Antenatal Care (ANC): Overview
Advances in Maternal and Neonatal Health
Session Objectives

Describe the purpose of antenatal care and its role in
relationship to Safe Motherhood initiatives

Define current issues related to providing effective antenatal
care
Antenatal Care: Overview
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Essential Health Sector Interventions for
Safe Motherhood
Essential Obstetric Care
Postpartum Care
Clean/safe Delivery
Antenatal Care
Postabortion
Family Planning
SAFE
MOTHERHOOD
BASIC HEALTH SERVICES
EQUITY
EMOTIONAL AND PSYCHOLOGICAL
SUPPORT
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Objectives of ANC

Promote and maintain the physical, mental and social health of
mother and baby by providing education on nutrition, personal
hygiene and birthing process

Detect and manage complications during pregnancy, whether
medical, surgical or obstetrical

Develop birth preparedness and complication readiness plan

Help prepare mother to breastfeed successfully, experience
normal puerperium, and take good care of the child physically,
psychologically and socially
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What is Effective ANC?

Care from a skilled attendant and continuity of care

Preparation for birth and potential complications

Promoting health and preventing disease


Detection of existing diseases and treatment


Tetanus toxoid, nutritional supplementation, tobacco and
alcohol use, etc
HIV, syphilis, tuberculosis, other co-existing medical
diseases (e.g., hypertension, diabetes)
Early detection and management of complications
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Why Disease Detection and Not Risk
Assessment

Risk approach is not an efficient or effective strategy for
maternal mortality reduction:




“Risk factors” cannot predict complications: usually not
direct cause of complication
What do you do once you identify risks? What about “low
risk?”
Maternal mortality is relatively rare in population at risk (all
women of reproductive age); “risk factors” are relatively
common in same population, these “risk factors” do not
appear to be good indicators of which women will
experience complications
Majority of women who experienced complication were
considered “low risk;” vast majority of women considered
to be “high risk” gave birth without experiencing a
complication
Fortney 1995; Yuster 1995.
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Goal-Directed Interventions Give a
Framework for Effective ANC

Disease detection

Counseling and health promotion

Birth preparedness

Complication readiness
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Goal-Directed Components of ANC:
Disease Detection

Look for problems requiring additional care
Parameter
Skin, general appearance, night
blindness, goiter
Temperature, dysuria
Blood pressure, edema, proteinuria,
reflexes
Hemoglobin, conjunctiva/palms/
tongue pallor
Breast exam
Baby’s movements, fundal height,
baby’s heart beat
Pelvic and speculum exam
Condition
Malnutrition
Signs of infection
Signs of pre-eclampsia
Signs of anemia
Breast disease
Fetal distress/demise
Sexually transmitted diseases
Antenatal Care: Overview
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Goal-Directed Components of ANC:
Counseling and Health Promotion

Client-centered and gestational age-specific counseling for
women and partners/ supporters on:

Nutrition and micronutrients

Rest and avoidance of heavy physical work

Danger signals of complications and disease/illness

Family planning

Breastfeeding

Malaria prophylaxis

Tobacco and alcohol use
Antenatal Care: Overview
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Goal-Directed Components of ANC:
Birth Preparedness


Make plans for the birth:

Prepare the necessary items for birth

Identify a skilled attendant and arrange for presence at
birth

Identify appropriate site for birth, and how to get there

Identify support people, including who will accompany the
woman and who will take care of the family
Establish a financing plan/scheme
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Goal-Directed Components of ANC:
Complication Readiness
15% of all pregnant women develop a life-threatening complication
requiring obstetric care

Establish a financing plan/scheme

Make a plan for decision-making

Arrange a system of transport

Establish a plan for blood donation
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Goal-Directed ANC

Goal-directed interventions

Increasing use of systematic review of evidence to evaluate
effectiveness of interventions

This effort is now underway and is ongoing
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Summary
Antenatal care includes goal-directed interventions

Skilled attendant

Preparation for birth and complications

Health promotion

Detection of complications
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References
Fortney J. 1995. Antenatal risk screening and scoring: a new look.
Int J Gynecol Obstet 50(Suppl 2): S53–S58.
Yuster EA. 1995. Rethinking the role of the risk approach and
antenatal care in maternal mortality reduction. Int J Gynecol
Obstet 50(Suppl 2): S59–S61.
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