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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
Clean/safe Delivery
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
Tetanus toxoid, nutritional supplementation, tobacco and alcohol use, etc HIV, syphilis, tuberculosis, other co-existing medical diseases (e.g., hypertension, diabetes)
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
Antenatal Care: Overview 6
Disease detection
Counseling and health promotion Birth preparedness Complication readiness
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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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
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
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Establish a financing plan/scheme Make a plan for decision-making Arrange a system of transport
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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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