Antenatal Care ANC: Overview

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Antenatal Care (ANC) Overview

• Advances in Maternal and Neonatal Health

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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

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Essential Health Sector Interventions for Safe
Motherhood
SAFE MOTHERHOOD
Postabortion
Clean/safe Delivery
Postpartum Care
Family Planning
Antenatal Care
Essential Obstetric Care
BASIC HEALTH SERVICES
EQUITY
EMOTIONAL AND PSYCHOLOGICAL SUPPORT
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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

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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

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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.
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Goal-Directed Interventions Give a Framework for
Effective ANC

• Disease detection
• Counseling and health promotion
• Birth preparedness
• Complication readiness

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Goal-Directed Components of ANC Disease Detection

• Look for problems requiring additional care

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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

10
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.