ANC AND PNC Flashcards
What is ANC?
Care that a woman receives during pregnancy which helps to ensure the healthy outcome for the woman and the baby (WHO/UNICEF 2003)
What are the aims for ANC?(5)
-To provide advice , education and support for the woman and her family.
-To deal with the “minor ailments” of pregnancy.
-To screen for, diagnose and manage pre-existing maternal disorders such as diabetes, heart disease and infection.
-To identify and treat any new medical or obstetric problems arising in pregnancy and where possible to prevent these from adversely affecting the health of the mother or her baby.
-To plan for labor and delivery, care of the newborn and future general and reproductive health.
What are the Key Components of ANC?
Nutritional interventions
Maternal and fetal assessment
Preventive measures
Interventions for common physiological symptoms
Health systems interventions to improve the utilization and quality of ANC
What elements are targeted during ANC visits?(7)
-Blood pressure measurements
-Tetanus toxoid immunization
-Intermittent prevention treatment for malaria (IPTp)
-Blood samples for HIV, syphilis and STIs.
-Deworming Treatment
-Iron-folic acid supplements
-Counselling for healthy behaviors including dietary advice, breastfeeding , exercise in pregnancy and social habits.
How many contacts should one have by the time they have reached 40 weeks of their pregnancy? And when should they be done?
8 contacts
Refer to handout for when.
Who are the providers for ANC in malawi?
Mostly from midwives and nurses.
But also can be from doctors,clinical officers, health surveillance assistant.
What is assessed for at the first anc visit?
1.confirm pregnancy and determine the gestation age.
2.Complete obstetric and gynecological history
3.Full clinical examination
4.Lab and Bedside Investigations- UPT,RBG, Urine Dipstick, Fbc(HB), Rhesus Factor, Blood Group
5.Infection screening such as malaria, HIV, syphilis ,Hep B/C and cervical screening
6.Give Iron(30 -60mg) and Folic Acid (400mcg).
7.If in 2nd trimester:
-Sulphadoxine-Pyrimethamine(SP)
-Anti-helminths in the form of Albendazole(Direct Observed Therapy)
-Tetanus Toxoid Vaccine
8.Risk Grading
9.Advice patient to sleep in an ITN and give her one
10.Advise on nutrition, diet and weight gain, personal hygiene, clothing, family planning and safer sex
Beginning to develop the individualized birth plan and complication preparedness
How often is Sulphadoxine-Pyrimethamine(SP) given?
-At each scheduled visit from 2nd trimester.
What services are offered in the up coming visits?
-Services provided during the first visit
Sulphadoxine-Pyrimethamine (SP) as Intermittent Preventive Treatment (IPTp) - DOT
at each scheduled visit from second trimester
-Albendazole(DOT) if not given during the first visit
-Confirm fetal heart sounds
-Confirm lie of the foetus
-Detect, treat and manage any abnormalities such as multiple gestation, pre-eclampsia and anaemia
-Remind about Individual Birth Plan and danger signs
What are the prerequisites for referring a woman?
danger signs and symptoms
previous caesarean section
neonatal death
Rhesus factor negative (Rh-)
first pregnancy after 35 years
parity > 5
abnormality of pelvic
What are some of the Pregnancy Danger signs to look out for?
Lethargy, fatigue, breathlessness that could indicate severe anaemia or a haemoglobin of less than 8.5gm/dl or 60%
Vaginal bleeding during pregnancy
Severe headache and/or blurred vision
Blood pressure of 140/90 mmHg or more OR a systolic blood pressure rise of 30 mmHg or diastolic pressure rise of 15mmHg or more from the baseline blood pressure
Loss of consciousness or convulsions
Severe oedema (hands or face)
Severe abdominal pain
Leaking of amniotic fluid from the vagina
Foul-smelling vaginal discharge
Fever, chills, vomiting which could indicate malaria
Foetal malpresentation after 36 weeks
Decreased or absent foetal movement
Contractions before 37 weeks
What are some of the Labor Danger Signs?
Vaginal bleeding
Severe headache and/or blurred vision
Blood pressure of 140/90 mmHg or more OR a systolic blood pressure rise of 30 mmHg or diastolic pressure rise of 15 mmHg or more from the baseline blood pressure
Loss of consciousness or convulsions
Difficult breathing
Rupture of the membranes in the early 1st stage of labour
Cord prolapse
Prolonged labour guided by use of partograph.
Fever
What are Newborn Danger Signs?
Difficult breathing – retractions &/or rate >60/minute
High pitched cry and irritability
Difficult feeding (unable to suckle)
Fits (convulsions) or loss of consciousness
Blueness of lips, tongue or hands
Hot to touch (hyperthermia) or cold to touch (hypothermia)
Unable to pass urine and stool or both within 24 hours after delivery
Low birth weight including prematurity.
Bleeding from the cord
Jaundice – palms of hands &/or soles of feet
What are some of the things to asses 24hrs after delivery?
-Vital Signs
-PV bleeding
-Uterus Contracted
- Voiding Urine (Within 6hrs)
What are the keys things to asses in a patient beyond 24hrs of delivery?
assess her general well-being, micturition & urinary incontinence, bowel function, healing of any perineal wound, headache, fatigue, back ache, hygiene, breast pain, uterine tenderness & lochia, breastfeeding, emotional well-being
