1. Antenatal Care: Interventions
SBA - Presentation 3 (b)
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
Antenatal Care: Interventions

2. Antenatal Care: Interventions
Iron-folic acid (IFA) supplementation
Injection tetanus toxoid (Inj.TT) administration
Malaria prophylaxis and treatment
Folic acid supplementation (400 µg) upto 12 weeks of pregnancy to prevent neural tube defects
Regular consumption of iodised salt
Antenatal Care: Interventions

3. Antenatal Care: Interventions
Why is IFA supplementation needed?
To meet the increased demand of iron and folic acid during pregnancy
Additionally
Ensure regular intake of IFA tablet
Counsel for increase in dietary intake of iron rich food : green leafy vegetables, jaggery, whole pulses, meat, fish, chicken, eggs, groundnuts etc
Antenatal Care: Interventions

4. Antenatal Care: Interventions
What is the prophylactic dose of IFA?
Dose :
1 tablet of IFA (100mg elemental iron+0.5 mg of folic acid)
Duration :
At least 100 days starting at weeks
Continue for 3 months postpartum
Given for preventing anemia even if Hb>11gm/dl
Antenatal Care: Interventions

5. Antenatal Care: Interventions
What is the therapeutic dose of
IFA if Hb < 11 gm/dl?
Dose :
1 tablet twice a day of IFA
(100mg elemental iron+0.5 mg of folic acid)
Duration :
At least 100 days during pregnancy
Continue for 3-6 months in postpartum period
Follow up
Repeat Hb after 1 mth : If increased, continue the same treatment
If no increase refer to MO for further investigations
Antenatal Care: Interventions

6. Antenatal Care: Interventions
What are the indications for referral
in women with anemia?
Women with severe anemia, that is, Hb < 7 gm%
Anemic women with breathlessness and or tachycardia HR > 100 beats / min
Start with therapeutic dose of IFA and REFER the woman immediately to MO at FRU
Antenatal Care: Interventions

7. Prescribing IFA tablets: Counseling
Tablets to be taken regularly preferably early morning on an empty stomach
If nausea or pain abdomen, it may be taken after meals or at night
Stools will be dark in color while on tablets
May have constipation, relieved by taking plenty of fluids and roughage
Antenatal Care: Interventions

8. Prescribing IFA tablets: Counseling
Absorption of iron is interfered if taken with tea, coffee or foods rich in fluoride
Enhanced if taken with lemon water or orange juice
Encourage her to take plenty of fruits and vegetables like mango, guava, orange, amla etc containing vitamin C
Emphasize the importance of high protein diet like black gram, ground nuts, whole grains, milk, eggs etc
Give advice not to stop the medication on her own
Antenatal Care: Interventions

9. Injection tetanus toxoid administration
Importance
For preventing maternal and neonatal tetanus
Dosage schedule :
Two doses 0.5 ml I/M in upper arm
First dose - As soon as woman registers for ANC
Second dose - 4 weeks after the first dose even if it is after delivery
If previously fully vaccinated within 3 years,
give only one dose as early as possible
Inform that there may be slight swelling,
stiffness or pain at the injection site or in the arm
Antenatal Care: Interventions

10. Malaria prophylaxis and treatment
All clinically suspected cases should be investigated for malaria by Microscopy or Rapid Diagnostic Kit (RDK)
No prophylaxis in pregnant women
In non endemic areas : All clinically suspected cases should be investigated by RDK
In highly endemic areas : All pregnant women are routinely tested for malaria at 1st AN visit and then every month
If positive, the woman is referred to PHC for treatment
Antenatal Care: Interventions

11. Antenatal Care: Interventions
Thank you
Antenatal Care: Interventions