Antenatal Care (ANC)
By
Francis Kamwendo
@
Nkhota-kota
Definition (Health Evidence Network)
Antenatal care is all the care that a pregnant
woman receives from organized health services.
The primary aims of this care are to:
• detect early factors that may heighten the perinatal risk
of both individual pregnancies and
members of vulnerable groups;
• intervene to improve outcomes;
• educate all who provide or receive care; and
• help make pregnancy and birth a positive life
experience.
Antenatal care activities found to be effective
The basic activities of antenatal care fall within
three general areas:
1. Screening for health and socioeconomic conditions likely to
increase the possibility of
specific adverse outcomes;
2. providing therapeutic interventions known to be beneficial; and
3. Educating pregnant women about planning for safe birth,
emergencies during pregnancy
and how to deal with them.
Antenatal interventions known to be effective
Condition/stage
Test/treatment
Effect
Reduced number of antenatal visits
Reduced to 4-5 include proven effect
interventions
Similar maternal results
Delivering antenatal visits
Midwife/GP managed care compared wit
Obstet./Gynaecol. Led shared care
Similar clinical effectiveness
Prevention of anaemia
Routine iron & folate supplementation +
Malaria Chemoprophylaxes
Reduces or prevents fall in Hgb, reduces
% of anaemic women
Detection and investigation of anaemia
Blood tests
Diagnosis and type of anaemia → correct
treatment
Treatment of iron deficiency anaemia
Oral iron and folate/IM or IV iron
Packed cell transfusion
Raises Hgb prenatally
Detection and investigation of HDP
Measurement of blood pressure with
sphygmomanometer using 2nd & 5th
Korotkoff sound
Urine analysis of clean catch urine
Detects Hypertention
Detects proteinuria. Indicative of preeclampsia in presence of hypertention
Antenatal interventions known to be effective
Condition/stage
Test/treatment
Effect
Detection and investigation of HDP
Measurement of BP
Urine analysis of clean catch urine
Detects Hypertention
Detects proteinuria. Indicative of preeclampsia in the presence of hypertention
Treatment of severe pre-eclampsia
Transfer to first referal level for expert care
Control of disease. Reduces case fatality
Treatment of eclampsia
Supportive first aid maintaining airway and
preventing injury during fit
Magnesium sulphate (IM or IV).
Reduces case fatality
Reduces recurrent convulsions and maternal
mortality.
Recognition and speedy transfer to fully
equiped facility.
Reduces case fatality.
Expedited delivery
Only definite treatment.
Prevention of obstructed labour
External cephalic version at term
Reduces Ceasarean Section
Screening for infection
Serological screening and treatment for
Syphylis
Detects asymptomatic disease. Coupled
with effective treatment, contact tracing
and follow-up, reduces fetal loss and
maternal and infant morbidity
Microbiological screening for gonorrhoea
Detects asymptomatic disease. Coupled
with effective treatment, contact tracing
and follow-up, reduces fetal loss and
maternal and infant morbidity
Antenatal interventions known to be effective
Condition/stage
Test/treatment
Effect
Screening for infection
Screening for bacteriuria with
quantitative culture of urine
Detects asymptomatic disease. Coupled
with effective treatment prevents
pyelonephritis and pre-term delivery/low
birth weight
Prevention of infection
Tetanus immunization in pregnancy
and/or women of child bearing age
Prevents maternal and neonatal Tetanus
Induction of labour in uncomplecated
prelabour rupture of membranes
Prevents maternal infection