General Objective • To enhance the knowledge, attitude and practice of midwives on FOCUSEDANTENATAL CARE Specific Objectives • To demonstrate how to make an immediate general assessment of the pregnant woman • To apply the process flow of providing antenatal care. • To discuss the importance of a birth and emergency plan
Objectives of Prenatal Care • To detect diseases which may complicate pregnancy • Educate women on danger and emergency signs & symptoms • Prepare the woman and her family for childbirth
Steps to Follow in Prenatal Care 1)IMMEDIATE ASSESSMENT for emergency signs. • Unconscious/Convulsing • Vaginal bleeding • Severe abdominal pain • Looks very ill • Severe headache with visual disturbance • Severe difficulty in breathing • Dangerous Fever • Severe vomiting * Attend to sick woman quickly.
Steps to Follow in Prenatal Care 2) Make the woman comfortable. • Greet her, make sure she is comfortable and ask how she is feeling. • If first visit, register the woman and issue a Mother and Child Book (antenatal record form)
Steps to Follow in Prenatal Care3) Assess the pregnant woman FIRST visit: • How old is patient? • Past Medical History • Obstetric History: Gravidity? LMP? AOG? • Alcohol/Drug/substance abuse? • Ask about or check record for prior pregnancies: • Convulsions • Stillbirth or death in the first day • Heavy bleeding during or after delivery • Prior cesarean section, forceps or abortion
Steps to Follow in Prenatal Care3) Assess the pregnant woman ON ALL VISITS: • Check duration of pregnancy (AOG). • Ask for bleeding/danger signs during this pregnancy • Check record for previous treatments received during this pregnancy • Prepare birth and emergency plan • Ask patient if she has other concerns • Give education and counseling on family planning and breastfeeding
Steps to Follow in Prenatal Care3) Assess the pregnant woman THIRD TRIMESTER • Leopold’s exam, fetal heart beat • Give education & counseling on family planning • Do not perform vaginal exam as a routine • prenatal care procedure. • Always record findings. • All pregnancies are at risk. Encourage all pregnant • women to deliver in the health facility. • Refer patients with abnormal findings to higher facility.
Steps to Follow in Prenatal Care • Get baseline laboratory information of the woman on the first or following the first visit. • Hemoglobin, blood type • Urinalysis • VDRL or RPR to screen for syphilis • If not available, refer to the nearest RHU or hospital for the tests.
Steps to Follow in Prenatal Care 5) Check for pallor or anemia. • Ask about getting tired easily or shortness of breath during routine work. • On 1st visit, check hemoglobin & blood type. The normal hemoglobin cut-off level for a pregnant woman is 11g/dl. • On subsequent visits: • Look for conjunctival pallor. • Look for palmar pallor. • Count number of breaths in one minute.
6) Check for hypertension/ pre-eclampsia. Steps to Follow in Prenatal Care • Measure BP in sitting position. • If diastolic BP is 90 mm Hg or higher repeat measurement after 1 hour rest. • If diastolic BP is still 90 mm Hg or higher ask the woman if she has: • Severe headache • Blurred vison • Epigastric pain • Check urine for protein.
Steps to Follow in Prenatal Care 7) Check for gestational diabetes. ASK ABOUT • Family history of diabetes & history of obesity. • Past pregnancy for difficult labor, large babies, congenital malformations and previous unexplained fetal death. LOOK FOR • signs of maternal overweight or obesity • Polyhydramnios • Signs of large baby or fetal abnormality • Vaginal infection. Low Risk: 24-28 wks High Risk: Immediately, any AOG
8) Check for fever, burning sensation on urination and abnormal vaginal discharge. Steps to Follow in Prenatal Care • Ask about episodes of fever or chills and take temperature. • Ask about pain or burning sensation on urination. • Ask about presence of abnormal vaginal discharge, itching at the vulva or if partner has a urinary problem.
9) Immunize against tetanus. Steps to Follow in Prenatal Care
Steps to Follow in Prenatal Care 10) Give MEBENDAZOLE to treat for intestinal parasites. 500 mg single dose once in six months (after the 1st trimester) 11) Give iron and folate supplementation to prevent anemia and neural tube defects: 60 mg Fe & 250 mcg Folate If Hgb<80 gm/dl→ double the dose 12) Refer for preventive intermittent treatment for falcifarum malaria (if area is endemic)
Steps to Follow in Prenatal Care 13) Provide health information, advice • HEALTH INFORMATION: • Nutrition • Self-care during pregnancy • Effect of tobacco, alcohol & drugs • Breastfeeding • Birth & Emergency situations • Schedule of appointment
Steps to Follow in Prenatal Care14) Advise on Danger Signs • Vaginal bleeding • Convulsions • Severe headache • Severe abdominal pain • Fast or difficult breathing • Fever or burning urination
Steps to Follow in Prenatal Care 15) Encourage the woman to come back for return visits. At least 4 routine antenatal visits 1st visit: before 4 months 2nd visit: 6 months 3rd visit: 8 months 4th visit: 9 months – return if undelivered within 2 weeks after the EDC. Pregnant women who do not come for prenatal care should be visited at home.
The Birth Plan • A written document prepared during the first prenatal consultation • Discussed with the patient and her family • May change anytime during pregnancy if a problem is detected.
The Birth Plan Contains information on: • the woman’s condition during pregnancy • preferences for her place of delivery and choice of birth attendant • available resources for her childbirth and newborn baby • preparations needed should an emergency situation arise during pregnancy, childbirth and postpartum.
Emergency Plan • Advise on danger signs • Where to go? • How to go? • Who will go with you to health center? • How much will it cost? Who will pay? How will you pay? • Start saving for these possible costs now. • Who will care for your home and other children when you are away?
B I R T H and E M E R G E N C Y P L A N
ANTENATAL CARE: Key Messages • Reduced number of visits • Provided by skilled birth attendant • Screening and prevention of diseases that may complicate pregnancy • Preventive Measures: Tetanus immunization, iron and folic acid supplementation • Counseling on family planning, nutrition, breastfeeding, and danger signs • BIRTH PLAN: Birth preparedness and complication readiness