2. objectives
• Good care during pregnancy is important for the
health of the mother and the development of the
unborn baby.
• Pregnancy is a crucial time to promote healthy
behaviours and parenting skills.
• Good ANC links the woman and her family with the
formal health system, increases the chance of using
a skilled attendant at birth and contributes to good
health through the life cycle.
2
3. History
• Prenatal care started in Edinburgh at the turn of the
20th century, but clinics for the checking of apparently
well pregnant women were rare before the first world
war.
• Janet Campbell, one of the most farsighted and clear
thinking women in medicine, started a national system
of antenatal clinics with a uniform pattern of visits and
procedures; her pattern of management can still be
recognised today in all the clinics of the Western
world.
3
4. Definition
• General health care given to pregnant women to
promote and maintain optimal health of the
mother throughout the pregnancy, labor and
puerperium with having and rearing of healthy
baby
• Prenatal care is an excellent example of
preventive medicine.
4
5. • The quality of antenatal care (ANC) is
dependent on
• the qualifications of health providers
and the number and frequency of ANC
visits.
• The content of services received and
the kinds of information given to
women during their ANC visits are also
important components of quality care.
5
6. • These services raise awareness of
the danger signs during the
pregnancy, delivery, and postnatal
period, improve the health-seeking
behaviour of women, orient them to
birth preparedness issues, and
provide basic preventive and
therapeutic care.
7. where and by who
• Prenatal care is provided at a variety of sites,
ranging from referral Hospitals , the private
health institutions, health centres, to the
patient’s home.
• Most pregnant women are healthy, with normal
pregnancies, and can be followed by an
obstetrical team including nurses, nurse
practitioners, and nurse- midwives, with an
obstetrician available for consultation.
8. • The goal of the ANC package is to prepare for birth
and parenthood as well as prevent, detect, alleviate,
or manage the three types of health problems during
pregnancy that affect mothers and babies:
• complications of pregnancy itself
• pre-existing conditions that worsen during
pregnancy
• effects of unhealthy lifestyles
10. Routine/Traditional ANC
• Based on high risk / low risk approach.
• Emphasis on frequent visits:
For high risk mothers
• every 4 weeks for the first 28 weeks of
pregnancy, every 2 to 3 weeks until 36 weeks,
and weekly thereafter, if the pregnancy
progresses normally.
10
11. risk approach
A strategy to identify risk factors for
undesirable outcomes, with care to be
delivered according to individual needs
1. high levels of false positive and false
negative
2. No amount of screening will separate those
women who will from those who will not
need emergency medical care .
11
12. Advantage
high maternal satisfaction with care, as well as
decreased maternal anxiety.
Disadvantage
•quantity was emphasised than quality
•not suitable for resource limited setup
•difficult to predict most obstetrical complication
•Risk factors are usually not direct cause of
complications
•It fails to distinguish who will develop complications and
who will not
•women may have a false sense of security and may not
be prepared for an emergency
12
13. For ANC to be effective in reducing
maternal mortality, it must be
• goal oriented and
• focused on “screening to detect a
problem rather than screening to predict
a problem” and on treating any problem
that can complicate a pregnancy.
13
15. • Focused or goal oriented ANC services
provide specific evidence-based
interventions for all women, carried out at
certain critical times in the pregnancy.
• The new model had median of 4/5 goal
oriented visits vs 12 visits in the standard.
• Hospital admission diagnosis rate of LBW, UTI,
Eclampsia, PE similar between the two groups.
16. Individualized, woman-centered care
based on each woman’s:
• Specific needs and concerns
• Circumstances
• History, physical examination, testing
• Available resources
16
17. Advantage
• goal oriented
• every pregnancy is risk
• low cost
Disadvantage
• less maternal satisfaction
• more perinatal mortality
17
18. principles of FANC
• The model should include simple format
• Identification of women with special health conditions
or risk factors should be done very carefully
• Health care providers should make all pregnant
women feel welcome at their clinic
• Only examinations & tests that serve an immediate
purpose that have been proven to be beneficial
should be performed.
• Whenever possible rapid & easy to perform test
should be used, treatment should be initiated at the
clinic the same day.
18
19. The essential elements of a focused
approach to antenatal care
1. Identification and surveillance of the
pregnant woman and her expected child
2. Recognition and management of
pregnancy-related complications,
particularly pre-eclampsia
3. Recognition and treatment of underlying
or concurrent illness
19
20. 4. Screening for conditions and diseases
such as anaemia, STIs (particularly syphilis),
HIV infection, mental health problems, and/or
symptoms of stress or domestic violence
5. Preventive measures, including tetanus
toxoid immunisation, de-worming, iron and
folic acid, intermittent preventive treatment of
malaria in pregnancy (IPTp), insecticide
treated bednets (ITN)
21. 6 . Advice and support to the woman and her
family for developing healthy home behaviours
and a birth and emergency preparedness plan
to:
o Promote healthy behaviours in the home,
including healthy lifestyles and diet, safety
and injury prevention, and support and care in
the home, such as advice and adherence
support for preventive interventions like iron
supplementation, condom use, and use of ITN
21
22. o Support care seeking behaviour, including
recognition of danger signs for the woman and the
newborn as well as transport and funding plans in
case of emergencies
o Help the pregnant woman and her partner prepare
emotionally and physically for birth and care of their
baby, particularly preparing for early and exclusive
breastfeeding and essential newborn care and
considering the role of a supportive companion at birth
o Promote postnatal family planning/birth spacing
23. goal of FNAC
To promote maternal and newborn health and
survival through:
• Early detection and treatment of problems and
complications
• Prevention of complications and disease
• Birth preparedness and complication readiness
• Health promotion
23
24. Timing of ANC Visits
• First visit: By 12 weeks or when woman first thinks she is
pregnant
• Second visit: At 24–28 weeks or at least once in second
trimester
• Third visit: At 32 weeks
• Fourth visit: At 36 weeks
• Other visits: If complication occurs, follow up or referral is
needed, woman wants to see provider, or provider changes
frequency based on findings (history, exam, testing) or local
policy
24
25. first visit
• The first assessment in ANC is to distinguish
pregnant women who require standard care, such
as the four-visit model, from those requiring special
attention and more visits. Depending on the setting,
approximately 25-30 percent of women will have
specific risk factors which require more attention.
These women need more than four visits.
25
28. goals
first visit second visit third visit fourth visit
Confirm
pregnancy and
EDD, classify
women for basic
ANC (four visits)
or more
specialized care.
Screen, treat and
give preventive
measures.
Develop a birth
and emergency
plan. Advise and
counsel
Assess maternal
and fetal well-being.
Exclude PIH and
anaemia.
Give preventive
measures.
Review and modify
birth and emergency
plan. Advise and
counsel.
Assess maternal and
fetal well-being.
Exclude PIH,
anaemia, multiple
pregnancies. Give
preventive measures.
Review and modify
birth and emergency
plan. Advise and
counsel.
Assess maternal and
fetal well-being.
Exclude PIH,
anaemia, multiple
pregnancy,
malpresentation.
Give preventive
measures. Review
and modify birth and
emergency plan.
Advise and counsel.
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29. activities
• history taking
• physical examination
• screening and testing
• Treatments
• Preventive measures
• Health education, advice, and counselling
29
30. first visit activities
• history taking - detailed obstetric , medical and psychosocial Hx
• physical examination - complete examination
• screening and testing - Haemoglobin Syphilis ,HIV , Proteinuria
Blood/Rh group* Bacteriuria*
• Treatments - Syphilis ,ARV .Treat bacteriuria if indicated
• preventive measures - tetanus toxoid Iron and folate+
• Health education, advice, and counselling -Self-care, alcohol and
tobacco use, nutrition, safe sex, rest, sleeping under ITN, birth
and emergency plan
30
31. second visit activities
• history taking -Assess significant symptoms. Check record for previous
complications and treatments during the pregnancy. Re-classification if
needed
• physical examination - Anaemia, BP, fetal growth, and movements
• screening and testing - bacteriuria , GDM
• Treatments - Antihelminthic. Treat bacteriuria if indicated*
• Preventive measures - Tetanus toxoid, Iron and folate IPTp , ARV
• Health education, advice, and counselling -Birth and emergency plan,
nutrition , reinforcement of previous advice
31
32. third visit activities
• history taking -Assess significant symptoms. Check record for previous
complications and treatments during the pregnancy. Re-classification if
needed
• physical examination - Anaemia, BP, fetal growth, and movements , multiple
pregnancy
• screening and testing - bacteriuria
• Treatments - ARV if eligible Treat bacteriuria if indicated*
• Preventive measures - Iron and folate IPTp , ARV
• Health education, advice, and counselling -Birth and emergency plan, infant
feeding, postpartum/postnatal care, nutrition, pregnancy spacing,
reinforcement of previous advice
32
33. fourth visit activities
• history taking -Assess significant symptoms. Check record for previous
complications and treatments during the pregnancy. Re-classification if needed
• physical examination - Anaemia, BP, fetal growth, and movements , multiple
pregnancy , malpresentation
• screening and testing - bacteriuria , HIV , HGB
• Treatments - ARV if eligible Treat bacteriuria if indicated , If breech, ECV or referral
for ECV
• Preventive measures - Iron and folate , ARV
• Health education, advice, and counselling -Birth and emergency plan, infant
feeding, postpartum/postnatal care, pregnancy spacing, nutrition , reinforcement of
previous advice
33
34. Birth Preparedness and Complication
Readiness
Objectives
• Develop birth plan—exact plan for normal birth
and possible complications:
• Arrangements made in advance by woman and
family (with help of skilled provider)
• Usually not a written document
• Reviewed/revised at every visit
• Minimize disorganization at time of birth or in
an emergency
• Ensure timely and appropriate care
34
35. Birth Preparedness and Complication
Readiness
Objectives
• Develop birth plan—exact plan for normal birth
and possible complications:
• Arrangements made in advance by woman and family
(with help of skilled provider)
• Usually not a written document
• Reviewed/revised at every visit
• Minimize disorganization at time of birth or in an
emergency
• Ensure timely and appropriate care
35
36. …Birth Plan
• Family and Community Support: Care for family in
woman’s absence and birth companion during labor
• Blood Donor: In case of emergency
• Needed Items: For clean and safe birth and for newborn
care
• Danger Signs/Signs of Advanced Labor
36
37. Berhanu M
Essential Elements of a Birth
Plan
• Facility or Place of Birth: Home or health facility for
birth, appropriate facility for emergencies
• Skilled Provider: To attend birth
• Provider/Facility Contact Information
• Transportation: Reliable, accessible, especially for
odd hours
• Funds: Personal savings, emergency funds
• Decision-Making: Who will make decisions, especially
in an emergency
37
38. Record Keeping
First ANC Visit
• History
• Physical examination
• Testing
• Care provision
• Counseling, including birth plan
• Date of next ANC visit
Subsequent ANC Visits
• Interim history
• Targeted physical
examination, testing
• Care provision,
• Counseling, including birth
plan and use of ITNs (and
relevant information on how
client obtained and used
ITN)
• Date of next ANC visit
Record all information on the ANC chart and clinic card:
38
39. Barriers to effective antenatal care
• Inadequate infra-structural resources
• Poor quality of care and treatment of clients
• Ignorance of the importance and value of ANC
• Not customary, In most societies there is no tradition of
antenatal care
• Cultural, traditional and religious practices
39
40. ….Barriers
• Lack of women’s autonomous decision-making on their
own health care seeking
• Poverty – fear of costs of transport and medical care
• Household responsibilities
• Illiteracy
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41. READ ON
• nutrition during pregnancy
• immunisation during pregnancy
• weight gain during pregnancy
41
