Antenatal period is special and unique to every women and needs continuous care and supervision to avoid preventable complications.

1. ANTENATAL CARE
PRESENTED BY:
Srujani Swetasina Dash
Nursing Tutor
A.N.M.M.C.H, Gaya
Quality Antenatal Care 1

2. Quality Antenatal Care 2
Session Objective
To understand
– Definition of ANC
– Importance of antenatal check-up
– Components of quality ANC
– Need for early registration of pregnancy
– Number and timing of antenatal check-ups
– How to calculate number of pregnancies in a year
– How to track all pregnant women

3. Antenatal period
• The time duration from
conception of the fetus
in the woman’s uterus
to the delivery of the
baby is called
antenatal period.

4. Quality Antenatal Care 4
The term - Antenatal Care
Antenatal care is systemic supervision of
a woman during antenatal period/
pregnancy at regular intervals to monitor :
– Maternal wellbeing
– Fetal wellbeing
– Progress of fetal growth

5. Quality Antenatal Care 5
What is the importance of Antenatal Care?
• Preparation of birth plan and identification of
facility for delivery
• Providing quality of care for well being of
pregnant women and the foetus
• Early identification of maternal and fetal
complications and timely referral
• Identification of a facility for referral

6. COMPONENTS OF QUALITY ANC
PRIMARY COMPONETS
ESSENTIAL COMPONENTS
DESIRABLE COMPONENTS
COUNSELLING
(Source: SBA Guidelines)
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7. Quality Antenatal Care 7
Quality Antenatal Care:
PRIMARY COMPONENTS
• Early Registration and first check up within first
trimester (12 wks)
• Minimum 4 antenatal check ups; at least one ANC by
M.O. (Preferably 3rd ANC)
• Two doses of Injection tetanus toxoid
• Intake of at least 100 tablets of IFA

8. Quality Antenatal Care 8
Quality Antenatal Care:
ESSENTIAL COMPONENTS
• History taking
• Physical examination (Weight, BP, pallor,
respiratory rate, edema)
• Abdominal Examination
• Laboratory investigations (Hb %, Urine for
sugar and proteins)

9. Quality Antenatal Care 9
Quality Antenatal Care:
DESIRABLE COMPONENTS
• Blood group and Rh typing
• VDRL / RPR (Rapid Plasma Reagin)
• Offering rapid testing for HIV screening
Tie up with nearest ICTC / PPTCT centre for:
– Rapid testing kits for HIV screening
– Referral and management of +ve cases
• Hepatitis B and HbsAg (Australia Antigen testing)
• Blood sugar testing

10. Quality Antenatal Care 10
Quality Antenatal Care:
COUNSELLING
What are the important points?
• Promotion of institutional delivery & stay for 48 hrs.
• Birth preparedness
• Recognizing danger signs & symptoms during pregnancy,
labor & post natal period
• Plan for complication management
• Diet, Rest, Family planning
• Care of new born
• Initiation of breast feeding EBF and complimentary feeding
• Immunisation
• Janani Suraksha Yojana (JSY)
• Emphasising importance of seeking ANC & PNC

11. PRIMARY
COMPONENTS
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12. PRIMARY COMPONENTS
• Ensure early registration
• Track every pregnancy - at
least four antenatal check-
ups
• Administer two doses of TT
injection.
• Provide at least 180 tablets
of IFA

13. EARLY DETECTION AND REGISTRATION
• For proper planning and
adequate care
• Recording LMP and EDD.
• Assess mothers health
status.
• Timely detection of
complications
• Facilitates a good
interpersonal relationship
• Folic Acid Suplementation
in early prenancy- 400 mcg.

14. Calculation of Expected Date of Delivery
(EDD)
• LMP – first day of last menstrual period.
• EDD = Date of LMP + 9 months + 7 days

15. Exercise
Exercise 1:
• Mrs. Seema, who is 30 years old come to you and says
that she has not got her period for the past three months.
She last got her period on the day before Holi , March
10 2023 .Calculate her EDD.
Exercise 2:
• Mrs. Laxmi, 18 years old says that she last got her
period on January 2 2023. Calculate her EDD.

16. Answer
Exercise 1
Answer: 16.12.2023
Exercise 2
Answer: 9.10.2023

17. Quality Antenatal Care 17
Number and Timing of Antenatal visits
No. of visit Timing of visit
1st Visit With in 12 weeks preferably as soon as
pregnancy is suspected
2nd Visit Between 14 – 26 weeks
3rd Visit Between 28 – 34 weeks
4th Visit Between 36 weeks and term

18. Quality Antenatal Care 18
Estimation of total no. of
expected pregnancies in your area
• The expected no. of pregnancies to be registered annually can be
estimated
• Information required :
Live Birth rate (BR) and Population size of the area under
consideration
Estimation the number of pregnancies in your area
 Expected number of live birth (y) /year = Birth rate (per 1000
population) x population of the area /1000
 The total number of expected pregnancies (z) =y+10% of y

19. Quality Antenatal Care 19
Tracking missed and lost pregnant women
Rule of Thumb
• In any given month approximately half the
number of pregnancies estimated should be in
the records
• If less, community workers such as AWWs and
ASHAs should identify pregnant women
• Home visits should be conducted by ANMs to
pregnant women who have not returned for ANC

20. Td Injection
 The administration of two doses of Td injection is an important
step in the prevention of maternal and neonatal tetanus.
 The first dose of Td should be administered as soon as possible
preferably when the woman register for ANC.
 The second dose is to be given one month after the first
preferably at least one month before the EDD.
 If the woman receives the first dose after 38 weeks of pregnancy
,then the second dose may be given in the postnatal period, after
a gap of four weeks.
 If the woman has been previously immunized with two dose
during a previous pregnancy within the past three years, then
give her only one dose as early as possible in this pregnancy.

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21. Dose of Td
 o.5 ml by deep intramuscular injection.
 It should be given in the upper arm and not in the
buttocks as this might injure the sciatic nerves.
 Inform the woman that there may be a slight swelling
pain and or redness at the site of the injection for a day
or two.

22. IFA Supplementation
>11 gm% - no anaemia
7 – 11 gm% - mild anaemia
< 7 gm% - severe anaemia
• Help preventing the complication due to
anemia.
• besides recommending IFA supplementation
counsel the woman to increase her dietary
food of iron rich foods such as green leafy
vegetables, whole pulses , jiggery, meat ,
poultry and fish.

23. Prophylactic dose :-
180 tab IFA OD starting after
the first trimester at 12 weeks of gestation
until delivery.
Therapeutic dose :-
(Hb less than 11 gm% /dl )
or has pallor 200 tab IFA , BD . If it does
not rise in spite, refer the woman to the mo
(medical officer ) at the PHC .

24. COUNSELLING FOR IFA
 IFA tab must be taken regularly, preferably early in the
morning on an empty stomach .
 In case the woman has nausea and pain in the abdomen, she
may take the tablet after meals or at night . This will help
avoid nausea dispel.
 The myths and misconceptions r/t to IFA and convince the
woman about the importance of IFA supplementation. An
example of a common myths is that the consumption of IFA
may affect the baby’s complexion.
 It is normal to pass black stool while consuming IFA. Tell the
woman not to worry about it.
 In case of constipation, the woman should drink more water
and add roughage to her diet.
 IFA tab should not be consumed with tea, coffee, milk or
calcium tab, as these reduce the absorption of iron.

25. Contd….
 Ask the woman to return to you if she has problems
taking IFA tablets. Refer her to the MO for further
management.
 Emphasis the important of a high protein diet, including
items such as black gram, ground nuts, ragi , whole
grains, milk, eggs, meats and nuts for anaemic women .
 Encourage the woman to take plenty of fruits and
vegetables containing vitamin ‘c’( e.g.:- mango, guava,
orange and sweet lime) as these enhance the
absorption.

26. ESSENTIAL COMPONENTS
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27. ESSENTIAL COMPONENTS
-- Take the patient’s history.
– Conduct a physical examination
• measure the weight
• blood pressure
• respiratory rate
• check for pallor and edema

28. ESSENTIAL COMPONENTS
– Conduct abdominal palpation
• foetal growth
• foetal lie
• auscultation of Foetal Heart Sound
– Carry out laboratory investigations
– haemoglobin estimation
– urine tests for sugar and proteins.

29. DESIRABLE COMPONENTS
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30. DESIRABLE COMPONENTS
• Determine the blood group
and the Rh factor.
• Conduct the VDRL test to
rule out syphilis.
• Test the woman for (HIV).
• Check the blood sugar.
• Carry out the (HBsAg) test.

31. COUNSELLING
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32. Quality ANC components
 BPCR
 Institutional deliveries
 Where to go if an
emergency arises
 Signs of labour
 Danger signs
Importance of seeking ANC
and PNC.

33. Institutional Delivery and JSY
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34. Contd…..
Diet (nutrition) and
rest.
Family planning

35. Breast Feeding and EBF
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36. Contd…
Immunisation
Sex during pregnancy.
Domestic violence
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37. Key Message
“Every Pregnancy is at Risk”
Every pregnancy needs special and
quality antenatal care
All pregnant women should be registered
and encouraged for institutional delivery
Ensured at least 4 antenatal check-ups.
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