Integrated Maternal and Newborn Care Basic Skills Course ...

has been contaminated by blood (or if she has schistosomiasis), vaginal discharge,
or amniotic fluid.
o Grouping and Rhesus factor: All pregnant women should have their blood grouped
for ABO and Rhesus (Rh) types. Knowing the woman’s blood type can facilitate
transfusion in the case of an emergency. Knowing her Rhesus type will allow timely
administration of Rhesus antibodies (anti-D immunoglobulin) to prevent maternal
iso-immunization. Women with Rh-negative blood group are screened for Rhesus
antibodies with an indirect Coombs’ test. If there are no antibodies, the blood will be
retested at 28 and 34 weeks of pregnancy. If antibodies are found at any stage,
referral to a specialist will be required to decide on management of the pregnancy
and the newborn.
o Urine test for bacteriuria (as needed): This test is used to diagnose urinary tract
infections, which are conditions beyond the scope of basic care.
o Other tests as needed based on findings in history and physical examination.
• Provide prophylaxis for health promotion and disease prevention: TT, intermittent
preventive treatment (IPTp) of malaria, insecticide-treated bednets, iron/folate tablets,
broad-spectrum anti-helminthics, and other nutritional supplements as needed.
• Provide treatment for any medical conditions, illnesses, and infections detected.
• Manage any pregnancy-related complications.
• Provide client-centered and gestational-age-specific counseling for women and partners/
supporters.
• Help the woman and her partner/support person develop a birth-preparedness and
complication-readiness plan. Begin discussing the plan at the first visit and bring it up to
date at each subsequent visit.
• Ideally, during the antenatal visits, the mother should be counseled on basic preventive
care of herself and her baby after delivery, identification of danger signs, and the
required care-seeking. A number of women may end up delivering at home even after
having visited the antenatal clinic.
• Refer all women who need specialized care for any reason to an appropriate hospital.
Health Promotion and Disease Prevention
Certain medications or simple health care measures can prevent or reduce the risk of suffering
from specific health problems. The following measures should be explained and offered to all
pregnant women.
Preventing malaria
• Intermittent preventive treatment (IPTp)
of malaria with sulfadoxine-pyrimethamine
(SP) 500 mg + 25 mg. Do not give SP
during the first trimester of pregnancy or
during the 9th month of pregnancy.
SP Dose
1 st dose
Provide SP to all pregnant women: give 2
doses to women who are not infected with 2 nd dose
HIV; check national protocols for dose
recommendations for women infected with
HIV (if the woman is on cotrimoxazole
prophylaxis, use another anti-malarial drug for IPTp).
Table 3. Timing of SP dose
Timing
From 18 weeks (after
quickening). Not before 16
weeks gestation.
At 28 weeks or 1 month
After the 1 st dose.
34
Integrated maternal and newborn care
Basic skills course