antenatal care (anc): overview advances in maternal and neonatal health

Antenatal Care (ANC): Overview

Advances in Maternal and Neonatal Health

2 Antenatal Care: Overview

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


Essential Health Sector Interventions for Safe Motherhood

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BASIC HEALTH SERVICES

EMOTIONAL AND PSYCHOLOGICAL SUPPORT

EQUITY

SAFEMOTHERHOOD


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


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

Detection of existing diseases and treatment

HIV, syphilis, tuberculosis, other co-existing medical diseases (e.g., hypertension, diabetes)

Early detection and management of complications


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.


Goal-Directed Interventions Give a Framework for Effective ANC

Disease detection

Counseling and health promotion

Birth preparedness

Complication readiness


Goal-Directed Components of ANC: Disease Detection

Look for problems requiring additional care

Parameter Condition Skin, general appearance, night blindness, goiter

Malnutrition

Temperature, dysuria Signs of infection Blood pressure, edema, proteinuria, reflexes

Signs of pre-eclampsia

Hemoglobin, conjunctiva/palms/ tongue pallor

Signs of anemia

Breast exam Breast disease Baby’s movements, fundal height, baby’s heart beat

Fetal distress/demise

Pelvic and speculum exam Sexually transmitted diseases


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


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


Goal-Directed Components of ANC: Complication Readiness

Establish a financing plan/scheme

Make a plan for decision-making

Arrange a system of transport

Establish a plan for blood donation

15% of all pregnant women develop a life-threatening complication requiring obstetric care


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


Summary

Antenatal care includes goal-directed interventions

Skilled attendant

Preparation for birth and complications

Health promotion

Detection of complications


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.

antenatal care (anc): overview advances in maternal and neonatal health

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