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