Antenatal Care Overview

Antenatal Care (ANC) Definition

• WHO defines ANC as the care provided by skilled health professionals to pregnant women to ensure the best health conditions for both mother and baby during pregnancy.

Components of ANC

• Assessment (1): Checking for diseases
• Responding to problems (3): Addressing any issues
• Preventive measures (4): Implementing preventative measures
• Education and Counselling (5): Educating and counseling about home care, danger signs during labor, birth and emergency plan, breastfeeding, and family planning.

ANC in Iraq (2018)

• First antenatal contact is 88% and postnatal health check for the mother is 83%.
• Pregnant women having four or more ANC contact is 68%.
• Eight antenatal contact is 22%. (MICS 6, 2018)

General Principles of Good Care

• Communication (1): Effective communication skills
• Workplace and Administrative Procedures (2): Proper procedures in the workplace
• Quick Check (3): Quick assessments
• Organizing a Visit (4): Procedures for visiting, including routine, emergency and follow-up visits.

Routine Visits

• At least eight visits during pregnancy are recommended, even without health problems (following the schedule below):
• First visit: During the first 12 weeks
• Second visit: 18 weeks
• Third visit: 24 weeks
• Fourth visit: 28 weeks
• Fifth visit: 32 weeks
• Sixth visit: 36 weeks
• Seventh visit: 38 weeks
• Eighth visit: 40 weeks

First Visit (Booking)

• Ask about personal information, current/past medical and reproductive history, any risk factors for STI, taken medication
• Physical examination: look, listen, feel for general health (weight, height, BMI, blood pressure, fundal height, fetal heart rate)
• Investigations: Urine examination (GUE), complete blood count (CBC), hemoglobin (Hb), Venereal Disease Research Laboratory (VDRL), Hepatitis B surface antigen (HBsAg), antibodies to HIV, ultrasound (10-14 weeks)
• Preventive measures: Folic acid
• Counseling: Home care, danger signs during labor, birth plan, breastfeeding, family planning

Second Visit (18 weeks)

• Review the same information and ask about fetal movement, drugs taken, vaginal bleeding, and birth plan.
• Look, Feel, Listen: Weight, blood pressure, fundal height, fetal heart rate
• Preventive measures: Folic acid, tetanus vaccine
• Counseling

Third Visit (24 weeks)

• Ask the same questions as the previous visit.
• Look, Feel, Listen
• Investigations: Glucose tolerance test (GTT) (24-28 weeks)
• Preventative measures
• Counseling

Fourth Visit (28 weeks/fifth 32 weeks)

• Ask the same questions
• Look, Feel, Listen
• Investigation: GUE, Hb, ultrasound (28-33 weeks)
• Preventative measures
• Refer for anti-D antibodies if necessary
• Counseling

Sixth Visit (36 weeks)/Seventh Visit (38 weeks)/ Eighth Visit (40 weeks)

• Ask similar questions
• Look, Feel, Listen: Baby's position (transverse or breech)
• Preventative measures
• Counseling

Emergency Visit

• Contact PHC (Primary Health Care) or hospital immediately for these symptoms: severe nausea, vomiting, vaginal bleeding, severe abdominal pain, clear fluid leakage from vagina, fever/chills, convulsions, severe headache, blurred vision, difficult breathing, decrease or no fetal movement.

Follow-up Visit for specific problems

• If the problem is: Fever, follow-up needed in 2 days.
• Lower UTI, follow-up needed in 2 days.
• Perineal infection or pain: follow-up in 2 days.
• High blood pressure: follow-up in 1 week.
• Syphilis: follow-up in 1 week.
• Severe anemia: follow-up in 2 weeks.
• Postpartum depression: follow-up in 2 weeks.
• Anemia: follow-up in 4 weeks.

This quiz explores the definition, components, and statistics of antenatal care (ANC), particularly focusing on practices in Iraq as of 2018. It covers aspects like assessment, preventive measures, and the importance of communication in providing care to pregnant women. Test your knowledge on the essentials of ANC and ensure an understanding of maternal health.