Antenatal services
Introduction
Pregnancy –a physiological process
May be associated with certain risk factors
Antenatal care is a good example of social
obstetrics – undesirable outcome of
pregnancy can be prevented by good
antenatal care
What is an antenatal service?
A special services
Intended to provide adequate care and
necessary help to pregnant
Within the framework of MCH services
Necessity for antenatal care
qualitative and systematic
care
to pregnant women
healthy mother and healthy baby
What health care systems provide these
services in India?
Public health sector
PRIMARY HEALTH CENTRES
primary health care level
SUBCENTRES
CONTD……
COMMUNITY HEALTH CENTRE
SCEONDARY HEALTH CARE LEVEL RURAL HOSPITALS
DISTRICT HOSPITALS
SPECIALIST HOSPITALS
TERTIARY HEALTH CARE LEVEL
TEACHING HOSPITALS
REGIONAL HOSPITALS
PRIVATE HEALTH SECTOR
HOSPITALS
CLINICS
VOLUNTARY HEALTH AGENCIES
LIKE INDIAN RED CROSS also
extends its hand in the implementation
of antenatal care services.
National health programmes
Reproductive and child health (RCH)
Maternal and child health (MCH)
Integrated and child development scheme
National family welfare programme
Child survival and safe motherhood
Who are the persons engaged in carrying
out the services
Village level subcentre PHC CHC
level level level
Village health guide, MPHW MPHW specialists in
Locally trained dais, (ANM) health obstetrics and
Anganwadi worker, assistant gynecology
Accredited social MPHW
Health worker
What are the antenatal services
Broadly studied under
antenatal visits - preventive services
antenatal advice
specific protection
delivery services
Antenatal visits
Ideally :
once a month –in first 7 months
twice a month – in the next month
thereafter once in a week till term
Most of the Indian women –working
women number of visits reduced to a
minimum of 3:
20,32,36
weeks of gestation
Home visits
Backbone of MCH services.
Enables a health worker to monitor the
surroundings and the condition of the
house.
And hence is it safe to go for a delivery in
the home.
Preventive services at first visit
Early registration and
issue of antenatal card
for record and
evaluation.
It is called as booking
visit.
First visit includes :
Detailed history
Menstrual obstetric
previous present
Contd……….
Confirmation of pregnancy
General physical examination
Obstetric examination
Fundal height, foetal
movements, foetal
heart rate, lie and
prsentation.
Laboratory examinations
Complete urine examination
Complete blood picture
Hb%, CV
Stool examination
Serological examination
Blood grouping and Rh typing
Pap test, gonorrhea test
Ultrasonogram ,to know the correct gestational
age, detect any abnormalities,lie of foetus,position
of placenta &,amniotic fluid index
On subsequent visits
Maternal parameters:
BP, weight gain, any symptoms of
abdominal pain, nausea, vomitting,
bleeding or draining p/v
Fetal parameters:
Size of fetus, fetal heart rate, presentation
fetal activity.
Investigations include:
Complete urine examination
Hemoglobin estimation
Random blood sugar
Preventive services include:
Iron folic acid supplementation
100mg Fe, 0.5mg folic acid
(100 tablets)
TT immunization-two doses
Referral services for high risk cases
Specific protection
Against anemia-IFA TABLETS
Against congenital syphilis-procaine
penicillin
Prevention of nutritional deficiency
Against vertical transmission of HIV
Contd….
Prevention of Rh incompatibility by giving
anti D to Rh positive.
Prenatal genetic screening for
chromosomal abnormalities-like screening
for Down’s syndrome.
Delivery services
Aseptic delivery services at health centres
If delivery at home- by locally trained dais
by providing them with delivery kits.
Antenatal advice
Diet
Personal hygiene
Drugs
Radiation hazards
Warning signs
Talk on family planning
Facts and fictions regarding pregnancy
Advice regarding breast feeding to child and
newborn care
3 E’s
The above services have been integrated
by current RCH programme and
interventions are done in three ways:
essential antenatal care to all
early detection of complications
emergency obstetric care
(for high risk group at CHC/FRU)
Evaluation
35% women in developing countries
receive no care.
50% give birth without a skilled attendant.
70% receive no postpartum care.
Maternal mortality reduced in developed,
but not in developing countries (406/ lakh).
Why?
Because of poor service utilization
99%
100
90 By the
80
70
63% developing
60 42%
countries
50
40
compared to
30 the developed.
20
10
0
1st Qtr 2nd Qtr 3rd Qtr
Africa Developing Developed
countries
countries
Reasons for not utilizing:
No physical access to the services
High costs
Poor information regarding the services
Cultural preferences
Lack of decision making in pregnant women and
in-laws refusal to attend the clinics
Poor quality of services, shortage of
equipement,poorly trained staff, lack of staff.
What can be done to bring out a
healthy pregnancy?
Improving Increased
the quality utilization
of services of available
provided to services by
the pregnant
pregnant by woman will
filling the ensure a
drawbacks healthy
outcome of
pregnancy
Services provided by
General health
health care systems
services
include
Mch services
Antenatal
Healthy mother Proper utilization of services
and a healthy these services by
child mothers ensure
