Antenatal care in the midwiferynursing.pptx

2.0 Health status of women during pregnancy,
labour and puerperium
Friday, April 19, 2024 Cecilia E. Mushi 1

2.7
By: Cecilia E. Mushi

Objectives
At the end of this session each student is expected to be able to:
1. Define the term antenatal care
2. Explain the aims of antenatal care
3. Equipped with knowledge on assessment of a woman during ANC
visits
4. Acquire knowledge on antenatal screening and early detection of
diseases and abnormalities

1. Definition
• Antenatal care is the systematic supervision (examination
and advice) of a woman during pregnancy
• The supervision should be regular and periodic in nature
according to the need of the individual

Importance of ANC
• The objective is to ensure a normal pregnancy with delivery of a
healthy baby from a healthy mother

2. The aims of antenatal care
1. Screen the “high risk” cases such as anemia, hypertension, HIV, TB
and STIs
2. Prevent or to detect and treat at the earliest any complication such
as hypertensive disorders
3. Ensure continued risk assessment and to provide ongoing primary
preventive health care

The aims of antenatal care cont.………
4. Educate the mother about the physiology of pregnancy and labor, so
that fear is removed and psychology is improved
5. Discuss with the couple about the place, time and mode of delivery,
provisionally and care of the newborn
6. Provide micronutrient supplementation such as Vitamin A, Iron, folic
acid and calcium
7. Provide health education on nutrition, medication and lifestyle,
exercise, personal and environmental hygiene, exclusive breastfeeding
and Family planning

3. Assessment during ANC visits
Trimester Week of contacts
First trimester Up to 12 weeks
Second trimester 20 weeks
26 weeks
Third trimester 30 weeks
34 weeks
36 weeks
38 weeks
40 weeks
Return for delivery at 41 weeks if the woman has not given birth
Pregnant women should have a minimum of eight contacts with a
health care provider during the period of pregnancy
Recommended antenatal contacts

Maternal assessment
• The major goal of ANC is to ensure the health of pregnant
women by early detection and intervention of danger
signs/complications
• Health care providers must perform a thorough assessment
(detailed history and physical examination) on every
pregnant woman to make a proper diagnosis

Quick Assessment and Management
• A quick check is performed by a health care service provider to
identify pregnant women who need immediate attention
Providers should follow these steps:
• Assess general condition of the woman immediately on arrival at
antenatal clinic by observing her general appearance (e.g., facial
appearance and expression, pallor, sweating, shivering, difficulty in
breathing)

Quick Assessment ……….
• Ask general screening questions, such as:
• Why did you come to clinic today?
• What is your gestation age?
• What is your concern?

• Record all information given
• If the woman is very sick and cannot respond, talk to her companion
Ask, look, and feel:
• Bleeding vaginally
• Headache and visual disturbance
• Severely pale
• Severe vomiting
• Convulsing

• Looking very ill (lethargic, drowsy)
• A fever
• Unconscious
• Severe pain
• Severe difficulty breathing
• In labour
• Imminent delivery
• In case of any problem, stabilize, treat, and/or refer the woman
immediately

History taking
Thorough history should be taken from
every pregnant woman to determine:
• Duration of pregnancy (LNMP & EDD)

Example of EDD calculations:
• Make a quick estimate by taking the date of the LMP, add 7days the
date, and 9 months on the month
i. If the LNMP was on 2-2-2023, what will be the EDD?
ii. If the LNMP is 27-10-2022, what will be the EDD?
• LNMP 2-2-2023 EDD 9-11-2023
• LNMP 27-10-2022 EDD 3-8-2023

History taking cont.…..
• Obstetric history
• Medical and surgical history with pregnancy implication
• Contraceptive history

Physical Examination
• When conducting a physical examination, the woman may
remain seated or lying down and relaxed
General Examination
The following should be checked:
• General appearance of the patient
• Nutritional status
• Facial puffiness

General Examination cont.…..
• Blood pressure
• Weight (recorded on first contact and in all follow-up
contacts during pregnancy to Monitor maternal weight
gain)
• Height
• Pulse rate
• Temperature (if indicated)
• Respiration rate
• Pallor (conjunctiva, palms, tip of the tongue, gums)
• Breasts and axillary lymph nodes

Abdominal Examination
Inspection:
• Signs of pregnancy, scars, movement with respiration,
shape of the abdomen
Palpation:
• To rule out tenderness, masses and determine fundal
height:
• Determined by measuring the Symphysis fundal height
(SFH) from 20 weeks’ gestation
• Lie and presentation are only important after 36 weeks

Auscultation:
• Listening for the presence
of a fetal heart from 24
weeks’ gestation

Pelvic Examination
• Pelvic examination should be done only when indicated
• It may help to diagnose women who have vaginal bleeding,
abnormal vaginal discharge, sores, and swellings

Ultrasound scan
• One ultrasound scan, preferably before
24 weeks’ gestation, is recommended

• Additional early or late
ultrasound scans may be
done if indicated

4. Antenatal screening
Routine antenatal screening is mandatory to identify at risk pregnant
mothers
The following should be screened during ANC visits:
1. Anemia: Hemoglobin level should be checked at every contact
2. GBV: Clinically inquire the history of GBV and other forms of violence
at each ANC contact when assessing conditions that may be caused or
complicated by GBV in order to improve clinical diagnosis and
subsequent care

Antenatal screening cont.……
3. Gestational diabetes mellitus (GDM)
• Glucose in urine (glycosuria) should be tested on all pregnant women
at 12weeks (or first ANC contact), 26, and 34weeks’ gestation
• Women found to have glucose in their urine should have their
random blood sugar checked and treated
• Hyperglycemia first detected from 24 week should be classified as
GDM

4. Albuminuria: Albumin in urine (albuminuria) should be tested to all
pregnant women at every ANC contact

5. Tobacco use
• Ask all pregnant women about their tobacco use (past and present) and
exposure to secondhand at booking and at every ANC contact
• Smokers (or recently quit using tobacco) should be offered counselling and
psychosocial interventions for tobacco cessation at every visit

6. Substance use
• Ask all pregnant women about their use of alcohol and other
substances (past and present) as early as possible in the pregnancy
and at every ANC contact
• Alcohol or drugs dependents should be counseled to cease substance
use and be referred to medical-assisted therapy services

7. HIV:
• Counselling and testing HIV to
all pregnant women at booking
• The test should be repeated at
26 and 34weeks’ pregnancy
• Women who are found to be
HIV-positive should be started
on treatment according to the
existing PMTCT guidelines

8. Syphilis:
• Test for syphilis at booking and repeat at 26 and 34 weeks
• If found positive, the woman should be treated together with her
partner after he has been tested
• The newborn of a mother who tested positive for syphilis should also
be treated according to neonatal guidelines
• Where facilities permit, HIV and Syphilis testing should be done
together as one test (dual testing)

9. Malaria:
• Offer mRDT to all pregnant women at booking and whenever they
have a history or signs of fever
• Treat all positive malaria pregnant women as per National Malaria
Diagnostic and Treatment Guidelines to all malaria positive

10. Tuberculosis
• Screening for TB to all pregnant women should be done at 12 (or the
first ANC contact), 26 and 34weeks using TB screening tool
• Treat all pregnant women with active TB as per National TB guideline
• Newborns, once delivered, should be given preventive treatment

Mandatory investigations during pregnancy
• Blood grouping and Rhesus Factor
• Hemoglobin level (FBP is highly recommended)
• Urinalysis (Protein, sugar, UTI)
• Syphilis test
• HIV test
• Hepatitis B test
• Ultrasound (at 24weeks gestation and any other time if
indicated)
• Random blood glucose (only for positive glycosuria)
• UPT in early pregnancy

SN Prophylactic item Item given Frequency of administration Dosage
1 Deworming Tabs Mebendazole/ Albendazole Once (from 2nd trimester) ● Tabs Mebendazole 500mg
start.
● Tabs Albendazole 400mg start
2 IPT-SP Sulphadoxine pyrimethamine. Start at 13th week and repeat every 4 weeks till
delivery (at least 3 doses)
Three tablets/dose.
3 Tetanus Tetanus toxoid vaccine. ● First dose at booking
● Second dosage after 4 weeks
● Third dose after six month
● Fourth dosage after one year
● Fifth dosage after one year.
Single dose injection.
4 Anemia ● Ferrous sulphate.
● T. Folic acid
Daily -60 Mg of elemental iron
-4mg of Folic acid.
5 Rhesus incompatibility Anti D ● At 28 and 34 weeks. (and within 72hours post-
delivery preferably after cord blood results)
● Within 72 hours post abortion
- 300mcg start
-(50-100)mcg following abortion.
6 Calcium Oral elemental calcium Daily (1.5-2)g of oral elemental calcium .
Mandatory prophylaxis and vaccination

Mandatory prophylaxis …….
Administration of IPT-
Sulphadoxine pyrimethamine (SP)
Under Directly Observed Therapy
(DOT)

Summary

Reference
• MoHCDGEC | Antenatal Care Guidelines (2018)
• Fraser, D, M., & Cooper, M. A. (2009). Myles textbook for
midwives (15th ed.). London: Churchill Livingstone

Antenatal care in the midwiferynursing.pptx

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