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