Antenatal Care (ANC) Lecture PDF

Antenatal Care (ANC) A lecture for the physiotherapy program at Aloufog College Dr.Mohamed Abdebagi Abdelghani Babiker M.B.B.S MHPE  The Objectives ❑By the end of this lecture you should be able to: ✓Outline the goals of ante...

Antenatal Care (ANC) A lecture for the physiotherapy program at Aloufog College Dr.Mohamed Abdebagi Abdelghani Babiker M.B.B.S MHPE  The Objectives ❑By the end of this lecture you should be able to: ✓Outline the goals of antenatal care. ✓Identify Why antenatal care is important. ✓Mention the steps of antenatal care.  Introduction ▪ Prenatal care in USA and others. ▪ All of the authorities and Experts or regulatory bodies refer to ANC as: ▪ A comprehensive antepartum program that involves a coordinated approach to Medical care and continuous risk assessment and psychological support that optimally begins before conception and extends throughout the postpartum period and inter-conceptional period. ▪ Plus Health Education.  ANC Goals ▪ Example 1: ▪ Identification and surveillance of the pregnant woman and her expected child. ▪ Recognition and management of pregnancy-related complications, particularly preeclampsia. ▪ Recognition and treatment of underlying or concurrent illness. Adopted from : WHO’s Opportunities for Africa’s Newborns  Goals continued… ▪ Screening for conditions and diseases such as anemia, STIs (particularly syphilis), HIV infection, mental health problems, and/or symptoms of stress or domestic violence. ▪ Preventive measures, including tetanus toxoid immunization, de-worming, iron and folic acid, intermittent preventive treatment of malaria in pregnancy (IPTP), insecticide treated bed nets (ITN). ▪ Advice and support to the woman and her family for developing healthy home behaviors and a birth and emergency preparedness plan. Adopted from : WHO’s Opportunities for Africa’s Newborns  Goals continued… Example 2: ◊Management of maternal symptomatic problems. ◊Management of fetal symptomatic problems. ◊Screening for and prevention of fetal problems. ◊Screening for and prevention of maternal problems. ◊Preparation of the couple for childbirth. ◊Preparation of the couple for childrearing. From ABC of Antenatal care Fourth edition.  What about Sudan ❑Maternal Mortality Rate or ratio-MMR: ❑300-549 per 100,000 Women. (UNDP&WHO 2018) ❑Stillbirths : 24 per 1000 Total births. (WHO 2016) ❑Neonatal MR: 21.2-38.6 per 1000 Live Births. (UNICEF 2018) ✓The aim of ANC in Sudan Must be decreasing Maternal and Fetal Mortality and Morbidity. ANC Structure  Who conducts ANC? 1st line: ▪ Midwives (OBG Nurses). ▪ General Practitioners or family physicians. ▪ Obstetricians. 2nd line: ▪ Medical laboratorists. ▪ Pharmacists. ▪ Physiotherapists. ▪ etc… All work together in the ANC Process.  Steps of ANC ✓History and Examination.[Getting the story of pregnancy and clinically examining the pregnant lady] ✓Pregnancy Diagnosis. (Most Important Step). ✓Investigations plus Screening. ✓Supplements and Nutrition. ✓Vaccination and Drugs. ✓Advise about important Issues. ✓Plan for Labour and Delivery. These steps does not have to be in order, except the first 2.  Steps Continued… ✓Pregnancy Diagnosis: ▪ Only done once. ▪ By pregnancy symptoms (Examples: Amenorhea at least 35 days,Nausea & Vomiting of Preg or Morning Sickness and Frequency of Micturition). ▪ Plus clinical examination (Skin changes, Abdominal distension), ▪ And doing Urinary or serum pregnancy tests.  Steps Continued… ✓Investigations plus Screening: Routine: ▪ Hemoglobin screening for anemia. ▪ Urine general screening for UTI and Pre-eclampsia. ▪ Blood grouping for labour and blood complications. ▪ Fasting blood glucose for diabetes mellitus. ▪ Ultrasound for dating pregnancy and others. Routine if available: ▪ HIV,HBV,HCV, Syphilis, Tuberculosis, and Malaria.  Steps Continued… ✓Supplements and Nutrition: Supplements: ▪ Iron and Folic acid to prevent anemia. ▪ Vit D and Calcium to prevent their loss (Ca-Preecalmpsia). ▪ Vit A to prevent night blindness. Nutritional Advise: [most important] ▪ Reduction of weight gain in pregnancy. ▪ Restricting caffeine intake.  Steps Continued… ✓Vaccination and Drugs: Vaccination: ▪ Mainly Tetanus Toxoid. Drugs: ▪ All drugs are not allowed in pregnancy until proved otherwise. (Rule of Thumb). ▪ Paracetamol is the safest.  Steps Continued… ✓Advise about important Issues: ▪ Exercise: Should be light not vigorous. Prepregnancy activities can be continued. ▪ Travel: Air travel is safe till 36 weeks. And is not safe in some cases like severe anemia and sickle cell disease. Prolonged travel Should be avoided (Thrombosis). ▪ Smoking and Alcohol: Should be stopped.  Number of ANC visits or Focused ANC contacts:- ❑1st visit at 16 weeks. ▪ WHO recommends: ❑2nd visit between 24-28 ▪ 8 contacts Worldwide. weeks. ▪ 4 contacts for low-income ❑3rd visit at 32 weeks. countries. (Focused ANC) ❑4th visit at 36 weeks. Documentation ‫أرجو لكم التوفيق‬  References ▪ Chamberlain G, Morgan M. ABC of antenatal care. [Internet]. London: BMJ Books; 2002 [cited 2019 Oct 1]. Available from: http://site.ebrary.com/id/10032993 ▪ Dunn PM. Adolphe Pinard (1844-1934) of Paris and intrauterine paediatric care. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2005 Oct 13;91(3):F231–2. ▪ Zaidi SS, Perveen A, Parveen S. AN INSIGHT OF ANTENATAL CARE: A REVIEW. seeds. 12(13):14. ▪ Incetto O, Mothebesoane-Anoh S, Gomez P, Munjanja S. Antenatal care. Opportunities for Africa’s newborns: Practical data, policy and programmatic support for newborn care in Africa. 2006;55–62. ▪ Conrad P, Schmid G, Tientrebeogo J, Moses A, Kirenga S, Neuhann F, et al. Compliance with focused antenatal care services: do health workers in rural Burkina Faso, Uganda and Tanzania perform all ANC procedures?: Compliance with focused antenatal care services in rural africa. Tropical Medicine & International Health. 2011 Dec;no-no. ▪ Dewhurst J, Edmonds DK, editors. Dewhurst’s textbook of obstetrics & gynaecology. 8th ed. Chichester, West Sussex ; Hoboken, N.J: Wiley-Blackwell; 2011. 852 p. ▪ Reiss HE. Historical insights: John William Ballantyne 1861-1923. Human reproduction update. 1999;5(4):386–9 ▪ Evans AT. Manual of obstetrics. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2007. ▪ Kenny LC, Myers JE. Obstetrics by ten teachers [Internet]. 2017 [cited 2019 Oct 1]. Available from: http://www.crcnetbase.com/isbn/ ▪ Collins S, editor. Oxford handbook of obstetrics and gynaecology. Third edition. Oxford, United Kingdom: Oxford University Press; 2013. 824 p. (Oxford medical publications). ▪ Ferraro JJ, Caccavo FA, Saifer A. P-Hydroxybenzoic acid hydrazide procedure for serum glucose adapted to the Technicon “SMA 12/60,” and compared with other glucose methods. Clin Chem. 1976 Feb;22(2):263–6. ▪ Maloni JA, Cheng C-Y, Liebl CP, Jeanmarie SM. Transforming Prenatal Care: Reflections on the Past and Present With Implications for the Future. Journal of Obstetric, Gynecologic & Neonatal Nursing. 1996 Jan;25(1):17–23. ▪ Weltgesundheitsorganisation. WHO recommendations on antenatal care for a positive pregnancy experience. Geneva, Switzerland: World Health Organization; 2016. 152 p. ▪ Cunningham FG. Williams obstetrics. 2014.