Focused Antenatal Care

FOCUSED ANTENATAL CARE
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R ÔNTRODUCTÔON
R GOALS OF FOCUSED ANC
R SCHEDULE AND TÔ ÔNG OF ANC

VÔSÔTS
R CONCLUSÔON
ÔNTRODUCTÔON
R Antenatal care, the care a woman

receives throughout her pregnancy, is
important in helping to ensure that
women and newborns survive
pregnancy and childbirth
ÔNTRODUCTÔON
R The traditional approach to antenatal

care, which is based on European
models developed in the early 1900s,
assumes that more is better in care for
pregnant women. Frequent routine
visits are the norm, and women are
classified by risk category to determine
their chances of complications and the
level of care they need
ÔNTRODUCTÔON
R Traditionally, antenatal care (ANC) programs have

mirrored those in developed countries. Too often,
programs are poorly implemented and do little to
promote the health of mothers and newborns
R Until recently, many of the components of antenatal

care had not been rigorously evaluated. Now the
World Health Organization (WHO) has developed a
focused ANC package that includes only counseling,
examinations, and tests that serve immediate
purposes and have proven health benefit
ÔNTRODUCTÔON
R The new approach to ANC emphasizes

the quality of care rather than the
quantity. For normal pregnancies WHO
recommends only four antenatal visits
ÔNTRODUCTÔON
Focused ANC is an approach to ANC that emphasizes:
Evidence ±based , goal-directed actions
Family ±centered care
Quality, rather than quantity of visits &
Care by skilled providers.

Goals of Focus ANC
To promote maternal and newborn health and survival through:
Early detection and treatment of problems and

complication
Prevention of complications and diseases
Birth preparedness and complication readiness
Health promotion
Goal NO 1:Early detection and treatment
of conditions
R alaria
R Severe anaemia
R Pre-eclampsia/eclampsia
R HÔV
R STÔS including Syphylis ±testing
R TB-screening
Goal NO 2:Prevention
R alaria:
-ÔPT
-ÔTNs
R TT immunization
R Ôron/folate supplement
R Nutrition
Goal NO3: Birth preparedness and complication
readiness.
R Develop individual birth plan:
Facilityor place of birth

Skilled provider to attend birth
Provider/facility contact information
Transportation
Funds
Decision- aking
R Family and community support
R Blood donor in case of emergency
R Needed items: for safe and clean

delivery and care of newborn
R Danger signs/signs of advanced

labour
Danger signs during pregnancy
R Vaginal bleeding
R Difficulty in breathing
R Fever
R Severe abdominal pain
R Severe headache/blurred vision

R Convulsions/Loss of consciousness
R Labour pains before 37 weeks

Goal No 4: Health education
R Prevention of malaria
R Nutrition
R Avoid potentially harmful substances
R Rest and activity

R Prevention of tetanus and anaemia
R HÔV/AÔDS prevention and care
R Sexual relations and safer sex
R Ômportance of delivery by skilled attendant

R Early and exclusive breastfeeding
R Child spacing
R Post-natal care
Schedule and timing of ANC visits
R First visit: Within 16 weeks
R Second visit: At 20-24 weeks
R Third visit: At 28-32 weeks
R Fourth visit: At 36 weeks or later
R Post-natal visit: 2 weeks after delivery

First ANC visit(within 16 weeks)
R Use classifying form to obtain:

ùObstetric & medical history.
- Senior registrars to classify patients.
- High risk patients should be seen frequently
- Ôf at anytime patient becomes high risk visits

should be frequent
Contents of first visit
R Demographic data
R edical history
R Obstetric history
R Obstetric operations
R Perinatal complications
R History of present pregnancy
R Examination
Signsof anaemia
Weight and height
Blood pressure
Chest and heart auscultation
SFH
R Ônvestigations
Urinalysis for bacteriuria &protenuria. All
patients
VDRL
Blood group typing (ABO and Rh)
HB if signs of severe anaemia
HÔV screening
Ônterventions
R FE /Folate supplement. 60mg of fe and

250mcg folate. HB <7gm/dl double dose
R Ôf rapid test for syphylis is +ve treat
R Tetanus toxoid first injection
R SP once in 2nd and 3rd trimester

Counselling
R Practice safe sex(faithfullness /condom use)
R Avoid tobacco, alcohol, and other harmful

substance
R Advice on where to go in case of bleeding,

abdominal pain or other emergency.
R Birth plan, use of ÔTNs and HÔV testing

R Give date of next ANC visit
R Complete clinic record and ANC card

2nd visit(20-24weeks )
R Personal history- any change since 1st visit or

complaints
R Note intercurrent disease, injury or other

condition since 1st visit
R Note intake of medicines other than haematinics
R Note abnormal changes in body features or

physical capacity-oedema & dyspnoea
R Check up on habits eg. Smoking and
alcohol
R Examination:
Blood pressure
SFH
Peripheral oedema
V/E only if not done at 1st visit
Ônvestigations
R Urinalysis for evidence of bacteriuria.

Proteinuria if nulliparous or has high BP,
PE or Eclampsia in previous pregnancy
All women with hypertension in index preg

be tested for proteinuria
Repeat HB if sign of severe anaemia

Ôntervention
R Haematinics
Counselling

substance

R Birth plan, use of ÔTNs and HÔV testing


3rd visit (28-32wks)
R Personal history- any change since 2nd visit or

complaints

condition since 2nd visit

Symptoms & events since 2nd visit
R Abdominal or back pain (? Preterm labour)
R Bleeding
R Vaginal discharge(?amniotic fluid)
R Oedema, dyspnoea
R Check up on habits eg smoking and alcohol
R Examination:
Blood pressure
SFH
Palpate abdomen for detection of multiple fetuses
Auscultate for fetal heart sounds
Peripheral oedema
Ônvestigations

Proteinuria if nulliparous or has high
BP, PE or Eclampsia in previous
pregnancy
All women with hypertension in index

preg be tested for proteinuria
HB for all women

Counselling

substance

R Birth plan
R Provide recommendation on lactation,
contraception and importance of
postpartum visit

4th visit (36wks)
R Personal history- any change since 3rd visit or

complaints

condition since 3rd visit

R Obtain history of previous delivery
complications
R Examination:
Blood pressure
SFH
Palpate abdomen for detection of multiple fetuses
Fetal lie and presentation
Aucultate for fetal heart sounds
Peripheral oedema
Ônvestigations

Proteinuria if nulliparous or has high BP, PE
or Eclampsia in previous pregnancy
All women with hypertension in index preg be

tested for proteinuria
R Women with breech presentation should be
evaluated for ECV
R Offer information on where to go when

labour start or if there are other symptoms
R Birth plan
R Advice if undelivered by the end of 41 wk for

hospital evaluation ± Ônd. Of labour
RComplete clinic record and
ANC card
Post partum visit
R The committee recommend that this should take

place 2 weeks after delivery
R Activities:
Advice on prevention of unplanned pregnancy
Reinforcement of breast feeding
Complete TT immunization for late attendants

to ANC
Continue iron & folate supplement
Planned any continued surveillance if

required
Conclusion
R The result of the WHO randomized trial &

review of scientific evidence on ANC models
with reduced number of visits justifies the
introduction of the new WHO model for
general use; including in Family edicine
R The new model is not associated with increase

risk for either the woman or the fetus
R Ôt reduces the time and resources
necessary for ANC by limiting the
number of visits
Thank you

Focused Antenatal Care

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FOCUSED ANTENATAL CARE

R GOALS OF FOCUSED ANC

R SCHEDULE AND TÔ ÔNG OF ANC

R Antenatal care, the care a woman

R The traditional approach to antenatal

R Traditionally, antenatal care (ANC) programs have

R Until recently, many of the components of antenatal

R The new approach to ANC emphasizes

Focused ANC is an approach to ANC that emphasizes:

 Evidence ±based , goal-directed actions

 Family ±centered care

 Quality, rather than quantity of visits &

 Care by skilled providers.

 To promote maternal and newborn health and survival through:

Early detection and treatment of problems and

Prevention of complications and diseases

Birth preparedness and complication readiness

R Develop individual birth plan:

Facilityor place of birth

Provider/facility contact information

R Blood donor in case of emergency

R Needed items: for safe and clean

R Danger signs/signs of advanced

R Severe abdominal pain

R Severe headache/blurred vision

R Labour pains before 37 weeks

R Avoid potentially harmful substances

R Rest and activity

R HÔV/AÔDS prevention and care

R Sexual relations and safer sex

R Ômportance of delivery by skilled attendant

R First visit: Within 16 weeks

R Second visit: At 20-24 weeks

R Third visit: At 28-32 weeks

R Fourth visit: At 36 weeks or later

R Post-natal visit: 2 weeks after delivery

R Use classifying form to obtain:

- Senior registrars to classify patients.

- High risk patients should be seen frequently

- Ôf at anytime patient becomes high risk visits

R History of present pregnancy

 Chest and heart auscultation

 Blood group typing (ABO and Rh)

 HB if signs of severe anaemia

R FE /Folate supplement. 60mg of fe and

R Ôf rapid test for syphylis is +ve treat

R Tetanus toxoid first injection

R SP once in 2nd and 3rd trimester

R Practice safe sex(faithfullness /condom use)

R Avoid tobacco, alcohol, and other harmful

R Advice on where to go in case of bleeding,

R Birth plan, use of ÔTNs and HÔV testing

R Complete clinic record and ANC card

R Personal history- any change since 1st visit or

R Note intercurrent disease, injury or other

R Note intake of medicines other than haematinics

R Note abnormal changes in body features or

R Urinalysis for evidence of bacteriuria.

 All women with hypertension in index preg

 Repeat HB if sign of severe anaemia

Evidence ±based , goal-directed actions

Family ±centered care

Quality, rather than quantity of visits &

Care by skilled providers.

To promote maternal and newborn health and survival through:

Facilityor place of birth

Provider/facility contact information

Chest and heart auscultation

Blood group typing (ABO and Rh)

HB if signs of severe anaemia

All women with hypertension in index preg

Repeat HB if sign of severe anaemia

Palpate abdomen for detection of multiple fetuses

Auscultate for fetal heart sounds

All women with hypertension in index

HB for all women

Palpate abdomen for detection of multiple fetuses

Fetal lie and presentation

Aucultate for fetal heart sounds

All women with hypertension in index preg be

Reinforcement of breast feeding

Complete TT immunization for late attendants

Planned any continued surveillance if