WHO

ANTENATAL
CARE MODEL

Prepared by:
Rowilyn B. Aduana, RN,RM,MAN
PREPARED BY: ROWILYN B.ADUANA,RN,RM,MAN
 General Objective

To enhance the knowledge, attitude and practice of

midwives on FOCUSED ANTENATAL CARE

Specific Objectives
• To demonstrate how to make an immediate general
assessment of the pregnant woman
• To apply the process flow of providing antenatal care.
• To discuss the importance of a birth and emergency
plan
Objectives of Prenatal Care
To detect diseases which may
complicate pregnancy

Educate women on danger

and emergency signs &
symptoms

Prepare the woman and her

family for childbirth
 ANTENATAL CARE is critical

 Through timely and appropriate evidence-based actions

related to health promotion, disease prevention,
screening, and treatment
 Reduces complications from pregnancy and childbirth
 Reduces stillbirths and perinatal deaths

 Integrated care delivery throughout pregnancy

QUALITY throughout the
continuum of care
WHO envisions a world where “every pregnant woman and
newborn receives quality care throughout the pregnancy, childbirth
and the postnatal period”.
Prioritizes person-centred health and well-being:

 Reducing mortality and morbidity

 Providing respectful care that takes into account woman’s views

 Optimizing service delivery within health systems

 WOMEN’S VIEWS

 A healthy pregnancy for mother and baby

(including preventing or treating risks, illness
and death)
 Physical and sociocultural normality during
pregnancy
 Effective transition to positive labour and birth
 Positive motherhood (including maternal self-
esteem, competence and autonomy)
 Steps to Follow in Prenatal Care

1) IMMEDIATE ASSESSMENT
for emergency signs.
 Unconscious/Convulsing
 Vaginal bleeding
 Severe abdominal pain
 Looks very ill
 Severe headache with visual disturbance
 Severe difficulty in breathing
 Dangerous Fever
 Severe vomiting

* Attend to sick woman quickly.

 Steps to Follow in Prenatal Care

2) Make the woman comfortable.

Greet her, make sure she is comfortable and ask
how she is feeling.

If first visit, register the woman and issue a

Mother and Child Book (antenatal record form)
 Steps to Follow in Prenatal Care
3) Assess the pregnant woman

FIRST visit:
How old is patient?
Past Medical History
Obstetric History: Gravidity? LMP? AOG?
Alcohol/Drug/substance abuse?
Ask about or check record for prior pregnancies:
Convulsions
Stillbirth or death in the first day
Heavy bleeding during or after delivery
Prior cesarean section, forceps or abortion
Screening for gestational diabetes
using risk factors is recommended in
all women.
a) body mass index above 30 kg/m2
b) previous macrosomic baby weighing 4.5
kg or above
c) previous gestational diabetes
d) family history of diabetes
e) family origin with a high prevalence of
diabetes such as south asian, black caribbean
and middle eastern.
Steps to Follow in Prenatal Care

ON ALL VISITS:
Check duration of pregnancy (AOG).
Ask for bleeding/danger signs during this
pregnancy
Check record for previous treatments received
during this pregnancy
Prepare birth and emergency plan
Ask patient if she has other concerns
Give education and counseling on family
planning and breastfeeding
 Steps to Follow in Prenatal Care

THIRD TRIMESTER
1. Leopold’s exam, fetal heart beat
2. Give education & counseling on
family planning

Do not perform vaginal exam as a routine

prenatal care procedure.
Always record findings.
All pregnancies are at risk. Encourage all
pregnant
women to deliver in the health facility.
Refer patients with abnormal findings to higher
facility.
 Steps to Follow in Prenatal Care

4) Get baseline laboratory information of the

woman on the first or following the first visit.

Hemoglobin, blood type

Urinalysis
VDRL or RPR to screen for syphilis

 If not available, refer to the nearest RHU or hospital for the tests.
Steps to Follow in Prenatal Care

5) Check for pallor or anemia.

Ask about getting tired easily or shortness of
breath during routine work.
On 1st visit, check hemoglobin & blood type.

The normal hemoglobin cut-off level for a

pregnant woman is 11g/dl.

On subsequent visits:
1. Look for conjunctival pallor.
2. Look for palmar pallor.
3. Count number of breaths in
one minute.
 Steps to Follow in Prenatal Care
6) Check for hypertension/ pre-eclampsia.
Measure BP in sitting position.
If diastolic BP is 90 mm Hg or higher repeat
measurement after 1 hour rest.

If diastolic BP is still 90 mm Hg or higher ask the woman

if she has:
• Severe headache
• Blurred vision
• Epigastric pain

Check urine for protein.

 Steps to Follow in Prenatal Care
7) Check for gestational diabetes.
ASK ABOUT
 Family history of diabetes & history
of obesity.
 Past pregnancy for difficult labor,
large babies, congenital
malformations and previous
unexplained fetal death.
LOOK FOR
 signs of maternal overweight or
obesity
 Polyhydramnios Low Risk:
 Signs of large baby or fetal 24-28 wks
abnormality High Risk:
 Vaginal infection. Immediately,
any AOG
 Steps to Follow in Prenatal Care
8) Check for fever, burning sensation on urination and
abnormal vaginal discharge.
 Ask about episodes of fever or chills and take
temperature.

 Ask about pain or burning sensation on

urination.

 Ask about presence of abnormal vaginal

discharge, itching at the vulva or if partner has
a urinary problem.
Steps to Follow in Prenatal Care
9) Immunize against tetanus.
Tetanus Toxoid Immunization Schedule

Vaccine Minimum Interval Duration of Protection

TT1 at first contact with woman 15-49

yrs or at first ANC visit no protection

TT2 at least 4 weeks after TT1 •Infants born to the mother will be protected from
neonatal tetanus
•3 years of protection for the mother
TT3 at least 6 months after TT2 •Infants born to the mother will be protected from
neonatal tetanus
•5 years of protection for the mother
TT4 at least 1 year after TT3 •Infants born to the mother will be protected from
neonatal tetanus
•10 years of protection for the mother
TT5 at least 1 year after TT4 •Infants born to the mother will be protected from
neonatal tetanus
•Lifetime protection for the mother
Steps to Follow in Prenatal Care

10. Give MEBENDAZOLE to treat for intestinal parasites.

500 mg single dose once in six months (after the 1st
trimester)

11. Give iron and folate supplementation to prevent

anemia and neural tube defects:
60 mg Fe & 250 mcg Folate
 If Hgb <80 gm/dl→ double the dose

12. Refer for preventive intermittent treatment for

falcifarum malaria (if area is endemic)
Steps to Follow in Prenatal Care
13) Provide health information, advice

HEALTH INFORMATION:

1. Nutrition
2. Self-care during pregnancy
3. Effect of tobacco, alcohol & drugs
4. Breastfeeding
5. Birth & Emergency situations
6. Schedule of appointment
Steps to Follow in Prenatal Care

14) Advise on Danger Signs

1.Vaginal bleeding
2.Convulsions
3.Severe headache
4.Severe abdominal pain
5.Fast or difficult breathing
6.Fever or burning urination
Steps to Follow in Prenatal Care
15) Encourage the woman to come back for return
visits.
At least 4 routine antenatal visits

1st visit: before 4 months

2nd visit: 6 months

3rd visit: 8 months

4th visit: 9 months – return if undelivered within 2 weeks after

the EDC.

Pregnant women who do not come for prenatal care should be visited at home.
WHO 2016 MODEL
Antenatal care models with a minimum of eight contacts are
recommended to reduce perinatal mortality and improve
women’s experience of care.

• Evidence suggesting increased perinatal deaths in 4-visit

ANC model
• Evidence supporting improved safety during pregnancy
through increased frequency of maternal and fetal
assessment to detect complications
• Evidence supporting improved health system
communication and support around pregnancy for women
and families
• Evidence indicating that more contact between pregnant
women and respectful, knowledgeable health care workers is
more likely to lead to a positive pregnancy experience
 The Birth Plan
 A written document prepared during the
first prenatal consultation
a. Discussed with the patient and her family
b. May change anytime during pregnancy if a
problem is detected.
 The Birth Plan
Contains information on:

 the woman’s condition during pregnancy

 preferences for her place of delivery and choice of birth
attendant
 available resources for her childbirth and newborn baby
 preparations needed should an emergency situation arise
during pregnancy, childbirth and postpartum.
 Emergency Plan

Advise on danger signs

Where to go?
How to go?
Who will go with you to health center?
How much will it cost? Who will pay? How will
you pay?
Start saving for these possible costs now.
Who will care for your home and other children
when you are away?
B
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ANTENATAL CARE: Key
Messages
 Reduced number of visits
 Provided by skilled birth attendant
 Screening and prevention of diseases that may
complicate pregnancy
 Preventive Measures: Tetanus immunization, iron and
folic acid supplementation
 Counseling on family planning, nutrition,
breastfeeding, and danger signs
 BIRTH PLAN: Birth preparedness and complication
readiness
Because Giving birth should be about giving life not giving
up a life.
THANK YOU FOR
LISTENING!