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, assesing fetal growth and wellbeing, hypertensive disorders of pregnancy, antepartum haemorrhage, preterm labour, important medical conditions

1. SK ILLS WORKSHOP : SCREENING TESTS FOR HIV 57
7. Wait a minimum of 15 minutes and then 3. If the second test is also positive, the
read the results. The maximum waiting patient is HIV positive.
time for reading the test is 24 hours. After 4. Proceed with post-test counselling for a
24 hours the test becomes invalid. patient with a positive test.
C Reading the results of the HIV rapid test F Management if the first HIV rapid test
is positive but the second is negative
1. Positive.
A red bar will appear within both the 1. A blood sample for an ELISA test must be
Control window and the Patient window sent to the laboratory.
on the test strip. Any visible red bar in 2. The patient must be informed that
the Patient window must be regarded as the results of the HIV rapid tests are
positive. The result is positive even if the inconclusive and that a laboratory test
patient bar appears lighter or darker than is required to finally determine her HIV
the control bar. status.
2. Negative. 3. If the ELISA test is positive the patient is
A red bar will appear within the Control HIV positive (i.e. HIV infected).
window and but no red bar is seen in the 4. If the ELISA test is negative the patient is
Patient window. HIV negative (i.e. not HIV infected).
3. Invalid. 5. Proceed with appropriate counselling.
If no red bar appears in the Control
window, even if a red bar is visible in the G Recording the results of the rapid
Patient window, the result is invalid and HIV test on the antenatal card
the test must be repeated.
1. If the first rapid test is negative, it is
D The interpretation of the HIV rapid test accepted that the patient is HIV negative.
In the space for special investigations on
The test is a specific test for HIV and will
the front of the antenatal card, ‘Yes’ must
become positive when there are antibodies
be circled if the test was accepted while
against HIV (the virus that causes AIDS) in
precautions ‘No’ must be circled as the
the blood.
result was negative for RVD. RVD is the
1. A positive test indicates that a person has abbreviation for Retroviral Disease.
antibodies against HIV (HIV positive). 2. If both the first rapid test and the
Therefore the person is infected with HIV. confirmatory (second) test are positive, it
2. A negative test indicates that a person is accepted that the patient is HIV positive.
does not have antibodies against HIV Circle ‘Yes’ for the test accepted and again
(HIV negative). Therefore the person is ‘Yes’ for precautions.
not infected with HIV, unless infected 3. If, after counselling, the patient decides
very recently and the HIV antibodies have not to have an HIV test, test accepted ‘No’
not appeared yet. must be circled as the test was not done.
Therefore there is no result.
E Management if the HIV
rapid test is positive
1. Explain to the patient that the first
screening test for HIV is positive but that
this should be confirmed with a second test.
2. Proceed with a second test using a different
kit.

2. 58 PRIMAR Y MATERNAL CARE
RVD: Test done Yes No Precautions Yes No
Figure 1-5 A: Recording of a negative HIV test on the antenatal card
RVD: Test done Yes No Precautions Yes No
Figure 1-5 B: Recording of a positive HIV test on the antenatal card
RVD: Test done Yes No Precautions Yes No
Figure 1-5 C: Recording that the patient decided not to be tested for HIV

3. 2
Assessment of
fetal growth and
condition during
pregnancy
Before you begin this unit, please take the INTRODUCTION
corresponding test at the end of the book to
assess your knowledge of the subject matter. You
1. During the antenatal period, both maternal
should redo the test after you’ve worked through
and fetal growth must be continually
the unit, to evaluate what you have learned.
monitored.
2. Individualised care will improve the
Objectives accuracy of antenatal observations.
3. At every antenatal visit from 28 weeks
When you have completed this unit you gestation onwards, the wellbeing of the
should be able to: fetus must be assessed.
• Assess normal fetal growth.
• List the causes of intra-uterine growth 2-1 How can you assess the condition
of the fetus during pregnancy?
restriction.
• Understand the importance of The condition of the fetus before delivery is
measuring the symphysis-fundus height. assessed by:
• Understand the clinical significance of 1. Documenting fetal growth.
fetal movements. 2. Recording fetal movements.
• Use a fetal movement chart.
When managing a pregnant woman, remember
• Manage a patient with decreased fetal
that you are caring for two individuals.
movements.
• Understand the value of antenatal fetal
heart-rate monitoring.