Antenatal Care.ppt
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Antenatal period is special and unique to every women and needs continuous care and supervision to avoid preventable complications.
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Antenatal Care.ppt
- 1. ANTENATAL CARE PRESENTED BY: Srujani Swetasina Dash Nursing Tutor A.N.M.M.C.H, Gaya Quality Antenatal Care 1
- 2. Quality Antenatal Care 2 Session Objective To understand – Definition of ANC – Importance of antenatal check-up – Components of quality ANC – Need for early registration of pregnancy – Number and timing of antenatal check-ups – How to calculate number of pregnancies in a year – How to track all pregnant women
- 3. Antenatal period • The time duration from conception of the fetus in the woman’s uterus to the delivery of the baby is called antenatal period.
- 4. Quality Antenatal Care 4 The term - Antenatal Care Antenatal care is systemic supervision of a woman during antenatal period/ pregnancy at regular intervals to monitor : – Maternal wellbeing – Fetal wellbeing – Progress of fetal growth
- 5. Quality Antenatal Care 5 What is the importance of Antenatal Care? • Preparation of birth plan and identification of facility for delivery • Providing quality of care for well being of pregnant women and the foetus • Early identification of maternal and fetal complications and timely referral • Identification of a facility for referral
- 6. COMPONENTS OF QUALITY ANC PRIMARY COMPONETS ESSENTIAL COMPONENTS DESIRABLE COMPONENTS COUNSELLING (Source: SBA Guidelines) Quality Antenatal Care 6
- 7. Quality Antenatal Care 7 Quality Antenatal Care: PRIMARY COMPONENTS • Early Registration and first check up within first trimester (12 wks) • Minimum 4 antenatal check ups; at least one ANC by M.O. (Preferably 3rd ANC) • Two doses of Injection tetanus toxoid • Intake of at least 100 tablets of IFA
- 8. Quality Antenatal Care 8 Quality Antenatal Care: ESSENTIAL COMPONENTS • History taking • Physical examination (Weight, BP, pallor, respiratory rate, edema) • Abdominal Examination • Laboratory investigations (Hb %, Urine for sugar and proteins)
- 9. Quality Antenatal Care 9 Quality Antenatal Care: DESIRABLE COMPONENTS • Blood group and Rh typing • VDRL / RPR (Rapid Plasma Reagin) • Offering rapid testing for HIV screening Tie up with nearest ICTC / PPTCT centre for: – Rapid testing kits for HIV screening – Referral and management of +ve cases • Hepatitis B and HbsAg (Australia Antigen testing) • Blood sugar testing
- 10. Quality Antenatal Care 10 Quality Antenatal Care: COUNSELLING What are the important points? • Promotion of institutional delivery & stay for 48 hrs. • Birth preparedness • Recognizing danger signs & symptoms during pregnancy, labor & post natal period • Plan for complication management • Diet, Rest, Family planning • Care of new born • Initiation of breast feeding EBF and complimentary feeding • Immunisation • Janani Suraksha Yojana (JSY) • Emphasising importance of seeking ANC & PNC
- 12. PRIMARY COMPONENTS • Ensure early registration • Track every pregnancy - at least four antenatal check- ups • Administer two doses of TT injection. • Provide at least 180 tablets of IFA
- 13. EARLY DETECTION AND REGISTRATION • For proper planning and adequate care • Recording LMP and EDD. • Assess mothers health status. • Timely detection of complications • Facilitates a good interpersonal relationship • Folic Acid Suplementation in early prenancy- 400 mcg.
- 14. Calculation of Expected Date of Delivery (EDD) • LMP – first day of last menstrual period. • EDD = Date of LMP + 9 months + 7 days
- 15. Exercise Exercise 1: • Mrs. Seema, who is 30 years old come to you and says that she has not got her period for the past three months. She last got her period on the day before Holi , March 10 2023 .Calculate her EDD. Exercise 2: • Mrs. Laxmi, 18 years old says that she last got her period on January 2 2023. Calculate her EDD.
- 16. Answer Exercise 1 Answer: 16.12.2023 Exercise 2 Answer: 9.10.2023
- 17. Quality Antenatal Care 17 Number and Timing of Antenatal visits No. of visit Timing of visit 1st Visit With in 12 weeks preferably as soon as pregnancy is suspected 2nd Visit Between 14 – 26 weeks 3rd Visit Between 28 – 34 weeks 4th Visit Between 36 weeks and term
- 18. Quality Antenatal Care 18 Estimation of total no. of expected pregnancies in your area • The expected no. of pregnancies to be registered annually can be estimated • Information required : Live Birth rate (BR) and Population size of the area under consideration Estimation the number of pregnancies in your area Expected number of live birth (y) /year = Birth rate (per 1000 population) x population of the area /1000 The total number of expected pregnancies (z) =y+10% of y
- 19. Quality Antenatal Care 19 Tracking missed and lost pregnant women Rule of Thumb • In any given month approximately half the number of pregnancies estimated should be in the records • If less, community workers such as AWWs and ASHAs should identify pregnant women • Home visits should be conducted by ANMs to pregnant women who have not returned for ANC
- 20. Td Injection The administration of two doses of Td injection is an important step in the prevention of maternal and neonatal tetanus. The first dose of Td should be administered as soon as possible preferably when the woman register for ANC. The second dose is to be given one month after the first preferably at least one month before the EDD. If the woman receives the first dose after 38 weeks of pregnancy ,then the second dose may be given in the postnatal period, after a gap of four weeks. If the woman has been previously immunized with two dose during a previous pregnancy within the past three years, then give her only one dose as early as possible in this pregnancy. Quality Antenatal Care 20
- 21. Dose of Td o.5 ml by deep intramuscular injection. It should be given in the upper arm and not in the buttocks as this might injure the sciatic nerves. Inform the woman that there may be a slight swelling pain and or redness at the site of the injection for a day or two.
- 22. IFA Supplementation >11 gm% - no anaemia 7 – 11 gm% - mild anaemia < 7 gm% - severe anaemia • Help preventing the complication due to anemia. • besides recommending IFA supplementation counsel the woman to increase her dietary food of iron rich foods such as green leafy vegetables, whole pulses , jiggery, meat , poultry and fish.
- 23. Prophylactic dose :- 180 tab IFA OD starting after the first trimester at 12 weeks of gestation until delivery. Therapeutic dose :- (Hb less than 11 gm% /dl ) or has pallor 200 tab IFA , BD . If it does not rise in spite, refer the woman to the mo (medical officer ) at the PHC .
- 24. COUNSELLING FOR IFA IFA tab must be taken regularly, preferably early in the morning on an empty stomach . In case the woman has nausea and pain in the abdomen, she may take the tablet after meals or at night . This will help avoid nausea dispel. The myths and misconceptions r/t to IFA and convince the woman about the importance of IFA supplementation. An example of a common myths is that the consumption of IFA may affect the baby’s complexion. It is normal to pass black stool while consuming IFA. Tell the woman not to worry about it. In case of constipation, the woman should drink more water and add roughage to her diet. IFA tab should not be consumed with tea, coffee, milk or calcium tab, as these reduce the absorption of iron.
- 25. Contd…. Ask the woman to return to you if she has problems taking IFA tablets. Refer her to the MO for further management. Emphasis the important of a high protein diet, including items such as black gram, ground nuts, ragi , whole grains, milk, eggs, meats and nuts for anaemic women . Encourage the woman to take plenty of fruits and vegetables containing vitamin ‘c’( e.g.:- mango, guava, orange and sweet lime) as these enhance the absorption.
- 26. ESSENTIAL COMPONENTS Quality Antenatal Care 26
- 27. ESSENTIAL COMPONENTS -- Take the patient’s history. – Conduct a physical examination • measure the weight • blood pressure • respiratory rate • check for pallor and edema
- 28. ESSENTIAL COMPONENTS – Conduct abdominal palpation • foetal growth • foetal lie • auscultation of Foetal Heart Sound – Carry out laboratory investigations – haemoglobin estimation – urine tests for sugar and proteins.
- 29. DESIRABLE COMPONENTS Quality Antenatal Care 29
- 30. DESIRABLE COMPONENTS • Determine the blood group and the Rh factor. • Conduct the VDRL test to rule out syphilis. • Test the woman for (HIV). • Check the blood sugar. • Carry out the (HBsAg) test.
- 32. Quality ANC components BPCR Institutional deliveries Where to go if an emergency arises Signs of labour Danger signs Importance of seeking ANC and PNC.
- 33. Institutional Delivery and JSY Quality Antenatal Care 33
- 34. Contd….. Diet (nutrition) and rest. Family planning
- 35. Breast Feeding and EBF Quality Antenatal Care 35
- 36. Contd… Immunisation Sex during pregnancy. Domestic violence Quality Antenatal Care 36
- 37. Key Message “Every Pregnancy is at Risk” Every pregnancy needs special and quality antenatal care All pregnant women should be registered and encouraged for institutional delivery Ensured at least 4 antenatal check-ups. Quality Antenatal Care 37
Editor's Notes
- The time duration from conception of the fetus in the woman’s uterus to the delivery of the baby is called antenatal period.
- Primary steps: Ensure early registration and see to it that the first check-up is conducted within 12 weeks (first three months of pregnancy). Track every pregnancy for conducting at least four antenatal check-ups (including the first visit for registration) Administer two doses of TT injection. Provide at least 100 tablets of IFA
- Importance of early detection and registration of pregnancy: It facilitates proper planning and allows for adequate care to be provided during pregnancy for both the mother and the foetus. Helps in recording the date of the Last Menstrual Period (LMP), and calculate the Expected Date of Delivery (EDD). The health status of the mother can be assessed and any medical illness that she might be suffering from can be detected. Baseline information (on blood pressure, weight, haemoglobin, etc.) can be obtained. Helps in timely detection of complications at an early stage and manage them appropriately by referral as and where required. This also helps to confirm whether the pregnancy is wanted and if it is not, then refer the woman at the earliest to a 24-hour PHC or First Referral Unit (FRU) (whichever is closer) that provides safe abortion services. It is important to find out as early as possible whether the woman wants to go in for an abortion so that the procedure can be done safely as per the legal provisions laid down under the Medical Termination of Pregnancy (MTP) Act, 1972. If pregnancy is detected early and the woman is provided care from the initial stage, it facilitates a good interpersonal relationship between the provider and the pregnant woman. So she will be, more likely to express her particular needs and wants while planning for delivery.
- It is important to record the date of the last menstrual period (LMP) during the first visit as this helps to calculate the EDD and prepare a birth plan. The LMP is used to calculate the gestational age at the time of check-up and the EDD. The LMP refers to the FIRST day of the woman’s last menstrual period. Make sure that the woman is not referring to the date of the first missed period, i.e. the date when menstruation was expected to occur the following month and failed to occur. This mistake will lead to a miscalculation of the gestational age and EDD by about four weeks. If the woman is unable to remember the exact date, encourage her to remember some major event, festival or occurrence which she might link with her LMP. A calendar with the Indian system of months and local festivals might be useful while determining the LMP.
- Take the patient’s history. Conduct a physical examination–measure the weight, blood pressure and respiratory rate and check for pallor and oedema. Conduct abdominal palpation for foetal growth, foetal lie and auscultation of Foetal Heart Sound (FHS) according to the stage of pregnancy. Carry out laboratory investigations, such as haemoglobin estimation and urine tests for sugar and proteins.
- Desirable components Determine the blood group, including the Rh factor. Conduct the Venereal Disease Research Laboratory VDRL)/Rapid Plasma Reagent (RPR) test to rule out syphilis. Test the woman for Human Immuno deficiency Virus (HIV). Check the blood sugar. Carry out the Hepatitis B Surface Antigen (HBsAg) test.
- Counseling Help the woman to plan and prepare for birth (birth preparedness/micro birth plan). This should include deciding on the place of delivery and the presence of an attendant at the time of the delivery. Advantages of institutional deliveries and risks involved in home deliveries. Advise the woman on where to go if an emergency arises, and how to arrange for transportation, money and blood donors in case of an emergency. Educate the woman and her family members on signs of labour and danger signs of obstetric complications. Emphasize the importance of seeking ANC and PNC. Advise on diet (nutrition) and rest. Inform the woman about breastfeeding, including exclusive breastfeeding. Provide information on sex during pregnancy. Warn against domestic violence (explain the consequences of violence on a pregnant woman and her foetus). Promote family planning