW. 0. = Weight 35 x = measurement 30 30 25 25 20 20 15 15 10 10 Start SF measurement Repeat examination of breasts at 34 weeks 5 Uterine size using PRESENTING PART 5 anatomical landmarks HEAD ABOVE PELVIS (fifths) GESTATION 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 BLOOD- Syst. PRESSURE Diast. P P Urine S S OEDEMA RRT 2/01 Fetal movements Antenatal Haemoglobim (g/dl) card B ENGFigure 2-D: A patient’s gestational age, according to her last menstrual period, is 31 weeka and the S-F heightmeasurement is 25 cm
    • 74 PRIMAR Y MATERNAL CARE el el el SIGNATURE: N N N F. F. F. /5 /6 /7 DATE: 20 17 15 GESTATION 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 45 GESTATION EST. BY: 45 Dates Sonar 40 40 Both SF-measurement 35 LW. 0. = Weight 35 x = measurement 30 30 25 25 20 20 15 15 10 10 Start SF measurement Repeat examination of breasts at 34 weeks 5 Uterine size using PRESENTING PART 5 anatomical Vx landmarks HEAD ABOVE PELVIS (fifths) 4 GESTATION 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 BLOOD- Syst. PRESSURE Diast. P P Urine S S OEDEMA RRT 2/01 Fetal movements Antenatal Haemoglobim (g/dl) card B ENGFigure 2-E: A patient’s SF height measurement is 30 cm, 4 weeks after her last visit. Four weeks later the SFheight is 32 cm Date PROBLEM LIST 1 20/5 Grande multipara 2 20/5 Gestational diabetes 3 23/6 Pre-eclamsia 4 5 Date NOTES (essential facts only) 20/5 Diabetes to be managed with diet 23/6 Good diabetic control Admit to ward for PET assessment and management Requests tubal ligationFigure 2-F: A problem list with short notes