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Components of Antenatal care

Antenatal care is the systemic supervision of women during pregnancy to monitor the progress of foetal growth and to ascertain the well-being of the mother and the foetus.
A proper antenatal check-up provides necessary care to the mother and helps identify any complications of pregnancy such as anaemia, pre-eclampsia and hypertension etc. in the mother and slow/inadequate growth of the foetus.
Antenatal care allows for the timely management of complications through referral to an appropriate facility for further treatment.
It also provides opportunity to prepare a birth plan and identify the facility for delivery and referral in case of complications.
As provider of ante natal care, you are involved in ensuring a healthy outcome both for the mother and her baby.
However, one must realise that even with the most effective screening tools, one cannot predict which woman will develop pregnancy-related complications during and immediately after child birth.

You must therefore:
_ Recognise that ‘Every pregnancy is special and every pregnant woman must receive special care’.
_ Complications being unpredictable may happen in any pregnancy/child birth and we should be ready to deal with them if and whenever they happen.
_ Ensure that ANC is used as an opportunity to detect and treat existing problems, e.g. essential hypertension.
_ Prepare the woman and her family for the eventuality of an emergency.
_ Make sure that services to manage obstetric emergencies are available on time.

Care during Pregnancy—Antenatal Care

Quality ANC has several components,

A. A few primary steps:
_ Ensure early registration and see to it that the first check-up is conducted within 12 weeks (first three months of pregnancy).
_ Track every pregnancy for conducting at least four antenatal check-ups (including the first visit for registration), keeping in mind all the essential components listed under section B.
_ Administer two doses of TT injection.
_ Provide at least 100 tablets of IFA.

B. Essential components of every antenatal check-up:
_ Take the patient’s history.
_ Conduct a physical examination–measure the weight, blood pressure and respiratory rate and check for pallor and oedema.
_ Conduct abdominal palpation for foetal growth, foetal lie and auscultation of Foetal
Heart Sound (FHS) according to the stage of pregnancy.
_ Carry out laboratory investigations, such as haemoglobin estimation and urine tests for sugar and proteins).

C. Desirable components
_ Determine the blood group, including the Rh factor.
_ Conduct the Venereal Disease Research Laboratory (VDRL)/Rapid Plasma Reagin (RPR) test to rule out syphilis.
_ Test the woman for Human Immunodeficiency Virus (HIV).
_ Check the blood sugar.
_ Carry out the Hepatitis B Surface Antigen (HBsAg) test.

D. Counselling
_ Help the woman to plan and prepare for birth (birth preparedness/micro birth plan).
This should include deciding on the place of delivery and the presence of an attendant at the time of the delivery.
_ Advantages of institutional deliveries and risks involved in home deliveries.
_ Advise the woman on where to go if an emergency arises, and how to arrange for transportation, money and blood donors in case of an emergency.
_ Educate the woman and her family members on signs of labour and danger signs of obstetric complications.
_ Emphasise the importance of seeking ANC and PNC.
_ Advise on diet (nutrition) and rest
_ Inform the woman about breastfeeding, including exclusive breastfeeding.
_ Provide information on sex during pregnancy
_ Warn against domestic violence (explain the consequences of violence on a pregnant woman and her foetus).
_ Promote family planning
_ Inform the woman about the Janani Suraksha Yojana (JSY)/any other incentives offered by the state.
*Tie up with the nearest Integrated Counselling and Testing Centre (ICTC)/Prevention of Parent-to-Child Transmission (PPTCT) facility for counselling and testing for HIV.

Reference:
Maternal Health Division, Department of Family Welfare, Ministry of Health & Family Welfare, Government of India: April 2010, Guidelines for Antenatal Care and Skilled Attendance at Birth by ANMs/LHVs/SN available at: http://www.nhp.gov.in/sites/default/files/anm_guidelines.pdf downloaded on 20th Dec 2016

Antenatal Care: http://www.ihatepsm.com/blog/antenatal-care
Components of Antenatal Care: http://www.ihatepsm.com/blog/components-antenatal-care
Prenatal Advice: http://www.ihatepsm.com/blog/prenatal-advice
Risk Approach in Antenatal Care: http://www.ihatepsm.com/blog/risk-approach-antenatal-care
Ensuring Complete Registration of Antenatal Women in the Jurisdiction: http://www.ihatepsm.com/blog/ensuring-complete-registration
Specific Health Protection during Antenatal Visits; http://www.ihatepsm.com/blog/specific-health-protection-during-antenatal...
Lecture on Antenatal Care: http://www.ihatepsm.com/resource/antenatal-care