Prenatal Care Guidelines For Developing Countries

Focused Prenatal Care

• Focused four antenatal visits by skilled provider—a midwife, nurse, doctor to detect any problems
• Birth preparedness and complications readiness planning with family
• Detection and management of co-existing conditions and complications
• HIV-voluntary counseling and testing
• Counseling for breast feeding, family planning, danger signs, HIV/STIs and nutrition
• Treatment of diagnosed infections, i.e., syphilis, gonorrhea or tuberculosis
• Tetanus toxoid (2 doses)
• Iron and folate-for 6 months of pregnancy, 60mg iron and 400 mg of folate, for areas with >40% anemia continue same dosage for 3 months postpartum
• Helminth Presumptive treatment – studies shown that eradication of hookworms can reduce moderate and severe anemia by 42-56%
• Routine testing and treatment of malaria- reduces anemia and low birth weight

 

Services Provided For Each Antenatal Care Visit

Visit	Service to be provided	Purpose of service	Equipment/supplies needed
1st visit or registration	A personal medical history is taken	To diagnose pregnancy and identify any complications during previous pregnancies
	Thorough physical and abdominal exam	To detect and manage any co-existing condition or complication: TB, Malaria, STDS	Stethoscope, speculum
	Check blood pressure	To identify and manage hypertension	Blood pressure apparatus and stethoscope
	Lab testing	Test for anemia, HIV, STDs	Rapid test kits, hemoglobinometer
	Malaria test and treatment of positives with 1 gm chlorquine and then 500 mg the following week	Treat malaria and prevent the anemia it causes.	Rapid test kit and chloroquine
	Urine test	Test for proteinuria/albumin for pre-eclampsia and sugar for diabetes	Dipsticks
	Weight measured	Establish baseline weight	Scale
	Registration of pregnant woman	To effectively track the completeness of care and pregnancy outcomes	Registration form/pregnancy register
	First dose of Tetanus Toxoid	Prevention of tetanus in newborn and mother	Vaccine
	Provide 3 month supply of Iron and Folate	Prevention of anemia	Adult Iron and folate tablets
	Counsel on need for 3 ANC visits, healthy diet, need for rest and signs of an emergency	To prevent and prepare for possible complications	Flipcharts, teaching aids
2nd visit (4th-6th month)	Check blood pressure	Detect and manage hypertension	Blood pressure apparatus and stethoscope
	Do an abdominal and physical exam	To detect and manage any co-existing condition or complication. Refer to expert medical care if a sign of an emergency is detected (vaginal bleeding, blurring vision with severe headache, convulsions)
	Urine test	Protein/albumin	Dipsticks
	Second dose of Tetanus Toxoid
	Provide 3 additional months supply of Iron and Folate	Prevent anemia	Adult tablets
	Review Nutrition, need for rest, signs of emergency	Prevent and prepare for complications
	Test and Treat for malaria if not done in 1st trimester	Prevent severe anemia	Rapid tests and Chloroquine
	Treat for (worms) Albendazole 400 mg X 1 or mebendazole 500 mg X 1	Prevent severe anemia	Albendazole
3rd visit (8th month)	Check blood pressure	Detect and manage hypertension	Blood pressure apparatus
	Do an abdominal and physical exam	To detect and manage any co-existing condition or complication. Refer if indicated.	Stethoscope and fetoscope
	Provide additional Iron and folate	Prevent anemia	Adult tablets
	Assist woman and family in developing a birth preparedness/complication readiness plan-selection of birth place, attendants	To be prepared for a safe and clean delivery and in the event of an emergency	Birth Kit if available Clean sheets
	Test for malaria at 32 weeks and treat positives with Cloroquine 1 gm now then 500 mg in 1 wk	Prevent severe anemia	Rapid tests and chloroquine
	Treat for (worms) Albendazole 400 mg X 1 or mebendazole 500 mg X 1	Prevent severe anemia	Stool test
4th visit (9th month)	Check blood pressure	To detect and manage hypertension	Blood pressure apparatus
	Do abdominal and physical exam	To detect and manage any co-existing complication, Refer if indicated	Stethoscope or fetoscope
	Counsel on breast feeding, birth spacing, Postpartum care, newborn care	To prevent unwanted pregnancies and too closely spaced pregnancies To Prevent complications	Flipcharts, teaching aids
	Review birth preparedness and complication readiness plan, meet the matrone who will attend a planned home birth	To prevent any delays in case of an emergency