Integrated Maternal and Newborn Care Basic Skills Course ...

Reference Manual
ANTENATAL CARE
Antenatal care (ANC) should begin as early as possible in the pregnancy. Appropriate
scheduling depends on the gestational age of the pregnancy and also the woman’s individual
needs. For women whose pregnancies are progressing normally, the following schedule for a
minimum of four ANC visits may be sufficient:
1 st Visit: 16 weeks (by the end of 4 months) or as soon as
the woman thinks she is pregnant
2 nd Visit: 24-28 weeks (6-7 months)
3 rd Visit: 32 weeks (8 months)
4 th Visit: 36 weeks (9 months) for a total of 2 visits
during the 3 rd trimester
Elements of a Routine Antenatal Visit
During a routine antenatal visit, a skilled provider should:
• Perform a systematic examination including a rapid assessment to recognize danger
signs and features of advanced labor and respond immediately and appropriately.
• Detect pregnancy-related complications, fetal complications, medical conditions, and
infections.
• Take a detailed history to identify abnormalities and problems/potential problems that
may affect the pregnancy: social problems, medical problems, history of obstetrical
complications with previous pregnancies or births, and reported symptoms/problems.
• Perform a physical, obstetrical, and gynecological exam.
• Perform the following laboratory tests to evaluate the woman’s health and her pregnancy
and screen for selected medical conditions and infections. Where essential tests are not
feasible at the peripheral center, the woman must be referred to an appropriate facility.
o Hemoglobin levels (first visit/as needed).
o RPR (Reactive Plasma Reagin) or VDRL (Venereal Disease Research Laboratory) at
first visit or as needed: The test should be repeated in the 3 rd trimester if the woman
or her partner engages in risky sexual behavior.
o HIV (first visit/repeat in 3 rd trimester/as needed): If the woman volunteers for testing
or if the testing is initiated by the health care provider, a test should be conducted as
early as possible during the pregnancy. A positive HIV status affects many aspects of
ANC. Therefore, steps should be taken to prevent transmission of the virus to the
baby and for appropriate treatment of the mother.
o Urine for glucose: This test is used to screen for diabetes, which is a condition
beyond the scope of basic care. Although many women with normal glucosetolerance
tests spill sugar in their urine without any associated problems for mother
or child, this test can help identify women who actually do have high blood glucose
levels.
o Urine for protein: This test is used to screen for preeclampsia, which is a condition
beyond the scope of basic care. Although proteinuria is most commonly associated
with preeclampsia or eclampsia, a woman's urine can test positive for protein if she is
severely anemic, has kidney disease, or has a urinary tract infection, or if the urine
Integrated maternal and newborn care
Basic skills course
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