Antenatal Care (ANC) By Francis 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/stageTest/treatmentEffect Reduced number of antenatal visitsReduced to 4-5 include proven effect interventions Similar maternal results Delivering antenatal visitsMidwife/GP managed care compared wit Obstet./Gynaecol. Led shared care Similar clinical effectiveness Prevention of anaemiaRoutine iron & folate supplementation + Malaria Chemoprophylaxes Reduces or prevents fall in Hgb, reduces % of anaemic women Detection and investigation of anaemiaBlood testsDiagnosis and type of anaemia → correct treatment Treatment of iron deficiency anaemiaOral iron and folate/IM or IV iron Packed cell transfusion Raises Hgb prenatally Detection and investigation of HDPMeasurement of blood pressure with sphygmomanometer using 2nd & 5th Korotkoff sound Urine analysis of clean catch urine Detects Hypertention Detects proteinuria. Indicative of pre- eclampsia in presence of hypertention

Antenatal interventions known to be effective Condition/stageTest/treatmentEffect Detection and investigation of HDPMeasurement of BP Urine analysis of clean catch urine Detects Hypertention Detects proteinuria. Indicative of pre- eclampsia in the presence of hypertention Treatment of severe pre-eclampsiaTransfer to first referal level for expert careControl of disease. Reduces case fatality Treatment of eclampsiaSupportive first aid maintaining airway and preventing injury during fit Magnesium sulphate (IM or IV). Recognition and speedy transfer to fully equiped facility. Expedited delivery Reduces case fatality Reduces recurrent convulsions and maternal mortality. Reduces case fatality. Only definite treatment. Prevention of obstructed labourExternal cephalic version at termReduces Ceasarean Section Screening for infectionSerological screening and treatment for Syphylis 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/stageTest/treatmentEffect Screening for infectionScreening 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 infectionTetanus immunization in pregnancy and/or women of child bearing age Induction of labour in uncomplecated prelabour rupture of membranes Prevents maternal and neonatal Tetanus Prevents maternal infection