WEEK 1: ANTE NATAL CARE

Question 1

What does ANC stand?

Answer 1

Ante Natal Care

Question 2

What is ante natal care?

Answer 2

A comprehensive antepartum care program that involves a coordinated approach to medical care and psychosocial support that optimally begins before conception and extends throughout the antepartum period.

Question 3

What is safe motherhood?

Answer 3

Means ensuring that all women have access to the information and care they need to go safely through pregnancy, childbirth and puerperium.

Question 4

What is puerperium?

How long does it last?

Answer 4

Puerperium is the period of adjustment after childbirth during which the mother’s reproductive system returns to its normal pre-pregnant state.

It generally lasts six to eight weeks and ends with the first ovulation and the return of normal menstruation.

Question 5

Essential Health Sector Interventions for Safe Motherhood

Question 6

State 4 purposes of ANC.

Answer 6

*Client assessment and Treatment of diseases and disorders
*Prevention of diseases or complications
*Birth preparedness and complication/Emergency readiness.
*Health promotion.

Question 7

Assessment and Treatment

-History, exam, tests.
-‘Risk’ assessment

What is always important to remember?

Answer 7

Remember;

Every pregnant, delivering or postpartum woman is at risk of serious life-threatening complications.

Question 8

Assess Risks

Outline 4 things to look out for in risk assession.

Answer 8

Medical disorders in pregnancy
Obstetric history
Nulliparity and grandmultiparity:
“Too young, too frequent, too old”.

Question 9

State 2 pregnancy related and psychosocial risks during pregnancy.

Answer 9

Pregnancy related
-Multiple gestation
-Abnormal lie or presentation

Psychosocial
-Unwanted pregnancy
-Extreme social disruption or deprivation

Question 10

State a list of diseases usually treated for in ANC.

Answer 10

Hypertensive disease
Anemia
Syphilis
STIs, HIV/AIDS, TB
Asymptomatic bacteriuria

Question 11

Preventive Care: provide as per National Guidelines:

State the 3 main guidelines.

Answer 11

-Tetanus toxoid immunizations
-Malaria prophylaxis in endemic areas or intermittent presumptive treatment (IPT)
-Micronutrients including iron, vit c, folate, (and vitamin A, calcium, iodine according to local needs)

Question 12

Outline Health Promotion in the Antenatal Clinic activities.

Answer 12

Health education and counselling on:

-Personal hygiene, rest, nutrition, breastfeeding, baby care, FP, STIs, HIV/AIDS, safe sex, malaria, danger signs

-Complication readiness, plan for accessing emergency obstetric care

-Participation of client, partner, mother, mother-in-law, sisters, other caregivers.

Question 13

Schedule of Visits

Focused activities are carried out to guide the woman along the path of survival. Some women may require more visits.

How many visits does WHO recommend?

Answer 13

WHO recommends 8 visits?

Question 14

Outline the 2016 WHO ANC model visits schedule.

Answer 14

First trimester
*Contact 1: up to 12 weeks

Second trimester
*Contact 2: 20 weeks
*Contact 3: 26 weeks

Third trimester
*Contact 4: 30 weeks
*Contact 5: 34 weeks
*Contact 6: 36 weeks
*Contact 7: 38 weeks
*Contact 8: 40 weeks

Return for delivery at 41 weeks if not
given birth.

Question 15

When should intermittent preventive treatment of malaria in pregnancy should be started in endemic areas?

Answer 15

Note: Intermittent preventive treatment of malaria in pregnancy should be started at 13 weeks in endemic areas.

Question 16

State the 6 steps followed when registering pregnancy for the first visit.

Answer 16

1. Obstetric Record
2. History
3. Examination
4. Investigations
5. Treat/counsel accordingly
6. Book for next visit

Question 17

Conduct of first visit
What is included in Obstetric record?

Answer 17

Obstetric Record:
*Name
*Age
*Parity: “parity” refers to the number of times a woman has given birth to a fetus or fetuses that have reached a viable gestational age, typically 20 weeks or more, regardless of whether the infant was born alive or stillborn.

*LMP: “Last Menstrual Period”

The LMP is the first day of a woman’s most recent menstrual period before she became pregnant. It is a key piece of information used to calculate how far along a pregnancy is and to determine the estimated due date.

*Obstetric history: Obstetric history refers to a patient’s medical history and past experiences related to pregnancies and childbirth.

Question 18

Outline the 7 components of the obstetrics history.

Answer 18

Obstetric history typically includes information such as:

1. Gravida: The total number of pregnancies a woman has had, including pregnancies that resulted in live births, stillbirths, and miscarriages, regardless of the outcome.
2. Para: The number of pregnancies that reached the stage of viability, which is usually considered to be 20 weeks or more of gestation. This includes pregnancies resulting in live births, stillbirths, and other outcomes.
3. Outcome of pregnancies: Details about the outcome of each pregnancy, such as the number of live births, the number of preterm births, and the number of pregnancies ending in stillbirth or miscarriage.
4. Complications: Any complications or issues experienced during previous pregnancies, such as gestational diabetes, preeclampsia, or other medical conditions that may impact future pregnancies.
5. Mode of delivery: Information about how previous pregnancies were delivered, such as vaginal delivery or cesarean section (C-section).
6. Birth weights: The birth weights of infants born during previous pregnancies, which can provide insights into potential issues related to fetal growth and development.
7. Any other relevant information: Any other pertinent details about the patient’s obstetric history that may be relevant for current or future pregnancies.

Question 19

Define the following terms.
*Gravida
*Para

Answer 19

Gravida: This term indicates the total number of pregnancies a woman has had, including both pregnancies that resulted in a live birth and those that did not. Gravida is not affected by the number of fetuses in each pregnancy.

Para: Para refers to the number of pregnancies that reached the stage of viability, which is typically 20 weeks or more, resulting in either a live birth or a stillbirth.

Question 20

Statethe 11 disorders included in history when in first visit for pregnancy registration?

Answer 20

History:
1. Antepartum Hemorrhage: APH can refer to “Antepartum Hemorrhage,” which is bleeding that occurs during pregnancy but before the onset of labor. This condition can have various causes, including placental abruption, placenta previa, and other factors, and it is a significant concern in obstetrics.

2. PPH: Postpartum Hemorrhage. This is heavy bleeding that occurs after childbirth, typically within the first 24 hours.
3. Multiple Gestation: This term refers to a pregnancy in which there are two or more fetuses developing in the womb simultaneously. Commonly known as a multiple pregnancy, it includes twins, triplets, etc.
4. Eclampsia: Eclampsia is a severe complication of pregnancy, characterized by the onset of seizures or convulsions in a woman with preeclampsia, a condition marked by high blood pressure and damage to organs, most often the liver and kidneys.
5. Sepsis: Sepsis is a potentially life-threatening condition caused by the body’s response to an infection. It can lead to organ dysfunction and failure.
6. Operative Vaginal Delivery: This refers to a method of childbirth that involves the use of medical instruments (such as forceps or a vacuum extractor) to assist in delivering the baby through the birth canal.
7. C/S: This stands for Cesarean Section, which is a surgical procedure used to deliver a baby when vaginal delivery is not possible or safe.
8. SB: Stillbirth. This term is used when a fetus dies in the womb after 20 weeks of gestation.
9. NND: Neonatal Death. This refers to the death of a newborn baby shortly after birth.
10. Prem: Premature or Preterm. This indicates that a baby is born before completing a full-term pregnancy, which is typically around 37 to 40 weeks of gestation.
11. IUGR: Intrauterine Growth Restriction. This is a condition in which a baby’s growth is significantly slower than expected during pregnancy. It may be due to various factors, including placental insufficiency or maternal health issues.

Question 21

State the 10 exams done on pregnant women.

Answer 21

1. Examination: General: This is a general assessment of the patient’s overall health and well-being, including their appearance, vital signs, and initial observations.
2. BP: Blood Pressure. This involves measuring the patient’s blood pressure, which is an essential vital sign used to assess cardiovascular health.
3. Pallor: Pallor refers to an abnormally pale appearance of the skin, often indicating a reduced blood flow or anemia.
4. Breasts: This part of the examination likely involves an assessment of the patient’s breasts, which can be relevant in a clinical setting for various reasons, including breast health and lactation.
5. Chest: The chest examination typically involves assessing the patient’s respiratory and cardiac health. This may include auscultation of lung and heart sounds.
6. Scars: The examination may involve noting any scars on the patient’s body, which can be important for medical history and can provide insights into past surgeries or injuries.
7. Obstetric Exam: This part of the examination is specific to pregnant women and involves assessing the progress of the pregnancy, the position of the fetus, and the overall health of the mother and baby.
8. FMs: Fetal Movements. This refers to the assessment of the baby’s movements in the womb, which can be important for monitoring fetal well-being.
9. FHR: Fetal Heart Rate. This involves monitoring the baby’s heart rate to ensure it is within a healthy range, which is crucial for assessing the baby’s well-being during pregnancy.
10. Surgical Scars: This is a specific examination of any surgical scars the patient may have, which can provide information about past medical procedures and their impact on the patient’s health.

Question 22

State the 6 investigations done on pregnant women when registering for pregnancy for the first time.

Answer 22

1. Group+Rh: This refers to a blood type test that determines a person’s ABO blood group and Rh factor (i.e., whether they are Rh-positive or Rh-negative). It is important information for blood transfusions and organ transplants.
2. Hb: Hemoglobin (Hb) is a protein in red blood cells that carries oxygen. A hemoglobin test measures the amount of hemoglobin in the blood and is used to assess anemia and other blood-related conditions.
3. VDRL: Venereal Disease Research Laboratory (VDRL) test is a blood test used to screen for syphilis, a sexually transmitted infection (STI). It checks for the presence of antibodies against the bacterium that causes syphilis.
4. HIV: Human Immunodeficiency Virus (HIV) is a virus that attacks the immune system. The HIV test is used to detect the presence of the virus in a person’s blood or other body fluids. It’s crucial for diagnosing HIV infection.
5. Urinalysis: Urinalysis is a laboratory test of a urine sample. It examines the physical, chemical, and microscopic properties of urine. This test can help diagnose a wide range of medical conditions, including kidney disease, diabetes, and urinary tract infections.
6. USS: “Ultrasound Scan” or “Ultrasonography.” An ultrasound scan uses high-frequency sound waves to create images of the inside of the body. It is commonly used in prenatal care to monitor the development of a fetus, as well as for various diagnostic purposes, such as evaluating organs, blood vessels, and soft tissues.

Question 23

Outline activities conducted on subsequent visits.

Answer 23

*Social support, new complaints, follow up of previous
*Do physical exam, plot SFH, weight gain, urine dipstick
*Necessary tests
*Provide preventive care
*Manage any diseases or disorders
*Review birth plan and emergency preparedness
*Promote healthy lifestyle

Question 24

Outline the 6 danger signs in pregnancy.

Answer 24

*Bleeding per vaginum
*Drainage of liquor
*Severe abdominal pains
*Severe headaches
*Generalized body swelling
*Reduced fetal movements

Question 25

Birth preparedness – what does the patient need to know?

Answer 25

*Her expected date of delivery
*The danger signs in pregnancy, childbirth, the postpartum period, and the newborn.
*The skilled provider who will attend her at delivery and where (home or facility)
*What transport in labor or complication
*The appropriate facility to access for complications and emergencies
*Essential items/supplies
*Partners are encouraged to be involved in the whole process.