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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.

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Schedule of ante natal check-ups:

Every pregnant woman need to have atelast four antenatal check-ups. It should be emphasized that this is only a minimum requirement and that more visits may be necessary, depending on the woman’s condition and needs. The suggested schedule for antenatal visits is as follows.

  • Timing of the first visit/registration – The first visit or registration of a pregnant woman for ANC should take place as soon as the pregnancy is suspected. Every woman in the reproductive age group should be encouraged to visit her health provider if she believes she is pregnant. Ideally, the first visit should take place within 12 weeks
  • Second visit – Between 14 and 26 weeks
  • Third visit – Between 28 and 34 weeks
  • Fourth visit – Between 36 weeks and term

Components of Ante natal check-up:

History Taking

A detailed history of the woman needs to be taken to:

  • Confirm the pregnancy (first visit only).
  • Identify whether there were complications during any previous pregnancy/confinement that may have a bearing on the present one.
  • Identify any current medical/surgical or obstetric condition(s) that may complicate the present pregnancy.
  • Menstrual history to calculate the Expected Date of Delivery
  • Ask her about the Nausea and vomiting / Heartburn / Constipation / Increased frequency of urination
  • Ask about symptoms indicating complications:
    • Fever
    • Persistent vomiting
    • Abnormal vaginal discharge/itching
    • Palpitations, easy fatigability
    • Breathlessness at rest/on mild exertion
    • Generalized swelling of the body, puffiness of the face
    • Severe headache and blurring of vision
    • Passing smaller amounts of urine and burning sensation during micturition
    • Vaginal bleeding
    • Decreased or absent fetal movement
    • Leaking of watery fluid per vaginum (P/V)
  • Ask about her previous pregnancies or obstetric history
    • Ask about the number of previous pregnancies. Confirm whether they were all live births, and if there was any stillbirth, abortion or any child who died.
    • Ascertain the date and outcome of each event, along with the birth weight, if known. Find out if there was any adverse perinatal (period between 7 days before birth and 28 days after birth) outcome.
    • Obtain information about any obstetric complications and events in the previous pregnancies – Recurrent early abortion/ Post-abortion complications /Hypertension, pre-eclampsia or eclampsia / Ante-Partum Hemorrhage (APH) / Breech or transverse presentation / Obstructed labor, including dystocia / Perineal injuries/tears / Excessive bleeding after delivery / Puerperal sepsis.
    • Ascertain whether the woman has had any obstetrical operations (caesarean sections/ instrumental delivery/vaginal or breech delivery/manual removal of the placenta).
    • Ask for a history of blood transfusions.
  • History of any current systemic illness / past history of illness
    • High blood pressure (hypertension)
    • Diabetes
    • Breathlessness on exertion, palpitations (heart disease)
    • Chronic cough, blood in the sputum, prolonged fever (tuberculosis)
    • Renal disease
    • Convulsions (epilepsy)
    • Attacks of breathlessness or asthma
    • Jaundice
    • Malaria
    • Other illnesses, e.g. Reproductive Tract Infection (RTI), Sexually Transmitted Infection (STI) and HIV/AIDS. Family history of systemic illness
    • History of intake of habit-forming or harmful substances – Chews or smokes tobacco and/or takes alcohol.

Physical Examination:

General examination

  • Pallor
  • Pulse
  • Respiratory rate
  • Jaundice
  • Edema
  • Blood pressure
  • Weight
  • Breast examination

Abdominal examination:

  • Measurement of fundal height
  • Determination of fetal lie and presentation by fundal palpation, lateral palpation and pelvic grips
  • Auscultation of the Fetal Heart Sounds
  • Inspection of scars/any other relevant abdominal findings.

Laboratory Investigations:

  • Urine Pregnancy test
  • Blood investigations for Hemoglobin estimation and blood grouping including Rh factor
  • Urine test to assess the presence of sugar and proteins
  • Rapid test for malaria and syphilis

Interventions:

  • Iron Folic Acid (IFA) supplementation along with counseling about the necessity of taking IFA and the dangers associated with anemia
  • Administration of TT injection – two doses of TT injection for prevention of maternal and neonatal tetanus (tetanus of the newborn).

Micro-Birth Planning and Counseling:

  • Registration of pregnant woman and filling up of the Maternal and Child Protection Card and JSY card/below poverty line (BPL) certificates/necessary proofs or certificates for the purpose of keeping a record.
  • Informing the woman about the dates of antenatal visits, schedule for TT injections and the Expected Date of Delivery.
  • Identifying the place of delivery and the person who would conduct the delivery.
  • Identifying a referral facility and the mode of referral.

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