Focused antenatal care aims to provide individualized care through a minimum of 4 visits during pregnancy, detecting and treating any complications early. It addresses the most prevalent health issues through evidence-based actions like immunizations, supplements, and preventative treatment. The new approach reduces visits without negatively impacting outcomes, focusing on quality over quantity of care from a skilled provider. Each woman's specific needs, history, and available resources are considered to develop an appropriate birth plan and promote health through discussions of nutrition, hygiene, danger signs, and postpartum care.

1. ANTENATAL CARE OVERVIEW
MR. ABDOU PANNEH
(RM,FWACN,DHAF, NT, RN)

2. DEFINITION
• Antenatal Care is the care given to a
pregnant woman from the time that
conception is confirmed until the beginning
of labor. It involves the midwife providing a
woman-centered approach to the care of the
woman and her family by sharing the
information with the woman to facilitate her
to make informed choices about her care.

3. HISTORY OF ANTENATAL CARE
• Before the rise of modern Obstetrics, the
pregnant woman usually had antenatal care
but as a single interview with a physician. At
that interview, often not much more was
accomplished than an attempt to only
anticipate the expected date of delivery.
When next seen by the physician, the woman
might already be in an eclamptic convulsion or
suffering severe chills and high fever from
malaria, pyelonephritis, or struggling to expel
a very large but dead fetus.

4. CONT’D
Appropriate antenatal care started since 1929
and its pattern of care was not challenged for
over 50 years. The traditional approach was:-
Monthly visits until 28th weeks of gestation,
Fortnightly visits until 36 weeks and then,
Weekly until the birth of the baby. In 1980, Hall
et al first questioned this approach through their
analysis, in which they explained that the
expectations of antenatal care may not be met
with this approach, they concluded that with
this approach, conditions requiring
hospitalization including pre-eclampsia were
neither prevented nor detected.

5. CONT’D.
Sikorsi et al (1996) also conducted a randomized
controlled trial with low risk pregnant women to
compare the acceptability and effectiveness of a
reduced antenatal visit of six to seven visits with
the traditional visit of 13 routine visits. The
results revealed no difference in clinical outcome
between the two. Jewel et al (2000) also
conducted another study between traditional
visiting versus flexible visiting in 11 Primary
Health Care Centers with 609 women. The
findings revealed no difference in either attitude
to pregnancy and motherhood or in women
urgently reporting with antenatal problems.

6. AIMS AND OBJECTIVES OF ANTENATAL CARE
• Antenatal Care is the first component of
Safe Motherhood Initiative which
actually calls for:
• Effective antenatal care
• Safe and clean delivery
• Essential obstetric care
• Post partum care and
• Family planning

7. AIM OF ANTENATAL CARE
• The aim of antenatal care is to
ensure safety for the mother
and her child during pregnancy,
delivery and post partum period
through effective prevention,
early detection and
management of complications.

8. THE OBJECTIVES
• Assessment, management and/or referral pregnant
mothers through history taking, physical examination and
laboratory tests where necessary, proper care and safe
transport.
• Information, Education and Counseling on nutrition,
danger signs of pregnancy and delivery.
• Development of an appropriate delivery plan based on
the woman’s health status and previous history.
• Provision of Tetanus Toxoid immunizations, Iron and
Folate supplementation, Intermittent Preventive
treatment for malaria (IPT), hook worm treatment and
Sexually Transmissible Infections (STIs) management
including Parent-To-Child-Transmission.

9. FOCUSED ANTENATAL CARE
• Focused Antenatal Care is the provision of an
integrated, individualized care to a pregnant
woman by a skilled provider from the time
conception is confirmed until the beginning of
labor.
• This approach is based on the following reasons:-
• Better, cheaper and faster provision of care
• Evidenced based goal oriented and centered care
• Individualized woman centered care
• Quality versus quantity of visits and care
• Care by only skilled providers.

10. THE BENEFITS OF FOCUSED
ANTENATAL CARE
• EVIDENCED –BASED, GOAL DIRECTED
ACTIONS
• Addresses most prevalent health issues
affecting women and new born
• Adjusted to specific populations and
regions
• Appropriate to gestational age
• Based on firm rationale

11. INDIVIDUALIZED, WOMAN-CENTERED CARE
• Based on each woman’s:-
• Specific needs and concerns
• Circumstances
• History, physical examination and
testing
• Available resources

12. QUALITY VERSUS QUANTITY OF
ANTENATAL VISITS
• Number of visits reduced without affecting outcome
for mother or baby
• Minimum of 4 visits such as-
• 1st visit – By 16weeks or when the woman
thinks/confirms she is pregnant
• 2nd visit – At 24 – 28 weeks or at least once in the 2nd
trimester
• 3rd visit – At 32 weeks
• 4th visit - At 36 weeks
• Other Visits – When necessary ( if complications begin
to occur, follow up or referral is needed, when woman
wants to see provider, or provider changes frequency
of visits based on findings)

13. CARE BY SKILLED PROVIDER WHO:
• Has formal training and experience
• Has knowledge, skills and qualifications to deliver
safe effective maternal and new born health care.
• Practices in home, hospital or health center.
• May be Midwife, Nurse, Doctor, Clinical officer or
other related field
• BETTER, CHEAPER AND FAST PROVISION OF CARE
• Less of human and material resources
• More time for the woman
• Less time spent on the care

14. CONT’D
• The new Focused Antenatal Care does away with
screening for “Risk Factors”.
• Research has discredited the risk approach. This
is because it has failed to predict who will go on
to develop complications of pregnancy and
delivery.
• The World Health Organizations package a
classifying form to help providers identify women
who have conditions requiring treatment and
more frequent monitoring.
• Focused Antenatal Care regard every woman who
is pregnant to be at risk.

15. STRATEGIES OF FOCUSED ANTENATAL CARE.
• IDENTIFICATION OF PRE-EXISTING HEALTH
PROBLEMS:-
• In order to achieve this, the provider during the initial
assessment should talk with the woman and examine
her for signs of chronic conditions and infectious
disease. These conditions are:-
• HIV/AIDs
• Malaria syphilis
• Heart diseases, Mental disorders, Diabetes, Kidney
diseases, Hypertension, Malnutrition, Tuberculosis, etc.
all these may affect the outcome of pregnancy and
require a more intensive level of monitoring and follow
up care over the course of pregnancy and post partum
period.

16. EARLY DETECTION AN TREATMENT OF
COMPLICATIONS
• The provider should talk with the woman and
examine her to detect problems of pregnancy
that might need treatment and closer
monitoring. These conditions are:_
• Anemia
• Vaginal bleeding, however slight
• Hypertensive disorders of pregnancy
• Abnormal fetal positioning after 36 weeks
gestation
• Abnormal fetal growth. All these may become
life-threatening if left untreated.

17. HEALTH PROMOTION AND DISEASE
PREVENTION
• This includes counseling about important issues
affecting a woman’s health status that of the new.
Discussion in that should include:-
• How to recognize danger sings, what to do and
where to get help.
• Good nutrition by specifying on the locally available
foods and the importance of rest.
• Hygiene and infection control and preventive
practices.
• Risk of using tobacco, alcohol, local drugs Over –The-
Counter (OTC) drugs and other traditional remedies.
Breast feeding and the importance of breast milk
• Post partum care, family planning and birth spacing.

18. CONT’D
• All women should receive preventive interventions
such as:-
• Immunization against Tetanus Toxoid
• Continuous Iron and Folate supplementations
• In areas of high prevalence, women should receive
the following:-
• Voluntary Counseling & Testing against HIV
• Presumptive treatment of hook worm
• Protecting against Malaria through Intermittent
Preventive Treatment (IPT), issue and use of
insecticide treated bed nets.
• Protection against vitamin A and iodine deficiencies.

19. BIRTH PREPAREDNESS AND
COMPLICTAION READINESS
• Approximately 15% of all pregnant women will
develop a life-threatening complication. Therefore,
every woman and her family should have a plan for
the following:
• A skilled attendant at birth
• Identify the place for birth and how to get there
including how to get emergency transportation if
needed.
• List of items needed for the birth
• Support during and after birth by the health
personnel, husband, family and friends.
• Attainment of potential blood donor in case of
emergency.

20. KEY STATEMENTS
• Antenatal Care should start as soon as pregnancy
is diagnosed and should continue until safe
delivery of the baby.
• An effective and thorough Antenatal care
requires team work of the Midwives, Nurses,
Doctors, Paramedical personnel and other stake
holders.
• Antenatal Care should take into account the
general health of Mental, Physical, Social, and
economic back ground of the client.

21. CONTRIBUTION
S,
CLARIFICATION
S &
CONSTRUCTIVE