Antenatal Care: Interventions

1. SBA - Presentation 3 (b) Antenatal Care: Interventions Maternal Health Division Ministry of Health & Family Welfare Government of India Antenatal Care: Interventions

2. Interventions • Iron-folic acid (IFA) supplementation • Injection tetanus toxoid (Inj.TT) administration • Malaria prophylaxis and treatment • Folic acid supplementation (400 µg) upto 12 weeks of pregnancy to prevent neural tube defects • Regular consumption of iodised salt Antenatal Care: Interventions

3. Interventions Why is IFA supplementation needed? To meet the increased demand of iron and folic acid during pregnancy Additionally • Ensure regular intake of IFA tablet • Counsel for increase in dietary intake of iron rich food : green leafy vegetables, jaggery, whole pulses, meat, fish, chicken, eggs, groundnuts etc Antenatal Care: Interventions

4. Interventions What is the prophylactic dose of IFA? Dose : 1 tablet of IFA (100mg elemental iron+0.5 mg of folic acid) Duration : At least 100 days starting at 14-16 weeks Continue for 3 months postpartum Given for preventing anemia even if Hb>11gm/dl Antenatal Care: Interventions

5. Interventions What is the therapeutic dose of IFA if Hb < 11 gm/dl? Dose : 1 tablet twice a day of IFA (100mg elemental iron+0.5 mg of folic acid) Duration : At least 100 days during pregnancy Continue for 3-6 months in postpartum period Follow up Repeat Hb after 1 mth : If increased, continue the same treatment If no increase refer to MO for further investigations Antenatal Care: Interventions

6. Interventions What are the indications for referral in women with anemia? • Women with severe anemia, that is, Hb < 7 gm% • Anemic women with breathlessness and or tachycardia HR > 100 beats / min Start with therapeutic dose of IFA and REFER the woman immediately to MO at FRU Antenatal Care: Interventions

7. Prescribing IFA tablets: Counseling • Tablets to be taken regularly preferably early morning on an empty stomach • If nausea or pain abdomen, it may be taken after meals or at night • Stools will be dark in color while on tablets • May have constipation, relieved by taking plenty of fluids and roughage Antenatal Care: Interventions

8. Prescribing IFA tablets: Counseling • Absorption of iron is interfered if taken with tea, coffee or foods rich in fluoride • Enhanced if taken with lemon water or orange juice • Encourage her to take plenty of fruits and vegetables like mango, guava, orange, amla etc containing vitamin C • Emphasize the importance of high protein diet like black gram, ground nuts, whole grains, milk, eggs etc • Give advice not to stop the medication on her own Antenatal Care: Interventions

9. Injection tetanus toxoid administration Importance For preventing maternal and neonatal tetanus Dosage schedule : Two doses 0.5 ml I/M in upper arm First dose - As soon as woman registers for ANC Second dose - 4 weeks after the first dose even if it is after delivery If previously fully vaccinated within 3 years, give only one dose as early as possible Inform that there may be slight swelling, stiffness or pain at the injection site or in the arm Antenatal Care: Interventions

10. Malaria prophylaxis and treatment All clinically suspected cases should be investigated for malaria by Microscopy or Rapid Diagnostic Kit (RDK) • No prophylaxis in pregnant women • In non endemic areas : All clinically suspected cases should be investigated by RDK • In highly endemic areas : All pregnant women are routinely tested for malaria at 1st AN visit and then every month If positive, the woman is referred to PHC for treatment Antenatal Care: Interventions

11. Thank you Antenatal Care: Interventions