Dr. MSc. Raul Hernandez Canete ANTENATAL CARE Dr. MSc. Raul Hernandez Canete

Is the clinical assessment of mother and fetus during pregnancy for the purpose of obtaining the best possible outcome for both mother and the child

The aims of Antenatal Care Assessment and management of maternal risk and symptoms Assessment of fetal risk Prenatal diagnosis and management of fetal abnormality Diagnosis and management of perinatal complications Decision regarding timing and mode of delivery Parental education regarding pregnancy and childbirth Parental education regarding child-rearing.

The first visit: should be done between 8- 14 weeks Schedule of key antenatal visits: -Preconception clinic visit 8-14 weeks visit 20-24 weeks visit 36-38 weeks visit 41-42 weeks visit

8-14 weeks: Booking visit The main purpose is to obtain a comprehensive history, establish the gestational age, and identify maternal and fetal risk factors. Baseline investigation Vaginal examination USG

Baseline investigation Hb, FBC, FBS, VDRL, HIV, Hemoglobin electrophoresis Urine test Vaginal swab Pap smear Group and Rh

20-24 weeks visit: The mid-trimester risk assessment visit Moment to review the result of the test and ultrasound scan Physical Exam: Mucosa, BP, Weight, Abdomen, Check oedema, Vaginal exam (if consider necessary) Investigations: Hb, Urine test, vaginal swab if necessary, Ultrasound scan. IPT and Immunization with TT.

36-38 weeks: with hospital team To anticipate any problems regarding the prospective delivery For suggest the best place to delivery To finalize de discussions on planned contraception after delivery Physical Exam: Mucosa, BP, Weight, Abdomen( Symphysis-fundal height, presentation, lie, engagement, fetal heart auscultation), check for oedema. Investigation: Hb, Urine test

41-42 weeks: Postdates visit It is a true postdate pregnancy? YES A joint decision should be taken as to whether induction of labour is appropriate Two methods of induction could be used: - Amniotomy - Medical methods using prostaglandin or oxytocin

Other model of antenatal care Booking visit 1 visit monthly until 32 weeks of gestation 1 visit every 2 weeks until 36 weeks 1 visit weekly until delivery

IPT Should be provide to all pregnant women at regular schedule clinic visits after 16 weeks of gestation. All pregnant women should receive 2 doses of SP (Sulfadoxine 500mg and Pyrimethamine 25mg) under directly observed therapy strategy. The interval between the 1st and 2nd dose should be 4 weeks Regimen for IPT: -1st dose: 16 – 27 weeks 3 tablets -2nd dose: 28 – 34 weeks 3 tablets

Why is important check the pregnant weight? Excessive weight gained is associated with Hypertensive disorder, fetal macrosomia, dystocia. Low weight gained is associated with anemia, IUGR, prematurity A woman should gain during pregnancy 8 to 12 kg, it mean +/- 0,5kg per week

Health Education during the Antenatal Care Diet Medication Toxic habit Rest and exercise Immunization and prevention of Malaria Dental care Information about: Infections, bleeding per vagina, abdominal pain, drain of liquid, headache, collapse or convulsions, fever. Preparation for breastfeeding Post delivery care