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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

Essential Health Sector Interventions for Safe Motherhood


SAFE MOTHERHOOD
Essential Obstetric Care

Clean/safe Delivery

BASIC HEALTH SERVICES EQUITY EMOTIONAL AND PSYCHOLOGICAL SUPPORT


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Postpartum Care

Family Planning

Antenatal Care

Postabortion

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

Antenatal Care: Overview

What is Effective ANC?

Care from a skilled attendant and continuity of care


Preparation for birth and potential complications Promoting health and preventing disease

Tetanus toxoid, nutritional supplementation, tobacco and alcohol use, etc HIV, syphilis, tuberculosis, other co-existing medical diseases (e.g., hypertension, diabetes)

Detection of existing diseases and treatment

Early detection and management of complications

Antenatal Care: Overview

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
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Fortney 1995; Yuster 1995.

Goal-Directed Interventions Give a Framework for Effective ANC

Disease detection
Counseling and health promotion Birth preparedness Complication readiness

Antenatal Care: Overview

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 Babys movements, fundal height, babys 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
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Antenatal Care: Overview

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

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): S53S58.
Yuster EA. 1995. Rethinking the role of the risk approach and antenatal care in maternal mortality reduction. Int J Gynecol Obstet 50(Suppl 2): S59S61.

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